OBJECTIVES: The aim of this study was to estimate the medical surge capacity required for mass prophylaxis based on a hypothetical outbreak of smallpox.METHODS: We performed a simulation using the Bioterrorism and Epidemic Outbreak Response Model and varied some important parameters, such as the number of core medical personnel and the number of dispensing clinics.RESULTS: Gaps were identified in the medical surge capacity of the Korean government, especially in the number of medical personnel who could respond to the need for mass prophylaxis against smallpox.CONCLUSIONS: The Korean government will need to train 1,000 or more medical personnel for such an event, and will need to prepare many more dispensing centers than are currently available.
Bioterrorism ; Korea ; Smallpox ; Surge Capacity ; Vaccination ; Variola virus

Injury is a serious problem that not only causes death but also significantly degrades the quality of life of the people and causes loss of socioeconomic opportunities and costs. Damage occurs as a result of an accident. Among them, natural disasters and artificial disasters take lives of many people in a short time and threaten their physical and mental health. The United States has responded to the disaster by establishing relevant laws and regulations and a response system with the recognition that health is recognised soon to be as national security in the wake of the 9/11 terrorist attacks and the Katrina disaster. It is necessary to build a knowledge infrastructure to train disaster response experts in public health area and to have health competence to cope with disasters.
Bioterrorism ; Disasters ; Jurisprudence ; Mental Competency ; Mental Health ; Public Health ; Quality of Life ; Security Measures ; Social Control, Formal ; United States

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

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

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

Tularemia is a high-risk infectious disease caused by Gram-negative bacterium Francisella tularensis. Due to its high fatality at very low colony-forming units (less than 10), F. tularensis is considered as a powerful potential bioterrorism agent. Vaccine could be the most efficient way to prevent the citizen from infection of F. tularensis when the bioterrorism happens, but officially approved vaccine with both efficacy and safety is not developed yet. Research for the development of tularemia vaccine has been focusing on the live attenuated vaccine strain (LVS) for long history, still there are no LVS confirmed for the safety which should be an essential factor for general vaccination program. Furthermore the LVS did not show protection efficacy against high-risk subspecies tularensis (type A) as high as the level against subspecies holarctica (type B) in human. Though the subunit or recombinant vaccine candidates have been considered for better safety, any results did not show better prevention efficacy than the LVS candidate against F. tularensis infection. Currently there are some more trials to develop vaccine using mutant strains or nonpathogenic F. novicida strain, but it did not reveal effective candidates overwhelming the LVS either. Difference in the protection efficacy of LVS against type A strain in human and the low level protection of many subunit or recombinant vaccine candidates lead the scientists to consider the live vaccine development using type A strain could be ultimate answer for the tularemia vaccine development.
Bioterrorism ; Communicable Diseases ; Francisella tularensis ; Humans ; Sprains and Strains ; Stem Cells ; Tularemia ; Vaccination ; Vaccines

OBJECTIVETo evaluate the protective performance of a positive pressure bio-protective clothing against viral aerosol.

METHODSThe suspension of indicating virus phage Phi-X174 was made for viral aerosol generating in a hermetic cabin. The diameter of viral aerosol particles were measured with a aerodynamics size analyzer. By adjusting the inner humidity of the cabin, the protective efficiency of the positive pressure bio-protective clothing against viral aerosol in high and low windshield conditions was determined with Andersen six-stage air sampler sampling and plage forming unit (PFU) counting, respectively.

RESULTSThe mass median diameter of Phage Phi-X174 aerosol particles was about 0.922 µm and the background concentration is beyond 2 × 10⁴ particles/m³. The protective efficiency of the clothing against phage Phi-X174 aerosol particles was above 99.9% under different test conditions with the range of viral aerosol concentration between 0 - 23 PFU/m³. Airflow (P = 0.84), environment humidity conditions (P = 0.33) and sampling time (P = 0.07) did not affect the protective efficiency statistically.

CONCLUSIONThe positive pressure bio-protective clothing provided a relatively high efficiency against phage Phi-X174 aerosol regardless of airflow rate, environment humidity and sampling time.

Aerosols ; Bacteriophage phi X 174 ; Bioterrorism ; prevention & control ; Equipment Design ; Humidity ; Occupational Exposure ; prevention & control ; Pressure ; Protective Clothing ; Time Factors ; Virus Diseases ; prevention & control

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

OBJECTIVETo develop a fast, high-throughput screening method with suspension array technique for simultaneous detection of biothreat bacteria.

METHODS16 S rDNA universal primers for Bacillus anthracis, Francisella tularensis, Yersinia pestis, Brucella spp.and Burkholderia pseudomallei were selected to amplify corresponding regions and the genus-specific or species-specific probes were designed. After amplification of chromosomal DNA by 16 S rDNA primers 341A and 519B, the PCR products were detected by suspension array technique. The sensitivity, specificity, reproducibility and detection power were also analyzed.

RESULTSAfter PCR amplification by 16 S rDNA primers and specific probe hybridization, the target microorganisms could be identified at genus level, cross reaction was recognized in the same genus. The detection sensitivity of the assay was 1.5 pg/microl (Burkholderia pseudomallei), 20 pg/microl (Brucella spp.), 7 pg/microl (Bacillus anthracis), 0.1 pg/microl (Francisella tularensis), and 1.1 pg/microl (Yersinia pestis), respectively. The coefficient of variation for 15 test of different probes was ranged from 5.18% to 17.88%, it showed good reproducibility. The assay could correctly identify Bacillus anthracis and Yersinia pestis strains in simulated white powder samples.

CONCLUSIONThe suspension array technique could be served as an opening screening method for biothreat bacteria rapid detection.

Bacillus anthracis ; isolation & purification ; Bioterrorism ; prevention & control ; DNA Primers ; DNA, Bacterial ; analysis ; Francisella tularensis ; isolation & purification ; Oligonucleotide Array Sequence Analysis ; methods ; Polymerase Chain Reaction ; methods ; RNA, Ribosomal, 16S ; genetics ; Yersinia pestis ; isolation & purification

In 1945, many Koreans, in addition to Japanese, were killed or injured by the atomic bombs dropped on Hiroshima and Nagasaki, Japan. This study compared the biological profiles of Korean atomic bomb survivors in residence at Daegu and Kyungbuk, Republic of Korea with those of a representative sample of Koreans obtained during a similar period. We evaluated anthropometric measurements, blood pressure, blood cell counts, blood chemistry, and urinalysis of survivors (n=414) and age- and sex-matched controls (n=414) recruited from the third Korea National Health and Nutrition Examination Survey conducted in 2005. Univariate analyses revealed significantly higher systolic blood pressure, white blood cell count, and serum total cholesterol, triglycerides, high-density lipoprotein-cholesterol, and aspartate aminotransferase levels (p<0.01) in the survivors. Conversely, hemoglobin concentration, hematocrit, red blood cell count, and the proportion of positive urine occult blood (p<0.01) were lower in the survivors. Our findings suggest that biological profiles of Korean atomic bomb survivors were adversely affected by radiation exposure.
Abnormalities, Radiation-Induced ; Aged ; Biological Markers/analysis ; Female ; Humans ; Japan ; Korea ; Male ; *Nuclear Warfare ; Radiation Injuries/diagnosis/*metabolism ; Radioactive Fallout ; Survivors