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Status Brief

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Current Assessment/State of the Field:



Web Resources

Centers for Disease Control and Prevention

  1. “Each week CDC analyzes information about influenza disease activity in the United States and publishes findings of key flu indicators in a report called FluView. During the week of August 30-September 5, 2009, a review of the key indicators found that influenza activity increased in the United States compared to the prior weeks.”

Cities Readiness Initiative last checked 12/27/2011

  1. ”CDC’s Cities Readiness Initiative (CRI) is a federally funded program designed to enhance preparedness in the nation’s largest cities and metropolitan statistical areas where more than 50% of the U.S. population resides. Through CRI, state and large metropolitan public health departments have developed plans to respond to a large-scale bioterrorist event by dispensing antibiotics to the entire population of an identified MSA with 48 hours.”
  2. “Participating Cities and Metropolitan Statistical Areas”
  3. “The program was originally established in 2004 with a 21 cities that were selected based on criteria such as population and potential vulnerability to a bioterrorism threat. The program has grown to now include a total of 72 metropolitan statistical areas (MSAs), with at least one CRI MSA in every state.
    • 2004: CRI funded 21 cities
    • 2005: CDC funded 15 additional MSAs, for a total of 36 CRI MSAs
    • 2006: CDC funded an additional 36 MSAs, for a total of 72 MSAs”

Biodefense, CDC, Bioterrorism, Flu


Tenborg, M., et. al., “Fatal Human Plague–Arizona and Colorado, 1996,” JAMA, Aug. 6, 1997, Vol. 278, No. 5. P. 380.

  1. “5 cases of human plague in US, 2 fatal. Summary of investigation and recommendation for greater awareness of plague among health care providers in high risk regions.”

Plague, CDC


Doris V. Sweet, Vernon P. Anderson, J.C.F. Fang. “An overview of the Registry of Toxic Effects of Chemical Substances (RTECS): Critical information on chemical hazards.Chemical Health & Safety, November/December 1999. Pgs 12-16

  1. “Since 1971, the National Institute for Occupational Safety and Health (NIOSH) has been building RTECS into a definitive toxicological database with supplemental information pertinent to both the chemical industry and the occupational safety and health community.” Pg 12
  2. “An individual RTECS record may include as little as a single toxicity citation in addition to the identifiers or it may contain multiple citations, in the cases of widely studied substances. Benz(a)pyrene, for example, includes more than 300 toxicity lines.” Pg 13
  3. “The process of maintaining and updating RTECS requires continuous searching of the world’s toxicological literature to find new substances for entry into the file and additional toxicity studies to add to or modify existing records.” Pg 13
  4. “The process of maintaining and updating RTECS requires continuous searching of the world’s toxicological literature to find new substances for entry in to the file and additional toxicity studies to add to or modify existing records.” Pg 15

CDC, Chemical, Chemical Surveillance


Vergano, Dan Bioterrorism defense under fire Doctors say military plans are wrong approachUSA TODAY. June 21, 2000.

  1. “At a recent briefing sponsored by the American Medical Association, infectious-disease specialists argued that military planners have botched the nation’s bioterrorism defenses and ignored the doctors who would form the leading lines of defense against terrorists wielding diseases to kill.”
  2. “It’s not the military who will respond to a biological event, but biologists,” says AMA briefing speaker Michael Osterholm of the Minneapolis-based Infection Control Advisory Network, an infectious-disease consulting firm. A former state health official, he warns “it’s just a matter of time” before a bioterrorist attack occurs. He estimates an anthrax attack could cause 3 million deaths.”
  3. “Osterholm criticizes the federal government’s allocation of funds as already too military-oriented, with about $ 121 million sent to the Centers for Disease Control and Prevention to combat bioterrorism, out of about $ 10 billion in the 1999 federal counterterrorism budget”
  4. “Biological weapons pose a unique public threat. Unlike explosives or gunfire, microbes overwhelm people slowly, spreading through the populace with symptoms that can mimic more benign maladies, like the flu.”
  5. “Lab analysis, vaccines and drugs, “disease detectives,” and quarantine are all tools that can be directed toward a biological disaster by the CDC director without the involvement of any other federal agency, Lillibridge says. “We anticipate the rest of the government catching up with us.””
  6. “Instead of funding military bioterrorism response teams, he says, the government should bulk up disease surveillance efforts staffed by physicians”
  7. “Most bioterrorism planning revolves around worst-case scenarios,” says terrorism expert Bruce Hoffman, who heads the Washington, D.C., office of RAND, a military and public policy think tank. Terrorists desire terror, he suggests, a goal achieved far more easily and cheaply with a gun or a bomb than with microbes.”

Public Health, Bioterrorism, CDC, Quarantine, Emergency Response, Military, Anthrax


Maddox, P.J., “Bioterrorism: A Renewed Public Health ThreatDermatology Nursing. December 1, 2001

  1. “Even though national emergency preparations since the cold war have included consideration of biological weapons, the post mortem on emergency responses to the terrorist attacks on September 11, 2001, has brought renewed concerns about bioterrorism.” (Pg. 1)
  2. “Even a single exposure could result in local outbreaks of difficult-to-diagnose disease and fatal disease outbreaks.” (Pg. 1)
  3. “Unlike weapons that use explosives or chemicals, attacks using biological weapons may occur silently and covertly and, thus, be difficult and time consuming to detect. To complicate the matter, public symptoms of biological exposure may be delayed for days or weeks.” (Pg. 1)
  4. “Once detected, a massive public exposure could overwhelm local health systems that must treat victims of an outbreak, provide care for mass casualties, and prevent further disease.” (Pg. 1)
  5. “Department of Health and Human Services (DHHS) has special responsibilities, including detecting the disease, investigating the outbreak, and providing stockpiled drugs and emergency supplies in the large amounts needed.” (Pg. 1)
  6. “The MMRS emphasizes enhancement of local planning and response capability, including hospital capacity, to care for victims of a bioterrorist incident. MMRS systems provide designated communities with structured operations, specially trained responders, special Pharmaceuticals, detection and personal protection equipment, decontamination capabilities” (Pg. 2)
  7. “The role of the National Pharmaceutical Stockpile Program is to maintain a national repository of lifesaving pharmaceuticals and medical material that will be delivered to the site of a bioterrorism disaster in order to reduce morbidity and mortality in those affected” (Pg. 3)
  8. “Through the CDC, efforts will continue to ensure that all laboratories that ship or receive specially identified biological agents axe registered and in compliance with federal requirements.” (Pg. 3)

Bioterrorism, Public Health, CDC, Emergency Response


Mattews, Gene, “Legal Preparedness for BioterrorismEBSCO Publishing, 2002.

  1. “In fact, many emergency health laws consist of one sentence stating that the health officer in an emergency may take whatever actions he/she deems necessary” (Pg. 1)
  2. “The Draft Model State Emergency Health Powers Act, which was fashioned out of existing state laws, was designed to assist states in reviewing their emergency public health powers. The draft covers reporting of diseases cases, quarantine, vaccination, protection of civil liberties, property issues, infectious waste disposal, control of healthcare supplies, access to medical records and effective coordination with other state, local, and federal agencies.” (Pg. 1-2)
  3. “It is important to know the legal ground rules in advance of an emergency. It will be necessary to brief the public, in multiple languages, on the nature of the disease and how to respond.” (Pg. 4)
  4. “In an emergency, public health officials will be called upon to deal with a variety of hoaxes and people who are concerned but not sick.” (Pg. 4)
  5. “The smallpox vaccine is currently classified as an Investigational New Drug, a classification that raises research implications because each state maintains a separate Institutional Review Board overseeing research protocols.” (Pg. 4)
  6. “Thoughtful decisions will need to be made about closing schools, advising the public to remain at home, and delivering necessary services.” (Pg. 5)

Bioterrorism, Public Health, Emergency Response, Quarantine, CDC


Hodge, James, “Bioterrorism Law and Policy: Critical Choices in Public HealthJournal of Law, Medicine & Ethics, 2002.

