Construção e validação de instrumento para avaliação das medidas de biossegurança em bioterrorismo pelos bombeiros / Construction and validation of and assessment tool for biosafety measures in bioterrorism for firefighters / Construcción y validación de un instrumento para evaluar las medidas de bioseguridad en el bioterrorismo de los bomberos

Objetivo: Este estudo teve como objetivo desenvolver e validar um instrumento de avaliação das medidas de Biossegurança adotadas pelos bombeiros militares, para a contenção dos agentes biológicos frente a um evento de bioterrorismo. Métodos: Tratou-se de um estudo descritivo de abordagem quantitativa, de desenvolvimento metodológico e do tipo de validação de conteúdo de um instrumento de avaliação. O estudo foi dividido nas fases de desenvolvimento e validação do instrumento. Para o desenvolvimento do instrumento foram feitas revisões da literatura e para a validação do instrumento foi utilizado o método Delphi. Para o estudo foram incluídos 6 juízes que avaliaram o instrumento através da escala numérica tipo Likert. Resultados: Os juízes avaliaram que o instrumento proposto está bem estruturado, possuindo boa clareza e coesão de escrita, com aplicabilidade no campo de estudo e de grande relevância, principalmente em vista a ausência desse tipo de instrumento para a população de bombeiros militares. Para avaliar a concordância entre os juízes foi utilizado o índice de Validade de Conteúdo, que alcançou 98% de concordância e o Índice de Fidedignidade Interavaliadores, que alcançou os conceitos bom e muito bom, mostrando baixa variância das respostas dos juízes, sendo estatisticamente válido. Conclusão: O estudo descreveu o processo de construção e validação do instrumento, provando ser apropriado e confiável para ser utilizado.

Objective: This study aimed to develop and validate an instrument to assess the Biosafety measures adopted by firefighters, for the containment of biological agents in the face of a bioterrorism event. Methods: This is a descriptive study with a quantitative approach, methodological development, and the type of content validation of an assessment instrument. The study was divided into instrument development and validation phases. For the development of the instrument, literature reviews were conducted and for the instrument validation, the Delphi method was used. For the study, 6 judges were included who evaluated the instrument using the Likert-type numerical scale. Results: The judges evaluated that the proposed instrument is well structured, with good clarity and cohesion of writing, with applicability in the field of study and of great relevance, especially considering the absence of this type of instrument for the military firefighter population. To evaluate the agreement between the judges, we used the Content Validity Index which reached 98% of agreement and the Interrate agreement, which reached the concepts good and very good, showing low variance of the judges' answers, being statistically valid. Conclusion: The study described the process of construction and validation of the instrument, proving to be appropriate and reliable to be used.

Objetivo: Este estudio tenía como objetivo desarrollar y validar un instrumento para evaluar las medidas de bioseguridad adoptadas por los bomberos militares para contener los agentes biológicos durante un evento de bioterrorismo. Métodos: Se trata de un estudio descriptivo de abordaje cuantitativo, de desarrollo metodológico y del tipo de validación de contenido de un instrumento de evaluación. El estudio se dividió en las fases de desarrollo y validación del instrumento. Para la elaboración del instrumento se realizaron revisiones bibliográficas y para la validación del mismo se utilizó el método Delphi. Para el estudio se incluyeron 6 jueces que evaluaron el instrumento mediante una escala numérica tipo Likert. Resultados: Los jueces evaluaron que el instrumento propuesto está bien estructurado, poseyendo buena claridad y cohesión de redacción, con aplicabilidad en el campo de estudio y de gran relevancia, especialmente en vista de la ausencia de este tipo de instrumento para la población de bomberos militares. Se utilizó el Índice de Validez de Contenido para evaluar la concordancia entre los jueces, alcanzando un 98% de acuerdo y el Índice de Fiabilidad Inter-registrador, que alcanzó conceptos buenos y muy buenos, mostrando una baja varianza en las respuestas de los jueces, siendo estadísticamente válido. Conclusión: El estudio describió el proceso de construcción y validación del instrumento, demostrando ser apropiado y confiable para ser utilizado.

