La tuberculosis, desde un problema de salud hasta un arma biológica / Tuberculosis from a health problem to a biological weapon

La tuberculosis es el principal asesino infeccioso del mundo, sin embargo, no constituye una prioridad política. Con el conocimiento que se tiene de la tuberculosis, se está en capacidad de controlarla y erradicarla, pues se cuenta con métodos probados de diagnóstico y esquemas terapéuticos efectivos. Pero existen factores que perpetúan el problema, como la inequidad social, la pandemia del VIH/ sida, el incremento de las poblaciones de riesgo, la inexistencia de una vacuna protectora, las deficiencias en los programas de control y la drogo resistencia. El desarrollo de la tuberculosis resistente a múltiples drogas revela debilitamiento de los servicios asistenciales, se considera un indicador de negligencia en salud pública. En la actualidad solo se logra curación en el 52 por ciento de los pacientes, con regímenes de 21-24 meses y un costo por paciente de 50 000 a 100 000 dólares estadounidenses. El incremento de la resistencia y la capacidad que tiene la tuberculosis para aprovechar y acentuar las desigualdades socioeconómicas en una población, aumenta la desestabilización de un área o país, lo cual ha llevado a que esta enfermedad sea incluida en la lista de posibles armas biológicas. En este trabajo se analizan los factores que hacen de la tuberculosis una enfermedad social, las acciones necesarias para su control, así como su papel como arma bioterrorista(AU)

Tuberculosis remains as the world's leading infectious killer, but it is not a political priority. With the knowledge of Tuberculosis, it is able to control and eradicate it, as there are proven methods of diagnosis and effective therapeutic schemes. But there are factors that perpetuate the problem, such as social inequality, the HIV/AIDS pandemic, the increase in risk populations, the absence of a protective vaccine, deficiencies in Tuberculosis control programs and drug resistance. The development of multi-drug resistant and extremely resistant Tuberculosis reveals a weakening of care services, so Tuberculosis from being a preventable and curable disease, is becoming a virtually incurable disease is considered an indicator of public health negligence. At present, healing is only achieved in 52 percent of patients with 21-24-month regimens and a cost per patient of 50,000 to 100,000 US dollars. The increase in multi-resistance and the ability of Tuberculosis to take advantage of and accentuate socioeconomic inequalities in a population, increasing the destabilization of an area or country has led to this disease being included in the list of possible biological weapons. Taking into account the importance of this disease, the factors that can influence its control and its role as a bioterrorist weapon, it was decided to analyze the elements that make Tuberculosis a social disease and a health emergency are analyzed(AU)

Production and Storage of Virus Simulants

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.

Factibilidad y pertinencia de una estrategia pedagógica para la preparación médica especial / Feasibility and pertinence of a pedagogical strategy for the special medical training

Fundamento: la preparación del profesional de la salud para enfrentar las consecuencias de las armas químicas y biológicas en humanos, es una misión de la universidad médica cubana. Objetivo: evaluar la factibilidad y pertinencia de una estrategia pedagógica de superación profesional médica para la enseñanza del diagnóstico y tratamiento de las consecuencias del empleo de las armas químicas y biológicas en humanos. Métodos: se realizó una investigación que culminó con la aplicación de un pre-experimento pedagógico en la sede universitaria Hospital Militar de Holguín, durante el curso 2010-2011. La muestra estuvo constituida por 20 especialistas en Medicina General Integral. Se utilizaron métodos teóricos: histórico-lógico, analítico-sintético y sistémico estructural y funcional; empíricos: la encuesta, criterio de especialistas por el método Delphi; del matemático: la estadística descriptiva con distribución de frecuencias absoluta y en porcientos y la prueba de signos. Resultados: se identificaron insuficiencias en los médicos para el diagnóstico y tratamiento de las consecuencias de las armas químicas y biológicas en humanos, por lo cual se diseñó y aplicó una estrategia pedagógica para la apropiación de los conocimientos y habilidades necesarios en estos casos. Conclusiones: la estrategia elaborada permitió resolver las dificultades para el desarrollo del proceso enseñanza aprendizaje de las enfermedades que resultan del empleo de las armas químicas y biológicas, y una mejor preparación en los médicos en cuanto al diagnóstico y tratamiento de ellas. Los especialistas consideran la estrategia de muy adecuada y bastante adecuada, lo que demuestra el grado de pertinencia y relevancia para su aplicación.

