index.pdf

Index

livestock vulnerability, 27–28

Agroterrorism. See Agricultural terrorism

Al Qaeda

biological weapons program in Afghanistan, 14, 16

Alaska

botulism outbreaks, 584

paralytic shellish poisoning analysis, 367

Alcide EXSPORE disinfectant

description, 529–530

Algal toxins. See Marine algal toxins

Alibek, Dr. Kenneth

Biohazard, 96

description of the former Soviet Union’s biowarfare program,

338

weaponization of monkeypox virus by the former Soviet

Union, 216

weaponization of Y pestis, 96

Alimentary toxic aleukia. See Trichothecene mycotoxins

Alkhurma virus

description, 276

transmission, 276

Alphavirus encephalitis. See also Eastern equine encephalitis;

Encephalitis; Venezuelan equine encephalitis; Western equine

encephalitis

active immunization, 257–258

aerosol transmission, 242, 250

antigenic classiication of (table), 245

antigenicity, 244–246

budding and release of progeny virus particles, 250

characteristics of, 242

clinical manifestations, 252–256, 259

description, 242–243, 259

diagnosis, 252–256

differential diagnosis, 254–255

endemic and epidemic activity, 246

environmental factors, 242

epidemic human pathogens, 242

epidemiology and ecology, 246–248

gene sequencing, 244

genetic manipulation, 259

genomic RNA, 249

glycoprotein synthesis, 249–250

historical background, 243–244

hospital infection control precautions and, 429

immune effector mechanisms, 256

inactivated vaccines, 258

live vaccines, 244, 256–259

medical management and prevention, 255–256

nonviral causes (exhibit), 255

passive immunization, 256–257

pathogenesis, 250–252

potential as a biowarfare agent, 242–244, 254, 256, 259

prophylaxis, 256–258

structure and replication of, 242, 248–250

structure (igure), 249

transmission, 242

vaccines, 244, 248, 256–259

vaccines available for VEE, EEE, and WEE viruses (table), 257

viral causes of endemic encephalomyelitis (exhibit), 255

viral infection cycle, 249

virion structure, 248–250

worldwide distribution, 242

American Association of Poison Control Center

Toxic Exposure Surveillance System report of ricin poisoning,

327

AAALAC International. See Association for Assessment and Ac-

creditation of Laboratory Animal Care International

Abrin

toxicity of, 325

ABSA

biosafety professional credentialing, 537

ABSL-3 facilities. See Animal biological safety level-3 facilities

ABSL-4 facilities. See Animal biological safety level-4 facilities

ACAM 2000 vaccine

candidate vaccine for smallpox, 490–491

Accidental release of biological agents

Former Soviet Union’s accidental release of anthrax into

Sverdlovsk, 10, 52–53, 70–71, 470, 545

former Soviet Union’s accidental release of smallpox in Aralsk,

51–52

ACCs. See Ancillary care centers

ACIP. See Advisory Committee on Immunization Practices

Activated charcoal

neurotoxic shellish poisoning treatment, 370

trichothecene mycotoxins exposure treatment, 364–365

Acyclovir

smallpox treatment, 231

Adverse events

anthrax treatment, 470

anthrax vaccine adsorbed, 469

eastern equine encephalitis vaccine, 481

NDBR 105 Q fever vaccine, 477

NDBR 101 vaccine, 473

pentavalent botulinum toxoid, 345, 496

ribavirin therapy, 292–293

smallpox vaccination, 216, 224, 230–231, 483–490

TC-83 vaccine, 479

V3526 vaccine, 481

Advisory Committee on Immunization Practices

anthrax treatment recommendations, 470

smallpox vaccination contraindications, 483

Afghanistan

biological weapons program, 14

Crimean-Congo hemorrhagic fever and, 274

former Soviet Union’s deployment of trichothecene toxins,

356, 545

former Soviet Union’s use of B mallei as a biowarfare agent

against, 122

melioidosis and, 151

Africa. See also speciic countries

Alphavirus encephalitis and, 242

Crimean-Congo hemorrhagic fever and, 274

dengue fever and, 593

Ebola viruses and, 275–276

glanders and, 122, 125

Lassa fever and, 273

monkeypox and, 224

plague incidence, 101

smallpox and, 223

yellow fever and, 276

African Americans

environmental susceptibility to Aspergillus fumigatus tests, 6

Agent Orange

use in Vietnam, 27

Agricultural terrorism

Colorado potato beetle outbreaks during World War II, 27

economic consequences, 28

farm-to-food continuum, 27, 29

xxix

Medical Aspects of Biological Warfare

American Biological Safety Association

biosafety risk group assignments, 518

American Civil War