Bioterrorismo: capacitar para responder / Bioterrorism: empower to respond

RESUMO A utilização de agentes biológicos com a finalidade de aterrorizar inimigos surgiu há muitos séculos. Essa ação foi popularizada como bioterrorismo. Ataques bioterroristas são perigosos devido ao envolvimento de diversos fatores, como a forma silenciosa na qual pode ocorrer, o tipo e a forma de transmissão do agente biológico utilizado, dependendo do objetivo do ataque. Para prevenção da contaminação por esses agentes, os profissionais que irão atuar no seu combate devem possuir conhecimentos a respeito dos mecanismos de ação e de disseminação desses patógenos, bem como a adequada forma de sua neutralização e eliminação; além de saber escolher os equipamentos de proteção, tanto de uso individual quanto coletivo, adequados. Diante disso, tais equipes de ação necessitam ser bem capacitadas e treinadas. O objetivo deste estudo foi analisar, na literatura, os modos de treinamentos existentes no mundo para os profissionais de primeira resposta aos ataques envolvendo agentes Químico, Biológico, Radiológico ou Nuclear (QBRN). A partir de uma revisão integrativa, encontraram-se três artigos, em um período de 20 anos. Conclui-se que são muito escassos os estudos nessa área e que mais pesquisas e treinamentos para este tipo de evento devem ser realizados no mundo inteiro.

ABSTRACT The use of biological agents for the purpose of terrorizing enemies dates back many centuries. This terror action with the use of biological agents became popularized as Bioterrorism. Bioterrorist attacks are dangerous due to various factors involved, such as the silent way in which it may occur, or the type of biological agent that can be used depending on the purpose of the attack. To prevent contamination by these agents, the professionals who will act to combat these events should have knowledge about the varieties of mechanisms of actions and dissemination of the pathogens, as well the best way to neutralize and eliminate them; besides, they should have known how to choose appropriates protection equipment, both for individual and collective protection. Thus, it is necessary that such action teams be well empowered and trained. The purpose of this paper is to analyze, in the existing literature, what are the training modes in the world for first responders to attacks involving Chemical, Biological, Radiological or Nuclear (CBRN) agents. Thus, an integrative review was made based on 3 articles found in a period of 20 years. It is concluded that studies in this field are minimals and that more research and training for this kind of event should be carried out worldwide.

Early Detection of Bacillus anthracis From Saliva in Anticipation of a Bioterrorism Attack

Objective: To assess potential for early detection of oral infection by B. anthracis spores for preparedness of a bioterrorism attack. Material and Methods: The laboratory study used saliva with a range of initial anthrax concentrations, to compare detection by direct observation from conventional blood agar culture and by anthrax-specific PCR after a shorter culture in BHI broth. Three types of saliva were collected: stimulated saliva, unstimulated/whole saliva, and unstimulated/whole saliva with antibiotic treatment (for negative control). Using bivariate Kruskal-Wallis and Mann-Whitney tests for statistical analysis for factors that could affecting anthrax detection, significant differences between the test groups was assumed at p<0.05. Results: From unstimulated whole saliva heat shock treated at 62.50C, B. anthracis growth was detected with both methods. PCR detection from a BHI broth culture could shorten the time to diagnosis in comparison to conventional culture in blood agar. Conclusion: Saliva can provide useful samples for diagnosis of oropharyngeal anthrax. In comparison to conventional culture on blood agar, shorter-term culture in BHI broth provides potential for earlier detection and diagnosis.

An evaluation method for medical intervention effect of urban anthrax aerosol terrorist attacks / 第二军医大学学报

Objective To establish a quantitative evaluation method for medical treatment effect of anthrax aerosol terrorist attacks. Methods We established an evaluation framework for the medical treatment effect of anthrax events through constructing the decision tree model of medical intervention after anthrax exposure, the allocation model of key resources consumption and the model of population state transition under different intervention measures. Then, under the scenario of the anthrax terrorist attacks in the big cities of China, we analyzed and evaluated the effects of 52 intervention strategies on the number of cases, peak value, and deaths based on the discrete event simulation method. Results The intervention effect was sensitive to time delay in intervention and resource reserve. When time delay in intervention was 1 h after the attack, the resource stock increase from 25% to 100% could reduce the deaths by 59.91%; while only about 7.33% of the deaths were reduced when the intervention was performed at 145 h after the attack. The intervention strategy had little effect on the peak time of the morbidity, with the maximum value being 10.52 d and the minimum value being 9.67 d; but it had a greater impact on the peak number of patients, with the maximum value being 255 072 patients and the minimum value being 103 943 patients. Conclusion A quantitative evaluation method for medical treatment effect of anthrax aerosol terrorist attacks is established in this study, and it may be conducive to medical rescue capacity building and emergency strategy-making.