Background: the professional training in order to face the consequences in human beings of the chemical and biological weapons is a mission of the Cuban medical university. Objective: to devise a strategy for the teaching of the diagnosis and treatment of the effects in human beings of the chemical and biological weapons. Methods: a research project was done that culminated in the application of a pedagogical pre-experiment at the University Venue Military Hospital of Holguín during the 2010-2011 academic year. The sample was chosen through a non-probabilistic sampling, composed of 20 specialists in Integral General Medicine. Theoretical methods were used: historical-logical, analytical-synthetic, inductive-deductive, modeling and systemic, structural and functional; empirical: Delphi method and survey; mathematical: descriptive statistics with distribution of absolute frequency and in percentage. Results: insufficiencies were identified among the doctors for the diagnosis and treatment of the effects in human beings of chemical and biological weapons, being this reason why a pedagogical strategy was designed and applied for the acquisition of the knowledge and skills that are necessary in these cases. Conclusions: the designed strategy allows to solve the difficulties for the development of the learning-teaching process of the illnesses resulting from the use of chemical and biological weapons, as well as a better training in doctors regarding their diagnosis and treatment. The specialists assessed the strategy in general as very adequate, what shows the degree of relevance and pertinence for its application.

Governança de novas dimensões de segurança internacional: Doenças infecciosas emergentes / Governance of new dimensions of international security: Emerging infectious diseases

Esse estudo objetiva compreender de que forma se estrutura a governança de uma nova dimensão de segurança internacional: as doenças infecciosas emergentes (DIEs). Inicialmente, discute-se como o tema das doenças infecciosas ­ em geral ­ tem sido apresentado pela literatura acadêmica especializada como novos riscos à segurança internacional. A partir desse escrutínio, foi possível organizar as contribuições de diversos autores sobre o tema, propondo cinco abordagens diferentes da relação entre doenças infecciosas e segurança internacional. A partir disso, averígua-se a maneira mais adequada para compreender a governança das DIEs com a análise das teorias de governança nos campos das Relações Internacionais e da "saúde global". Nesse contexto, e com essas ferramentas, mapeiam-se os atores e dispositivos internacionais que caracterizam a governança das doenças infecciosas, e, posteriormente a das DIEs. Do ponto de vista metodológico, essa dissertação adota o modelo analítico de Young (1999) e Fidler (2002) para analisar a principal peça jurídica desse regime, o Regulamento Sanitário Internacional, examinando sua evolução entre versões de 1969 e 2005 em seus componentes substantivos, processuais e de implementação. Essa análise inova ao apresentar, de um ângulo original, o desenvolvimento da governança internacional das DIEs nas últimas décadas.

This study aims to understand how is developed the governance of a new dimension of international security: emerging infectious diseases (EIDs). At first, we discuss how the topic of infectious disease - in general - have been presented by the academic literature as new risk to international security. From this analysis, it was possible to organize the contributions of various authors on the subject by proposing five different approaches to the relationship between infectious diseases and international security. After that, this study investigates the most appropriate way to understand the governance of EIDs analyzing theories of governance in the fields of International Relations and "global health." In this sense, and adopting these tools, it was possible to map actors and international devices that are involved in the governance of infectious diseases, and later in the EID. Methodologically, this dissertation adopts the analytical model of Young (1999) and Fidler (2002) to analyze the centerpiece of this regime, the International Health Regulations, tracing its development between its 1969 and 2005 versions. This analysis innovates for it presents, from an original point of view, the development of international governance of EIDs in recent decades.

