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Recommendations of the CDC Strategic Planning Workgroup
The following CDC staff members prepared this report:
Ali S. Khan, M.D.
Alexandra M. Levitt, M.A., Ph.D.
National Center for Infectious Diseases
Michael J. Sage, M.P.H.
National Center for Environment Health
in collaboration with the CDC Strategic Planning Workgroup
Samuel L. Groseclose, D.V.M., M.P.H.
Epidemiology Program Office
Edwin Kent Gray
Elaine W. Gunter
Alison B. Johnson, M.P.A.
Anne L. Wilson, M.S.
National Center for Environmental Health
David A. Ashford, D.V.M., M.P.H., D.Sc.
Robert B. Craven, M.D.
Robert P. Gaynes, M.D.
Stephen A. Morse, Ph.D.
Clarence J. Peters, M.D.
Richard A. Spiegel, D.V.M., M.P.H.
David L. Swerdlow, M.D.
National Center for Infectious Diseases
Scott D. Deitchman, M.D., M.P.H.
National Institute for Occupational Safety and Health
Paul K. Halverson, Dr.P.H., M.H.S.A.
Public Health Practice Program Office
Joseph Hughart, M.P.H.
Agency for Toxic Substances and Disease Registry
Patricia Quinlisk, M.D.
Iowa Department of Health
Des Moines, Iowa
Biological and Chemical Terrorism:Strategic Planfor Preparedness and Response
Recommendations of the CDC Strategic Planning Workgroup
". . . and he that will not apply new remedies must expect new evils; for time isthe greatest innovator. . . ."
--The Essays by Sir Francis Bacon, 1601
Summary
The U.S. national civilian vulnerability to the deliberate use of biologicaland chemical agents has been highlighted by recognition of substantialbiological weapons development programs and arsenals in foreign countries, attemptsto acquire or possess biological agents by militants, and high-profileterrorist attacks. Evaluation of this vulnerability has focused on the role public healthwill have detecting and managing the probable covert biological terrorist incidentwith the realization that the U.S. local, state, and federal infrastructure isalready strained as a result of other important public health problems. In partnershipwith representatives for local and state health departments, other federalagencies, and medical and public health professional associations, CDC has developeda strategic plan to address the deliberate dissemination of biological orchemical agents. The plan contains recommendations to reduce U.S. vulnerabilityto biological and chemical terrorism --- preparedness planning, detectionand surveillance, laboratory analysis, emergency response, andcommunication systems. Training and research are integral components for achievingthese recommendations. Success of the plan hinges on strengthening therelationships between medical and public health professionals and on building newpartner-ships with emergency management, the military, and law enforcement professionals.
INTRODUCTION
An act of biological or chemical terrorism might range from dissemination ofaerosolized anthrax spores to food product contamination, and predicting when and howsuch an attack might occur is not possible. However, the possibility of biological orchemical terrorism should not be ignored, especially in light of events during the past 10years (e.g., the sarin gas attack in the Tokyo subway[1] and the discovery of military bioweapons programs in Iraq and the former Soviet Union[2]). Preparing the nation to address this threat is a formidable challenge, but the consequences of beingunprepared could be devastating.
The public health infrastructure must be prepared to prevent illness and injurythat would result from biological and chemical terrorism, especially a covert terroristattack. As with emerging infectious diseases, early detection and control of biological orchemical attacks depends on a strong and flexible public health system at the local, state,and federal levels. In addition, primary health-care providers throughout the UnitedStates must be vigilant because they will probably be the first to observe and reportunusual illnesses or injuries.
This report is a summary of the recommendations made by CDC's StrategicPlanning Workgroup in Preparedness and Response to Biological and Chemical Terrorism: AStrategic Plan (CDC, unpublished report,2000), which outlines steps for strengtheningpublic health and health-care capacity to protect the United States against thesedangers. This strategic plan marks the first time that CDC has joined with law enforcement,intelligence, and defense agencies in addition to traditional CDC partners to address anational security threat.
As a reflection of the need for broad-based public health involvement interrorism preparedness and planning, staff from CDC's centers, institute, and offices participatedin developing the strategic plan, including the
- National Center for Infectious Diseases,
- National Center for Environmental Health,
- Public Health Practice Program Office,
- Epidemiology Program Office,
- National Institute for Occupational Safety and Health,
- Office of Health and Safety,
- National Immunization Program, and
- National Center for Injury Prevention and Control.
The Agency for Toxic Substances and Disease Registry (ATSDR) is also participatingwith CDC in this effort and will provide expertise in the area of industrial chemicalterrorism. In this report, the term CDC includes ATSDR when activities related to chemicalterrorism are discussed. In addition, colleagues from local, state, and federal agencies;emergency medical services (EMS); professional societies; universities and medicalcenters; and private industry provided suggestions and constructive criticism.
Combating biological and chemical terrorism will require capitalizing on advancesin technology, information systems, and medical sciences. Preparedness will also requirea re-examination of core public health activities (e.g., disease surveillance) in light ofthese advances. Preparedness efforts by public health agencies and primary health-careproviders to detect and respond to biological and chemical terrorism will have theadded benefit of strengthening the U.S. capacity for identifying and controlling injuriesand emerging infectious diseases.