La guerra biológica: un desafío para la humanidad / Biological warfare: a challenge for humanity

RESUMEN Fundamento: el control de enfermedades transmisibles contribuye al empleo ilegítimo de los agentes biológicos, de manera inicial con fines bélicos o criminales y en la actualidad con fines terroristas. Objetivo: describir la problemática del empleo de las armas biológicas, sus diferentes aristas y en su forma actual con fines terroristas y los aspectos que prohíben su uso según la normativa internacional vigente. Métodos: se realizó una revisión bibliográfica con el método de análisis bibliográfico con una búsqueda realizada entre los años 2000 al 2017, donde se consultaron bases de datos especializadas y se seleccionaron 31 publicaciones científicas sobre el tema. Desarrollo: se realizó un análisis del tema de la guerra biológica basado en los agentes utilizados y la amenaza que constituye su empleo, pues provocan enfermedades y causan la muerte al afectar la salud de los seres vivos y el medio ambiente. Son dañinas e incluyen conocimientos de ciencia, tecnología, ingeniería e involucran otras áreas, como la economía, el derecho, el marco jurídico que limita o no la obtención de materiales y los aspectos psicológicos ante tales ataques. Los avances tecnológicos en Biología e Ingeniería genética de las últimas décadas posibilitan modificar y crear nuevos microorganismos más resistentes al tratamiento y en particular en la búsqueda de inoculación de enfermedades como el cáncer. La biodefensa es el conjunto de medidas para la prevención y actuación frente a una alerta sanitaria donde está implicado el uso de los agentes biológicos con fines bélicos. Conclusiones: los agentes biológicos se utilizan como armas para ocasionar daños en circunstancias de guerra biológica y bioterrorismo, por ser de forma potencial el arma más destructiva conocida por la humanidad que implica aspectos políticos, económicos, científico-tecnológicos, jurídicos y psicológicos, por lo que la biodefensa protege a las personas y el medio ambiente con el uso de medidas sanitarias contra dichos agentes.

ABSTRACT Background: the control of transmittable diseases contributes to the illegitimate use of biological agents, initially for war or criminal purposes and currently for terrorist purposes. Objective: to describe the problem of the use of biological weapons, its different edges and in its current form for terrorist purposes and the aspects that prohibit its use according to current international regulations. Methods: a bibliographic review was made with the bibliographic analysis method with a search conducted between 2000 and 2017, where specialized databases were consulted and 31 scientific publications on the subject were selected. Development: an analysis on the issue of biological warfare was made based on the agents used and the threat that constitutes their use, since they cause diseases and cause death by affecting the health of living beings and the environment. They are harmful and include knowledge of science, technology, engineering and involve other areas, such as economics, law, the legal framework that limits or not the obtaining of materials and the psychological aspects of such attacks. The technological advances in Biology and Genetic engineering of recent decades make it possible to modify and create new microorganisms that are more resistant to treatment and in particular in the search for the inoculation of diseases such as cancer. The biodefense is the set of measures for the prevention and action facing a sanitary alert where the use of the biological agents with war aims is implied. Conclusions: biological agents are used as weapons to cause damage in circumstances of biological warfare and bioterrorism, as it is potentially the most destructive weapon known to humanity that involves political, economic, scientific-technological, legal and psychological aspects, which is why biodefense protects people and the environment with the use of sanitary measures against above-mentioned agents.

Injury Prevention, Disaster and Public Health Preparedness and Response / 보건행정학회지

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.

