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, 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...

remarkable adaptability of syndromic surveillance to meet public health needs

The goal of syndromic surveillance is the earlier detection of epidemics, allowing a timelier public health response than is possible using traditional surveillance methods. Syndromic surveillance application for public health purposes has changed over time and reflects a dynamic evolution from the collection, interpretation of data with dissemination of data to those who need to act, to a more holistic approach that incorporates response as a core component of the surveillance system. Recent infectious disease threats, such as severe acute respiratory syndrome [SARS], avian influenza [H5N1] and pandemic influenza [H1N1], have all highlighted the need for countries to be rapidly aware of the spread of infectious diseases within a region and across the globe. The International Health Regulations [IHR] obligation to report public health emergencies of international concern has raised the importance of early outbreak detection and response. The emphasis in syndromic surveillance is changing from automated, early alert and detection, to situational awareness and response. Published literature on syndromic surveillance reflects the changing nature of public health threats and responses. Syndromic surveillance has demonstrated a remarkable ability to adapt to rapidly shifting public health needs. This adaptability makes it a highly relevant public health tool

Bioterrorism - “My Role as a Dentist”.

Bioterrorism is the intentional use of micro-organisms and toxins to produce disease and death in humans, livestock and crops, their attraction in war and for use in terrorist attacks is attributed to various unique features. Biological weapons can be disseminated by aerosol sprays, explosives or food and water contamination. They can strike suddenly without any warning and inflict considerable mortality and morbidity that can continue for a long period, such attacks may create high level of panic, environment contamination and extreme pressures on emergency health services. Accurate and substantial information given to the public by credible public health and medical experts can do much to allay their fears and encourage their cooperation and participation in constructive, organized community response efforts. The dental profession could potentially play a significant role in the emergency response to a major bioterrorism attack.

Análise da construção da competência do Brasil em direção ao laboratório de contenção máxima: realidades e perspectivas / Analysis of the construction of the power of Brazil toward the maximum containment laboratory: realities and prospects

Este estudo apresenta uma análise sobre a necessidade de instalação de umlaboratório de contenção máxima (NB-4) no Brasil, a fim de atender as necessidades de pesquisa e diagnóstico de agentes patogênicos, de relevância epidemiológica e risco de disseminação ou causador de doença emergente que se torne epidemiologicamente importante ou cujo mecanismo de transmissão seja desconhecido.Discute, através de uma revisão bibliográfica, a emergência e reemergência de doenças infecciosas mostrando situações críticas enfrentadas no âmbito mundial.Destaca a susceptibilidade do Brasil, considerando a sua complexidade, representada especialmente, pela sua biodiversidade e pelos problemas sócio-econômicos, que afetam diretamente a saúde pública. Sublinha a questão dos investimentos no setor da saúde, voltados à vigilância, ao fortalecimento de bases epidemiológicas, laboratorial e clínica, centradas em medidas de prevenção e de controle nas áreas de vigilância, onde se inclui a perspectiva da Biossegurança. Aborda aspectos do monitoramento de risco, enfatizando as intercessões entre a Biossegurança e a Biosseguridade, como campos integrados e voltados para controlar aspossibilidades de risco relacionado com as questões de saúde pública , tais como o bioterrorismo, considerando a importância da construção de políticas institucionais voltadas para atender as demandas dos laboratórios e das situações de risco de saúde pública, em especial, através de eventos de grande impacto provocados pela circulaçãode agentes biológicos de alta letalidade.Em termos metodológicos, utiliza os dados do Centro de InformaçõesEstratégicas em Vigilância em Saúde, da Secretaria de Vigilância em Saúde, doMinistério da Saúde para construção do estudo de caso. =Conclui, a partir da análise da relevância epidemiológica dos eventos notificados e sua relação com o potencial de risco manifesto ou latente, a pertinência de investimentos em Biossegurança em termos da construção de uma infra-estrutura laboratorial e a conseqüente capacitação de profissionais, indicando a importância do debate sobre a localização desta unidade, a partir do contexto epidemiológico traduzido pelo sistema de notificação.