  1. “However, in many states, existing legal standards for response are absent, antiquated, or insufficient. Prior to September 11, many state health departments did not address bioterrorism in their emergency response plans.’^ Recently, public health lawyers and scholars at the Center for Law and the Public’s Health at Georgetown and Johns Hopkins Universities were asked by the Centers for Disease Control and Prevention and a series of national partners (i.e., the National Governors Association, the National Conference of State Legislatures, the Association of State and Territorial Health Officials, the National Association of City and County Health Officers, the National Association of Attorneys General, and the Turning Point Public Health Statute Modernization National Collaborative) to develop a model act for states to respond to public health emergencies.” (Pg. 1-2)
  2. “gives state and local public health authorities a modern series of powers to track, prevent, and disease threats resulting from bioterrorism or other public health emergencies. These powers include measures (e.g., isolation, quarantine, treatment, and vaccination requirements) that may temporarily compromise individual civil liberties (e.g., rights to due process, speech, assembly, travel, and privacy) to protect the public’s health. To date, thirty-two states have introduced legislative bills based on the Model Act.” (Pg. 2)
  3. “Bioterrorists may infect individuals through multiple routes: (1) intentional spread of contagious diseases through individual contact; (2) airborne dissemination of some infectious agents; or (3) contamination of water, food, controlled substances, or other widely distributed products. The equipment needed to manufacture biological weapons is easy to obtain and conceal.” (Pg. 3)
  4. “The Model Act broadly defines a “public health emergency” as: an occurrence or imminent threat of an illness or health condition that: (1) is believed to be caused by bioterrorism or the appearance of a novel or previously controlled or eradicated infectious agent or biological toxin; and (2) poses a high probability of any of the following harms: (a) a large number of deaths in the affected population; (b) a large number of incidents of serious permanent or long term disability in the affected population; or (c) widespread exposure to an infectious or toxic agent that poses a significant risk of substantial future harm to a large number of people in the affected population.”  (Pg. 3-4)
  5. “First, the federal government has greater financial resources at its disposal to respond to a bioterrorism threat. Second, it may be in a better position to negotiate the price of needed vaccines, drugs, or supplies, or to suspend the patent rights of high-demand medications. These techniques were recently used by President George Bush and DHHS in negotiations with the German drug company Bayer, concerning the sale of Cipro, the antibiotic used to treat anthrax. Third, most significant bioterrorism threats will exceed the boundaries of any single state, thus requiring a national, coordinated response.” (Pg. 5)

Bioterrorism, Public Health, Emergency Response, Model Act, CDC, Anthrax


Snyder, James, “Role of the Hospital-Based Microbiology Laboratory in Preparation for and Response to a Bioterrorism Event,” Journal of Clinical Microbiology. pg. 1-4, Vol. 41, No.1. Jan. 2003

  1. “The main role of the hospital-based clinical microbiology laboratory in support of a biothreat, biocrime, or act of bioterrorism is to “raise suspicion” when a targeted agent is suspected in a human specimen.”(Pg. 1)
  2. “These plans include the following: (i) criteria for distinguishing the type of bioterroism event; (ii) information regarding access to and utilization of the LRN, including diagnostic testing protocols; (iii) safety guidelines; (iv) communication and notification protocols…” (Pg. 1)
  3. “Therefore, risk assessment becomes the responsibility of the clinical microbiologist, infection control personnel, hospital risk management office, and infectious disease physicians.” (Pg. 3)
  4. “The laboratory, preferably the laboratory director, must establish and include in the laboratory bioterrorism response plan a notification policy that is enacted when a suspicious isolate cannot be ruled out and must be referred to the next higher level laboratory for confirmation of the organism’s identity.” (Pg. 3)

Public Health, Bioterrorism, CDC, Lab Safety, Biodetection, Biodefense, Biosafety, Biosecurity, Decontamination, Personnel Reliability


Gostin, Lawrence O., “SARS: How effective is the state and local response?“, Hearing before the Permanent Subcommittee on Investigations, May 2003, pgs 36-38.

  1. “The CDC, the Department of Health and Human Services, and the Institute of Medicine have recommended the reform of public health laws due to the fact that these laws are extremely out of date.”
  2. “Some of these laws date back to the 19th and early 20th century and as a result they have a number of serious problems.”
  3. “These laws have ineffective powers for novel infectious diseases.”
  4. “Some of these laws may even be in violation constitutional laws because most of these laws were passed before the Supreme Court’s modern constitutional era.”
  5. “With these laws being so outdated, we do not have clear criteria for action or procedural due process.”
  6. “These laws are also inconsistent, and in the midst of dealing with an epidemic it will be hard to work with other states when every state has different laws.”
  7. “After September 11th, the CDC asked the Center for Law and the Public’s Health to draft an emergency powers act which is known as the Model State Emergency Health Powers Act.
  8. “This act has taken a role as a checklist that twenty-two States and the District of Columbia use.
  9. “We still need more states to adopt this act or we will run into serious conflicts.”
  10. “A public heath law is currently being drafted that would apply to SARS and any other infectious diseases.”
  11. “The Board on Health Promotion and Disease Prevention came out with a report called “The Future of the Public’s Health in the 21st Century” which states that public health infrastructures have major issues to tackle.”
  12. “These places have insufficient laboratory structures, workforce development, surveillance capacity, and data systems.”
  13. “The reason for this is that the US spends less than 5 percent of its health dollars on public heath.”



Pavlin, Julie,”Innovative Surveillance Methods for Rapid Detection of Disease Outbreaks and Bioterrorism: Results of an Interagency Workshop on Health Indicator SurveillanceAmerican Journal of Public Health, August 2003.

  1. “A system designed to rapidly identify an infectious disease outbreak or bioterrorism attack and provide important demographic and geographic information is lacking in most health departments nationwide.” (Pg. 1)
  2. “One of the primary goals of public health is to prevent disease in a community. To best prevent disease, knowledge of existing disease rates, risk factors, and the effectiveness of preventive measures is necessary.” (Pg. 1)
  3. “Unfortunately, most infectious disease surveillance systems are passive and rely on practitioners voluntarily reporting to the public health system” (Pg. 1)
  4. “The Department of Defense’s Global Emerging Infections System sponsored a meeting in May 2000 that focused on 3 areas: (1) identifying surveillance system needs, (2) examining existing prototype systems attempting to meet these needs, and (3) identifying the ideal features of a “system of surveillance systems” that would be more timely, sensitive, and flexible in terms of detection and response.”(Pg. 1-2)
  5. “The strengths of these systems include large populations that can be placed under surveillance; previously, it was often the case that only those meeting reportable disease conditions were followed.” (Pg. 2)
  6. “After the terrorist attacks on September 11, 2001, the Centers for Disease Control and Prevention (CDC) deployed 45 epidemic intelligence service officers to New York City to assist in a syndromic surveillance effort.” (Pg. 2)
  7. “Bringing together information from various health indicator data sets can allow public health practitioners to (1) evaluate many indicators simultaneously, (2) compare variations and identify common trends, and (3) track confounding factors and decrease false alarms. (Pg. 3)

Bioterrorism, CDC, Syndromic Surveillance, Biosurveillance


Editors, “Sentinel bioterrorism responders: Are hospital labs ready?”. MLO, August 2003.