U.S. VULNERABILITY TO BIOLOGICALAND CHEMICAL TERRORISM
Terrorist incidents in the United States and elsewhere involving bacterialpathogens (3), nerve gas (1), and a lethal plant toxin (i.e., ricin)(4), have demonstrated that the United States is vulnerable to biological and chemical threats as well asexplosives. Recipes for preparing "homemade" agents are readily available(5), and reports of arsenals of military bioweapons(2) raise the possibility that terrorists might have accessto highly dangerous agents, which have been engineered for mass dissemination assmall-particle aerosols. Such agents as the variola virus, the causative agent of smallpox,are highly contagious and often fatal. Responding to large-scale outbreaks caused bytheseagents will require the rapid mobilization of public health workers, emergencyresponders, and private health-care providers. Large-scale outbreaks will also require rapidprocurement and distribution of large quantities of drugs and vaccines, which must beavailable quickly.
OVERT VERSUS COVERT TERRORIST ATTACKS
In the past, most planning for emergency response to terrorism has beenconcerned with overt attacks (e.g., bombings). Chemical terrorism acts are likely to be overtbecause the effects of chemical agents absorbed through inhalation or byabsorption through the skin or mucous membranes are usually immediate and obvious. Suchattacks elicit immediate response from police, fire, and EMS personnel.
In contrast, attacks with biological agents are more likely to be covert. Theypresent different challenges and require an additional dimension of emergency planningthat involves the public health infrastructure (Box 1). Covert dissemination of abiological agent in a public place will not have an immediate impact because of the delaybetween exposure and onset of illness (i.e., the incubation period). Consequently, the firstcasualties of a covert attack probably will be identified by physicians or other primaryhealth-care providers. For example, in the event of a covert release of the contagiousvariola virus, patients will appear in doctors' offices, clinics, and emergency rooms duringthe first or second week, complaining of fever, back pain, headache, nausea, and othersymptoms of what initially might appear to be an ordinary viral infection. As thedisease progresses, these persons will develop the papular rash characteristic ofearly-stage smallpox, a rash that physicians might not recognize immediately. By the time therash becomes pustular and patients begin to die, the terrorists would be far away andthe disease disseminated through the population by person-to-person contact. Only ashort window of opportunity will exist between the time the first cases are identified anda second wave of the population becomes ill. During that brief period, public healthofficials will need to determine that an attack has occurred, identify the organism, andprevent more casualties through prevention strategies (e.g., mass vaccination orprophylactic treatment). As person-to-person contact continues, successive waves oftransmission could carry infection to other worldwide localities. These issues might also berelevant for other person-to-person transmissible etiologic agents (e.g., plague or certainviral hemorrhagic fevers).
Certain chemical agents can also be delivered covertly through contaminated foodor water. In 1999, the vulnerability of the food supply was illustrated in Belgium,whenchickens were unintentionally exposed to dioxin-contaminated fat used to makeanimal feed (6). Because the contamination was not discovered for months, the dioxin, acancer-causing chemical that does not cause immediate symptoms in humans, wasprobably present in chicken meat and eggs sold in Europe during early 1999. Thisincident underscores the need for prompt diagnoses of unusual or suspicious healthproblems in animals as well as humans, a lesson that was also demonstrated by the recentoutbreak of mosquitoborne West Nile virus in birds and humans in New York City in1999. The dioxin episode also demonstrates how a covert act of foodborne biological orchemical terrorism could affect commerce and human or animal health.
FOCUSING PREPAREDNESS ACTIVITIES
Early detection of and response to biological or chemical terrorism are crucial.Without special preparation at the local and state levels, a large-scale attack withvariola virus, aerosolized anthrax spores, a nerve gas, or a foodborne biological orchemical agent could overwhelm the local and perhaps national public healthinfrastructure. Large numbers of patients, including both infected persons and the "worriedwell," would seek medical attention, with a corresponding need for medical supplies,diagnostic tests, and hospital beds. Emergency responders, health-care workers, andpublic health officials could be at special risk, and everyday life would be disrupted as aresult of widespread fear of contagion.
Preparedness for terrorist-caused outbreaks and injuries is an essentialcomponent of the U.S. public health surveillance and response system, which is designed toprotect the population against any unusual public health event (e.g., influenza pandemics,contaminated municipal water supplies, or intentional dissemination ofYersinia pestis, the causative agent of plague[7]). The epidemiologic skills, surveillance methods,diagnostic techniques, and physical resources required to detect and investigate unusualor unknown diseases, as well as syndromes or injuries caused by chemical accidents,are similar to those needed to identify and respond to an attack with a biological orchemical agent. However, public health agencies must prepare also for the special featuresa terrorist attack probably would have (e.g., mass casualties or the use of rareagents) (Boxes 2-5). Terrorists might use combinations of these agents, attack in more thanone location simultaneously, use new agents, or use organisms that are not on thecritical list (e.g., common, drug-resistant, or genetically engineered pathogens). Lists ofcritical biological and chemical agents will need to be modified as new informationbecomes available. In addition, each state and locality will need to adapt the lists to localconditions and preparedness needs by using the criteria provided in CDC's strategic plan.
