Bioterrorism and the Role of the Clinical Microbiology Laboratory

Abstract

SUMMARYRegular review of the management of bioterrorism is essential for maintaining readiness for these sporadically occurring events. This review provides an overview of the history of biological disasters and bioterrorism. I also discuss the recent recategorization of tier 1 agents by the U.S. Department of Health and Human Services, the Laboratory Response Network (LRN), and specific training and readiness processes and programs, such as the College of American Pathologists (CAP) Laboratory Preparedness Exercise (LPX). LPX examined the management of cultivable bacterial vaccine and attenuated strains of tier 1 agents or close mimics. In the LPX program, participating laboratories showed improvement in the level of diagnosis required and referral of isolates to an appropriate reference laboratory. Agents which proved difficult to manage in sentinel laboratories included the more fastidious Gram-negative organisms, especiallyFrancisella tularensisandBurkholderiaspp. The recent Ebola hemorrhagic fever epidemic provided a check on LRN safety processes. Specific guidelines and recommendations for laboratory safety and risk assessment in the clinical microbiology are explored so that sentinel laboratories can better prepare for the next biological disaster.

Identification of Burkholderia pseudomallei Genes Induced During Infection of Macrophages by Differential Fluorescence Induction

“…B. pseudomallei is resistant to many antibiotics, making it difficult to treat, and currently, there is no vaccine to protect against melioidosis (Dance, 2000). In the United States, B. pseudomallei is a Tier 1 select agent, owing to its potential to cause a mass casualty event after a deliberate release (Wagar, 2016). Additionally, B. pseudomallei is listed in Schedule five pathogens and toxins controlled under the Anti-Terrorism, Crime and Security Act (ATCSA) in the United Kingdom.…”

A Hexaplex PCR Assay Developed for Simultaneous Detection of Bacillus anthracis and Yersinia pestis and Distinguish Their Virulence Levels Tested on Vietnamese Samples

“…They are zoonotic pathogens causing life-threatening diseases in humans and animals and posing high risks for public health [1,2]. The Centers for Disease Control and Prevention (CDC) classified these pathogens as bioterrorism agents in category A of the most dangerous group of biological agents [3]. One of the most typical examples of bioterrorism, the BAnthrax letters^case in September 2001 in New York, USA, has affected the population with a huge impact at a psychological and political level [4].…”

“…Currently, there are a number of diagnostic methods for identification of B. anthracis and Y. pestis based on their phenotypic features, including bacteriological isolation, serology, and immunoassays. These approaches are time-consuming and required the use of skillful personnel and biosafety level 3 (BSL3) laboratory [3]. Moreover, serology and immune assays have limited sensitivity and specificity, particularly in case of immune assay-based rapid tests [5].…”

Occupational Health Update

“…15,21 Prevention of laboratory-acquired infection requires adherence to recommended administrative protocols (eg, no eating, drinking, or smoking in areas where microbiologic or pathologic samples are processed), engineering controls (eg, containment hoods), personal protective equipment (eg, N95 masks when culturing Mycobacterium tuberculosis), and appropriate immunizations. 22,23 DEFINITIONS HCP refers to all paid and unpaid persons providing services in health care settings who have the potential for exposure to patients and/or infectious materials, including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces, or contaminated air. These HCP may include but are not limited to those listed in Box 1.…”