  1. “Bioterrorism is the intentional application of microorganisms or their toxins for the purpose of causing death or disease in humans or in the animals or plants on which humans depend.”(Pg. 1)
  2. “Training is needed for laboratorians to know what specimens to collect and how to transport them.”(Pg. 1)
  3. “In May 2000, at the direction of the U.S. Congress, a mock bioterrorist event was held in Denver to test the nation’s systems. This $3-million exercise uncovered many deficiencies.” (Pg. 2)
  4. “Gradually, procedures for collection of specimens and detection of the agents in culture, when appropriate, are being posted on the ASM website at” (Pg. 2)
  5. “Generally, a leakproof package with a double liner and absorbent material to contain the specimen is sufficient. The package must be able to withstand the method of transport without damage.” (Pg. 3)
  6. “Staff can be trained specifically for the recognition of these agents. In addition, the laboratory will be able to identify other pathogens encountered on a daily basis more rapidly — but if the important tests for identification are not put into practice on a daily basis, rapid recognition will fail.” (Pg. 4)
  7. “The agents likely to be bioterrorist candidates, however, are all indolenegative.” (Pg. 4)
  8. “Do not wait for confirmatory tests to report to health department. Risk of human-to-human spread is significant.” (Pg. 5)

Bioterrorism, CDC, Emergency Response, Biosafety


Atlas, Ronald, “National Security and the LabMedical Laboratory Observer, Volume 35, Issue 9. 52. September 2003.

  1. ”The aftermath of anthrax attacks following the horrific 9/11 events increased fear that terrorists could acquire deadly pathogens from legitimate U.S. laboratories, which led to a series of laws and regulations directly impacting clinical microbiology laboratories.” – page 52
  2. ”Enhancement of clinical and public health laboratories is key to the nation’s biodefense capabilities, so the American Society for Microbiology (ASM) worked with the Centers for Disease Control and Prevention (CDC) to develop protocols for diagnostic laboratories to recognize and handle major biothreat agents.” – page 52
  3. ”Since clinical labs have been the sources of the agents used in prior acts of bioterrorism or biocrimes, (e.g., the 1989 use of salmonella by the Rajneesh cult in Dalles, OR), they must exercise appropriate oversight as to who is given access to any pathogen which can be misused to cause harm.” – page 52
  4. ”Clinical labs wishing to retain select agents as clinical specimens or reference standards must meet all of the registration requirements of the Biopreparedness Act, including imposing strict biosecurity procedures and obtaining Department of Justice clearance for all individuals with access to the select agents.” – page 52
  5. ”The CDC and USDA must maintain accurate tracking of the acquisition, transfer and possession of these select agents, and must establish safeguards and biosecurity procedures to be followed by institutions possessing select agents.” – page 52
  6. ”The FBI is responsible for conducting security risk assessments of individuals seeking access to listed agents and toxins, and individuals or entities seeking to register under the Act.” – page 52
  7. ”The Biopreparedness Act, a new regulatory burden, should have minimal impact. The greatest impact is likely to be on the labs in the western United States where plague, tularemia, and coccidioidomycoses occur.” – page 52

Public Health, Lab Security, Anthrax, Salmonella, Tularemia, Plague, CDC, Bioterrorism, Biodefense, Biosecurity


Hobbes, John,“Communicating Health Information to an Alarmed Public Facing a Threat Such as a Bioterrorist Attack”. Journal of Health Communication. 2004.

  1. “The Internet revealed much potential for effective and interactive communication in a sensitive and complex situation such as a bioterrorist attack.” (Pg. 1)
  2. “Yet, ultimately, investigation revealed that only four letters containing anthrax had been distributed through the postal system (Broad, 2002), demonstrating the ease with which a relatively small-scale bioterrorist attack could disrupt a population.” (Pg. 2)
  3. Finally, poor communication between the various healthcare workers and researchers, namely, public health officials, physicians, and field workers (both at the federal and state levels) resulted in a much slower response to the emerging risks than would be desirable.” (Pg. 3)
  4. “A key advantage the Internet has over traditional media is that the Internet provides multiple branches of information, all accessible almost simultaneously, and which the user can easily maneuver between. During the anthrax threat, the Internet also allowed for innovative communication devices such as interactive tutorials on anthrax self-care” (Pg. 5)
  5. “In the two days after the terrorist attacks, one out of four Internet users went online in addition to monitoring television and radio reports” (Pg. 5)
  6. “This is especially salient given that during the height of the bioterrorist threat many people were likely afraid to travel away from home. In some cases, when a number of cities issued warnings of potential threat, people preferred to stay at home or close to home; one survey published on September 15 found that ‘‘about 9% of Americans say that in the first two days after the terror attacks they cancelled some travel Plans”” (Pg. 5)
  7. “An advantage of this mode of communication is that it allows for more targeted information to be quickly distributed to patients from a trusted medical practitioner. However, although there is a demand from patients for e-mail communication with doctors (Deering, 2001), physicians are somewhat hesitant to adopt this practice. Through agencies such as the CDC, the government could help medical professionals by e-mailing them key messages, links to approved sites, and indicators of emerging risks.” (Pg. 6)
  8. “Search engines play a key role in organizing information for the public during a bioterrorist attack. The Internet industry in cooperation with the government should develop transparent protocols for organizing key information during emergency situations so that credible and validated sites are called up first when people search for information.” (Pg. 7)
  9. “However, there is some evidence that health information on the Internet does affect people’s management and response to health risk. The Pew Internet & American Life Project has found that 61% of those who searched online for health information—or about 43 million Americans—said that the information they found on the web improved the way they take care of themselves” (Pg. 7)
  10. “Wider use of e-mail from medical practitioners to patients could provide significant benefits in getting targeted messages on risks and suggested behavioral changes to patients, building on assumed trust between patient and physician. Finally, greater use and integration of shared electronic medical records made possible through Internet technology will provide considerable benefit in tracking emerging risks.” (Pg. 8)

Public Health, Anthrax, CDC, Bioterrorism, Biosurveillance


Kyriacou, Demetrios, “Clinical predictors of bioterrorism-related inhalational Anthrax“. Lancet 2004.

  1. “Unfortunately, clinical manifestations include a nonspecific prodrome of fever, cough, and chest discomfort that also characterizes other types of acute respiratory infections”
  2. “As a result, inhalational anthrax might not be recognized until the onset of respiratory distress and shock.”
  3. “The US Centers for Disease Control and Prevention (CDC) issued guidelines to differentiate between inhalational anthrax, community-acquired pneumonia, and influenza-like illness.”
  4. “For inhalational anthrax cases, clinical and pathological characteristics of the patients at the time of the assessment that resulted in the diagnosis of inhalational anthrax were abstracted from published accounts.”
  5. “The mortality rate was 94•4% for naturally occurring cases and 45•5% for bioterrorism-related cases.”
  6. “In particular, nausea, vomiting, pallor or cyanosis, diaphoresis, altered mental status, and raised haematocrit seemed to predict inhalational anthrax. The most accurate predictor was mediastinal widening or pleural effusion on chest radiograph. This finding was 100% sensitive (95% CI 84•6–100) for inhalational anthrax.”