Normativas internacionais de proteção contra bioterrorismo e biocrimes: lacunas e vulnerabilidades no Brasil / International standards for protection against bioterrorism and biocrimes: gaps and vulnerabilities in Brazil

Saúde Global pode ser entendida como questões de saúde que transcendem fronteiras nacionais e demandam intervenções nos assuntos que determinam a saúde das populações. Atualmente, os Estados deparam-se seguidamente com problemas e crises relacionadas à área da saúde. Em relação à segurança nacional, essa preocupação se manifesta sob a forma de ameaças de proliferação de Armas Biológicas e de Bioterrorismo. A comunidade internacional tem se esforçado para propor normas que previnam tais atos. Os melhores exemplos são a Convenção para a Proibição de Armas Biológicas e suas Toxinas (CPAB), a Resolução 1540 do Conselho de Segurança das Nações Unidas (Res 1540/CSNU) e o Regulamento Sanitário Internacional (RSI). Contudo, existem várias lacunas e vulnerabilidades que podem ser exploradas nesses documentos. O escopo desse estudo é propor questionamentos a partir da Análise Documental desses tratados, ponderando a articulação entre os órgãos nacionais com a responsabilidade de prevenção, controle e resiliência contra ataques biológicos. O Brasil é signatário das principais normativas internacionais direcionadas à prevenção e controle de uso intencional de agentes biológicos e vem respondendo a contento à comunidade internacional. Ainda assim, é necessário mais que uma resposta formal a entidades supranacionais para prover, efetivamente, a devida proteção à população. O País possui capacidades técnicas estruturadas de forma isolada e fragmentada em diversos órgãos inexistindo um sistema formalmente instituído para a prevenção,resposta e controle de ataques bioterroristas...

Global Health can be understood as health issues that transcend national borders andrequire intervention in matters that determine the health of populations. Currently, States face crisis and problems related to health realm. Regarding national security, thisconcern is manifested in the form of threats of Biological Weapons proliferation and Bioterrorism. The international community has endeavored to propose regulations that prevent such acts. The best examples of it are the Convention for the Prohibition ofBiological Weapons and their Toxins (BWC), the United Nations Security Council Resolution 1540 (Res 1540/UNSC) and the International Health Regulations (IHR). However, there are several gaps and vulnerabilities that can be exploited in thesedocuments. The scope of this study is questioning these treaties using DocumentAnalysis, pondering the link between national entities responsible for prevention,control and resilience against biological attacks. Brazil is signatory of the major international instruments aimed at the prevention and control of biological agentsintentional use and has responded satisfactorily to the international community. Never theless, it takes more than a formal supranational response to provide effectivelyappropriate protection to population. The country owns technical capabilities not connected, distributed in several organs and lacks a system for the prevention, responseand control of bioterrorist attacks. Likewise, there is no national protocol established inorder to coordinate the activities of the bodies responsible for controlling the threat. Factors that determine individuals or groups to employ biological agents and toxins intheir violent attacks are not fully understood. Thus, more reckless than exacerbate therisk of intentional actions with biological agents is not being properly prepared toprevent and control such acts...

The Management of Laboratory Biological Safety in Korea

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.

Bioterrorismo e a facilidade de acesso à biotecnologia e seus insumos / Bioterrorism and easy access to biotechnology and its inputs

Os fundamentalismos surgiram no Ocidente a partir de questões religiosas e posteriormente difundiram-se para outras partes do mundo tomando outras conotações, principalmente políticas. As técnicas de manipulação genética difundiram-se pelas universidades, que formam mestres e doutores com os conhecimentos básicos sobre clonagem gênica, que se tornou de domínio público. Todos os insumos para clonagem gênica podem ser adquiridos por meio de catálogos via internet. Podem-se recrutar profissionais fanáticos e com a competência para a manipulação genética de organismos patogênicos, lado perverso da biotecnologia. Os conflitos étnicos, culturais e religiosos estão associados a um cenário de contrastes entre os países ricos e carentes de matéria-prima e aqueles pobres, mas detentores de insumos básicos e energia, e atingem a sua forma mais aguda nos fundamentalismos. Grupos de fanáticos têm pleno acesso a essa biotecnologia. Estariam assim as populações civis vulneráveis aos ataques do bioterrorismo com armas biológicas geneticamente modificadas?.

