Genomics and bioterrorism

The use of biological weapons has been recorded throughout history. However, the anthrax-tainted letters of the fall of 2001 caused shock and panic in several countries. Knowledge of the principal bacteriological weapons allows design of novel rapid DNA-based diagnostic tests that should help defuse the impact of future bioterrorist attacks. Less than one-hour real-time PCR identification of bacteria and their associated antibiotic resistance genes will revolutionize the practice of medicine.     

Medical control of bioterrorism

Against the recently accrued risk of bioterrorism, the Biotox plan has been set up in order to take in charge any person that could be facing a potential terrorist contamination. It has to take into consideration the components of bioterrorism, i.e. the incubation period, the function of bacterial or viral agents, the variable number of concerned people, the difficulty of alert launching, and the diagnosis of the responsible agent. This plan relies on hospitals comprising departments of infectious diseases. Those are specifically in charge of informing, organising, and coordinating the reception of people having been in contact or infected by infectious agents, in order to isolate and treat them properly. The recent experience has allowed to test this plan, to precise and correct some of its features.     

Missouri nurses' bioterrorism preparedness

Nurses are the largest group of healthcare providers and will be at the forefront during a response to a bioterrorism attack in the U.S. However, nurses' bioterrorism risk perceptions and their participation in bioterrorism preparedness activities, such as bioterrorism-related exercises or drills, have not been evaluated. We mailed a survey to all members of the Missouri Nurses Association in July 2006, consisting of 1,528 registered nurses. The instrument measured risk perception, perceived susceptibility, perceived seriousness, bioterrorism education received, participation in exercises/drills, and personal response plan thoroughness. The response rate was 31% (474/1,528). Most respondents believe that a bioterrorism attack will occur in the U.S. (82.3%; n = 390), but few (21.3%; n = 101) believe that one will occur in their community. The majority of nurses reported that they believe that a bioterrorism attack would have serious consequences (96.1%, n = 448), including having a serious impact on U.S. citizens' safety (90.7%, n = 446) and on their own safety (84.3%, n = 379). Most (60%, n = 284) reported that they had not received any bioterrorism-related education nor participated in any drills/exercises (82.7%, n = 392). Of those who had received education, most had participated in 3 or fewer programs and in only 1 drill. Few nurses (3.6%, n = 15) reported having all aspects of a personal bioterrorism response plan; approximately 20% (19.4%, n = 81) did not have any components of a plan. Most of the registered nurses in Missouri who were surveyed are not receiving bioterrorism education, participating in bioterrorism exercises, or developing thorough personal response plans. Nurses need to be aware of and encouraged to participate in the many education and training opportunities on bioterrorism and infectious disease disasters.     

Prevention of bioterrorism by vaccines

Prevention against the weapons of bioterrorists is limited by the multiplicity of agents that could be used. Against smallpox, stocks of the classical vaccine must be prepared, but this vaccine is dangerous and we must look for a new and safer vaccine. A vaccine against anthrax is probably possible relatively soon. One may be less optimistic concerning plague, since it is not sure that we could protect against the pulmonary plague, but research in this field is an emergency. The large number of viruses capable of inducing haemorrhagic fevers makes especially difficult the preparation of vaccines against these infections. We must also make available monoclonal antibodies that could be used as therapies against toxin, notably botulism, or against antibiotic-resistant bacteria.     

Facing the possibility of bioterrorism

The possibility of bioterrorism has been met by significant financial outlays to map out public health responses. These have included comprehensive audits of potential agents, as well as exploring mechanisms for counteracting their impact. Psychological intervention and communication have been identified as key areas requiring further work, as fear of infection could pose a greater strain on social resources than the pathogens themselves. Bioterrorism provides a powerful metaphor for élite fears of social corrosion from within. Accordingly, a broader historical and cultural perspective is required to understand why individuals and societies feel so vulnerable to what remain largely speculative scenarios.     

Physician assistants and bioterrorism preparedness

Despite the resources dedicated since 2001 to training health providers in emergency and bioterrorism preparedness and response, the literature on the participation of physician assistants (PAs) is very limited. The purpose of this pilot study was to explore the training level and experiences of PAs in the diagnosis and treatment of chemical, biological, radiological, nuclear, and explosive agents that could be used in a bioterrorism attack. The study population consisted of licensed PAs in 37 northern Texas counties. Data were collected through mailed and web-based surveys. Response rate was 36%. More than half of the respondents (58.6%) had not participated in bioterrorism preparedness and response training. Results also indicated that the level of training has not increased since September 11, 2001. However, most respondents were receptive to the idea of participating in both preparedness training and response efforts. It is recommended that state agencies increase training opportunities for PAs in bioterrorism preparedness and response.