Potential biological and chemical agents are numerous, and the public healthinfrastructure must be equipped to quickly resolve crises that would arise from abiological or chemical attack. However, to best protect the public, the preparedness effortsmust be focused on agents that might have the greatest impact on U.S. health andsecurity, especially agents that are highly contagious or that can be engineered forwidespread dissemination via small-particle aerosols. Preparing the nation to address thesedangers is a major challenge to U.S. public health systems and health-care providers.Early detection requires increased biological and chemical terrorism awareness amongfront-line health-care providers because they are in the best position to reportsuspicious illnesses and injuries. Also, early detection will require improved communicationsystems between those providers and public health officials. In addition, state andlocalhealth-care agencies must have enhanced capacity to investigate unusual eventsand unexplained illnesses, and diagnostic laboratories must be equipped to identifybiological and chemical agents that rarely are seen in the United States. Fundamental tothese efforts is comprehensive, integrated training designed to ensure core competencyin public health preparedness and the highest levels of scientific expertise amonglocal, state, and federal partners.
KEY FOCUS AREAS
CDC's strategic plan is based on the following five focus areas, with each areaintegrating training and research:
- preparedness and prevention;
- detection and surveillance;
- diagnosis and characterization of biological and chemical agents;
- response; and
- communication.
Preparedness and Prevention
Detection, diagnosis, and mitigation of illness and injury caused by biologicaland chemical terrorism is a complex process that involves numerous partners andactivities. Meeting this challenge will require special emergency preparedness in all citiesandstates. CDC will provide public health guidelines, support, and technical assistanceto local and state public health agencies as they develop coordinated preparednessplans and response protocols. CDC also will provide self-assessment tools for terrorismpreparedness, including performance standards, attack simulations, and other exercises.In addition, CDC will encourage and support applied research to develop innovativetools and strategies to prevent or mitigate illness and injury caused by biological andchemical terrorism.
Detection and Surveillance
Early detection is essential for ensuring a prompt response to a biological orchemical attack, including the provision of prophylactic medicines, chemical antidotes, orvaccines. CDC will integrate surveillance for illness and injury resulting from biologicaland chemical terrorism into the U.S. disease surveillance systems, while developingnew mechanisms for detecting, evaluating, and reporting suspicious events that mightrepresent covert terrorist acts. As part of this effort, CDC and state and local healthagencies will form partnerships with front-line medical personnel in hospital emergencydepartments, hospital care facilities, poison control centers, and other offices to enhancedetection and reporting of unexplained injuries and illnesses as part of routinesurveillance mechanisms for biological and chemical terrorism.
Diagnosis and Characterization of Biological andChemical Agents
CDC and its partners will create a multilevel laboratory response networkfor bioterrorism (LRNB). That network will link clinical labs to public health agencies inall states, districts, territories, and selected cities and counties and to state-of-the-artfacilities that can analyze biological agents (Figure 1). As part of this effort, CDC willtransfer diagnostic technology to state health laboratories and others who willperforminitial testing. CDC will also create an in-house rapid-response and advanced technology(RRAT) laboratory. This laboratory will provide around-the-clock diagnostic confirmatoryand reference support for terrorism response teams. This network will include theregional chemical laboratories for diagnosing human exposure to chemical agents andprovide links with other departments (e.g., the U.S. Environmental Protection Agency, whichis responsible for environmental sampling).
Response
A comprehensive public health response to a biological or chemical terroristevent involves epidemiologic investigation, medical treatment and prophylaxis foraffected persons, and the initiation of disease prevention or environmentaldecontamination measures. CDC will assist state and local health agencies in developing resourcesand expertise for investigating unusual events and unexplained illnesses. In the event ofa confirmed terrorist attack, CDC will coordinate with other federal agencies in accordwith Presidential Decision Directive (PDD) 39. PDD 39 designates the Federal Bureau ofInvestigation as the lead agency for the crisis plan and charges the FederalEmergency Management Agency with ensuring that the federal response management isadequate to respond to the consequences of terrorism (8). If requested by a state healthagency, CDC will deploy response teams to investigate unexplained or suspicious illnessesorunusual etiologic agents and provide on-site consultation regarding medicalmanagement and disease control. To ensure the availability, procurement, and delivery ofmedical supplies, devices, and equipment that might be needed to respond toterrorist-caused illness or injury, CDC will maintain a national pharmaceutical stockpile.
Communication Systems
U.S. preparedness to mitigate the public health consequences of biological andchemical terrorism depends on the coordinated activities of well-trained health-care andpublic health personnel throughout the United States who have access to up-to-theminute emergency information. Effective communication with the public through the newsmedia will also be essential to limit terrorists' ability to induce public panic and disruptdaily life. During the next 5 years, CDC will work with state and local health agenciesto develop a) a state-of-the-art communication system that will support diseasesurveillance; b) rapid notification and information exchange regarding disease outbreaksthat are possibly related to bioterrorism; c) dissemination of diagnostic results andemergency health information; and d) coordination of emergency response activities.Through this network and similar mechanisms, CDC will provide terrorism-related trainingto epidemiologists and laboratorians, emergency responders, emergency departmentpersonnel and other front-line health-care providers, and health and safety personnel.
