The CBMTS VII at the Swiss National SPIEZ LABORATORY
from 13-18 April 2008 will have some exceptionally timely and important presentations.
Amongst them will be:
Current Research in Radiation Biodosimetry
Drs. Terry C. Pellmar, William F. Blakely, Marcy B. Grace, John F. Kalinich, Natalia Ossetrova, Alexandra C. Miller, Pataje G.S. Prasanna
AFRRI, USUHS, Bethesda, Maryland
In the event of a mass casualty involving exposure to ionizing radiation, medical personnel will require a means to assess an individual's exposure in order to provide appropriate care. Triage tools will be necessary to identify those with the most urgent need for medical attention. Clinical signs and symptoms including peripheral blood counts, time to nausea and vomiting, and cognitive effects provide an early indication of the severity of the exposure. A software program (Biodosimetry Assessment Tool, BAT) has been developed to integrate these findings and other relevant information to provide an initial assessment of exposure. Several other assays designed to provide a rapid assessment of radiation injury are in development.
Prospective biomarkers include serum proteins, gene expression markers, and metabolites in the urine. Many show excellent potential but each has its limitations, such as dose range restrictions, time dependence, variability, and confounding influences of other environmental or health factors. Using a combination of biomarkers can provide greater accuracy than any one biomarker alone.
The dicentric assay, the gold standard for biodosimetry, provides reliable dose assessment that is vital to medical management. The assay has been validated in hundreds of radiation exposures throughout the world. However, the assay is labor intensive, time consuming, and requires expertise to perform. Efforts are underway to automate this assay to improve throughput and reduce technical requirements.
Biodosimetric markers will be a valuable tool in responding to a radiological or nuclear event, but they must be considered in the context of the diverse population. The baseline levels of many markers are variable within the population and are affected by multiple factors such as smoking, diet, general health, and prescription drugs. These factors will need to be considered in the interpretation of biodosimetric assays.
Strategic Considerations for Public Health Emergencies
Jerome A. Donlon, MD, Ph.D., Chief Science Advisor
Office of Biomedical Advanced Research and Development Authority (BARDA),
Dept. of Health and Human Services
The presentation will cover an overview of the strategic issues considered in developing plans for medical countermeasures to prepare for public health emergencies. The discussion will take into consideration the directives of the Project BioShield Act of 2004 and the Pandemic and All-Hazards Preparedness Act of 2006 as well as the Department of Health and Human Services Public Health Emergency Medical Countermeasures Enterprise Strategy and Implementation Plans and apply those directives to specific acquisition, deployment and use considerations for the Strategic National Stockpile formulary.
Avian Influenza Transmission In Indonesia
Kandun I Nyoman1, Erna Tresnaningsih2, Wilfried H Purba3, Roenizar Roesin4
1 Director General, DC&EH, MOH.
2 Director, VBDC, DG of DC&EH, MOH.
3 Head, Sub Directorate of Zoonoses, Directorate of VBDC, DG of DC&EH, MOH.
4 APW, DG of DC&EH, MOH.
H5NI Avian influenza (AI) was first detected in poultry in Indonesia in November of 2003. Since then more than two million chickens have succumbed to AI and another 21 million have been culled in order to stamp out outbreaks of the disease. AI is now firmly entrenched in poultry in Indonesia with 31 out of 33 provinces reporting outbreaks. The first human case of H5N1 in Indonesia was detected in July 2005 in Tangerang, a suburb of Jakarta. Since then human cases have been reported in 12 of the 31 provinces that have reported AI in poultry. All confirmed cases are reported from provinces in Java, Sumatra, Bali and Sulawesi Islands. February, 4, 2008, 126 laboratory confirmed cases of H5N1 infection and 103 deaths from AI have been reported in Indonesia. The Provinces with the highest number of cases were West Java, Jakarta and Banten.
There are high fatality rates across all age groups. Even though the majority of cases are below 30 years of age, and the distribution of cases is relatively equal in males and females. A large proportion of cases (31,74%) are children under 14 years of age.
In this specific subset of cases 47,6% of them having direct contact with sick or dead poultry, 38,9% were recent poultry deaths in the environment or where there was any poultry in the environment and 13,5% cases where source of infection could not be determined, despite investigation.
The strategies for integrated Avian Influenza control: 1) Disease control in animals, 2) Case management in humans, 3) Protection of high risk groups, 4) Epidemiological surveillance in humans and animals, 5) Restructuring of poultry industry system, 6) Education, Communication and Information, 7) Law enforcement, 8) Capacity building, 9) Research and development, 10) Monitoring and evaluation.
These data point to the need for more intensive surveillance and control of H5NI in poultry in Indonesia, as more human cases can be expected as long as H5N1 remains entrenched in poultry. The public will have to be educated to avoid contact with infected poultry.
Crisis Management in an International Environment with an International Organization
Florin Paul, Mariana Niculae Romania
Crisis Management (CM) is a complex process that implies organization, procedures and arrangements to control crisis and shape its future course. CM activities range from information acquisition and assessment, analysis of the situation, establishment of goals, development of options for action and comparison, implementation of a selected option, including analysis of reaction and feedback.