Numerical simulation of chemico-biological particles transportation inside human micropassage / 军事医学

Objective To investigate the transportation of chemico-biological particles(CBP) through the micropassage inside the human body in order to improve chemico-biological protection.Methods Dissipative particle dynamics (DPD) method was used to study CBP transportation through micropassages inside the human body.Results The Poiseuille flow could be ensured by imposing boundary conditions including pressure gradient and no-slip.The axial velocity between fluid particles and CBPs was well matched except the area close to the passage wall.However, CBPs tended to accumulate and the density of CBPs slightly increased, leading to the jam effect and producing particle accumulation.Conclusion The characteristic of CBP transportation is better understood,which can help develop some chemico-biological protection devices according to movement of CBPs and improve the performance of CBPs during chemico-biological protection.

United States bioterror attacks and laboratory accidents in recent years and the impact on its policy-making / 军事医学

In the decades to come,the increasing development of biotechnology may give a significant boost to bioweapons.Herein,we summarize bioterror attacks and critical laboratory accidents that have happened in the United States since the late 20th Century.Based on this description,we analyze its policies involved and the strategic shift the US government came up with.In view of with the current situation and potential risks of biotechnology,we make recommendations on the administration of Chinese biosafety laboratories and ways of responding to biothreat.

Implementation of Biological Weapons Convention in China / 军事医学

According to the topics of general interest during the Eighth Review Conference of the Biological Weapons Convention,including the implementation of the convention,dual use research,bioterrorism and bio-technology misuse,we can become informed of the current situation of international bio-safety.In line with the reality of China's current bio-safety strategy,corresponding recommendations are made arms control,regarding implementation of the convention,legal systems,and institutional mechanism.

Immune response of a recombinant abrin B chain protein against abrin intoxication in BALB/c mice / 中国免疫学杂志

Objective:To evaluate the immune response efficiency of the recombinant abrin B chain protein (rATB) in BALB/c mice.Methods:BALB/c mice were vaccinated intraperitoneally (i.p.) with the purified rATB protein.ELISA was used to detect the IgG,IgG1 and IgG2a.Meanwhile,the expression of IL-4 and IFN-γwere detected by flow cytometry.Then the protein neutralization assay and efficacy of passive protection were done .Results:The anti-rATB antibody was detected by ELISA after vaccinated the rATB in the mice and results showed that the highest titer reached 106 ,which was acquired after the last vaccination .Meanwhile,a strong secondary response was triggered in mice when challenged with toxin .In contrast ,the antibody response of the PBS-vaccinated mice was less than 1:10 and P<0.05 indicated obvious difference between test group and control group .The result of IgG 1 was the same as the IgG ,while the result of IgG2a had not changed.There was significant difference for IL-4 between two groups (P<0.05),while no significant difference for IFN-γwas observed.All BALB/c mice survived after challenged with 5×LD50 of AT.Transfusion of sera from immunized mice provided passive protection in naive mice.Furthermore, the rATB could induce specific neutralizing antibodies against abrin toxin.Conclusion: The recombinant protein can induce the Th 2-type immune response and trigger a good immune response and protective efficacy,which means it may be a promising vaccine candidate against human exposure to AT .

Study on immune mechanism of a recombinant ricin B chain protein against ricin intoxication in BALB/c mice / 中国免疫学杂志

Objective:To explore the immunity provided to BALB/c mice by immunization with the recombinant ricin B chain protein (rRTB). Methods:Female BALB/c mice were randomly selected into rRTB-vaccinated group and PBS group. Mice were subcu-taneously (s. c. ) injected four times with 14 days immunization time interval. Changes of antibodies (IgG,IgG1and IgG2a) in serum were detected by ELISA. Meanwhile,the expression of IL-4 and IFN-γ were detected by flow cytometry. Results:The mean IgG titers reached 106 after the fourth immunization and a strong secondary response was induced in vaccinated mice when challenged with toxin. There was significant difference between rRTB-vaccinated group and PBS group ( P<0. 05 ) . The same result was shown in IgG1. However,no changed was detected in IgG2a. Meanwhile,there was significant difference for IL-4 between two groups (P<0. 05), while no significant difference for IFN-γwas observed. Conclusion:rRTB can produce higher levels of antigen-specific antibodies ( IgG and IgG1),and cytokine (IL-4) of splenocytes,which means the recombinant protein can induce the Th2-type immune response and trigger a good immune response. rRTB may be a potentially valuable vaccine candidate against human exposure to AT.

