The recent cases of anthrax due to bioterrorism in the United States have reminded us that our society is also vulnerable to biological attacks. Illnesses due to bioterrorism are not naturally occurring diseases, and therefore may show presentations not familiar to many doctors. The last case of smallpox was reported in 1960, and doctors aged less than 60 years have no experience of smallpox. Anthrax is a rare zoonosis, and no case of inhalation anthrax has been reported in Korea. American doctors might be on high alert to bioterrorism after September 11, 2001. However, it took more than 2 weeks from the symptom onset of the index case to the recognition that anthrax outbreak had occurred due to bioterrorism. This delay shows how difficult it is to recognize bioterrorism. This article describes clinical recognition and management of patients exposed to biological warfare agents, especially agents causing anthrax, smallpox, plague, and botulism.
Anthrax ; Biological Warfare Agents* ; Biological Warfare* ; Bioterrorism ; Botulism* ; Humans ; Inhalation ; Korea ; Plague* ; Smallpox ; United States

The management of nuclear, biological and chemical (NBC) terrorism events is critical to reducing morbidity and mortality in the next decade; however, initial patient care considerations and protective actions for staff are unfamiliar to most front-line clinicians. High explosive events (bomb and blast) remain the most common type of terrorism and are easy to detect. Conversely, some types of terrorist attacks are more likely to be unsuspected or covert. This paper explains the current threat of terrorism and describes clues for detection that an event has occurred. Specific criteria that should lead to a high suspicion for terrorism are illustrated. The manuscript outlines initial actions and clinical priorities for management and treatment of patients exposed to nuclear/radiological, biological, chemical and combined agents (for example an explosion involving a chemical agent). Examples of terrorist events include: a nuclear explosion, an aerosolised release of anthrax (biological), dissemination of sarin in a subway (chemical), and the detonation of a radiologic dispersion device or "dirty bomb" (combined explosive and radiological). Basic principles of decontamination include potential risks to healthcare providers from secondary exposure and contamination. Unique issues may hinder clinical actions. These include coordination with law enforcement for a crime scene, public health entities for surveillance and monitoring, hazardous materials teams for decontamination, and the media for risk communications. Finally, the importance of personal preparedness is discussed.
Biological Warfare Agents ; Chemical Warfare Agents ; Civil Defense ; Nuclear Weapons ; Terrorism

The Laboratories engaging with microorganisms have some potential risks, depending on handling of pathogens. The safety management system to extend recognition of biosafety and biosecurity needs to be established and practiced in order to prevent hazard possibility and secure safety of researchers who deal with pathogen. As the importance and regulation of global biosafety and biosecurity tended to be intensified, various laws and institutions for the security of biosafety were established when the Act on implementation of Living Modified Organisms, an implantation act of Cartagena was enforced in Korea in 2008. In particular, the system of permission report for Living Modified Organism (LMO), Highly Dangerous Pathogens (HDPs) and Biological Weapons Convention (BWC), in order to prevent intended or non-intended leakage and occurrence of biohazard derived from pathogen and infectious substance and safely use them. The bioterrorism can be controlled and autonomous management of biosafety by agencies that handle pathogens can be also secured by practicing the various laws and institutions.
Biological Warfare Agents ; Bioterrorism ; Jurisprudence ; Korea ; Safety Management

Bacillus anthracis is generally accepted as the most potent biological warfare agent because of its highly pathogenic nature and transmission efficiency. Identification of chromosomal markers for the rapid detection of B. anthracis is difficult since significant chromosomal homology exists among B. anthracis, B. cereus and B. thuringiensis. In this study, we tested whether the gyrB sequence could be used as the target for the PCR detection of B. anthracis. The gyrB sequence, composed of 1,923 bp, was identical in 17 Korean B. anthracis isolates. The comparison of gyrB sequence between B. anthracis and B. cereus type strain showed 8.8% difference (105 bp among 1,194 bp), and the gyrB sequence similarities of B. cereus, B. thuringiensis and B. mycoides with B. anthracis were 92.3%, 86.9% and 86.1%, respectively. When polymerase chain reaction was designed and performed based on the gyrB sequence, a specific amplicon (351 bp) could be amplified. These results indicate that gyrB could be useful as a chromosomal marker for the rapid screening of B. anthracis by PCR or differentiation of B. anthracis from other related species by multiplex PCR with other plasmid markers.
Bacillus anthracis* ; Bacillus* ; Biological Warfare Agents ; Mass Screening ; Multiplex Polymerase Chain Reaction ; Plasmids ; Polymerase Chain Reaction

Biological Warfare Agents ; China ; Disaster Planning ; Emergencies ; economics ; Laboratories ; economics ; Public Health Administration

We have examined isolation and identification protocols for three virus simulant candidates to biological warfare agents. MS2 phage, a simulant for yellow fever virus and Hantaan virus, was propagated using as a host an E. coli strain with F pilus. MS2 phage genome was examined by reverse transcription and polymerase chain reaction (RT-PCR). Coat protein of the phage preparation was examined by SDS-polyacrylamide gel electrophoresis (SDS-PAGE) and mass spectrometric analysis. Cydia pomonella granulosis virus (CpGV) is a virus simulant candidate to smallpox virus. CpGV was isolated from a commercialized CpGV pellet. In this study, we developed new isolation and identification protocols for CpGV. One disadvantage of using CpGV is that it is not easy to determine viability of the virus. Here, we have included T4 phage as an alternative. We established a high titer production protocol and developed an easy genome identification protocol that does not require purified phage DNA. Stability of these virus preparations was also examined under various storage conditions. When the virus preparations were not subjected to freeze drying, MS2 phage was most stable when it was stored in liquid nitrogen but unstable at 4℃. In contrast, T4 phage was most stable when it was stored at 4℃. CpGV was stable at −20℃ but not at 4℃. Stability during or after freeze drying was also investigated. The result showed that 70~80% MS2 survived the freeze drying process. In contrast, only about 15% of T4 phage survived during the freeze drying. CpGV was found to be degraded during freeze drying.
Bacteriophage T4 ; Bacteriophages ; Biological Warfare Agents ; DNA ; Electrophoresis ; Freeze Drying ; Genome ; Granulovirus ; Hantaan virus ; Levivirus ; Nitrogen ; Polymerase Chain Reaction ; Reverse Transcription ; Variola virus ; Yellow fever virus