Fundamentalism arose in the West based in religious matters and afterward diffused to other parts of theworld with other connotations, especially political. Genetic manipulation techniques spread to universities,which has given masters and doctors the basic knowledge on gene cloning, which has become public domain.All inputs for gene cloning may be obtained through online catalogs. Fanatic professionals may be recruited,with qualification for genetic manipulation of pathogenic organisms, the negative side of biotechnology. Eth-nic, cultural and religious conflicts are linked to a series of contrasts between countries that are rich but witha lack of raw materials and the poor countries that possess basic input and energy sources, when it reachesthe highest fundamentalist form. Fanatic groups have complete access to this biotechnology. Are civilian po-pulations in vulnerable to bioterrorist attacks involving genetically modified biological weapons?

Biological warfare, bioterrorism and biodefence.

Biological warfare 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 (BWs) can be disseminated by aerosol sprays, explosives or food and water contamination. Bws 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. Bioterrorism is the use of bws in terrorism. Current concerns regarding the use of bws result from the increasing number of countries that are engaged in the proliferation of such weapons and their acquisition by terrorist organizations. The need of the hour is to develop biodefence by full international cooperation and to educate the likely target populations about precautions and protective measures to be taken in such attacks.

Bioética e armas biológicas no contexto internacional / Bioethics and biological weapons in the international context

O estudo "Bioética e Armas Biológicas no Contexto Internacional" investiga a aplicação de análise sob a ótica da bioética de intervenção a diálogos internacionais no âmbito de um sistema de estados. O estudo de caso testa o método de investigação que consiste na identificação de valores e posicionamentos contratantes entre países desenvolvidos e em desenvolvimento e suas possibilidades de incorporação a regras, normas e regulações adotadas pela comunidade internacional. Nesse processo é verificado o equilíbrio de oportunidades entre países do Norte e do Sul para inserirem suas necessidades e interesses nas normas de convivência entre Estados como indicativo das condições de justiça e equidade no âmbito do diálogo internacional. As armas biológicas são tomadas como estudo de caso por sua relação intrínseca com a saúde e com a integridade de populações vulneráveis dos países periféricos

The study "Bioethics and biological weapons in an international context" investigates the application of an analysis from the perspective of intervention bioethics to international dialogues within a system of States. The case study tests the research method which consists in identifying and contrasting positions between developed and developing countries and their possibilities of their incorporation to rules, standards and regulations adopted by the international community. The analysis also considers the balance of opportunities between countries from the North and the South to insert their needs and interests in the rules of coexistence among States as indicative of the conditions of justice and equity in international dialogue. Biological weapons are taken as a case study for its intrinsic relationship with human health and the health of vulnerable populations of peripheral countries

Botulinum toxin: Bioweapon & magic drug.

Botulinum neurotoxins, causative agents of botulism in humans, are produced by Clostridium botulinum, an anaerobic spore-former Gram positive bacillus. Botulinum neurotoxin poses a major bioweapon threat because of its extreme potency and lethality; its ease of production, transport, and misuse; and the need for prolonged intensive care among affected persons. A single gram of crystalline toxin, evenly dispersed and inhaled, can kill more than one million people. The basis of the phenomenal potency of botulinum toxin is enzymatic; the toxin is a zinc proteinase that cleaves neuronal vesicle associated proteins responsible for acetylcholine release into the neuromuscular junction. As a military or terrorist weapon, botulinum toxin could be disseminated via aerosol or by contamination of water or food supplies, causing widespread casualties. A fascinating aspect of botulinum toxin research in recent years has been development of the most potent toxin into a molecule of significant therapeutic utility. It is the first biological toxin which is licensed for treatment of human diseases. In the late 1980s, Canada approved use of the toxin to treat strabismus, in 2001 in the removal of facial wrinkles and in 2002, the FDA in the United States followed suit. The present review focuses on both warfare potential and medical uses of botulinum neurotoxin.

Preparedness for terrorism: managing nuclear, biological and chemical threats

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.

Hantaviruses: an emerging public health threat in India? A review.