Army ambulance system development, 562

glanders and, 123

hantaviruses and, 275

inluence of military medicine on standard medical care

practice, 562

medical education and, 562

melioidosis and, 151

use of smallpox as a biological weapon, 220

American College of Surgeons

Advanced Trauma Life Support model, 444, 452

American Hospital Association

chemical and bioterrorism preparedness checklist, 431

American Society of Crime Laboratory Directors

bioforensic standards, 406

Amherst, Sir Jeffrey

introduction of smallpox to Native Americans, 3, 544

AMLs. See Army medical laboratories

Amnesic shellish poisoning

causative agent, 366, 371

clinical manifestations, 371–372, 377

diagnosis, 372

ingestion route, 371–372

inhalation route, 372

latency period, 372

mechanism of action, 371, 377

medical management, 372–373, 377

mortality rate, 372

potential biowarfare or bioterrorist threat, 373

toxin description, 371

Amoxicillin

anthrax treatment, 78–79, 470

melioidosis treatment, 157

Ancillary care centers

discharge of patients from, 431

expansion of healthcare system into, 430

Modular Emergency Medical System and, 430

operational low diagram of casualty evaluation and manage-

ment using the Modular Emergency Medical System (igure),

430

patient medical records and, 431

planning considerations, 430–431

stafing for, 431

suggested minimum stafing per 12-hour shift for a 50-bed

nursing subunit (exhibit), 431

Animal biological safety level-2 facilities. See also Laboratory

animal care and use program

special practices, 531–532

Animal biological safety level-3 facilities

primary barriers for, 524–525

secondary barriers for, 528

special practices, 531–532

Animal biological safety level-4 facilities

secondary barriers for, 528–529

special practices, 531–532

Animal welfare. See also Guide for Care and Use of Laboratory Ani-

mals; Laboratory animal care and use program

Anthrax. See also B anthracis

active vaccination and, 79–80

Aum Shinrikyo cult use of, 12, 48–49, 338–339, 407, 545

case studies and lessons learned, 45–46, 48–51

causes of infection, 70, 72, 467

clinical disease, 74–77, 445

composition of anthrax lethal protein toxin (igure), 73

cutaneous type, 74–75, 77–79

decontamination of people exposed to, 426

description, 70, 80, 467

diagnosis, 77–78

direct luorescent antibody stain (igure), 78

edema toxin, 72–73

epidemiology, 71–72

exotoxins, 72–73

former Soviet Union accidental release of, 10, 52–53, 470

funding for studies of, 71

gastrointestinal type, 76–79, 582–583

German use of infected animals during World War I, 3, 45–46

gram stain (igure), 70

handling corpses infected with, 436

historical background, 70–71

hospital infection control precautions and, 429

inhalational type, 11, 13, 16, 50–51, 57, 70, 72, 75–76, 78–80, 445,

467–468, 471, 583

lethal toxin, 72–74, 467

mailings of letters contaminated with, 11, 13, 16, 50–51, 57, 71,

76, 433, 460, 545, 546

meningitis and, 77–78

military relevance, 70

new vaccine research, 469

occurrence, 71

organism description, 71

oropharyngeal type, 76–78, 583

PA-based vaccines, 80, 469

PA receptor, 74

pathogenesis, 72–74

postexposure vaccination with chemoprophylaxis, 470–471

potential for use as a biowarfare or bioterrorism agent, 468, 583

prophylaxis, 13, 79–80, 469–471

scanning electron micrograph of spores (igure), 71

secondary aerosolization, 426

side effects of vaccines, 80

supportive therapy, 79

transmission of disease, 72, 467–468

treatment, 13, 78–80, 469–470

underdiagnosing and underreporting of cases, 72

vaccine for, 10–11, 71, 467–471

wild or domestic animals and, 71–72

Anthrax vaccine adsorbed

adverse events, 469

age limitations, 448

anthrax prophylaxis, 79–80, 471

description, 448, 468

dosing guidelines, 448, 468

effectiveness of, 448, 468–469

vaccination of military personnel, 79

vaccine breakthrough occurrence, 468

Anti-Terrorism Act

provisions, 546

Antibiotic susceptibility testing

description, 398

Kirby-Bauer disk diffusion, 398

Antibiotics. See also speciic drugs

anthrax treatment, 78–79, 469–470

brucellosis treatment, 190–192

emerging antibiotic resistance, 587

glanders treatment, 139–140

mass prophylaxis and, 433

melioidosis treatment, 156–157, 159

plague treatment, 107, 111–112

postexposure antibiotic prophylaxis regimens (table), 467

Q fever treatment, 205

tularemia treatment, 174–176