After the end of the Cold War the nature of peacekeeping and the means of managing crisis situation have been profoundly transformed. The conflict resolution capabilities of international organization such as the UN, the OSCE and the EU, the NATO, as well as relevant NGOs have been changed by the proliferation and complexity of contemporary conflicts. Many of them are intra-state conflicts rather than inter-state or international. They involve systematic violations of human rights and of international humanitarian low, collapsed stats structures and political mobilization based on ethnic or religious identities. These developments have fundamentally changed the role of international community.
During the last decades many international organization and NGO were involved in conflict prevention, crisis response and post conflict reconstruction in the same region or country. Unfortunately there are still far too many examples of inter-agency and inter-entity rivalry impeding progress and accomplish of the mandate. Overlapping mandate often results in tensions and inability of cooperation in crisis situation. This can exacerbate the difficulty in meeting the minimum requirements for an effective crisis management.
In a "multi-player" environment and particular circumstances key factors are: political and economical situation in the affected country/area, nature of the conflict, dimension and diversity of international presence and their mandates, expectations of both International Community and local population. The essence of collaboration in such environment lies in the principle that each "player" should contribute according to its capabilities and competences.
Knowledge management approach is explored from the perspective of respiratory transmitted diseases outbreak occurred within international organization during crisis time in international environment.
Evaluation of Human Health Risks of Indoor Chemical Contaminants
Before and After Decontamination
Deborah McKean, Ph.D.
National Homeland Security Research Center, Office of Research and Development,
U.S. Environmental Protection Agency, Cincinnati, Ohio
U.S. Environmental Protection Agency's role within programs such as Superfund has been the assessment and cleanup of contaminated environmental media such as soil, air and water. However, in response to Homeland Security Presidential Directives and in support of the National Response Framework, the Agency's role has expanded to include the cleanup of contaminated buildings and their contents. Consequently, there is a need to determine the level of cleanup required following accidental or purposeful contamination of a building to estimate "How clean is clean?". The answer to that question affects not only the assessment of human health risks; it guides the development of sampling techniques, analytical methods, and decontamination technologies. High hazard materials can present difficult challenges in the selection of decontamination technologies. A risk-based approach can strengthen the basis for selection of decontamination technologies for indoor surfaces contaminated with specific agents. The development of human health risk estimates for exposures to contaminated indoor surfaces and the application of those estimates to other aspects of a decontamination effort will be discussed.
Risk-based Assessment and Management Activities for Responding to the Release of a Biothreat Agent
Dr. Tonya Nichols
Preparing and responding to a catastrophic release (terrorist incident or accidental release) necessitates a coordinated effort between risk assessors and risk managers. Coordination requires the risk assessor to estimate and communicate risk from the biological contaminating event upon which scientifically-defensible decisions can be made. Much effort has gone into the development of risk management frameworks and protocols which address the stages of an incident: Threat Feasibility Analysis, Crisis Management, Consequence Management, Decontamination and Reoccupancy. However, there is no consensus-based risk assessment methodology or framework for evaluating biological contaminants and establishing clean-up goals following a large-scale environmental contamination. To address this need, the United States Environmental Protection Agency (USEPA) has embarked on the development of an Incident-based Microbial Risk Assessment framework. The primary goal of the risk assessment framework is to provide the process upon which realistic, achievable and acceptable risk goals can be derived. It is recognized that throughout a given response to a biological incident, risk assessment and risk management activities are on-going and evolving as more information is derived about the fate and transport of the biological agent. This presentation addresses the risk assessment and risk management activities that are necessary for the USEPA to conduct remediation activities.
SERRA: The Use of a Knowledgebase Approach to Meet the Needs of Pre-Event Planning and Post-Event Consequence Management
Michael L. Taylor, Ph.D.
Battelle, 10300 Alliance Road, Suite 155, Cincinnati, Ohio 45242, USA
Individuals who must deal with the aftermath of terrorist attacks will be required to make many time-critical decisions, a number of which contain a risk-based element.
SERRA (Support for Environmental Rapid Risk Assessment) has been developed to facilitate these efforts and effectively meet the needs of both pre-event planning and post-event consequence management.
Implementation of SERRA enhances multiple preparedness activities; for example, suggestions for basic response needs including sampling equipment and decontamination materials. For users with rigorous incident management and planning responsibilities, SERRA provides a comprehensive, multi-media view of biological agent behavior that can be used to improve response plans and operating procedures.
In the response to a biological event, users can query SERRA to determine potential hosts and vectors, human exposure routes, persistence, and appropriate decontamination strategies. The structure of SERRA enables rapid connections to be derived among multiple aspects of agent behavior necessary for holistic incident management. Continuing with the example, knowledge of possible animal hosts for a biological agent when considered in conjunction with relevant human routes of exposure will assist in the determination of appropriate risk management actions.
SERRA also contributes to development of the overall biological risk assessment process. It provides a proven collaborative authoring concept that allows for content development from many individuals, including those from different disciplines and physical locations.
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