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ABSTRACT: Conditions that facilitate sustained dengue transmission exist in the United States, and outbreaks have occurred during the past decade in Texas, Hawaii, and Florida. More outbreaks can also be expected in years to come. To combat dengue, medical and public health practitioners in areas with mosquito vectors that are competent to transmit the virus must be aware of the threat of reemergent dengue, and the need for early reporting and control to reduce the impact of dengue outbreaks. Comprehensive dengue control includes human and vector surveillance, vector management programs, and community engagement efforts. Public health, medical, and vector-control communities must collaborate to prevent and control disease spread. Policy makers should understand the role of mosquito abatement and community engagement in the prevention and control of the disease.
Public Health Reports 05/2012; 127(3):259-66. · 1.27 Impact Factor
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Biosecurity and bioterrorism: biodefense strategy, practice, and science 03/2012; 10(1):5. · 1.64 Impact Factor
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Biosecurity and bioterrorism: biodefense strategy, practice, and science 12/2011; 10(1):151-2. · 1.64 Impact Factor
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ABSTRACT: Over the past 3 decades, dengue has spread rapidly and has emerged as one of the world's most common mosquitoborne viral diseases. Although often found in tropical and semitropical areas, dengue is capable of being transmitted in temperate climates as well. Dengue is currently endemic to Mexico, most other Latin American countries, and parts of the Caribbean, and it has the potential to become reestablished as an endemic disease in the United States. In fact, sustained transmission of dengue has occurred in Florida within the past year. Conditions exist in the U.S. that could facilitate sustained dengue transmission, including environmental factors, competent mosquito vectors, limited vector and dengue surveillance, increased domestic outdoor daytime activities in warmer months, and low public awareness of the disease. If dengue were to be reestablished in the U.S., it could have significant medical, public health, and economic consequences for the country. The impact of dengue as a public health threat could be lessened through enhanced awareness and reporting of cases, increased support for vector surveillance and control programs, and a greater focus on vaccine development.
Biosecurity and bioterrorism: biodefense strategy, practice, and science 09/2010; 8(3):273-6. · 1.64 Impact Factor
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ABSTRACT: As the U.S. prepares to respond this fall and winter to pandemic (H1N1) 2009, a review of the 1957-58 pandemic of Asian influenza (H2N2) could be useful for planning purposes because of the many similarities between the 2 pandemics. Using historical surveillance reports, published literature, and media coverage, this article provides an overview of the epidemiology of and response to the 1957-58 influenza pandemic in the U.S., during which an estimated 25% of the population became infected with the new pandemic virus strain. While it cannot be predicted with absolute certainty how the H1N1 pandemic might play out in the U.S. this fall, lessons from the 1957-58 influenza pandemic provide useful and practical insights for current planning and response efforts.
Biosecurity and bioterrorism: biodefense strategy, practice, and science 09/2009; 7(3):265-73. · 1.64 Impact Factor
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Biosecurity and Bioterrorism 02/2006; 4(2):207-17. · 1.94 Impact Factor
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ABSTRACT: The threat of an influenza pandemic has alarmed countries around the globe and given rise to an intense interest in disease mitigation measures. This article reviews what is known about the effectiveness and practical feasibility of a range of actions that might be taken in attempts to lessen the number of cases and deaths resulting from an influenza pandemic. The article also discusses potential adverse second- and third-order effects of mitigation actions that decision makers must take into account. Finally, the article summarizes the authors' judgments of the likely effectiveness and likely adverse consequences of the range of disease mitigation measures and suggests priorities and practical actions to be taken.
Biosecurity and Bioterrorism 02/2006; 4(4):366-75. · 1.94 Impact Factor
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Penny J Hitchcock,
Michael Mair,
Thomas V Inglesby,
Jonathan Gross, D A Henderson,
Tara O'Toole,
Joa Ahern-Seronde,
William P Bahnfleth,
Terry Brennan,
H E Barney Burroughs,
Cliff Davidson,
William Delp,
David S Ensor,
Ralph Gomory,
Paula Olsiewski,
Jonathan M Samet,
William M Smith,
Andrew J Streifel,
Ronald H White,
James E Woods
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ABSTRACT: The prospect of biological attacks is a growing strategic threat. Covert aerosol attacks inside a building are of particular concern. In the summer of 2005, the Center for Biosecurity of the University of Pittsburgh Medical Center convened a Working Group to determine what steps could be taken to reduce the risk of exposure of building occupants after an aerosol release of a biological weapon. The Working Group was composed of subject matter experts in air filtration, building ventilation and pressurization, air conditioning and air distribution, biosecurity, building design and operation, building decontamination and restoration, economics, medicine, public health, and public policy. The group focused on functions of the heating, ventilation, and air conditioning systems in commercial or public buildings that could reduce the risk of exposure to deleterious aerosols following biological attacks. The Working Group's recommendations for building owners are based on the use of currently available, off-the-shelf technologies. These recommendations are modest in expense and could be implemented immediately. It is also the Working Group's judgment that the commitment and stewardship of a lead government agency is essential to secure the necessary financial and human resources and to plan and build a comprehensive, effective program to reduce exposure to aerosolized infectious agents in buildings.