Antibody tests. See also Fluorescent antibody tests

xxx

Index

staphylococcal enterotoxin B, 318

Antihistamines

neurotoxic shellish poisoning treatment, 370–371

staphylococcal enterotoxin B treatment, 318

APHL. See Association of Public Health Laboratories

API 20NE

melioidosis identiication kit, 156

AR 50X: Army Biological Surety Program. See U.S. Army Biosurety

Program

Arboviruses. See Alphavirus encephalitis; speciic viruses

Arenaviridae

agent characteristics, 277

Argentine hemorrhagic fever, 274, 279, 286, 293, 492, 493–494

Bolivian hemorrhagic fever, 274, 279, 292–293

epidemiology, 272–274

Lassa fever, 273, 279, 285, 292, 493–494, 518

Machupo virus, 274

New World group, 273

Old World group, 273

ribavirin treatment, 293

rodent reservoirs, 273

Sabia virus, 274, 293

skin rashes, 285

Whitewater Arroyo virus, 274

Argentine hemorrhagic fever

antibody therapy, 293

clinical manifestations, 279

description, 274

disseminated intravascular coagulation and, 286

ribavirin treatment, 493–494

transmission, 274

vaccine for, 290, 492

Arkansas

tularemia outbreaks, 169

Armed Forces Institute of Pathology

identifying and conirming the presence of biological threats, 392

Laboratory Response Network responsibilities, 394

Army Medical Command

biological select agents and toxins facilities registration, 395

Army medical laboratories

bioforensics and, 406

biological agent testing, 394

description, 392, 394

Laboratory Response Network and, 394

“reach back” capability, 394

Arthritis

causative organisms, 313

smallpox and, 224

Arthur D. Little Company, Inc.

glass-ilter paper development, 517

Asia. See also speciic countries

Alphavirus encephalitis and, 242

Crimean-Congo hemorrhagic fever and, 274

dengue fever and, 593

H5N1 inluenza virus and, 590

paralytic shellish poisoning and, 367

plague incidence, 101

smallpox and, 223

tularemia and, 168

ASP. See Amnesic shellish poisoning

Aspergillus

bioterrorism potential, 25

Aspergillus fumigatus

tests of African American susceptibility to, 6

Association for Assessment and Accreditation of Laboratory

Animal Care International

accreditation for laboratories, 536

laboratory safety audits, 534

Association of Oficial Analytical Chemists

paralytic shellish poisoning diagnosis, 368

Association of Public Health Laboratories

BSL-3 laboratory practices, 522

Athamna, A.

antibiotic-resistant B anthracis research, 405

Atomic Energy Commission

air iltration technology, 517

Audits. See Laboratory safety audits

Augmentin

glanders treatment, 475

Aum Shinrikyo cult

attempt to buy Ebola virus, 12, 276, 545

sarin attack in the Tokyo subway and, 12, 339, 427, 545

use of anthrax and botulinum toxin in attacks, 12, 16, 22,

48–49, 338–339, 407, 545

Aura virus. See Western equine encephalitis

Aureomycin

glanders treatment, 140

Australia

Alphavirus encephalitis and, 242

avian inluenza and, 589

brucellosis and, 187

Hendra virus and, 591

melioidosis and, 153–155, 157

Menangle virus and, 592

paralytic shellish poisoning and, 367

Q fever and, 200, 206, 476–477

smallpox and, 223

Austria

tularemia outbreaks, 170

AVA. See Anthrax vaccine adsorbed

Avian inluenza

outbreaks, 590

virus isolation, 589–590

Azaspiracid shellish poisoning

bioterrorism and, 366

causative agent, 366

Azithromycin

C jejuni infection treatment, 584

glanders treatment, 140

melioidosis treatment, 157

Aztec empire

introduction of smallpox to, 2

B anthracis. See also Anthrax

biosafety risk group assignment, 518

bioterrorism potential, 22, 583

Great Britain’s use of as a biological weapon during World

War II, 4

infective dose, 22

organism description, 71

Poland’s use of letters contaminated with during World War

II, 4

strain differential, 406–407

use of “cattle cakes” made of during World War II, 4–5

B cereus

anthrax-like characteristics, 73

B mallei. See also Glanders

B pseudomallei and, 124–125, 127–128, 135, 137

description, 136

irst isolation of, 123

taxonomy, 125

use in World War II as a biowarfare agent, 122

warm and moist environments and, 125–126

xxxi

Medical Aspects of Biological Warfare

B pseudomallei. See also Melioidosis

B mallei and, 124–125, 127–128, 135, 137

colony morphologies (igure), 149

description, 148–149

discovery of, 148

gene sequencing, 148–149

BabyBIG. See Botulism immune globulin

Baca, O.G.