PARTNERSHIPS AND IMPLEMENTATION
Implementation of the objectives outlined in CDC's strategic plan will becoordinated through CDC's Bioterrorism Preparedness and Response Program. Programpersonnel are charged with a) helping build local and state preparedness, b) developing U.S.expertise regarding potential threat agents, and c) coordinating response activitiesduring actual bioterrorist events. Program staff have established priorities for 20002002regarding the focus areas (Box 6).
Implementation will require collaboration with state and local public healthagencies, as well as with other persons and groups, including
- public health organizations,
- medical research centers,
- health-care providers and their networks,
- professional societies,
- medical examiners,
- emergency response units and responder organizations,
- safety and medical equipment manufacturers,
- the U.S. Office of Emergency Preparedness and other Department of Healthand Human Services agencies,
- other federal agencies, and
- international organizations.
RECOMMENDATIONS
Implementing CDC's strategic preparedness and response plan by 2004 willensure the following outcomes:
- U.S. public health agencies and health-care providers will be prepared tomitigate illness and injuries that result from acts of biological and chemical terrorism.
- Public health surveillance for infectious diseases and injuries --- includingevents that might indicate terrorist activity --- will be timely and complete, andreporting of suspected terrorist events will be integrated with the evolving,comprehensive networks of the national public health surveillance system.
- The national laboratory response network for bioterrorism will be extendedto include facilities in all 50 states. The network will include CDC'senvironmental health laboratory for chemical terrorism and four regional facilities.
- State and federal public health departments will be equipped withstate-of-the-art tools for rapid epidemiological investigation and control of suspectedor confirmed acts of biological or chemical terrorism, and a designated stockof terrorism-related medical supplies will be available through anational pharmaceutical stockpile.
- A cadre of well-trained health-care and public health workers will be availablein every state. Their terrorism-related activities will be coordinated through arapid and efficient communication system that links U.S. public health agenciesand their partners.
CONCLUSION
Recent threats and use of biological and chemical agents against civilians haveexposed U.S. vulnerability and highlighted the need to enhance our capacity to detectand control terrorist acts. The U.S. must be protected from an extensive range ofcritical biological and chemical agents, including some that have been developed andstockpiled for military use. Even without threat of war, investment in national defenseensures preparedness and acts as a deterrent against hostile acts. Similarly, investment inthepublic health system provides the best civil defense against bioterrorism. Toolsdeveloped in response to terrorist threats serve a dual purpose. They help detect rareor unusual disease outbreaks and respond to health emergencies, including naturallyoccurring outbreaks or industrial injuries that might resemble terrorist events intheir unpredictability and ability to cause mass casualties (e.g., a pandemic influenzaoutbreak or a large-scale chemical spill). Terrorism-preparedness activities described inCDC's plan, including the development of a public health communication infrastructure, amultilevel network of diagnostic laboratories, and an integrated disease surveillancesystem, will improve our ability to investigate rapidly and control public health threatsthat emerge in the twenty first century.
References
- Okumura T, Suzuki K, Fukuda A, et al. Tokyo subway sarin attack; disastermanagement, Part 1: community emergency response. Acad Emerg Med 1998;5:613-7.
- Davis, CJ. Nuclear blindness: an overview of the biological weapons programs ofthe former Soviet Union and Iraq. Emerg Infect Dis 1999;5:509-12.
- Török TJ, Tauxe RV, Wise RP, et al. Large community outbreak of Salmonellosis causedby intentional contamination of restaurant salad bars. JAMA 1997;278:389-95.
- Tucker JB. Chemical/biological terrorism: coping with a new threat. Politics and theLife Sciences 1996;15:167-184.
- Uncle Fester. Silent death. 2nd ed. Port Townsend, WA: Loompanics Unlimited, 1997.
- Ashraf H. European dioxin-contaminated food crisis grows and grows [news].Lancet 1999;353:2049.
- Janofsky M. Looking for motives in plague case. New York Times. May 28, 1995:A18.
- Federal Emergency Management Agency. Federal response plan. Washington,DC: Government Printing Office, 1999. Available at <http://www.fema.gov/r-n-r/frp>.Accessed February 3, 2000.
Figure 1
1
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Box 1
BOX 1. Local public health agency preparedness
- Because the initial detection of a covert biological or chemical attack willprobably occur at the local level, disease surveillance systems at state and localhealth agencies must be capable of detecting unusual patterns of disease orinjury, including those caused by unusual or unknown threat agents.
- Because the initial response to a covert biological or chemical attack willprobably be made at the local level, epidemiologists at state and local health agenciesmust have expertise and resources for responding to reports of clusters of rare,unusual, or unexplained illnesses.