Agentes del bioterrorismo: preparándose para lo impensable / Bioterrorism agents: getting ready for the unthinkable

The September 11, 2001 terrorist attacks in the USA demonstrated our vulnerability to terrorist raids. Furthermore, in the same year inhalational anthrax cases in humans caused by the international release of Bacillus anthracis spores via the USA postal system inflicted a lot of panic and terror over the civilian population. The succeeding terrorist events scattered in several other countries are continous reminders of our failness and of the risk that terrorists attempts in the future may be implemented by means of deliberate evil release of biological agents. These events may be perpetrated by either the release of an infectious agent or any of its products in order to spread death or sickness in humans, animals, or plants with the obnoxius purpose of scaring governments and societies for the profit of particular ideological causes. In the current article, we present a review of the main bioterrorism agents, as well as a historical and clinical aspects and their significance for public health preparedness and response.

Los eventos terroristas del 11 de septiembre del 2001 en Estados Unidos de América (EUA) cambiaron para siempre nuestra percepción de la vulnerabilidad a los ataques terroristas. Aunado a esto, los primeros casos de ántrax en humanos ocasionados por la liberación intencional de esporas de Bacillus anthracis a través del sistema postal de EUA infligieron pánico y terror en la población general. Los subsecuentes eventos de terrorismo ocurridos en diversos países son recordatorios continuos de nuestra fragilidad y del riesgo que futuros ataques terroristas pudieran organizarse a través de liberación intencional de agentes biológicos. El bioterrorismo consiste en el uso intencional o amenaza de utilizar agentes biológicos; ya sea el propio agente infeccioso o sus productos para causar la muerte o enfermedad en humanos, animales o plantas con el objetivo de intimidar a gobiernos y sociedades en beneficio de causas ideológicas particulares. En el presente artículo se hace una revisión de los principales agentes del bioterrorismo, aspectos históricos, clínicos y terapéuticos, así como su prevención e importancia para la salud pública mundial.

Biological warfare--an emerging threat.

As we approach the 21st century, there is an increasing worldwide awareness and threat regarding the use of biological warfare agents both for war and terrorist attack. Biological agents include microorganisms or biological toxins that are used to produce death in humans, animals and plants. They are characterized by low visibility, high potency, substantial accessibility and relatively easy delivery. Biological warfare agents are unconventional weapons that can be delivered by unconventional means like aerosol sprays, food and water contamination, conventional explosive munitions or by covert injections. Because of their concealed delivery, easy transportation and difficult identification they are readily adaptable for terrorist operations or to gain political advantages. The detection of such attack requires recognition of the clinical syndromes associated with various biological warfare agents. Diagnosis can be made on clinical grounds and on investigations. Protective measures can be taken against biological warfare agents. These should be implemented early (if warning is received) or later (once suspicion of agent use is made). After the confirmation of diagnosis emergency medical treatment and decontamination are performed in rapid sequence. Patients are then evacuated and specific therapy is given according to the agent involved. Appropriate emergency department and hospital response could significantly limit the morbidity and mortality of biological warfare agents.

Pakistan's experience of a bioterrorism-related anthrax scare

From November 2001 to March 2002, the National Institute of Health, Islamabad, Pakistan, received 230 samples from 194 different sources for analysis for anthrax spores. These samples were taken from letters/packages suspected of containing anthrax and from individuals exposed to them. When cultured on sheep blood agar, 141 samples yielded growth suggestive of Bacillus species. On the basis of growth characteristics, absence of beta-haemolysis, absent or doubtful motility and morphological characters of the isolates on Gram stain, 62 isolates were considered suspicious and were inoculated into guinea-pigs. Inoculated animals remained healthy well beyond the required observation period of 5 days. All the samples were therefore reported as negative for B. anthracis. Systems for h and ling and analysing suspected anthrax-contaminated materials are discussed

Bioterrorism: a threat for which we are ill prepared.

Of the weapons of mass destruction, the biological ones are the most feared and bioterrorism has become one of the most vicious threats to civilized society in recent times. Biological weapons have been sporadically used for centuries. Despite international regulations, there has been a global re-emergence of the threat of biological warfare. As many as 17 countries are suspected of either including or developing biological agents in their weapons programmes. In the past decade, a number of terrorist organizations with access to bioweapons technology have emerged. Current surveillance systems may be inadequate to detect biological attacks. The onset of illness is often delayed, thus the timing and location of such an event may be extremely difficult to identify. We are unfamiliar with most of the agents of biological warfare and are ill-equipped to handle the consequences of such an attack. In addition, there is no apparent coherent policy to handle a biological terrorist incident. Given the enormity of what is possible in the event of a biological attack, we must be prepared to detect, diagnose, epidemiologically characterize and respond appropriately to biological weapons. Of the potential biological weapons, smallpox and anthrax pose the greatest threats.