Bioterrorism, Anthrax, CDC, Biodefense


Gluodenis, Thomas, “Homeland security and bioterrorism applicationsMedical Laboratory Observer, February 2004.

  1. “Biological weapons or bioweapons — typically, pathogenic organisms and their toxic products — constitute a particularly pernicious threat” (Pg. 1)
  2. “Unless suspicions are aroused and appropriate measures taken to sample contaminated environments, the presence of such agents is not usually confirmed until they produce symptoms in compromised individuals.” (Pg. 1)
  3. “At present, two approaches have been widely adopted for identifying organisms by characterizing their DNA; real-time polymerase chain reaction (PCR) and endpoint PCR.” (Pg. 1)
  4. “Organisms can be packaged in ways that mask their identity and produce sets of symptoms that are not sufficiently characteristic early on for rapid and” (Pg. 3)
  5. “The logical next step would be better integration of the individual operations of DNA isolation, amplification, and microfluidic-based analysis.” (Pg. 4)

Bioterrorism, Homeland Security, Biodefense, CDC


Setlak, Paul, “Bioterrorism preparedness and response: Emerging role for health-system pharmacists”, American Journal of Health-System Pharmacy, 2004.

  1. “Furthermore, as pharmacists are becoming more integral in disaster relief and response, especially in the area of bioterrorism, they must be able to effectively and rapidly access the most current information about the biological agents they may encounter and the respective treatments.” (Pg. 1)
  2. “Once a pharmacist is accepted as a member of an NPRT, he or she must complete numerous Web-based training programs on emergency response, pharmaceutical caches, command operations, occupational health, and a host of other topics relating to bioterrorism and emergency response operations” (Pg. 3)
  3. “If called to serve in an emergency operation, each team will be deployed for approximately two weeks, during which time members will become temporary federal employees.” (Pg. 3)
  4. “The passage of USERRA by Congress in 1994 ensured that individuals serving in the uniformed services, including PHS and others designated by the president during war or an emergency, can return to their civilian job with the same seniority, pay, and status that they had before their service.” (Pg. 3)
  5. “The drill exposed pharmacists to the environment encountered during a pharmaceutical distribution campaign, taught them procedures for distributing mass quantities of medications, and allowed students to witness how pharmacists handle stressful situations.” (Pg. 4)
  6. “The SNS is an important deployable initial pharmaceutical stockpile for health care professionals at the state and local levels during the early stages of a bioterrorist attack.11 The Homeland Security Act of 2002 assigned responsibility for the deployment of the SNS to DHS.” (Pg. 4)
  7. “Avoiding unnecessary duplicated medications in stockpiles, repeated diagnostic steps, and similar patient paperwork can result in faster response and clinical decision-making and decrease patient fatalities.” (Pg. 7)
  8. “Treatment guidelines are available as downloadable charts for easy posting and presentation. In addition, links to federal and private sites that address bioterrorism are presented. All information is scrutinized by CDC, and great care is put into releasing correct and timely information that clinicians, especially health-system pharmacists, can use.” (Pg. 7)

Bioterrorism, Emergency Response, Pharma, CDC



  1. “In the case of a medical radiation emergency, response and recovery radiation exposure limits should be established to preserve lifesaving capabilities while taking into consideration risk to staff and facility operation.” (Pg. 13)
  2. “After removal of contaminated clothing, patients should be instructed (or assisted if necessary) to immediately shower with soap and water. Potentially harmful practices, such as bathing patients with bleach solutions, are unnecessary and should be avoided” (Pg. 17)
  3. “Patient clothing should be handled only by personnel wearing appropriate personal protective equipment, and placed in an impervious bag to prevent further environmental contamination.” (Pg. 17)
  4. “Gloves should be worn when contact with blood or body fluids is anticipated. Gloves should be removed immediately, without touching non-contaminated surfaces, as soon as the patient care task is complete.” (Pg. 17- 18)
  5. “Facial protection should be worn when performing patient care tasks likely to generate splashing or spraying of blood and body fluids onto the mucous membranes of the face.” (Pg. 18)
  6. “Disposable fluid-repelling gowns should be worn to protect skin and clothing” (Pg. 18)
  7. “Hospitals should plan for decontamination operations that will not exceed their capacity, but should also develop a contingency plan for mass decontamination when patient numbers do exceed their capacity.” (Pg 19)
  8. “Ensure large quantities of water are available for decontamination in order to dilute the agent as much as possible. Direct excess waste water to the sanitary sewer and immediately notify the POTW and/or MS4.” (PG. 21)

Decontamination, Public Health, Quarantine, Nuclear, Biosecurity, Biosafety, Biotechnology, CDC, Bioterrorism, Biodefense


Rebmann, Terri, “Defining bioterrorism preparedness for nurses: concept analysisBlackwell Publishing Ltd. Novembver 30, 2005.

  1. “Bioterrorism poses a major threat to the health of citizens around the world [Centers for Disease Control and Prevention (CDC) 2000, Miller et al. 2001]. Infectious diseases can spread rapidly through a hospital, community or around the world, making a bioterrorism attack occurring anywhere a threat to all nations.” (Pg. 1)
  2. “Nurses are the largest group of healthcare providers and, as such, are a cornerstone in bioterrorism response. Because of this, bioterrorism preparedness has become a necessity for nurses, regardless of their education level, expertise area or practice setting (Malone 1999).” (Pg. 2)
  3. “Despite this, the US National Institute of Nursing Research has asserted that bioterrorism preparedness is a necessity across nursing specialties” (Pg. 2)
  4. “All-hazards preparedness efforts focus on biological as well as chemical, nuclear and radiological events. For example, planning is required for both all-hazards and bioterrorism response plans, but knowledge of patient chemical decontamination is only needed for all-hazards preparedness because patient decontamination will probably not be required after a bioterrorism attack” (Pg. 3)
  5. “In preliminary research, Shadel et al. (2001) describe differences in bioterrorism knowledge for various professions. For example, infection control practices, triage, health education and mental health were topics identified as critical for nurses, while pathogen epidemiology and clinical diagnosis were essential for physicians” (Pg. 3)
  6. “There are four attributes of nursing bioterrorism preparedness: (a) gaining bioterrorism management knowledge that is specific to the nursing profession; (b) planning response strategies; (c) practicing response behaviors; and (d) evaluating knowledge level and response plan content. These four attributes consist of protective actions undertaken to mitigate the potential outcomes of a bioterrorism attack” (Pg. 4)
  7. “gaining bioterrorism management knowledge that is specific to the nursing profession. Topics include identifying and reporting an attack, casualty triage and management, implementing control measures and management of victims’ families (Steed et al. 2004).” (Pg, 4)
  8. “Nurses, regardless of their level of education, area of expertise or practice setting should participate in at least one educational offering and one exercise each year to meet the minimum requirements of engaging in the bioterrorism preparedness process.” (Pg. 6)
  9. “Hosting bioterrorism exercises is time-consuming and expensive; for example, most facilities in the USA conduct only one or two exercises per year, which is the minimum required by the Joint Commission on Accreditation of Healthcare Organizations standards [Joint Accreditation Commission on Hospital Organization (JACHO) 2001].” (Pg. 6)
  10. “A group of school nurses believe that bioterrorism is a conceivable threat to themselves and their community, but feel that the risk of it occurring is low. Although they want to become better prepared for a bioterrorism attack and intend to do so at some point in the future, they currently have many other responsibilities that they believe are more pressing.” (Pg. 7)

Bioterrorism, Public Health, Emergency Response, CDC


McNeil, Jr., Donald, G., “U.S., Issues Guidelines on Use of Face Masks in Flu Outbreak,” New York Times, May 4, 2007, A20

  1. Flu
  2. Little scientific data proving masks help
  3. feds building mask stockpile
  4. Gerberding
  5. other countries’ plan rely on masks more heavily
  6. option only for sick
  7. sloppy changing of infected masks may increase transmission in certain situations.