PURPOSE: Due to remarkable developments in technology and great efforts made by Health Organizations, most of infectious diseases had been under control. However, ecological changes and biological variations resulted in emerging and re-emerging infectious diseases, which threaten the global health and may have the possibility of being abused as biological weapon. Therefore it is indispensable to understand the latest information and knowledge in order to cope with the emergency situation. RESULTS: In Korea, several reemerging diseases such as Malaria, Hepatitis A, Shigellosis, Mumps, and food poisoning has been increasing conspicuously since 1990. Also Diphtheria, plague, yellow fever and dengue fever have been potential threats, considering substantial international trades. CONCLUSION: There have many newly emerged and re-emerged infectious diseases identified in recent few decades in Korea. Thus as epidemiologic professionals, we have to get ready, particularly following missions to be carried out : 1) to keep eyes open to look for emerging and reemerging diseases continuously and keep up the latest global information, 2) establish the co-operational organizations to prepare immediate action against the sudden outbreak, 3) publicize, educate, establish and perform the missions, taking initiative in training clinicians, 4) upgrade professional competency by familiarizing ourselves with epidemiologic investigations, and 5) fulfill the responsibilities as health keepers of the nation.
Biological Warfare Agents ; Communicable Diseases ; Communicable Diseases, Emerging ; Dengue ; Diphtheria ; Dysentery, Bacillary ; Emergencies ; Epidemiology* ; Foodborne Diseases ; Hepatitis A ; Humans ; Korea ; Malaria ; Missions and Missionaries ; Mumps ; Plague ; Yellow Fever

Serratia marcescens (S. marcescens) emerged as an opportunist in the setting of immunodeficiency in the 1970s, when serious infections occurred in San Francisco hospitals after USA. Navy experiments had aerosolized the bacteria to study biologic warfare. We investigate the risks of S. marcescens in San Franciscans who undergo mastectomy with implant reconstruction. From 2007 to 2011, the senior author took breast capsule cultures for all patients at the time of tissue expander exchange/explant. Of the 142 women who had reconstruction, 23 had positive cultures. Only the two patients who were positive for S. marcescens developed clinical infections that required explantation. Both had postoperative chemotherapy with transient neutropenia, and both had close ties to San Francisco. Clinical signs of infection emerged for both patients months after initial surgery, despite having previously well healed incisions. Other patients were culture positive for Pseudomonas, Proteus, Enterococcus and MRSA and did not develop require explant. While the link between San Francisco and S. marcescens is controversial, a patient's geography is a simple screening tool when considering postoperative risks, especially in the immunocompromised. Closer monitoring for neutropenia during chemotherapy, and a lower threshold to administer S. marcescens targeted antibiotics may be warranted in these patients.
Anti-Bacterial Agents ; Bacteria ; Biological Warfare ; Breast ; Breast Implants* ; Device Removal ; Drug Therapy ; Enterococcus ; Female ; Geography ; Humans ; Mass Screening ; Mastectomy ; Methicillin-Resistant Staphylococcus aureus ; Neutropenia ; Proteus ; Pseudomonas ; Risk Factors* ; Serratia ; Serratia marcescens* ; Tissue Expansion Devices

Human anthrax has been a zoonotic disease affecting those who have close contact with animals or animal products contaminated with the spore-forming bacterium Bacillus anthracis. Now the incidence of anthrax in herbivores and human are rare, but it remains an important health problem in Korea because anthrax is seen as one of the most likely biological weapon. The B. anthracis forms a spore, which is resistant to drought, heat and numerous disinfectants, and the spore can remain viable and infective in the environment for decades. There are three major forms of human disease depending on how infection is contracted, cutaneous, inhalation and ingestion. Inhalational anthrax is the most common form, but the events in the Korea show that gastrointestinal anthrax is the most common. Several cases of anthrax have been reported in Korea. In recent years, 2 cases of bovine anthrax and 5 cases of human anthrax occurred in Changnyeong-gun, 2000, but it haven't occurred any more so far. The most useful microbiological test remains the standard blood culture. Confirmatory diagnostic tests such as polymerase chain reaction can also be used and may help in early diagnosis. Prompt clinical suspicion and rapid administration of effective antimicrobials are essential for treatment of anthrax. Ciprofloxacin or doxycycline should be used for initial intravenous therapy until antimicrobial susceptibility results are known. The best measure to eliminate human anthrax is control in domestic animals by effective surveillance and by immunization of animals in endemic areas. Also, the government must establish countplan for knowledge and rational policies in dealing with potential bioterrorism attacks.
Animals ; Animals, Domestic ; Anthrax* ; Bacillus anthracis ; Biological Warfare Agents ; Bioterrorism ; Ciprofloxacin ; Diagnostic Tests, Routine ; Disinfectants ; Doxycycline ; Droughts ; Early Diagnosis ; Eating ; Herbivory ; Hot Temperature ; Humans ; Immunization ; Incidence ; Inhalation ; Korea ; Polymerase Chain Reaction ; Spores ; Zoonoses