Q fever treatment, 205

BACTEC

brucellosis diagnosis, 190

Baldwin, J.

The Eleventh Plague, 25

Bang, B.

brucellosis research, 186

Barkley, Dr. Emmett

oral pipetting hazards, 517

Basic Protocols for Level A (Sentinel) Laboratories

speciic precautions, 395

Bats

Filoviridae and, 275

Hendra virus and, 591

Menangle virus and, 592

Nipah virus and, 591–592

severe acute respiratory syndrome and, 591

Tioman virus and, 592

Baxby, D.

cowpox research, 225

Beal, D.

clostridial toxin research, 376

Bennett, M.

cowpox research, 225

BIDS. See Biological Integrated Detection System

Billings, John Shaw

creation of an indexing system for medical publications, 562

design of Johns Hopkins Hospital building, 562

Biocrimes

description and examples, 15

Biodefense and Pandemic Vaccine and Drug Development Act

provisions, 575

Bioforensics

B anthracis strain differentiation, 406–407

chain of custody and, 406

military laboratories and, 406

use of multiple test methods, 406

Biohazard (Alibek), 96

Biological Incident Annex

description, 420–421

elements of an effective biological response, 421

Biological Integrated Detection System

description, 445

Biological personnel reliability program

categories of persons who must be enrolled, 552

continuous monitoring component, 555

description, 551–552

drug testing, 554

inal review, 554–555

initial interview, 552–554

mandatory disqualifying factors, 552

medical evaluation, 554

personnel records review, 554

personnel security investigation, 554

potentially disqualifying factors, 552–554

purpose of, 551

Biological safety cabinets

certiication of, 524

class II and class III types, 524

HEPA ilters and, 517

primary containment and, 516

Biological Safety Program Manual

standard operating procedures, 523

Biological select agents and toxins

control over access to, 395

personnel, physical security, safety, and agent-inventory

guidelines, 395–396

storage safety procedures, 396

Biological terrorism. See also Epidemiology of biowarfare and

bioterrorism; Medical countermeasures against bioterrorism

Al Qaeda and, 14, 16

anthrax and glanders events of 1915-1916 case study, 3, 45–46

anthrax mailings, 11, 13, 16, 50–51, 57, 71, 76, 433, 460, 545, 546,

583

Aum Shinrikyo cult and, 12, 16, 48–49, 276, 338–339, 407, 427,

545

bioterrorism incidents, 1984–2004 (table), 405

case studies of events, 45–51

description, 11

hoaxes and, 11–12, 16

improving recognition and surveillance of, 58–60

increase in incidents of, 11

Minnesota Patriots Council and, 12

Rajneesh cult and, 12, 23, 46–48, 545, 584

recommended therapy for (and prophylaxis against) diseases

caused by category A biothreat agents (table), 453–454

ricin and, 324, 325

stepwise approach to medical management of casualties,

444–460

U.S. biological preparedness measures, 12–14

Biologics Control Act

biological product standards, 569

Biosafety. See also Biosurety; Laboratory Response Network;

