Preparedness Against Bioterrorism And Re-Emerging Infectious Diseases (Nato Science Series I:Life and Behavioural Sciences)

274 Pages·2004·14.06 MB·English

by  Janusz Kocik

PREPAREDNESS AGAINST BIOTERRORISM AND
RE-EMERGING INFECTIOUS DISEASES
NATO Science Series
A series presenting the results of scientific meetings supported under the NATO Science
Programme.
The series is published by IOS Press and Kluwer Academic Publishers in conjunction with the
NATO Scientific Affairs Division.
Sub-Series
I. Life and Behavioural Sciences IOS Press
II. Mathematics, Physics and Chemistry Kluwer Academic Publishers
III. Computer and Systems Sciences IOS Press
IV. Earth and Environmental Sciences Kluwer Academic Publishers
V. Science and Technology Policy IOS Press
The NATO Science Series continues the series of books published formerly as the NATO ASI
Series.
The NATO Science Programme offers support for collaboration in civil science between scientists
of countries of the Euro-Atlantic Partnership Council. The types of scientific meeting generally
supported are "Advanced Study Institutes" and "Advanced Research Workshops", although other
types of meeting are supported from time to time. The NATO Science Series collects together the
results of these meetings. The meetings are co-organized by scientists from NATO countries and
scientists from NATO's Partner countries - countries of the CIS and Central and Eastern Europe.
Advanced Study Institutes are high-level tutorial courses offering in-depth study of latest
advances in a field.
Advanced Research Workshops are expert meetings aimed at critical assessment of a field, and
identification of directions for future action.
As a consequence of the restructuring of the NATO Science Programme in 1999, the NATO
Science Series has been re-organized and there are currently five sub-series as noted above. Please
consult the following web sites for information on previous volumes published in the series, as well
as details of earlier sub-series:
http://www.nato.int/science
http://www.wkap.nl
http://www.iospress.nl
http://www.wtv-books.de/nato_pco.htm
Series I: Life and Behavioural Sciences - Vol. 357 ISSN: 1566-7693
Preparedness Against
Bioterrorism and Re-Emerging
Infectious Diseases
Edited by
Janusz Kocik
Military Institute of Hygiene and Epidemiology, Warsaw, Poland
Marek K. Janiak
Military Institute of Hygiene and Epidemiology, Warsaw, Poland
and
Marian Negut
Cantacuzzino Institute, Bucarest, Romania
IOS
Press
Amsterdam • Berlin • Oxford • Tokyo • Washington, DC
Published in cooperation with NATO Scientific Affairs Division
Proceedings of the NATO Advanced Research Workshop on
Preparedness Against Bioterrorism and Re-Emerging Infectious Diseases
15-18 January 2003
Warsaw, Poland
© 2004, IOS Press
All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted,
in any form or by any means, without prior written permission from the publisher.
ISBN 1 58603 4170
Library of Congress Control Number: 2004103094
Publisher
IOS Press
Nieuwe Hemweg 6B
1013 BG Amsterdam
Netherlands
fax: [phone]
e-mail: [email protected]
Distributor in the UK and Ireland Distributor in the USA and Canada
IOS Press/Lavis Marketing IOS Press, Inc.
73 Lime Walk 5795-G Burke Centre Parkway
Headington Burke, VA 22015
Oxford OX3 7AD USA
England fax: [phone]
fax: [phone] e-mail: [email protected]
LEGAL NOTICE
The publisher is not responsible for the use which might be made of the following information.
PRINTED IN THE NETHERLANDS
V
Editorial: Building Integrated Preparedness
against Bio-Terrorism
Janusz KOCIK1, Marek K. JANIAK1, Marian NEGUT2
1Military Institute of Hygiene and Epidemiology, Warsaw, Poland
Cantacuzzino Institute, Bucarest, Romania
NATO Advanced Research Workshop (ARW) entitled "Preparedness against Bio-
Terrorism and Re-Emerging Infectious Diseases - Regional Capabilities, Needs, and
Expectations in Central and Eastern European Countries" was held on 15-18 January 2003
in Warsaw, Poland. The meeting was organized by the Military Institute of Hygiene and
Epidemiology, Warsaw Poland, in co-operation with the Cantacuzzino Institute, Bucarest,
Romania.
The primary objective of the ARW was to provide countries in which bio-defence
systems are currently under development with the experience and expertise of those that are
more advanced and/or have already been exposed and responded to a bio-terrorist attack.
Such an approach was taken to allow avoiding mistakes and to properly allocate limited
resources in building preparedness against intentional and natural outbreaks of infectious
diseases. The ARW also aimed at increasing awareness of the problem at the political level
in the Region. Yet another objective was to consolidate the community of experts in the
Region and to reinforce connections with NATO and other international organisations in
this particular area. This forum allowed for integration of thinking, elaboration of common
approach to the problem, and exchange of the experience.
One of the main lessons learned from the ARW is that, in most of the countries, the
existing systems of the management of biological threats are convoluted and fragmented.
There is also no single international system that would provide all the information needed
to rapidly assess each particular situation and help bring a biological crisis under control.
Several international bodies only fragmentally deal with parts of the problem that are within
their competence. Some of these efforts were presented during the Workshop (Cosivi,
Niedrig, Kyncl). Projects for the informal experts' networks have been demonstrated (Price
et al, Woodal). Also, national approaches to the bio-defense and disease surveillance were
presented (Plochev, Faludi, Niedrig et al., Asokliene, Chomiczewski, Kapustiri). Moreover,