Flu, CDC


Young, Alison, “Georgia Lab Workers Exposed to Bioterror Agent,Atlanta Journal Constitution, January 30, 2008.

  1. “Hundreds of laboratory workers across the country -including 57 in Georgia- were potentially exposed to a weakened bioterrorism agent when samples were mishandled as part of a voluntary readiness test, state and federal health officials said.”
  2. “At 16 of Georgia’s 27 clinical labs participating in the test, workers failed to follow proper handling procedures and were potentially exposed to a vaccine strain of ”Brucella abortus RB51.””
  3. “So far, the CDC identified 916 workers in 254 clinical labs who were potentially exposed to Brucella during the nationwide Laboratory Preparedness Survey last fall.”
  4. “Twice a year, labs that voluntarily participate in the program are sent samples of various disease-causin organisms.  SInce 2006, the tests have included weakened bioterrorism organisms after the labs said they needed more realistic exercises of their preparedness, CDC officials said.”
  5. “The testing kits included written instructions stating the samples should be handled inside a special safety cabinet and within the protective barriers of a Biosafety Level 3 lab.  Despiet these instructions, some lab workers handled the samples in high risk ways, even sniffing open culture plates as they sought clues to what was growing on them, records show.  Certain odors are associated with some bacteria.”

Brucellosis, Lab Safety, CDC, BSL, Emergency Response


Roni Caryn Rabin, “Preparing for a Bioterror Attack, Assisted Suicide on TV and Bird Flu in Hong Kong,” December 10, 2008. NYT Last Checked, March 27, 2013.

  1. “States Cut Funding to Combat Disease Outbreaks The economy is jeopardizing the nation’s ability to handle public health emergencies and bioterror attacks, as both the federal government and states cut funding for programs to combat disease outbreaks and natural disasters, USA Today reports.”
  2. “Meanwhile Georgia, home to the Centers for Disease Control and Prevention, barely got a passing grade in a new report assessing its readiness to distribute stockpiled medicine and vaccines should a terror attack occur or pandemic break out, The Atlanta Journal Constitution reports. The stockpile is controlled by the C.D.C. and Georgia is one of 10 states that turned around a failing grade in the assessment last year.”
  3. “Hong Kong is reporting another outbreak of avian influenza, or bird flu, among chickens at one of the city’s largest poultry farms. Officials are concerned because the chickens were vaccinated against the virus. The city is culling birds and shutting down the local poultry industry for 21 days, Time Magazine reports.”

Emergency Response, Public Health, CDC


McNeil, Donald, G., “Swine Flu Officials Message: Don’t Blame Shots for All Ills,NYT, A1, Septmeber 28, 2009.

  1. Preemptive public relations strategy by CDC targeting media for reporting coincidental maladies and powerful antivaccine activists.  Due in part from lessons learned from 1976 flu vaccination campaign which was suspended due to questions over relationship with Guillain_Barre syndrome.
  2. “Every year there are 1.1 million heart attacks in the United States, 795,000 strokes and 876,000 miscariages, and 200,000 Americans have their first seizure.”
  3. “Some antivaccine groups are raising fears of thimerosal, a preservative used in some brands of vaccines.  Others issue dire warnings about squalene, an immune-booster used in military vaccines but not in any American ones.”

Vaccination, Flu, CDC



  1. “Since 2001, the U.S. government has devoted considerable time and effort identifying potential vulnerabilities to biological attacks, promoting prevention strategies, and anticipating how best to respond should a large-scale biological attack ever occur.” (Pg. 2)
  2. ““The more that sophisticated capabilities, including genetic engineering and gene synthesis, spread around the globe, the greater the potential that terrorists will use them to develop biological weapons . . . . Prevention alone is not sufficient, and a robust system for public health preparedness and response is vital to the nation’s security.’” (Pg. 3)
  3. “The changes generally grant broad sweeping powers to state governors and health officials, including the power to order forced treatment and vaccination without specifying which exemptions….Such changes could increase the chances for state abuse of power and lead to confusion during a mass vaccination campaign.” (Pg. 3)
  4. “Currently, the federal government lacks authority to exert control over a state’s emergency vaccination plans, regardless of whether the plans are too lenient and severely risk the public’s health or too rigid and unnecessarily restrict individual liberty” (Pg. 4)
  5. “Maryland, the state’s attorney summoned parents of more than 1,600 children to court, giving them a choice between vaccinating their children and facing penalties of up to ten days in jail and fifty dollars a day in fines.” (Pg. 7)
  6. “Three key factors determine the percentage of the population that must be immunized in order to reach the herd immunity threshold: (1) the degree of the disease’s infectiousness; (2) the population’s vulnerability; and (3) the environmental conditions.” (Pg. 8)
  7. “The Court explained that the state had a duty to protect the welfare of the many and to refrain from subordinating their interests to those of the few.”(Pg. 12)
  8. “The Court determined that an individual’s belief qualified as a religious belief, if it was “sincere and meaningful” and it “occupied in the life of its possessor a place parallel to that filled by the God of those admittedly qualifying for the exemption.”” (Pg. 20)
  9. “The district court warned that while an individual may possess sincerely held beliefs, instead of being rooted in religious convictions, those beliefs may merely be framed in religious terms to feign compliance with the law.” (Pg. 21)
  10. “The Sherr case raises two issues. First, how much proof an individual must provide to demonstrate to the government the sincerity of the individual’s religious beliefs. Second, how public health officials in an emergency will determine quickly and fairly whether an individual meets the requisite burden of proof.” (Pg. 22)
  11. “Current state public health emergency laws inadequately address mass vaccination situations and leave wide-open the potential for the abrogation of individuals’ rights” (Pg. 29)
  12. “The model law, drafted by The Center for Law and the Public’s Health, at Georgetown and John Hopkins Universities, seeks to “grant public health powers to state and local public health authorities to ensure strong, effective, and timely planning, prevention, and response mechanisms to public health emergencies (including bioterrorism) while also respecting individual rights.” (Pg. 31)
  13. “Additionally, MSEHPA fails to address the need for a consistent and coordinated nationwide approach to mass vaccination in a multi-state emergency…..”To prevent the spread of contagious or possibly contagious disease the public health authority may isolate or quarantine . . . persons who are unable or unwilling for reasons of health, religion, or conscience to undergo vaccination.”‘ (Pg. 31)
  14. “The Public Health Emergency Medical Countermeasures Enterprise (“PHEMCE”)”  is likely the most appropriate government body to be in charge of implementing the new informed consent requirements, the medical and religious exemptions, and the right of refusal conditioned on a discretionary requirement of isolation or quarantine” (Pg. 35)

Bioterrorism, Public Health, Vaccination, Law Enforcement, CDC, Quarantine, Pandemic


Jacobson, HollyTraining Needs of Nurses in Rural TexasPublic Health Nursing, February 2010.

