When Terrorism Threatens Health: How Far are Limitations on Personal and Ecomonic Liberties Justified

The government is engaged in a homeland-security project to safeguard the population\u27s health from potential terrorist attacks. This project is politically charged because it affords the state enhanced powers to restrict personal and economic liberties. Just as governmental powers relating to intelligence, law enforcement, and criminal justice curtail individual interests, so too do public health powers

Biological Terrorism, Emerging Diseases, and National Security

Examines the extent to which bioterrorist attacks have proven or may prove difficult to distinguish from outbreaks of emerging diseases. Makes recommendations for how the U.S. could better prepare to meet the threat of biological terrorism

Ready or Not? Protecting the Public's Health in the Age of Bioterrorism, 2004

Examines ten key indicators to evaluate state preparedness to respond to bioterrorist attacks and other public health emergencies. Evaluates the federal government's role and performance, and offers recommendations for improving readiness

Event-based surveillance during EXPO Milan 2015. Rationale, tools, procedures, and initial results

More than 21 million participants attended EXPO Milan from May to October 2015, making it one of the largest protracted mass gathering events in Europe. Given the expected national and international population movement and health security issues associated with this event, Italy fully implemented, for the first time, an event-based surveillance (EBS) system focusing on naturally occurring infectious diseases and the monitoring of biological agents with potential for intentional release. The system started its pilot phase in March 2015 and was fully operational between April and November 2015. In order to set the specific objectives of the EBS system, and its complementary role to indicator-based surveillance, we defined a list of priority diseases and conditions. This list was designed on the basis of the probability and possible public health impact of infectious disease transmission, existing statutory surveillance systems in place, and any surveillance enhancements during the mass gathering event. This article reports the methodology used to design the EBS system for EXPO Milan and the results of 8 months of surveillance

Report on DIMACS Working Group Meeting: Mathematical Sciences Methods for the Study of Deliberate Releases of Biological Agents and their Consequences

55 pages, 1 article*Report on DIMACS Working Group Meeting: Mathematical Sciences Methods for the Study of Deliberate Releases of Biological Agents and their Consequences* (Castillo-Chavez, Carlos; Roberts, Fred S.) 55 page

Concurrent Biological, Electromagnetic Pulse, And Cyber Attacks - A Challenge To The Interagency Response

The U.S. including its military depends on an electrical grid and electricity-based critical infrastructure. An electromagnetic pulse (EMP) and cyber attack can disable not just a significant portion of the electrical grid and critical infrastructure, but also the networkcentric military response to such an attack. There is a large range of actors that might attempt EMP attacks against the U.S.. Health surveillance systems are network-centric, and if mass destruction is the goal of an adversary, launching a biological attack concurrently with EMP and cyber attacks may achieve this goal. Current agency response plans focus on one WMD attack at a time but combined attacks without emergency management plans may compromise a timely response. An EMP and cyber attack could amplify the effects of a biological attack because the loss of the electrical grid and electricity-based critical infrastructure could disable detection and response efforts as well as disrupt interagency efforts to coordinate a medical response. EMP is often perceived as science fiction because the immediate effect does not result in loss of life, but the cascading failures of critical infrastructure will affect civilian and military capabilities to support survival and recovery. Key steps to mitigate the catastrophic effects of an EMP attack should be taken and include: prevent an attack in the first place, prepare so personnel can respond after an attack, protect the critical infrastructure to limit the impact, and recover after an attack to restore power and critical infrastructure

Lawrence O. Gostin on Biosecurity Policy: Are We Safer Today?

World-acclaimed authority Lawrence O. Gostin analyzes biosecurity policy since 9/11. He begins with the question: Are we safer now? Then comes a review of biosecurity legislation, followed by discussion of planning to deal with specific diseases and the problems with such an approach, and then an explanation of what the right approach is. He concludes by covering the Model State Emergency Health Powers Act and related civil liberties questions

Systems approaches to animal disease surveillance and resource allocation: methodological frameworks for behavioral analysis

While demands for animal disease surveillance systems are growing, there has been little applied research that has examined the interactions between resource allocation, cost-effectiveness, and behavioral considerations of actors throughout the livestock supply chain in a surveillance system context. These interactions are important as feedbacks between surveillance decisions and disease evolution may be modulated by their contextual drivers, influencing the cost-effectiveness of a given surveillance system. This paper identifies a number of key behavioral aspects involved in animal health surveillance systems and reviews some novel methodologies for their analysis. A generic framework for analysis is discussed, with exemplar results provided to demonstrate the utility of such an approach in guiding better disease control and surveillance decisions

Emerging Challenges and Opportunities in Infectious Disease Epidemiology.

Much of the intellectual tradition of modern epidemiology stems from efforts to understand and combat chronic diseases persisting through the 20th century epidemiologic transition of countries such as the United States and United Kingdom. After decades of relative obscurity, infectious disease epidemiology has undergone an intellectual rebirth in recent years amid increasing recognition of the threat posed by both new and familiar pathogens. Here, we review the emerging coalescence of infectious disease epidemiology around a core set of study designs and statistical methods bearing little resemblance to the chronic disease epidemiology toolkit. We offer our outlook on challenges and opportunities facing the field, including the integration of novel molecular and digital information sources into disease surveillance, the assimilation of such data into models of pathogen spread, and the increasing contribution of models to public health practice. We next consider emerging paradigms in causal inference for infectious diseases, ranging from approaches to evaluating vaccines and antimicrobial therapies to the task of ascribing clinical syndromes to etiologic microorganisms, an age-old problem transformed by our increasing ability to characterize human-associated microbiota. These areas represent an increasingly important component of epidemiology training programs for future generations of researchers and practitioners

Drug-Resistant Tuberculosis--Current Dilemmas, Unanswered Questions, Challenges and Priority Needs

Tuberculosis was declared a global emergency by the World Health Organization (WHO) in 1993. Following the declaration and the promotion in 1995 of directly observed treatment short course (DOTS), a cost-effective strategy to contain the tuberculosis epidemic, nearly 7 million lives have been saved compared with the pre-DOTS era, high cure rates have been achieved in most countries worldwide, and the global incidence of tuberculosis has been in a slow decline since the early 2000s. However, the emergence and spread of multidrug-resistant (MDR) tuberculosis, extensively drug-resistant (XDR) tuberculosis, and more recently, totally drug-resistant tuberculosis pose a threat to global tuberculosis control. Multidrug-resistant tuberculosis is a man-made problem. Laboratory facilities for drug susceptibility testing are inadequate in most tuberculosis-endemic countries, especially in Africa; thus diagnosis is missed, routine surveillance is not implemented, and the actual numbers of global drug-resistant tuberculosis cases have yet to be estimated. This exposes an ominous situation and reveals an urgent need for commitment by national programs to health system improvement because the response to MDR tuberculosis requires strong health services in general. Multidrug-resistant tuberculosis and XDR tuberculosis greatly complicate patient management within resource-poor national tuberculosis programs, reducing treatment efficacy and increasing the cost of treatment to the extent that it could bankrupt healthcare financing in tuberculosis-endemic areas. Why, despite nearly 20 years of WHO-promoted activity and >12 years of MDR tuberculosis–specific activity, has the country response to the drug-resistant tuberculosis epidemic been so ineffectual? The current dilemmas, unanswered questions, operational issues, challenges, and priority needs for global drug resistance screening and surveillance, improved treatment regimens, and management of outcomes and prevention of DR tuberculosis are discussed