Biosecurity and Bioterrorism 02/2006; 4(1):41-54. · 1.94 Impact Factor
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Luciana Borio,
Thomas Inglesby,
C J Peters,
Alan L Schmaljohn,
James M Hughes,
Peter B Jahrling,
Thomas Ksiazek,
Karl M Johnson,
Andrea Meyerhoff,
Tara O'Toole, [......], D A Henderson,
Richard T Johnson,
Gigi Kwik,
Marci Layton,
Scott Lillibridge,
Gary J Nabel,
Michael T Osterholm,
Trish M Perl,
Philip Russell,
Kevin Tonat
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ABSTRACT: To develop consensus-based recommendations for measures to be taken by medical and public health professionals if hemorrhagic fever viruses (HFVs) are used as biological weapons against a civilian population.
The Working Group on Civilian Biodefense included 26 representatives from academic medical centers, public health, military services, governmental agencies, and other emergency management institutions.
MEDLINE was searched from January 1966 to January 2002. Retrieved references, relevant material published prior to 1966, and additional sources identified by participants were reviewed.
Three formal drafts of the statement that synthesized information obtained in the evidence-gathering process were reviewed by the working group. Each draft incorporated comments and judgments of the members. All members approved the final draft.
Weapons disseminating a number of HFVs could cause an outbreak of an undifferentiated febrile illness 2 to 21 days later, associated with clinical manifestations that could include rash, hemorrhagic diathesis, and shock. The mode of transmission and clinical course would vary depending on the specific pathogen. Diagnosis may be delayed given clinicians' unfamiliarity with these diseases, heterogeneous clinical presentation within an infected cohort, and lack of widely available diagnostic tests. Initiation of ribavirin therapy in the early phases of illness may be useful in treatment of some of these viruses, although extensive experience is lacking. There are no licensed vaccines to treat the diseases caused by HFVs.
JAMA The Journal of the American Medical Association 06/2002; 287(18):2391-405. · 30.03 Impact Factor
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New England Journal of Medicine 05/2002; 346(17):1300-8. · 53.30 Impact Factor
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D A Henderson
Medicine and health, Rhode Island 04/2002; 85(3):107-8.
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D A Henderson
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ABSTRACT: After eradication, there is a small but finite risk that smallpox and/or poliomyelitis viruses could accidentally escape from a laboratory or be released intentionally. The reintroduction of either virus into a highly susceptible population could develop into a serious catastrophe. To counter such an occurrence will require the use of vaccine, perhaps in substantial quantities. In the United States, new stocks of smallpox vaccine are being procured and arrangements are being made for a standby production facility. Similar provisions need to be considered for polio. To counter an epidemic of polio will require the use of the oral vaccine, which is presently the World Health Organization-recommended vaccine of choice for countries throughout the developing world. In these countries, its continued use is advised because of its ability to induce intestinal immunity, its ability to spread to other susceptible household members and to protect them, its ease of administration, and its low cost.
Clinical Infectious Diseases 02/2002; 34(1):79-83. · 9.15 Impact Factor
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ABSTRACT: To destroy all remaining stocks of variola virus on or before 31 December 2002 seems an even more compelling goal today than it did in 1999, when the 52d World Health Assembly authorized temporary retention of remaining stocks to facilitate the possible development of (1) a more attenuated, less reactogenic smallpox vaccine and (2) an antiviral drug that could be used in treatment of patients with smallpox. We believe the deadline established in 1999 should be adhered to, given the potential outcomes of present research. Although verification that every country will have destroyed its stock of virus is impossible, it is reasonable to assume that the risk of a smallpox virus release would be diminished were the World Health Assembly to call on each country to destroy its stocks of smallpox virus and to state that any person, laboratory, or country found to have virus after date x would be guilty of a crime against humanity.