  1. “Federal funding for domestic biodefense increased from US$576 million in 2001 to an estimated US$5,415million in 2008, a 10-fold increase (Franco, 2008). This increase in funding has been instrumental in strengthening the preparedness infrastructure across a variety of federal, state, and local agencies.” (Pg. 1)
  2. “However, it still remains the responsibility of state and local health departments to create emergency plans that are specific to and reflect the unique characteristics of their communities” (Pg. 1)
  3. “Research suggests that nurses play an integral role in the early detection and timely management of biological agents” (Pg. 2)
  4. “response training is particularly notable in rural areas, which have unique organizational and geographic features demanding different approaches to bioterrorism preparedness training and response efforts.” (Pg. 2)
  5. “Also consistent with previous findings, nurses represented in this study have had very limited prior participation in emergency and bioterrorism preparedness and response. Considering the national interest in emergency preparedness, this result suggests that current training strategies may need to be revised.” (Pg. 5)

Bioterrorism, Emergency Response, Biodefense, CDC


Beam, ElizabethThe Nebraska Experience in Biocontainment Patient CarePublic Health Nursing Vol. 27 No. 2, April 2010.

  1. “The Centers for Disease Control (CDC) set health protection goals and objectives that address preparation for these emerging health threats in the current era of international travel (2007)” (Pg. 1) .
  2. “Public health nurses in local health departments may receive the first call regarding a potential case of avian influenza, monkeypox, or viral hemorrhagic fever. In some cases, caring for the index patient and their direct contacts in the diagnosing hospital is the most logical approach.” (Pg. 1)
  3. “Early access to a biocontainment patient care unit (BPCU) for isolation during a bioterrorism or a public health emergency event along with appropriate use of epidemiological and therapeutic interventions in the community may dramatically impact the size and severity of a disease outbreak” (Pg. 1-2)
  4. “The collaboration of many organizations in Nebraska led to the development of a BPCU for the care of patients with potentially dangerous, highly infectious illnesses.” (Pg. 2)
  5. “Plans are most effective when routinely practiced. Under the direction of the lead registered nurse, NBU personnel drill on a quarterly basis to test the adequacy of policies and procedures, learn new equipment as it is introduced, and test various care processes.” (Pg. 2)
  6. “Community education is required for an isolation unit to be successful in achieving its public health mission. The NBU personnel provide education and training focused on communication and decision making in a situation requiring isolation of a potentially dangerous emerging infectious disease.” (Pg. 3)
  7. “Some examples of unique policies to the NBU include: Transporting a patient to the biocontainment unit from the emergency department; Transporting a patient to the biocontainment unit from another patient care area within the Nebraska Medical Center; Obtaining and processing laboratory specimens; Laundry and biohazard waste removal from the biocontainment unit; Contingency plan for hospital surge capacity; Removal of patient remains.” (Pg. 3)
  8. “Beyond moving a patient inside the hospital, vehicle transport for those who require intense isolation continues to be a concern among local, state, and federal organizations charged with this responsibility.” (Pg. 4)
  9. “The continued success of the NBU has been a function of several key factors. These factors include three major areas: strong leadership, an engaged professional team, and successful collaborations.” (Pg. 4)
  10. “The role of the lead registered Beam et al.: Nebraska Biocontainment Patient Care 143 nurse includes managing day-to-day operations and guiding routine monthly meetings and quarterly procedural drills.” (Pg. 4-5)
  11. “A BPCU would allow health care workers to maintain their personal safety while providing care to a patient with a hazardous infection. The personnel who work in this specialized care unit could also become a resource for a larger public health emergency.” (Pg. 5)

Public Health, Bioterrorism, Emergency Response, Biosafety, CDC, Quarantine


Ziff, Deborah, Seely, Ron, “UW-Madison professor barred from lab for potentially dangerous experiments,” May 11, 2010, Wisconsin State Journal, last checked 10/30/2011.

  1. “A UW-Madison professor who studies an infectious disease lost his laboratory privileges for five years after conducting unauthorized experiments with a potentially dangerous drug-resistant germ.”
  2. “One person who worked in professor Gary Splitter’s lab got brucellosis but university officials don’t know if that individual, who has since recovered, caught the strain used in the unauthorized experiments.”
  3. “Brucellosis is a disease that is usually found in farm animals but can spread to humans and cause flu-like symptoms or worse.”
  4. “The 2007 experiments, which the National Institutes of Health calls a ‘major action violation,’ in part prompted the university to beef up its biological safety oversight. The university was also fined $40,000.”
  5. “Splitter, a tenured professor in the School of Veterinary Medicine, won’t be allowed to work in a lab for five years because of the violation.”
  6. “Splitter said he was not aware of the unauthorized experiments, which he said were conducted by graduate students in his lab, and that the university did not properly educate researchers about guidelines for working with antibiotic-resistant strains.”
  7. “His lab created antibiotic-resistant strains of brucellosis and inserted them into mice in 2007 and possibly earlier, university officials said, without approval from local or federal agencies. The concern is that if someone contracted the antibiotic-resistant version of the disease created in the lab, treatment might have been more difficult.”
  8. “The university learned of the stock of antibiotic-resistant strains after a round of university-wide lab inspections by the Centers for Disease Control and Prevention. They began investigating Splitter’s lab in early 2008.
  9. “University officials said evidence gathered during the investigation contradicted Splitter’s claim that he was unaware of the work being done by his students.”
  10. “Splitter said part of the problem was understaffing in the university’s bio-safety program, which is charged with training scientists about regulations. At the time of the experiments, he said, there were only two people employed in the program and neither were trained biologists.”
  11. “In the past year, UW-Madison has hired five biological safety officers and a new director, said Bill Mellon, associate dean for research policy.”

Brucellosis, Lab Safety, Misconduct, Oversight, CDC, Academia, Drug Resistance, Scientist


Basken, Paul, “Scientist, Banned From Lab, Blames U. of Wisconsin for Biosafety Lapse,” May 19, 2010, Chronicle of Higher Education, last checked 10/30/2011.

  1. “University of Wisconsin officials suspended a professor’s laboratory privileges over unapproved tests involving an infectious disease, and said they’ve sent a strong message about accountability for hazardous materials.”
  2. “The five-year ban on hands-on lab work “does not restrict other people from submitting grants; it doesn’t restrict me from being an investigator on a grant; it doesn’t restrict me from working with others on grants or on science,” Dr. Splitter, a tenured professor of pathobiological sciences and a veterinarian, told The Chronicle.”
  3. “The case, which dates back to a routine inspection of Dr. Splitter’s lab by federal officials nearly three years ago, has garnered national attention in the past week as an example of concerns that the government may not be doing enough to guard against accidental or intentional spreads of pandemic disease.”
  4. “In the case of Dr. Splitter, the work involved the pursuit of a vaccine for brucellosis, a disease that humans contract from farm animals. Its effects are usually limited to chronic flu-like symptoms, though complications make it fatal in about 3 percent of cases. The disease infects about 500,000 people a year, mostly in developing countries, where the months-long process of treatment with antibiotics can be prohibitive.”
  5. “Ensuing investigations, which involved interviews of Dr. Splitter’s graduate students by federal inspectors and a nine-month closure of his lab, led to an agreement with federal officials last October in which the university paid the $40,000 fine. The university disclosed this month its decision to suspend Dr. Splitter’s laboratory privileges for a five-year period, ending in 2013. (He has not been allowed in his lab since 2008 because of the investigation, so the university is counting those years as part of his suspension.)”
  6. “William S. Mellon, associate dean for research policy at the University of Wisconsin at Madison Graduate School, said the university acted to penalize Dr. Splitter after concluding that Dr. Splitter was aware that new federal rules imposed after the September 11, 2001, attacks on the United States required him to seek specific government approval for his work with antibiotic-resistant genes.”
  7. “It appears, Mr. Mellon said, that Dr. Splitter—who has spent 32 years at the University of Wisconsin and is one of only about five experts worldwide working on a vaccine for brucellosis—simply never accepted the new requirements imposed on researchers. “Those are hard transitions to make—I understand that,” Mr. Mellon said.”
  8. “Investigations, both by federal officials and by outside analysts hired by the university, found the campus’s Institutional Biosafety Committee ‘was an organization in disarray,’ Dr. Splitter said.”
  9. “Mr. Mellon said he recognized that the case highlighted some shortcomings in the university’s operations and that the university has responded, hiring five new biological-safety officers and a new director for the operation. He said it’s ‘silly,’ however, for Dr. Splitter to deny his own responsibility.”
  10. “One of the graduate students, discussing the case with The Chronicle on the condition he not be identified, said the case pointed out the confusion over regulations and the hassles that await him if he decides to continue working with hazardous agents.”
  11. “The university’s penalty against Dr. Splitter became public the same week the Proceedings of the National Academy of Sciences published an analysis suggesting that the more restrictive biosafety laws imposed after the 2001 attacks had led to far fewer published studies in the field and accelerated the rate of researchers turning to other fields of study.”