The emerging viral diseases haemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS) are a cause of global concern as they are increasingly reported from newer regions of the world. The hantavirus species causing HFRS include Hantaan virus,Seoul virus, Puumala virus, and Dobrava-Belgrade virus while Sin Nombre virus was responsible for the 1993 outbreak of HCPS in the Four Corners Region of the US. Humans are accidental hosts and get infected by aerosols generated from contaminated urine,feces and saliva of infected rodents. Rodents are the natural hosts of these viruses and develop persistent infection. Human to human infections are rare and the evolution of the virus depends largely on that of the rodent host. The first hantavirus isolate to be cultured, Thottapalayam virus,is the only indigenous isolate from India,isolated from an insectivore in 1964 in Vellore, South India. Research on hantaviruses in India has been slow but steady since 2005. Serological investigation of patients with pyrexic illness revealed presence of anti-hantavirus IgM antibodies in 14.7% of them. The seropositivity of hantavirus infections in the general population is about 4% and people who live and work in close proximity with rodents have a greater risk of acquiring hantavirus infections. Molecular and serological evidence of hantavirus infections in rodents and man has also been documented in this country. The present review on hantaviruses is to increase awareness of these emerging pathogens and the threats they pose to the public health system.

O desenvolvimento biológico em conexão com a guerra / The Biological development in connection with the war

O século XX foi cenário da construção de um sistema para a operacionalização da ciência estratégica das grandes potências, chamada Big Science. Este sistema é constituído por uma vasta rede institucional integrada, o "complexo militar-industrial-acadêmico", que desenvolve pesquisas estratégicas e direciona a ciência de ponta. O objetivo deste estudo foi investigar a lógica desta construção sob a ótica do poder, fazendo um contraponto entre os desenvolvimentos tecnológicos da Física e da Biologia. Os movimentos de poder identificam algumas características que, em tese, refletem o incentivo para indução do desenvolvimento científico da modernidade, potencializado na era atômica com a fabricação de armas de destruição em massa, as armas de alta tecnologia. Nesta perspectiva, buscamos a relevância do desenvolvimento biológico de interesse político-militar, tomando por base a fabricação de três gerações de armas ao longo do século XX, com crescente posicionamento na corrida armamentista. Esta análise envolve as décadas de 1940 até 1980, na busca de demonstrar uma convergência técnico-política nas trajetórias do desenvolvimento biológico e da guerra biológica, que culminou numa conexão científico-militar no início da era biotecnológica.

The XX Century was the scenario for the construction of a system devoted to operationalizing the strategic science of the great potentials named the Big Science. This system comprehends a vast institutional and integrated network, the "military-industrial-academic complex", which carries out strategic research and guides high quality science. The objective of this study was to investigate the logics of such construction under the perspective of power, highlighting a counterpoint between the technological development of Physics and Biology. The power movement points to some characteristics, that theoretically reflect the incentive to the induction of the scientific development of modern times, potentialized during the atomic age by the manufacturing of high technology weapons. In this perspective one can search the relevance of the biological development of political-military interest in the three-generation manufacturing of weapons throughout the XX Century, and the participation in the armaments race. This historiographic analysis encompasses the decades of 1940 through 1980, in an attempt to show the ethnical-political convergence in the paths taken by the biological development and the biological war which eventually led to a scientific and military connection at the beginning of the biotechnological era.