Box 2
BOX 2. Preparing public health agencies for biological attacks
Steps in Preparing for Biological Attacks
- Enhance epidemiologic capacity to detect and respond to biological attacks.
- Supply diagnostic reagents to state and local public health agencies.
- Establish communication programs to ensure delivery of accurate information.
- Enhance bioterrorism-related education and training for health-care professionals.
- Prepare educational materials that will inform and reassure the public duringand after a biological attack.
- Stockpile appropriate vaccines and drugs.
- Establish molecular surveillance for microbial strains, including unusual ordrug- resistant strains.
- Support the development of diagnostic tests.
- Encourage research on antiviral drugs and vaccines.
Box 3
BOX 3. Critical biological agents
Category AThe U.S. public health system and primary health-care providers mustbe prepared to address varied biological agents, including pathogens that arerarely seen in the United States. High-priority agents include organisms that pose arisk to national security because they
- can be easily disseminated or transmitted person-to-person;
- cause high mortality, with potential for major public health impact;
- might cause public panic and social disruption; and
- require special action for public health preparedness (Box 2).
Category A agents include
- variola major (smallpox);
- Bacillus anthracis (anthrax);
- Yersinia pestis (plague);
- Clostridium botulinum toxin (botulism);
- Francisella tularensis (tularaemia);
- filoviruses,
- Ebola hemorrhagic fever,
- Marburg hemorrhagic fever; and
- arenaviruses,
- Lassa (Lassa fever),
- Junin (Argentine hemorrhagic fever) and related viruses.
Category B
Second highest priority agents include those that
- are moderately easy to disseminate;
- cause moderate morbidity and low mortality; and
- require specific enhancements of CDC's diagnostic capacity andenhanced disease surveillance.
- Coxiella burnetti (Q fever);
- Brucella species (brucellosis);
- Burkholderia mallei (glanders);
- alphaviruses,
- Venezuelan encephalomyelitis,
- eastern and western equine encephalomyelitis;
- ricin toxin from Ricinuscommunis (castor beans);
- epsilon toxin of Clostridiumperfringens; and
- Staphylococcus enterotoxin B.
These pathogens include but are not limited to
- Salmonella species,
- Shigella dysenteriae,
- Escherichia coli O157:H7,
- Vibrio cholerae, and
- Cryptosporidium parvum.
Category C
Third highest priority agents include emerging pathogens that couldbe engineered for mass dissemination in the future because of
- availability;
- ease of production and dissemination; and
- potential for high morbidity and mortality and major health impact.
- Nipah virus,
- hantaviruses,
- tickborne hemorrhagic fever viruses,
- tickborne encephalitis viruses,
- yellow fever, and
- multidrug-resistant tuberculosis.
* CDC. Preventing emerging infectious diseases: a strategy for the 21st century.Atlanta, Georgia: U.S. Department of Health and Human Services, 1998.
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Box 4
BOX 4. Preparing public health agencies for chemical attacks
Steps in Preparing for Chemical Attacks
- Enhance epidemiologic capacity for detecting and responding tochemical attacks.
- Enhance awareness of chemical terrorism among emergency medicalservice personnel, police officers, firefighters, physicians, and nurses.
- Stockpile chemical antidotes.
- Develop and provide bioassays for detection and diagnosis of chemical injuries.
- Prepare educational materials to inform the public during and after achemical attack
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Box 5
BOX 5. Chemical agents
Chemical agents that might be used by terrorists range from warfare agentsto toxic chemicals commonly used in industry. Criteria for determiningpriority chemical agents include- chemical agents already known to be used as weaponry;
- availability of chemical agents to potential terrorists;
- chemical agents likely to cause major morbidity or mortality;
- potential of agents for causing public panic and social disruption; and
- agents that require special action for public health preparedness (Box 4).
- nerve agents,
- tabun (ethyl N,N-dimethylphosphoramidocyanidate),
- sarin (isopropyl methylphosphanofluoridate),
- soman (pinacolyl methyl phosphonofluoridate),
- GF (cyclohexylmethylphosphonofluoridate),
- VX (o-ethyl-[S]-[2-diisopropylaminoethyl]-methylphosphonothiolate);
- blood agents,
- hydrogen cyanide,
- cyanogen chloride;
- blister agents,
- lewisite (an aliphatic arsenic compound, 2-chlorovinyldichloroarsine),
- nitrogen and sulfur mustards,
- phosgene oxime;
- heavy metals,
- arsenic,
- lead,
- mercury;
- Volatile toxins,
- benzene,
- chloroform,
- trihalomethanes;
- pulmonary agents,
- phosgene,
- chlorine,
- vinyl chloride;
- incapacitating agents,
- BZ (3-quinuclidinyl benzilate);
- pesticides, persistent and nonpersistent;
- dioxins, furans, and polychlorinated biphenyls (PCBs);
- explosive nitro compounds and oxidizers,
- ammonium nitrate combined with fuel oil;
- flammable industrial gases and liquids,
- gasoline,
- propane;
- poison industrial gases, liquids, and solids,
- cyanides,
- nitriles; and
- corrosive industrial acids and bases,
- nitric acid,
- sulfuric acid.