Editors, “Detection of ”Enterobacteriaceae” Isolates Carrying Metallo-Beta-Lactamase — United States, 2010,” MMWR Morbidity and Mortality Weekly Report, Vol. 59, No. 24, CDC, Published June 25,2010.

  1. “Current CDC infection control guidance for carbapenem-resistant ”Enterobacteriaceae” also is appropriate for NDM-1–producing isolates (5). This includes recognizing carbapenem-resistant ”Enterobacteriaceae” when cultured from clinical specimens, placing patients colonized or infected with these isolates in contact precautions, and in some circumstances, conducting point prevalence surveys or active-surveillance testing among other high-risk patients. Laboratory identification of the carbapenemresistance mechanism is not necessary to guide treatment or infection control practices but should instead be used for surveillance and epidemiologic purposes.”
  2. “Current CDC infection control guidance for carbapenem-resistant Enterobacteriaceae also is appropriate for NDM-1–producing isolates.”
  3. “Carbapenem resistance and carbapenemase production conferred by blaNDM-1 is detected reliably with phenotypic testing methods currently recommended by the Clinical and Laboratory Standards Institute (3), including disk diffusion testing and the modified Hodge test.”
  4. “Clinicians should be aware of the possibility of NDM-1–producing ”Enterobacteriaceae” in patients who have received medical care in India and Pakistan, and should specifically inquire about this risk factor when carbapenem-resistant ”Enterobacteriaceae” are identified. CDC asks that carbapenem-resistant isolates from patients who have received medical care within 6 months in India or Pakistan be forwarded through state public health laboratories to CDC for further characterization. Infection control interventions aimed at preventing transmission, as outlined in current guidance (5), should be implemented when NDM-1–producing isolates are identified, even in areas where other carbapenem-resistance mechanisms are common among ”Enterobacteriaceae”.

NDM-1, Public Health, CDC


Ebscohost. “Germ beats ‘last resort’ antibiotics“. USA TODAY, Sept. 17, 2010.

  1. “Bacteria that are able to survive every modern antibiotic are cropping up in many U.S. hospitals and are spreading outside the USA, public health officials say.”
  2. “The bugs, reported by hospitals in more than 20 states, typically strike the critically ill and are fatal in 30% to 60% of cases”
  3. “The bacteria are equipped with a gene that enables them to produce an enzyme that disables antibiotics.’’
  4. “Today, resistance has spread to more than 8% of these bacteria. No one knows precisely how many people have KPC infections because cases aren’t routinely reported to the CDC.”
  5. “One of the only drugs that combats these bugs is polymixin, which was all but abandoned years ago because it is so toxic to the kidneys, Fishman says. As a result, he says, prevention is crucial.”
  6. “”When MRSA started to develop 15 years ago, the industry started producing antibiotics now coming onto the market,” he says. “We’re in the same position with KPCs as we were with staph aureus 15 years ago, except that the pharmaceutical industry isn’t rushing to produce new drugs.”’

NDM-1, CDC, Pharma


Katz J., “CDC: Haiti cholera matches South Asian strainAP Last accessed November 6, 2010.

  1. “A cholera outbreak that has killed more than 300 people in Haiti matches strains commonly found in South Asia, the U.S. Centers for Disease Control and Prevention said Monday.”
  2. “The finding intensifies scrutiny on a U.N. base above a tributary to the Artibonite River that is home to a contingent of recently arrived peacekeepers from Nepal, a South Asian country where cholera is endemic and which saw outbreaks this summer.”
  3. “It is also a significant step toward answering one of the most important questions about the burgeoning epidemic: How did cholera, a disease never confirmed to have existed in Haiti, suddenly erupt in the vulnerable country’s rural center?”
  4. “Speculation among Haitians has increasingly focused on the U.N. base. The outbreak began among people who live downstream from where the tributary meets the Artibonite and drank from the river. On Friday, hundreds of protesters marched from the nearby city of Mirebalais to demand the Nepalese peacekeepers be sent home.”
  5. “The Associated Press found questionable sanitation in an unannounced visit to the base last week and an exclusive tour of the facility given by peacekeepers Sunday. Despite earlier statements that sanitation at the base was up to international standards, on Monday the mission acknowledged there are santiation problems and said they are being solved.”
  6. “The finding does not identify the source of the disease or say how it arrived in Haiti, but it eliminates other possibilities including a hypothesis that the strain might be related to a 1990s South American outbreak, Braden said. He said the strain was “fairly common.””
  7. “The outbreak is spreading across Haiti, its transmission eased by a lack of immunity among the population. A confirmed case of cholera had never been detected in Haiti before the current outbreak, said Claire-Lise Chaignat, head of the World Health Organization’s global task force on cholera control.”
  8. “The AP visited the Nepalese U.N. base last Wednesday to follow up on a statement by the mission that its sanitation measures met U.S. and U.N. standards. The area between the base and the river reeked of human waste. Several pipes were leaking, including a broken plastic pipe emitting a foul-smelling black liquid near what the soldiers identified as latrines. A U.N. engineer later said the liquid was most likely run-off from the camp kitchen.”
  9. “The dump site for the human waste was a few hundred yards (meters) away, across the street from the base in shallow, shovel-dug pits next to several homes. Neighbors said the pits often overflow and run to the river. They said they had stopped drinking from the river and sought fresh water uphill.”
  10. “The AP returned Sunday for a tour with U.N. officials, who acknowledged the facility had undergone a cleanup since then: Septic tanks were emptied, a drainage canal was cleared and the leaky pipe was replaced. The smell of excrement was mostly gone.”

Cholera, CDC, UN


Russell, Kevin et. alThe Global Emerging Infection Surveillance and Response System (GEIS), a U.S. government tool for improved global biosurveillance: a review of 2009BMC Public Health, 2011, Issue 2, Vol.11, p1-10.