as a result of the attendance of specialists from such relevant fields as epidemiology,
infectious diseases, NBC threats, medical planning, vaccinology, detection and
identification of biological agents, physical protection and decontamination it was possible
to examine most of the avenues a country should ideally explore in order to build its
preparedness and capacity to respond to a biological attack.
Development of the integrated system of response against bio-terrorism is a very
complex endeavor requiring integration of the activities of the relevant institutions at the
national level. In this regard, a multidisciplinary approach is crucial. Physicians should be
trained to entertain suspicions facing unusual profiles of the disease (Pavlin). Other medical
personnel and first responders should be also familiar and adequately trained to cope with
signs and symptoms presented by victims of a biological attack (Stopa). New laboratory
systems and approaches can revolutionize disease surveillance. Integration of the real time
epidemiological data collection, analysis, and dissemination with the timely laboratory
vi
support based on the advanced technology platforms (Morse, Hanson et al, Niemeyer) will
accelerate diagnosis and increase awareness of the situation. Even though rapid progress is
being made in the field of the remote sensing (Niemeyer), biosensors (Donlori), proteomics
(delVecchio), and other relevant methodologies (Bartoszcze), there is currently no "silver
bullet" for application in the real time biological detection and identification. Since a
variety of approaches and technologies are evolving in the biological threat detection,
prophylaxis, and therapeutics, a flexible and rapidly responsive bio-manufacturing
infrastructure is an essential part of the effective overall strategy for bio-terrorism
preparedness (O'Connell). Consequence management should be planned in advance
(Ahrens), preferably based on the effective risk assessment? (Bellenkes). Innovations in
medical countermeasures and prophylaxis (Oyston) as well as in the decontamination
procedures (Pivovarov et al., Kartel et al.) are still necessary and being introduced.
In view of the fact that infectious diseases do not respect boundaries preparedness
against outbreaks should be built from the scratch using the "thinking outside-of-the-box"
approach with consideration for the international interdependence. This requires unification
of the epidemiological and laboratory procedures as well as of the public health planning in
countries of the Region. Taking into account the differences and gaps in the existing health
systems of these countries, the very complicated goal of leveling the approaches certainly
requires firm and sustained regional co-operation. We hope to witness it in the nearest
future. Hopefully, the present NATO ARW will help to pave the way for such co-operation.
The Editors:
Dr. Janusz Kocik, M.D., Ph.D.
Dr. MarekK. Janiak, M.D., Ph.D.
Prof. Marian Negut, M.D., D.Sc.
vii
Acknowledgements
The meeting was sponsored by the NATO Scientific and Environmental Affairs Division,
the U.S. Army Research Office and the U.S. Army Soldier, Biological and Chemical
Command; the US. Naval Research International Field Office, as well as Baxter Vaccines.
We take this opportunity to express our thanks to the sponsors. We also are grateful to Dr.
Deborah Niemeyer, Kevin O'Connel, Mildred Donlon, and Adam Wilczynski for their
efforts to spread the news about the ARW in the scientific community and help attract the
outstanding key speakers to the event. Finally, the hard and dedicated work of Mrs.
Magdalena Baranowska, Dr. Dr. Emil Lisiak, Marek Brytan, and Mr. Hubert Radziejewski
of the Military Institute of Hygiene and Epidemiology is highly appreciated. Indeed,
without their organizational and technical support this meeting would not have gone as
smoothly as it did.
Dr. Marek K. Janiak, M.D.,Ph.D. - Co-Director
Prof. Marian Negut, M.D., D.Sc. - Co-Director
Dr. Janusz Kocik, M.D., Ph.D. - Head of the Organizing Committee
This page intentionally left blank
ix
KEY SPEAKERS
Theodore Ahrens Ditta Ciganikowa
US European Command Bio Weapons Prevention Project
Feldbergstrasse 102 C/o PSIS
71134Aidlingen, 132, Rue de Lausanne
GERMANY 1211, Geneva 21,
e-mail: [email protected] SWITZERLAND
tel: [phone]
LTC Gerard P. Andrews, Ph.D. fax: + 41 22 738 35 82
Chief, Bacteriology Division e-mail: [email protected],
USAMRIID, Ft. Detrick, MD, 21701, www.bwpp.org
USA
Dr. Ottorino Cosivi
Dr. Loreta Asokliene World Health Organization
Public Health Specialist Department of Communicable Disease
Centre for Communicable Diseases Surveillance and Response
Prevention and Control 20, Avenue Appia
Kalvariju str. 153, CH-1211 Geneva 27,
LT-2042 Vilnius, SWITZERLAND
LITHUANIA tel:[phone]
e-mail: [email protected] fax: [phone]
tel: [phone] e-mail: [email protected]
fax: [phone]
Helene van Cuyck
Dr hab. n. med. Michal Bartoszcze Expert in Biology
Military Institute of Hygiene & Weapons of Mass Destruction Centre, AB
Epidemiology 310
2 Lubelska St., NATO
24-100Pulawy, Bd. Leopold III
POLAND BE. IIIo. Brussels,
BELGIUM
CDR Dr. Andrew H. Bellenkes tel: [phone]
MSC USN, School of Aviation Safety e-mail: [email protected]
Naval Postgraduate School (Code 10)
1588 Cunningham Rd., Monterey, Prof. Vito DelVecchio
California 93943-5002, Institute of Molecular Biology and
USA Medicine
tel. US (country code) + 831.656.2581 University of Scranton
e-mail: [email protected] Scranton, PA 18510-4625,
USA
Prof. Krzysztof Chomiczewski
Military Institute of Hygiene & Dr. Mildred Donlon
Epidemiology DARPA/SPO
4 Kozielska St., 3701 North Fairfax Drive
01-163 Warsaw, Arlington, VA 22203-1714,
POLAND USA