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BOX 6. Implementation Priorities Regarding Focus Areas for 2000-2002
Preparedness and Prevention- Maintain a public health preparedness and response cooperative agreementthat provides support to state health agencies who are working with local agenciesin developing coordinated bioterrorism plans and protocols.
- Establish a national public health distance-learning system thatprovides biological and chemical terrorism preparedness training to health-careworkers and to state and local public health workers.
- Disseminate public health guidelines and performance standards onbiological and chemical terrorism preparedness planning for use by state and localhealth agencies.
Detection and Surveillance
- Strengthen state and local surveillance systems for illness and injuryresulting from pathogens and chemical substances that are on CDC's critical agents list.
- Develop new algorithms and statistical methods for searching medicaldatabases on a real-time basis for evidence of suspicious events.
- Establish criteria for investigating and evaluating suspicious clusters of humanor animal disease or injury and triggers for notifying law enforcement ofsuspected acts of biological or chemical terrorism.
Diagnosis and Characterization of Biological and Chemical Agents
- Establish a multilevel laboratory response network for bioterrorism thatlinks public health agencies to advanced capacity facilities for the identificationand reporting of critical biological agents.
- Establish regional chemical terrorism laboratories that will providediagnostic capacity during terrorist attacks involving chemical agents.
- Establish a rapid-response and advanced technology laboratory within CDCto provide around-the-clock diagnostic support to bioterrorism response teamsand expedite molecular characterization of critical biological agents.
Response
- Assist state and local health agencies in organizing response capacities torapidly deploy in the event of an overt attack or a suspicious outbreak that might bethe result of a covert attack.
- Ensure that procedures are in place for rapid mobilization of CDCterrorism response teams that will provide on-site assistance to local healthworkers, security agents, and law enforcement officers.
- Establish a national pharmaceutical stockpile to provide medical supplies inthe event of a terrorist attack that involves biological or chemical agents.
- Establish a national electronic infrastructure to improve exchange ofemergency health information among local, state, and federal health agencies.
- Implement an emergency communication plan that ensures rapiddissemination of health information to the public during actual, threatened, or suspected actsof biological or chemical terrorism.
- Create a website that disseminates bioterrorism preparedness andtraining information, as well as other bioterrorism-related emergency information,to public health and health-care workers and the public.
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FAQs
What you can do to best prepare for a bioterrorism event? ›
- Build an Emergency Supply Kit.
- Make a Family Emergency Plan.
- Check with your doctor to make sure everyone in your family has up-to-date immunizations.
- Personal cleanliness - daily bath, don't grow long nails and wear clean clothes.
- Hand Hygiene (Wash hands with soap and water before preparing food or eating, after passing stools, coughing or sneezing). ...
- Eat nutritious and balanced food.
- Immunisation state should be upto date.
- Prevent overcrowding.
Available protective equipment include respiratory protective devices, full face protective masks and surgical masks for respiratory protection, battle dress overgarments, protective gloves and overboots for skin protection. Full protection is needed when the agent has not been identified.
Are we prepared for a bioterrorist attack? ›Reports reveal that we are not well-prepared to deal with a terrorist attack that employs biological weapons. As was done in response to the nuclear threat, the medical community should educate the public and policy makers about the threat.
What is the purpose of bioterrorism? ›The goal of bioterrorism is usually to create fear and/or intimidate governments or societies for the purpose of gaining political, religious, or ideological goals. Bioterrorism may have a different effect on societies than would weapons such as explosives.
What is bioterrorism and how can it impact on human health? ›A bioterrorism attack is the deliberate release of viruses, bacteria, or other germs to cause illness or death. These germs are often found in nature. But they can sometimes be made more harmful by increasing their ability to cause disease, spread, or resist medical treatment.
What are the general precautions we should take during a chemical disaster? ›- Avoid mixing chemicals, even common household products. ...
- Always read and follow the directions when using a new product. ...
- Store chemical products properly. ...
- Beware of fire. ...
- Clean up any spills immediately with some rags, being careful to protect your eyes and skin. ...
- Dispose of unused chemicals properly.
Wash hands before and after work. Also wash hands immediately before and after wearing protective clothing, uniforms or gloves to reduce the possibility of infection. Biological hazards can kill. Or they may cause discomfort and affect the health and performance of employees at the very least.
What is meant by biological disaster explain with the help of an example? ›Examples of biological disasters include outbreaks of epidemic diseases, plant or animal contagion, insect or other animal plagues and infestation.
How can you protect against chemical and biological weapons? ›The first and most important line of defense against chemical agents is the individual protection provided by gas masks and protective clothing and the collective protection of combat vehicles and mobile or fixed shelters.
How do you prepare for a chemical war? ›
Close doors and windows and turn off all ventilation, including furnaces, air conditioners, vents and fans. Seek shelter in an internal room with your disaster supplies kit. Seal the room with duct tape and plastic sheeting. Listen to the radio or television for instructions from authorities.