Toxicity and treament of ricin poisoning:a review / 中国药理学与毒理学杂志

Ricin is a plant toxin isolated from the seed of the castor plant(Ricinus communis). As a typical II ribosome inactivating protein,ricin consists of two polypeptide chains named ricin toxin A chain(RTA)and ricin toxin B chain(RTB),linked via a disulfide bridge. RTB binds to both glycopro?tein and glycolipid at the surface of the target cell and mediates ricin to be endocytosed and transported retro?gradely to the endoplasmic reticulum. After being reduced and retrotranslocated to the cytosol,RTA mediates its toxicity due to its activity of a RNA N- glycosidases. Aside from its main toxic effect of protein synthesis inhibition,ricin also displays other properties that contribute to its toxicity such as inducing apoptosis,cytokine secreting and peroxidation. Ricin is stable and can be easily isolated. It has many routes of intoxication with no specific antidotes. Due to its natural abundance,remarkable toxicity,and the potential to be used in biological warfare as well as terrorist attacks,ricin has been classified as a Category B biothreat agent. Here we reviewed its history as a biothreat agent,constitu?tion,intoxication mechanism,detection methods and the development of specific antitodes.

Bibliometrics and visualized analysis of plague research literature / 军事医学

Objective By analyzing domestic and foreign papers on plague research with bibliometrics and visualized methods, we explored the current situation research trends and cutting-edge dynamics in order to provide information sup-port for plague research as well as strategies for countering bioterrorism.Methods Based on data sources from SCI and CNKI databases, bibliometrics and visualized methods were adopted,including Pajek,VOSviewer, Bibexcel and Citespace, so as to show the major cutting-edge areas of plague research.Results Comprehensive research analysis showed that the USA is leading in plague research, with some strong related institutions.There is still a gap between China and international community for research.Academy of Military Medical Sciences and other institutions are our main plague research efforts. Conclusion We should strengthen plague research, improve our overall level of plague research to provide the necessary support for effective response to natural epidemics and potential bioterrorism incidents.

Bacillus anthracis como ameaça terrorista / Bacillus anthracis as terrorist threat

Após 2001, a utilização de patógenos reforçou seu emprego como arma de guerra. Este estudo descritivo tem por objetivo discutir estratégias de contingenciamento em ataque por anthrax, auxiliando no reconhecimento precoce e estabelecimento de medidas de contenção. Profissionais de saúde necessitam reconhecer a infecção, pois em atentados, o elemento-chave é médico e não militar. O anthrax por inalação é a forma de atentado mais provável com 100% de mortalidade, caso não haja tratamento imediato. É altamente resistente; tem período de incubação de um a seis dias; seus sintomas iniciais são similares à influenza; só permite diagnóstico em NB3; a vacina é aquela recomendada para ocupações de risco, de disponibilidade restrita; e requer profilaxia antibiótica longa.

As from 2001, the use of biological agents reinforced the possibility of its consolidation as warfare. This descriptive study aims to discuss the contingency strategies for anthrax attack, seeking early recognition and establishment of containment measures. Health professionals need to recognize the infection since the key-element during an attack is medical rather than military one. Anthrax inhalation is the most likely form of attack with 100% mortality rate, if no immediate treatment is provided. The virus is highly resistant; has an incubation period of one to six days; its early symptoms are similar to influenza's; diagnosis is only allowed in NB3; the vaccine is the one recommended for risk occupations, of restricted availability; and requires long antibiotic prophylaxis.

Metrology and visualized analysis of anthrax research literature / 军事医学

Objective To explore the development of the anthrax research field in order to provide information and strategies for anti-bioterrorism in China.Methods Pajek, Vosviewer, Bibexcel running on Web of Knowledge platform, and Excel running on CSCD platform were used.Results According to the results of anthrax literature metrology,the USA is by far the leader in research while the Academy of Military Medical Sciences, Chinese Academy of Sciences and other in-stitutions are our main anthrax research institutions in China, but there is a gap between China and international research institutions.Conclusion We should strengthen anthrax research, improve the overall research strength, and provide the necessary protection to respond to potential bioterrorism incidents.