  1. “U.S. DoD has a long and impressive history of infectious disease research and product development.” (pg.9)
  2. “Between 1992 and 1996, numerous documents and communications within DoD recognized the need for global emerging infection surveillance initiatives leveraging these overseas laboratories, and emphasized the commitment of DoD to these endeavors.” (pg.1)
  3. “In 1996, the Executive Office of the President of the United States issued a Presidential Decision Directive (NSTC-7) stating that current capabilities were inadequate to protect the U.S. or global public health communities from emerging infectious disease (EID) threats.” (pg.1)
  4. “The DoD Global Emerging Infections Surveillance and Response System (DoD-GEIS) was established, thereby expanding the mission of DoD to address threats posed to the U.S. and other nations by newly emerging and reemerging infectious diseases.” (pg.1)
  5. “In 2009, Armed Forces Health Surveillance Center- Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) provided direction, funding and oversight to a network of 39 partners at approximately 500 sites.” (pg.2)
  6. “Ninety-two countries were impacted with either active surveillance, capacity-building initiatives or participation in training exercises.” (pg.2)
  7. “With rapidly increasing involvement of other U.S. government agencies, a unique niche that U.S. uniformed officers throughout the world can and should expand engagement is with their global uniformed counterparts.” (pg.8)
  8. “By conducting surveillance and capacity building and assisting with training and outbreak investigations, all integrated into the functions and capabilities of host-country agencies, relationships are forged and trust is developed.” (pg.4)
  9. “In 2009, the U.S. Agency for International Development (USAID) spent more than $1.7 billion on health and over $1.4 billion on humanitarian assistance.” (pg.2)
  10. “Fiscal year 2009 appropriations by the U.S. Congress totaled $33.7 million for the Centers for Disease Control and Prevention’s (CDC) Global Disease Detection Program, the principal and most visible CDC program for developing and strengthening global public health capacity to rapidly identify and contain disease threats from around the world.” (pg.2)
  11. “The U.S. Department of State’s Biological Engagement Program (BEP) received congressional appropriations of $27 million in fiscal year 2009 to engage scientists internationally on issues related to disease surveillance and detection, biosafety, and biosecurity.” (pg.2)
  12. “DoD had a major role in developing and licensing 40 percent of currently available vaccines for adults in the U.S.” (pg.4)
  13. “Funding avenues and oversight for these different U.S. government health and surveillance initiatives are independent of each other, and coordination is complex.” (pg.4)
  14. “The Center for Strategic and International Studies commented that with expanding efforts, agencies should leverage the existing successful programs, and seek a ‘unity of effort.’” (pg.4)
  15. “In November 2009 of the National Strategy for Countering Biological Threats (Presidential Policy Directive-2) also emphasizes the need for coordination.” (pg.4)
  16. “Considerable coordination and communication with in-country ministries, academic institutions and other in-country government assets is done by AFSH-GEIS global partners.” (pg.7)
  17. “Collaboration and capacity building conducted by DoD partners is being reexamined to comply with a broader U.S. government response, the National Strategy for Countering Biological Threats, and the IHR (2005) framework.” (pg.7)
  18. “The White House National Security staff is playing an active role in this U.S. government coordination. By conducting our program in coordination with this whole of US Government, then our capacity building, outbreak assistance and facilitating in-country diagnostic capabilities with host countries will meet the objectives of all by a) reinforcing amiable relationships between host-country government public health assets and DoD partners; b) developing the capability to report ‘public health emergencies of international concern,’ whereby the entire global community and DoD learns, and world preparations to minimize impact can proceed in a unified and transparent manner; and c) improving DoD’s situational awareness through close, transparent, trusting relationships with host countries, even if an actual public health emergency of international concern does not occur.” (pg.7-8)
  19. “The assistant to the secretary of defense for nuclear and chemical and biological defense programs recently embraced emerging infections as a threat to national security, placing global surveillance also within scope of that organization.” (pg.2)
  20. “The wisdom of establishing improved global DoD EID surveillance capabilities is reinforced by numerous contributions to global outbreaks, most recently the 2009 H1N1 pandemic.” (pg.9)
  21. “With the framework of current U.S. government guidelines, such as the National Strategy for Countering Biological Threats and IHR (2005), the world is closer than ever to truly working together on surveillance and control of infectious diseases without consideration of borders.” (pg.9)

Biosurveillance, CDC


Editors, “Russia, U.S. to Resist Eliminating Smallpox Strains,” Global Security Newswire, January 18, 2011, Last checked Jan. 28, 2011

  1. “The United States and Russia are expected to argue to the international community this week that bioterrorism fears justify their continued retention of smallpox strains for countermeasure research purposes, the Wall Street Journal reported today (see GSN, Jan. 13).”
  2. “Envoys from 34 member governments to the World Health Organization, including Moscow and Washington, are slated tomorrow to debate whether adequate study has been conducted on producing smallpox countermeasures so that a cutoff date could be established for eliminating the Russian and U.S. strains. The WHO Executive Board would then turn the matter over to the entire World Health Assembly for a verdict in May.”
  3. “Washington has said it must retain its smallpox samples to prepare new medical treatments and vaccines that would be used in the event of a biological weapons strike or the unintended release of the deadly virus from a third party (see GSN, Jan. 14).”
  4. “Moscow also thinks its smallpox cache must be retained for study and is anticipated to agree with Washington’s argument on the matter, said Vladimir Starodubov, a member of the Kremlin’s delegation to the WHO Executive Board.”
  5. “Foreign states and public health specialists, however, worry that U.S. and Russian smallpox stocks could be misappropriated or accidentally released.”
  6. “Hundreds of millions of people are thought to have died following exposure to the virus — approximately one-third of the total number contaminated. A worldwide public health effort resulted in smallpox officially being eliminated from nature in 1980.”
  7. “The debate over eliminating the last known smallpox stocks has been highly contentious. Some argue the virus could be created in a laboratory using synthetic biology technology, leaving complete elimination unachievable. That possibility makes it even more important to destroy the Russian and U.S. stockpiles, others counter (see GSN, Sept. 10, 2010).”
  8. “The U.S. Centers for Disease Control and Prevention today stores 451 specimens of the smallpox virus, while Russia keeps 120 different strains at its Vector laboratory in Siberia, biological weapons expert Jonathan Tucker stated in a recent report.”
  9. “Developing states are likely to make the main push to eliminate the smallpox remnants, according to the Journal.”
  10. “A 2010 assessment by a WHO advisory board said that smallpox strains were still necessary for the preparation of antiviral medicines in addition to a safer vaccine. Laboratories in the United States and Russia do both kinds of work. U.S. officials say work on antiviral medicines is especially needed as no post-infection medications for are presently licensed.”
  11. “There are scientifically valid reasons to continue to study the virus in safe and secure circumstances,” CDC pox and rabies branch chief Inger Damon said. Fewer than 10 CDC scientists, including Damon, have access to the centers’ smallpox strains (Betsy McKay, Wall Street Journal, Jan. 18).”
  12. “To put it bluntly, it is the same logic by which the superpowers continue the possession of the nuclear weapons; they wish to hold o to the smallpox virus as a super bioweapon,” said Indian virologist Kalyan Banerjee, who served on the WHO advisory panel on smallpox research.”
  13. “Eliminating smallpox is “not good public policy,” argued Kenneth Bernard, a health security specialist for the Clinton and Bush administrations. Varieties of the virus could be present in addition to the U.S. and Russian caches, creating a public danger, he said.”
  14. “If the sanctioned stocks are eradicated, ‘any lab, scientist or country found to have the virus after the date of destruction is de facto guilty of very serious crimes against humanity,’ WHO smallpox eradication campaign chief D.A. Henderson said.”
  15. “The World Health Assembly in 1996 called for the disposal of all smallpox stores, but bioterror concerns have helped keep the material in existence.”

Smallpox, Russia, WHO, CDC, Bioterrorism





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