Clinical Infectious Diseases 11/2001; 33(7):1057-9. · 9.15 Impact Factor
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D T Dennis,
T V Inglesby, D A Henderson,
J G Bartlett,
M S Ascher,
E Eitzen,
A D Fine,
A M Friedlander,
J Hauer,
M Layton,
S R Lillibridge,
J E McDade,
M T Osterholm,
T O'Toole,
G Parker,
T M Perl,
P K Russell,
K Tonat
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ABSTRACT: The Working Group on Civilian Biodefense has developed consensus-based recommendations for measures to be taken by medical and public health professionals if tularemia is used as a biological weapon against a civilian population.
The working group included 25 representatives from academic medical centers, civilian and military governmental agencies, and other public health and emergency management institutions and agencies.
MEDLINE databases were searched from January 1966 to October 2000, using the Medical Subject Headings Francisella tularensis, Pasteurella tularensis, biological weapon, biological terrorism, bioterrorism, biological warfare, and biowarfare. Review of these references led to identification of relevant materials published prior to 1966. In addition, participants identified other references and sources.
Three formal drafts of the statement that synthesized information obtained in the formal evidence-gathering process were reviewed by members of the working group. Consensus was achieved on the final draft.
A weapon using airborne tularemia would likely result 3 to 5 days later in an outbreak of acute, undifferentiated febrile illness with incipient pneumonia, pleuritis, and hilar lymphadenopathy. Specific epidemiological, clinical, and microbiological findings should lead to early suspicion of intentional tularemia in an alert health system; laboratory confirmation of agent could be delayed. Without treatment, the clinical course could progress to respiratory failure, shock, and death. Prompt treatment with streptomycin, gentamicin, doxycycline, or ciprofloxacin is recommended. Prophylactic use of doxycycline or ciprofloxacin may be useful in the early postexposure period.
JAMA The Journal of the American Medical Association 07/2001; 285(21):2763-73. · 30.03 Impact Factor
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S S Arnon,
R Schechter,
T V Inglesby, D A Henderson,
J G Bartlett,
M S Ascher,
E Eitzen,
A D Fine,
J Hauer,
M Layton,
S Lillibridge,
M T Osterholm,
T O'Toole,
G Parker,
T M Perl,
P K Russell,
D L Swerdlow,
K Tonat
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ABSTRACT: The Working Group on Civilian Biodefense has developed consensus-based recommendations for measures to be taken by medical and public health professionals if botulinum toxin is used as a biological weapon against a civilian population.
The working group included 23 representatives from academic, government, and private institutions with expertise in public health, emergency management, and clinical medicine.
The primary authors (S.S.A. and R.S.) searched OLDMEDLINE and MEDLINE (1960-March 1999) and their professional collections for literature concerning use of botulinum toxin as a bioweapon. The literature was reviewed, and opinions were sought from the working group and other experts on diagnosis and management of botulism. Additional MEDLINE searches were conducted through April 2000 during the review and revisions of the consensus statement.
The first draft of the working group's consensus statement was a synthesis of information obtained in the formal evidence-gathering process. The working group convened to review the first draft in May 1999. Working group members reviewed subsequent drafts and suggested additional revisions. The final statement incorporates all relevant evidence obtained in the literature search in conjunction with final consensus recommendations supported by all working group members.
An aerosolized or foodborne botulinum toxin weapon would cause acute symmetric, descending flaccid paralysis with prominent bulbar palsies such as diplopia, dysarthria, dysphonia, and dysphagia that would typically present 12 to 72 hours after exposure. Effective response to a deliberate release of botulinum toxin will depend on timely clinical diagnosis, case reporting, and epidemiological investigation. Persons potentially exposed to botulinum toxin should be closely observed, and those with signs of botulism require prompt treatment with antitoxin and supportive care that may include assisted ventilation for weeks or months. Treatment with antitoxin should not be delayed for microbiological testing.
JAMA The Journal of the American Medical Association 03/2001; 285(8):1059-70. · 30.03 Impact Factor
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ABSTRACT: This article presents an overview of the nature and scope of the challenges posed by biological weapons, and offers ways by which the infectious diseases professional community might address the challenges of biological weapons and bioterrorism.
Clinical Infectious Diseases 07/2000; 30(6):926-9. · 9.15 Impact Factor
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T V Inglesby,
D T Dennis, D A Henderson,
J G Bartlett,
M S Ascher,
E Eitzen,
A D Fine,
A M Friedlander,
J Hauer,
J F Koerner,
M Layton,
J McDade,
M T Osterholm,
T O'Toole,
G Parker,
T M Perl,
P K Russell,
M Schoch-Spana,
K Tonat
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ABSTRACT: The Working Group on Civilian Biodefense has developed consensus-based recommendations for measures to be taken by medical and public health professionals following the use of plague as a biological weapon against a civilian population.