Anthrax: An Overview / 한국역학회지

Human anthrax has been a zoonotic disease affecting those who have close contact with animals or animal products contaminated with the spore-forming bacterium Bacillus anthracis. Now the incidence of anthrax in herbivores and human are rare, but it remains an important health problem in Korea because anthrax is seen as one of the most likely biological weapon. The B. anthracis forms a spore, which is resistant to drought, heat and numerous disinfectants, and the spore can remain viable and infective in the environment for decades. There are three major forms of human disease depending on how infection is contracted, cutaneous, inhalation and ingestion. Inhalational anthrax is the most common form, but the events in the Korea show that gastrointestinal anthrax is the most common. Several cases of anthrax have been reported in Korea. In recent years, 2 cases of bovine anthrax and 5 cases of human anthrax occurred in Changnyeong-gun, 2000, but it haven't occurred any more so far. The most useful microbiological test remains the standard blood culture. Confirmatory diagnostic tests such as polymerase chain reaction can also be used and may help in early diagnosis. Prompt clinical suspicion and rapid administration of effective antimicrobials are essential for treatment of anthrax. Ciprofloxacin or doxycycline should be used for initial intravenous therapy until antimicrobial susceptibility results are known. The best measure to eliminate human anthrax is control in domestic animals by effective surveillance and by immunization of animals in endemic areas. Also, the government must establish countplan for knowledge and rational policies in dealing with potential bioterrorism attacks.

Evaluation of gyrB as Chromosomal Marker in Bacillus anthracis

Bacillus anthracis is generally accepted as the most potent biological warfare agent because of its highly pathogenic nature and transmission efficiency. Identification of chromosomal markers for the rapid detection of B. anthracis is difficult since significant chromosomal homology exists among B. anthracis, B. cereus and B. thuringiensis. In this study, we tested whether the gyrB sequence could be used as the target for the PCR detection of B. anthracis. The gyrB sequence, composed of 1,923 bp, was identical in 17 Korean B. anthracis isolates. The comparison of gyrB sequence between B. anthracis and B. cereus type strain showed 8.8% difference (105 bp among 1,194 bp), and the gyrB sequence similarities of B. cereus, B. thuringiensis and B. mycoides with B. anthracis were 92.3%, 86.9% and 86.1%, respectively. When polymerase chain reaction was designed and performed based on the gyrB sequence, a specific amplicon (351 bp) could be amplified. These results indicate that gyrB could be useful as a chromosomal marker for the rapid screening of B. anthracis by PCR or differentiation of B. anthracis from other related species by multiplex PCR with other plasmid markers.

Clinical Recognition and Management of Patients Exposed to Biological Warfare Agents : Anthrax, Smallpox, Plague, and Botulism

The recent cases of anthrax due to bioterrorism in the United States have reminded us that our society is also vulnerable to biological attacks. Illnesses due to bioterrorism are not naturally occurring diseases, and therefore may show presentations not familiar to many doctors. The last case of smallpox was reported in 1960, and doctors aged less than 60 years have no experience of smallpox. Anthrax is a rare zoonosis, and no case of inhalation anthrax has been reported in Korea. American doctors might be on high alert to bioterrorism after September 11, 2001. However, it took more than 2 weeks from the symptom onset of the index case to the recognition that anthrax outbreak had occurred due to bioterrorism. This delay shows how difficult it is to recognize bioterrorism. This article describes clinical recognition and management of patients exposed to biological warfare agents, especially agents causing anthrax, smallpox, plague, and botulism.

The Role of Epidemiology against Emerging and Reemerging Diseases / 한국역학회지

PURPOSE: Due to remarkable developments in technology and great efforts made by Health Organizations, most of infectious diseases had been under control. However, ecological changes and biological variations resulted in emerging and re-emerging infectious diseases, which threaten the global health and may have the possibility of being abused as biological weapon. Therefore it is indispensable to understand the latest information and knowledge in order to cope with the emergency situation. RESULTS: In Korea, several reemerging diseases such as Malaria, Hepatitis A, Shigellosis, Mumps, and food poisoning has been increasing conspicuously since 1990. Also Diphtheria, plague, yellow fever and dengue fever have been potential threats, considering substantial international trades. CONCLUSION: There have many newly emerged and re-emerged infectious diseases identified in recent few decades in Korea. Thus as epidemiologic professionals, we have to get ready, particularly following missions to be carried out : 1) to keep eyes open to look for emerging and reemerging diseases continuously and keep up the latest global information, 2) establish the co-operational organizations to prepare immediate action against the sudden outbreak, 3) publicize, educate, establish and perform the missions, taking initiative in training clinicians, 4) upgrade professional competency by familiarizing ourselves with epidemiologic investigations, and 5) fulfill the responsibilities as health keepers of the nation.