What are chemical and biological weapons? ›Encyclopædia Britannica, Inc. The military use of chemicals, bacteria, viruses, toxins, or poisons to injure or kill soldiers or civilians is called chemical and biological warfare. The means by which the harmful substances are delivered to the enemy are called chemical and biological weapons.
How can bioterrorism impact a community? ›Bioterrorism and other high consequence biological events can result in mass casualties, epidemic illness, healthcare worker illness, environmental contamination, legal issues, and cause unease within the medical community and the community at large.
What is an example of bioterrorism? ›A biological attack, or bioterrorism, is the intentional release of viruses, bacteria, or other germs that can sicken or kill people, livestock, or crops. Bacillus anthracis, the bacteria that causes anthrax, is one of the most likely agents to be used in a biological attack.
How do you identify bioterrorism? ›- An unusual age distribution for common diseases. An increase in what appears to be a chickenpox-like illness among Adult patients, but which might be smallpox.
- A large number of cases of acute flaccid paralysis with prominent bulbar palsies, suggestive of a release of botulinum toxin.
The model shows that the economic impact of a bioterrorist attack can range from an estimated $477.7 million per 100,000 persons exposed (brucellosis scenario) to $26.2 billion per 100,000 persons exposed (anthrax scenario).
What is meant by bio terrorism explain briefly? ›What is bioterrorism? Bioterrorism is the intentional release or threat of release of biologic agents (i.e. viruses, bacteria, fungi or their toxins) in order to cause disease or death among human population or food crops and livestock to terrorize a civilian population or manipulate the government [3].
What's another word for bioterrorism? ›Find another word for bioterrorism. In this page you can discover 6 synonyms, antonyms, idiomatic expressions, and related words for bioterrorism, like: biological terrorism, bio-terrorism, bioterror, biological-warfare, bioterrorist and biowarfare.
What are the advantages of biological weapons? ›One huge advantage of biological warfare is that it is efficient. In fact, a single gram of agents, like the botulinum toxin, used in a biological weapon can kill millions of individuals. 3. It is cheap and relatively easy to make.
Why is bioterrorism a public health threat? ›Bioterrorists agents can be genetically modified organisms that are commonly resist to various well-known drugs and vaccines, these are highly contagious and can harm massive population.
Which of the following are considered necessary preventative measures to stay safe from biological agents? ›
Preventive measures include:
Safe handling of infectious specimens, sharps waste, contaminated linen and other material. Safe handling and cleaning of blood spills and other body fluids. Adequate protective equipment, gloves, clothing, glasses. Appropriate hygienic measures.
In a chemical emergency, if you come in contact with a known or unknown chemical, you should get away from the area, get it off your body as soon as you can, and get help by calling the Poison Control Center at 800-222-1222 or calling 911 or going to the nearest hospital.
What are the goals or objectives for the chemical release emergency plan? ›The ultimate goal is to ensure that a release area is safe for people and the environment.
What do you understand by chemical disaster and how can we prevent such type of disaster? ›A chemical accident is the unintentional release of one or more chemical hazard substances which could harm human health and the environment. Such events include fires, explosions, leakages or release of toxic or hazardous materials that can cause people illness, injury, or disability.
What are the important things to consider during emergencies? ›- Follow your emergency plan.
- Get your emergency kit.
- Make sure you are safe before assisting others.
- Listen to the radio or television for information from local officials and follow their instructions.
- Stay put until all is safe or until you are ordered to evacuate.
Being prepared can reduce fear, anxiety, and losses that accompany disasters. Communities, families, and individuals should know what to do in the event of a fire and where to seek shelter during a powerful storm.
What are the three steps to being prepared in disaster? ›- Know the risks.
- Make a plan.
- Get an emergency kit.
Biological disasters might be caused by epidemics, accidental release of virulent microorganism(s) or Bioterrorism (BT) with the use of biological agents such as anthrax, smallpox, etc.
What are examples of biological disaster? ›Cholera, influenza H1N1(Swine-flu), and the most recent COVID-19 outbreaks are examples of biological disasters.
What are the effects of chemical and biological weapons? ›Possible long-term effects of such warfare include: chronic illness caused by exposure to chemical and biological agents; delayed effects in persons directly exposed (causation of cancer, severe damage to the human foetus, and detrimental alterations in the human gene); organic, particularly nervous, damage which lasts ...
What is the difference between chemical biological and nuclear weapons? ›
Both chemical and nuclear are weapons of mass destruction. Nuclear weapons shape via nuclear fission and smash lives whereas chemical weapons use toxic chemicals to kill huge number of people. Nuclear weapons are extra damaging when we compare it to chemical weapons and the destruction caused is permanant.
Do chemical weapons affect the environment? ›Not only Germany, but other countries also overtly or covertly engaged in this type of warfare. War-time use and testing of CBWs are known to cause unprecedented damage to the environment. Their impacts in terms of biodiversity loss, and even species extinction have been recorded.
How can we prepare for bioterrorism attacks? ›...
To prepare:
- Build an Emergency Supply Kit.
- Make a Family Emergency Plan.