Laboratory safety audits

assessing individual risk, 523–524

Basic Protocols for Level A (Sentinel) Laboratories, 395

biohazard deinition, 516

biological safety cabinets, 516, 524

biosafety level terminology, 516, 520–521

biosafety levels (exhibit), 458

brucellosis, 186, 190, 192

BSL-1 facilities, 520–521, 530–531, 534, 535

BSL-2 facilities, 394–395, 521–522, 530–531, 534–535

BSL-3 facilities, 395, 521–522, 524–526, 530–531, 534–535

BSL-4 facilities, 395, 516, 521–522, 524, 527, 530–531, 534–535

case-fatality rate by disease (table), 519

Certiied Biological Safety Professionals, 537

credentialing of professionals, 537–538

description, 516

documenting safety procedures, 523

elements of a positive biosafety culture, 537–538

evolution of, 516–517

ive steps of the risk management process (igure), 533

glanders, 127, 138, 141

goals, 516, 537

human infectious dose by organism (table), 519

institute personnel (igure), 533

laboratory animal care and use programs, 536

laboratory safety audits, 533–535

management role, 532–535, 537

measures taken in research to protect laboratory workers, 523

medical surveillance, 526–527

melioidosis, 150

military clinical and ield medical laboratories and, 394–395

objectives of occupational health and safety programs, 527

“Occupational Exposure to Blood-borne Pathogens,” 395

xxxii

Index

physical barriers, 524–525

primary barriers, 524–525, 551

primary containment deinition and examples, 516

program elements required for containment and maximum

containment laboratories, 523–532

protecting the community and the environment, 528–529

Q fever, 200

Registered Biosafety Professionals, 537

relationship of risk groups, biosafety levels, practices, and

equipment (table), 518

risk groups, 517–520

risk management process, 533

risk mitigation, 523–524

secondary barriers, 528–529, 551

secondary containment deinition and examples, 516

Select Agent Program, 535–536

solid and liquid waste inactivation and disposal, 529–530

standard and special microbiological practices, 530–532

training issues, 516, 537

tularemia, 173, 177

two-person rule when working with biological select agents

and toxins, 536

universal bloodborne pathogen precautions, 395

vaccinations and, 527–528

viral hemorrhagic fevers, 277

Biosafety in Microbiological and Biomedical Laboratories

animal-holding rooms for BSL-4 facilities, 529

areas necessary to establish containment, 551

biosafety level terminology, 516, 520–521

deinition of agents to be handled in each laboratory safety

level, 551

description, 551

primary barriers, 551

room ittings and ventilation for ABSL-3 facilities, 528

secondary barriers, 551

Biosecurity. See also Biosurety

DHHS controls over access to biological select agents and

toxins, 395

DoD and Army personnel reliability program, 397, 551–555

personnel, physical security, safety, and agent-inventory

guidelines, 395–396

storage of biological select agents and toxins, 396

BioSense surveillance program

description, 60

Biosurety. See also Biosecurity

agent accountability, 555–556

attenuated strains exempted from regulation (table), 548

CDC regulations for entities handling select agents, 548–549

diagnostic specimens and, 546–547

extremist groups and, 325, 545–546

historical background, 544–546

immediate reporting requirements for select agents (exhibit),

547

regulated amounts of toxins (table), 549

regulatory agencies, 546–548

regulatory framework for working with and transferring select

agents and toxins, 546–547

U.S. Army Biosurety Program, 549–556

BioThrax

anthrax prophylaxis, 79–80

BioWatch program

description, 59

Birds

amnesic shellish poisoning and, 371

avian inluenza and, 589–590

eastern equine encephalitis and, 253

western equine encephalitis and, 243, 246

Black Death. See also Plague

clinical descriptions by contemporary observers, 93

description, 92–93

mortality rate, 93

Bliska, J.B.

intracellular replication in plague, 105

Blue Book. See Medical Management of Biological Casualties Handbook

BMBL. See Biosafety in Microbiological and Biomedical Laboratories

Boccaccio, Giovanni

Decameron description of the plague, 93

Bolivian hemorrhagic fever

antibody therapy, 293

clinical manifestations, 279

description, 274

ribavirin treatment, 293

transmission, 274

vaccine for, 290

Borreliosis. See Lyme disease

Borzenkov, V.M.

genetic engineering research, 405

BOTOX

use by an unlicensed physician, 344

Botulinum antitoxin, heptavalent, equine

botulism treatment, 343–344, 497

Botulinum antitoxin F(ab’)

botulism treatment, 343–344, 497

Botulinum immune globulin

early treatment with, 344

Botulinum toxin. See also C botulinum

antigenic types, 584

antitoxin treatment, 343–344, 346, 571, 584

assassination of Reinhard Heydrich and, 4

Aum Shinrikyo cult’s use of, 12, 16, 22, 48–49, 339

botulinum neurotoxin A composition (igure), 338

classic symptoms, 341, 346

clinical manifestations, 340–341, 344, 445, 584

clinically relevant signs of bioterrorist attack, 344

cultures in foodborne botulism, 342

description of the agent, 339–340

diagnosis, 341–344, 346

differential diagnosis, 341

early symptoms, 340

early treatment importance, 344

electrophysiological studies, 341–342

foodborne ingestion route of infection with, 338, 340, 342, 344

foods associated with, 584

future research recommendations, 346

historical background, 338–339

incubation period, 340

inhalation route of exposure, 341–343

lethal dose, 340, 584

mass casualty event model, 339, 345

mortality rate, 338, 340, 343, 346, 584

neurotoxin production, 340

new vaccine research, 346, 496–497

notiication of public oficials and, 341

paralysis and, 339–341, 344

pathogenesis, 340

potential use as a biowarfare or bioterrorism agent, 338, 340,

344, 346

prophylaxis, 344–346, 497

ricin and, 324

secondary infections and, 340

supportive care for infection with, 343, 346

toxin assays in foodborne botulism, 342

treatment, 343–346

vaccines, 345–346, 495–497, 571

xxxiii

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