The working group included 25 representatives from major academic medical centers and research, government, military, public health, and emergency management institutions and agencies.
MEDLINE databases were searched from January 1966 to June 1998 for the Medical Subject Headings plague, Yersinia pestis, biological weapon, biological terrorism, biological warfare, and biowarfare. Review of the bibliographies of the references identified by this search led to subsequent identification of relevant references published prior to 1966. In addition, participants identified other unpublished references and sources. Additional MEDLINE searches were conducted through January 2000.
The first draft of the consensus statement was a synthesis of information obtained in the formal evidence-gathering process. The working group was convened to review drafts of the document in October 1998 and May 1999. The final statement incorporates all relevant evidence obtained by the literature search in conjunction with final consensus recommendations supported by all working group members.
An aerosolized plague weapon could cause fever, cough, chest pain, and hemoptysis with signs consistent with severe pneumonia 1 to 6 days after exposure. Rapid evolution of disease would occur in the 2 to 4 days after symptom onset and would lead to septic shock with high mortality without early treatment. Early treatment and prophylaxis with streptomycin or gentamicin or the tetracycline or fluoroquinolone classes of antimicrobials would be advised.
JAMA The Journal of the American Medical Association 06/2000; 283(17):2281-90. · 30.03 Impact Factor
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D A Henderson
The Lancet 01/2000; 354 Suppl:SIV64. · 38.28 Impact Factor
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D A Henderson,
T V Inglesby,
J G Bartlett,
M S Ascher,
E Eitzen,
P B Jahrling,
J Hauer,
M Layton,
J McDade,
M T Osterholm,
T O'Toole,
G Parker,
T Perl,
P K Russell,
K Tonat
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ABSTRACT: To develop consensus-based recommendations for measures to be taken by medical and public health professionals following the use of smallpox as a biological weapon against a civilian population.
The working group included 21 representatives from staff of major medical centers and research, government, military, public health, and emergency management institutions and agencies. Evidence The first author (D.A.H.) conducted a literature search in conjunction with the preparation of another publication on smallpox as well as this article. The literature identified was reviewed and opinions were sought from experts in the diagnosis and management of smallpox, including members of the working group.
The first draft of the consensus statement was a synthesis of information obtained in the evidence-gathering process. Members of the working group provided formal written comments that were incorporated into the second draft of the statement. The working group reviewed the second draft on October 30, 1998. No significant disagreements existed and comments were incorporated into a third draft. The fourth and final statement incorporates all relevant evidence obtained by the literature search in conjunction with final consensus recommendations supported by all working group members.
Specific recommendations are made regarding smallpox vaccination, therapy, postexposure isolation and infection control, hospital epidemiology and infection control, home care, decontamination of the environment, and additional research needs. In the event of an actual release of smallpox and subsequent epidemic, early detection, isolation of infected individuals, surveillance of contacts, and a focused selective vaccination program will be the essential items of an effective control program.
JAMA The Journal of the American Medical Association 07/1999; 281(22):2127-37. · 30.03 Impact Factor
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T V Inglesby, D A Henderson,
J G Bartlett,
M S Ascher,
E Eitzen,
A M Friedlander,
J Hauer,
J McDade,
M T Osterholm,
T O'Toole,
G Parker,
T M Perl,
P K Russell,
K Tonat
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ABSTRACT: To develop consensus-based recommendations for measures to be taken by medical and public health professionals following the use of anthrax as a biological weapon against a civilian population.
The working group included 21 representatives from staff of major academic medical centers and research, government, military, public health, and emergency management institutions and agencies.
MEDLINE databases were searched from January 1966 to April 1998, using the Medical Subject Headings anthrax, Bacillus anthracis, biological weapon, biological terrorism, biological warfare, and biowarfare. Review of references identified by this search led to identification of relevant references published prior to 1966. In addition, participants identified other unpublished references and sources.
The first draft of the consensus statement was a synthesis of information obtained in the formal evidence-gathering process. Members of the working group provided formal written comments which were incorporated into the second draft of the statement. The working group reviewed the second draft on June 12, 1998. No significant disagreements existed and comments were incorporated into a third draft. The fourth and final statement incorporates all relevant evidence obtained by the literature search in conjunction with final consensus recommendations supported by all working group members.
Specific consensus recommendations are made regarding the diagnosis of anthrax, indications for vaccination, therapy for those exposed, postexposure prophylaxis, decontamination of the environment, and additional research needs.
JAMA The Journal of the American Medical Association 06/1999; 281(18):1735-45. · 30.03 Impact Factor