- Check with your doctor to make sure everyone in your family has up-to-date immunizations.
An act of bioterrorism involves the deliberate release of harmful biological agents to cause illness or death in people, animals, or plants. Bioterrorism agents can be spread through the air or put into food or water, and can be extremely difficult to detect.
What are some common biological weapons? ›Along with smallpox, anthrax, plague, botulism, and tularemia, hemorrhagic fever viruses are among six agents identified by the Centers for Disease Control and Prevention (CDC) as the most likely to be used as biological weapons. Many VHFs can cause severe, life-threatening disease with high fatality rates.
Why do terrorists use biological weapons? ›Terrorists use biological agents because they are often difficult to detect and illness onset may be delayed for hours to days increasing dispersal. The challenge with bioweapons is that they may affect both enemy and friendly forces, and do not discriminate between combatants and civilians.
What are the types of chemical weapons? ›- GA – Tabun.
- GB – Sarin.
- GD – Soman.
- GF – Cyclosarin.
- VX – Methylphosphonothioic Acid.
Terror tactics may include biologic, chemical, nuclear, or explosive events. Biologic. Bioterrorism is the intentional release of biological agents to cause illness or death in humans, animals, or plants. These agents may be bacteria, fungi, toxins, or viruses. They may be naturally occurring or human-modified.
Which team will respond immediately to a potential bioterrorism event? ›HHS coordinates Disaster Medical Assistance Teams, Disaster Mortuary Operational Response Teams, Veterinary Medical Assistance Teams, and other medical specialty teams located throughout the country. These units can be deployed immediately in the event of natural disasters.
What is an example of bioterrorism? ›A biological attack, or bioterrorism, is the intentional release of viruses, bacteria, or other germs that can sicken or kill people, livestock, or crops. Bacillus anthracis, the bacteria that causes anthrax, is one of the most likely agents to be used in a biological attack.
How can agroterrorism be prevented? ›
Partnerships—the best way to prevent an agroterrorism attack and the only way to contain one—must be created among local farmers, truckers, feedlot owners, and other critical members of the food-supply chain.
How do you identify bioterrorism? ›- An unusual age distribution for common diseases. An increase in what appears to be a chickenpox-like illness among Adult patients, but which might be smallpox.
- A large number of cases of acute flaccid paralysis with prominent bulbar palsies, suggestive of a release of botulinum toxin.
A line source technique is the most effective dispersal means for biological agents. For example, this may involve a truck or air sprayer moving perpendicular to the wind during an inversion (when air temperature increases with altitude and holds surface air and pollutants down).
What are indicators that a biological incident may have occurred? ›Biological incidents (indicators)
Unusual number of sick and dying – Casualties may occur minutes to hours to days or weeks after an incident has occurred. The time required before symptoms are observed is dependent on the agent used. Unscheduled and unusual spray – Especially outdoors during periods of darkness.
An act of bioterrorism involves the deliberate release of harmful biological agents to cause illness or death in people, animals, or plants. Bioterrorism agents can be spread through the air or put into food or water, and can be extremely difficult to detect.
What are three types of bioterrorism? ›Anthrax (Bacillus anthracis) Botulism (Clostridium botulinum toxin) Plague (Yersinia pestis)
How can bioterrorism impact a community? ›Bioterrorism and other high consequence biological events can result in mass casualties, epidemic illness, healthcare worker illness, environmental contamination, legal issues, and cause unease within the medical community and the community at large.
How does bioterrorism spread? ›Biological agents can be spread through the air, through water, or in food. Terrorists may use biological agents because they can be extremely difficult to detect and do not cause illness for several hours to several days.
What is the most common goal of agroterrorism? ›A subset of bioterrorism, agroterrorism is defined as “the deliberate introduction of an animal or plant disease for the purpose of generating fear, causing economic losses, or undermining social stability.”3 It represents a tactic to attack the economic stability of the United States.
How many types of terrorism are there? ›One popular typology identifies three broad classes of terrorism: revolutionary, subrevolutionary, and establishment. Although this typology has been criticized as inexhaustive, it provides a useful framework for understanding and evaluating terrorist activities.
What are some examples of agroterrorism? ›
Agroterrorism also includes attacks against animals using infectious pathogens such as Burkholderia mallei (glanders), Bacillus anthracis (anthrax), viral avian influenza, foot and mouth disease, and several equine encephalitis viruses.
What is the impact of bioterrorism? ›The model shows that the economic impact of a bioterrorist attack can range from an estimated $477.7 million per 100,000 persons exposed (brucellosis scenario) to $26.2 billion per 100,000 persons exposed (anthrax scenario).
What's another word for bioterrorism? ›Find another word for bioterrorism. In this page you can discover 6 synonyms, antonyms, idiomatic expressions, and related words for bioterrorism, like: biological terrorism, bio-terrorism, bioterror, biological-warfare, bioterrorist and biowarfare.
Why is bioterrorism a public health threat? ›Bioterrorists agents can be genetically modified organisms that are commonly resist to various well-known drugs and vaccines, these are highly contagious and can harm massive population.