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

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

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

OBJECTIVES: Bioterrorism (BT) preparedness and response plans are particularly important among healthcare workers who will be among the first involved in the outbreak situations. This study was conducted to evaluate the current status of education for BT preparedness and response in healthcare-related colleges/junior colleges and to develop learning objectives for use in their regular curricula. METHODS: We surveyed all medical colleges/schools, colleges/junior colleges that train nurses, emergency medical technicians or clinical pathologists, and 10% (randomly selected) of them that train general hygienists in Korea. The survey was conducted via mail from March to July of 2007. We surveyed 35 experts to determine if there was a consensus of learning objectives among healthcare workers. RESULTS: Only 31.3% of medical colleges/schools and 13.3% of nursing colleges/junior colleges had education programs that included BT preparedness and responses in their curricula. The most common reason given for the lack of BT educational programs was 'There is not much need for education regarding BT preparedness and response in Korea'. None of the colleges/junior colleges that train clinical pathologists, or general hygienists had an education program for BT response. After evaluating the expert opinions, we developed individual learning objectives designed specifically for educational institutions. CONCLUSIONS: There were only a few colleges/junior colleges that enforce the requirement to provide education for BT preparedness and response in curricula. It is necessary to raise the perception of BT preparedness and response to induce the schools to provide such programs.
*Bioterrorism ; Curriculum ; Disaster Planning/*organization & administration ; Humans ; Korea ; Schools, Health Occupations/*organization & administration

Due to heightened concerns regarding possible bioterrorist attacks, the Korea Center for Disease Control and Prevention introduced syndromic surveillance systems, which have been run by emergency departments in hospitals throughout Korea since 2002. These systems are designed to identify illness clusters before diagnoses are confirmed and reported to public health agencies, to mobilize a rapid response, and thereby to reduce morbidity and mortality. The Korea Center for Disease Control and Prevention performed drop-in syndromic surveillance successfully during the World Cup Football Games in 2002, the Universiad games in 2004, and the Asian Pacific Economic Cooperation meeting in 2005. In addition, sustainable syndromic surveillance system involving the collaborative efforts of 125 sentinel hospitals has been in operation nationwide since 2002. Because active data collection can bias decisions a physician makes, there is a need to generate an automatic and passive data collection system. Therefore, the Korea Center for Disease Control and Prevention plans to establish computerized automatic data collection systems in the near future. These systems will be used not only for the early detection of bioterrorism but also for more effective public health responses to disease.
*Bioterrorism ; Disaster Planning/organization & administration ; Disease Notification/*methods ; Disease Outbreaks/prevention & control ; Emergency Service, Hospital/*organization & administration ; Humans ; Korea ; Public Health Informatics/*organization & administration ; *Sentinel Surveillance ; Syndrome

Bioterrorism events have worldwide impacts, not only in terms of security and public health policy, but also in other related sectors. Many countries, including Korea, have set up new administrative and operational structures and adapted their preparedness and response plans in order to deal with new kinds of threats. Korea has dual surveillance systems for the early detection of bioterrorism. The first is syndromic surveillance that typically monitors non-specific clinical information that may indicate possible bioterrorismassociated diseases before specific diagnoses are made. The other is infectious disease specialist network that diagnoses and responds to specific illnesses caused by intentional release of biologic agents. Infectious disease physicians, clinical microbiologists, and infection control professionals play critical and complementary roles in these networks. Infectious disease specialists should develop practical and realistic response plans for their institutions in partnership with local and state health departments, in preparation for a real or suspected bioterrorism attack.
*Bioterrorism ; Communicable Disease Control/organization & administration ; Disaster Planning/*organization & administration ; Disease Notification/methods ; Disease Outbreaks/prevention & control ; *Health Policy ; Humans ; Korea ; *Sentinel Surveillance ; Specialties, Medical/organization & administration

Following the Anthrax bioterrorism attacks in the US in 2001, the Korean government established comprehensive countermeasures against bioterrorism. These measures included the government assuming management of all infectious agents that cause diseases, including smallpox, anthrax, plaque, botulism, and the causative agents of viral hemorrhagic fevers (ebola fever, marburg fever, and lassa fever) for national security. In addition, the Korean government is reinforcing the ability to prepare and respond to bioterrorism. Some of the measures being implemented include revising the laws and guidelines that apply to the use of infectious agents, the construction and operation of dual surveillance systems for bioterrorism, stockpiling and managing products necessary to respond to an emergency (smallpox vaccine, antibiotics, etc.) and vigorously training emergency room staff and heath workers to ensure they can respond appropriately. In addition, the government's measures include improved public relations, building and maintaining international cooperation, and developing new vaccines and drugs for treatments of infectious agents used to create bioweapons.
Anti-Infective Agents/supply & distribution ; Bacteria ; *Bioterrorism ; Disaster Planning/legislation & jurisprudence/*organization & administration ; Disease Notification/methods ; Disease Outbreaks/prevention & control ; Humans ; Korea ; Practice Guidelines as Topic ; *Sentinel Surveillance ; Vaccines/supply & distribution ; Viruses