SMALLPOX
The Bush administration announced its smallpox vaccination policy-the first nationwide measure to address the threat of bioterrorism-on December 13, 2002. An article in the Journal of Biolaw and Business in 2004 reported that the vaccination policy received "mixed reactions" as a result of partisan issues, tensions in public health policy and federal and state jurisdiction, conflicting scientific views, and different risk assessments. The difficulties of the program serve as a case study revealing current shortcomings in federal and state antiterrorist and public health policies.
An estimated 10% to 15% of the US population cannot tolerate the live Dryvax vaccine for smallpox. In 2004, the US government contracted with two companies-Acambis, based in Cambridge, UK, and Cambridge, Massachusetts, and Bavarian Nordic of Denmark-to produce a modified smallpox vaccine that will not replicate within cells like the current live one does, thus lessening the risk of adverse reactions.
Ricin is a toxic protein made from castor beans. It enters the inside of cells and prevents them from producing proteins, resulting in cell death. Within hours of inhalation of significant amounts of ricin, symptoms would appear, including respiratory distress, fever, cough, nausea, and tightness in the chest. Pulmonary edema could cause heavy sweating. Excess fluid in the lungs would be present, and low blood pressure and respiratory failure may occur, leading to death. No antidote exists for ricin.
Human testing of an experimental vaccine against ricin began last year at the University of Texas Southwestern Medical Center in Dallas. In January, DOR BioPharma, licensor of RiVax, announced results of a Phase I clinical trial indicating that the vaccine is well tolerated and induces antibodies in humans that neutralize ricin toxin. An approved ricin vaccine could take four years or longer to develop, according to medical center officials in Dallas.
CHEMICAL WEAPONS
With one notable exception, hospitals are not equipped for combating chemical weapons such as sarin gas, which was used in the Tokyo subway attacks in 1994 that killed 19 and injured 6,000. Because chemical agents permeate clothing, victims of an attack must undergo decontamination before the victim can be admitted to a hospital.
"Hospitals are not equipped with decontamination rooms outside or away from the main hospital," said Dr. Prockup. "Each hospital should have a decontamination room. Treatment must be initiated within minutes, or else the patient dies. This isn't known by the average person and by many physicians. Most people, including physicians, know very little about nerve gases or how to treat the victims."
One new facility in Nebraska gives a boost to response efforts. Using Homeland Security funding, the state spent nearly $1 million to build a novel 10-bed biocontainment facility administered by the University of Nebraska Medical Center in Omaha. The Center for Biosecurity includes a secure isolation area, with filters that kill airborne germs, and an automated mobile lab. A dozen medical experts affiliated with the center are studying transmission and diagnosis of biological and chemical agents and prevention of their effects. Omaha hospital staff recently participated with the university in holding a practice disaster drill in January to simulate response to bioterror attacks involving anthrax, smallpox, and the avian flu.
EXPLOSIVES
Inexpensive and easy to detonate, explosives are a commonly used terrorist weapon. Explosives were used in the Madrid bombings in March 2004 and the London subway and bus incidents last summer. An improvised explosive device (IED) can be made from explosives alone or in combination with toxic chemicals, biological toxins, or radiological material.
Package, vehicle, or suicide bombs are detonated on a daily basis in Iraq. Nearly 800 US soldiers serving in Iraq have been killed by IEDs, and tens of thousands have been injured by the homemade explosives.
Persons at the site of an explosion may have a limb blown off and/or experience pulmonary damage and extreme concussions to the brain. "If they survive, they may suffer brain damage, emotional damage, and physical damage to the nervous system, and concussion," said Dr. Prockup. "Sometimes it's easy to detect physical damage from an explosion, but others suffer mental impairment. We're seeing this is the case with lots of returning veterans. They may be walking and talking, but they're mentally impaired. They can't hold down a job, and suffer from depression."
PHARMACEUTICAL AND GOVERNMENT RESEARCH INITIATIVES
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