Bioterrorismo, riscos biológicos e as medidas de biossegurança aplicáveis ao Brasil / Bioterrorism, biological risks and biosafety measures applicable to Brazil

A história registra o uso de patógenos como potencializadores de recursos bélicos. Considerando os eventos bélicos da contemporaneidade, observa-se a formulação de projetos voltados para elaboração tecnológica sofisticada. Nessa categoria se incluem as armas biológicas, vinculadas aos programas de caráter coercitivo conhecidos como guerras biológicas, que pertencem à lógica da ameaça assimétrica, não definindo território e gerando repercussões econômicas, políticas e sociopsicológicas devastadoras. Esses eventos demandam a elaboração de planos que contemplem o risco, incluindo a capacitação de recursos humanos, investimentos na identificação de materiais empregados em bioterrorismo e também em equipamentos de segurança. Objetiva-se neste artigo discutir a associação entre patógenos, seu potencial de risco e eficácia para o emprego em estratégias de bioterrorismo, destacando as medidas de biossegurança necessárias. Utiliza-se a revisão integrativa para a construção de análises de contextos de risco. O levantamento bibliográfico compreendeu o período 1990/2010, nas bases de dados ISI, LILACS, SciELO e PubMed. Demonstra-se a importância do envolvimento e da capacitação dos profissionais na identificação de agentes biológicos com potencial de risco, considerando que o bioterrorismo pode resultar na sobrecarga dos sistemas de saúde. A biossegurança orienta os procedimentos que devem ser adotados para a contenção dos patógenos, visando ao controle dos riscos...

History records the use of pathogens as improvers of military resources. Considering the events of contemporary war, there is the formulation of projects aimed at sophisticated technological development. They shall include biological weapons, linked to coercive programs known as biological warfare, which belong to the logic of asymmetric threat, not defining territory and generating devastating economic, political and socio-psychological repercussions. These events require the preparation of plans that address the risk, including the training of human resources, investments in the identification of materials used in bioterrorism and also in safety equipment. This paper aims to discuss the association between pathogens, their potential risk and effectiveness for use in bioterrorism strategies, highlighting the necessary biosecurity measures. It uses an integrative review to construct contexts risk analysis. The literature included the period 1990/2010, the ISI databases, LILACS, SciELO and PubMed. It demonstrates the importance of the involvement and training of professionals in the identification of biological agents with potential risk, whereas bioterrorism may result in overload of health systems. Biosecurity guides the procedures to be adopted for the containment of pathogens, aimed at controlling risk...

A strategic construction plan for implementing military biodefense syndromic survei-llance system in China / 军事医学

The paper discusses the feasibility and urgency of building the military syndromic surveillance system ( SSS) against biological threats in China .Based on the external environment and necessary conditions for our military SSS , the study proposeds a strategic construction plan for implementing our military biodefense SSS , involving the function objectives and performance indexes , system principles and framework , functional modules , syndromic classification and task flow analysis.

Suggestions about the ability to respond to bioterrorism in military hospitals / 军事医学

According to the investigation about the current ability of military hospitals to cope with bioterrorism , we suggest that military hospitals improve the capability for bioterrorism response based on the research above by satisfying mission requirements , combining peacetime with wartime , carrying out crisis management , classifying response and cooperating with local sectors .

Current situation and developments of biodefense information systems / 军事医学

Biodefense research based on modern information technology is an important supplement to traditional biode -fense capacity building and an important part of the national biodefense system in the 21st century.This article outlines the typical biodefense information systems developed in the last ten years and analyzes the development trends of this research field.It is hoped that more domestic research institutions or researchers can become interested in this field .

Technological response measures against subway bioterrorism in the United States:investigation and analysis / 军事医学

Due to the large population and relatively closed space environment , the subway system is vulnerable to bioterrorist attacks.This paper analyzes the technological response measures against subway bioterrorism in the United States, including Detect to Protect program of Department of Homeland Security (DHS) and PROTECTS program of Depart-ment of Energy ( DOE) .We also put forward some proposals on how to improve China′s capability of prevention of and response to subway bioterrorism .