Threats of bioterrorism in public health, Epidemiological clue, Detection and Safety pre-cautions for outbreaks

Bioterrorism is release of biological agents such bacteria, viruses and toxin in peoples to reduce their population by causing illness which is leads to death. These bio-wars are continue panic threat in public health which is ignored and denier. Disrupting the economic, religious, social distraction, ideological and political infl uence. These infectious agents have massive impact on human life as compare to war. Millions of population have been died with life threating agents which including bubonic plague, smallpox, measles, infl uenza, typhus. Bioterrorism is international practice of biological products or pathogen to cause destruction in human-being, animals, plants and other living organisms. For decades Epidemiologists investigated the non-infectious and infectious diseases among human and animals population. Investigation identifi ed the risk factors, vehicle and transmission mode among the familiar and unfamiliar outbreaks. Verity of information systems are used to detect the occurrence of disease or syndrome, dominated syndromic system. Importance of the system is to identify the data of outbreaks and storage of disease information that helpful in control of life threatening diseases via automatic monitoring system, detection or occurrence of disease in various groups. The launch of particular system is to collect the information or data for disease syndrome or occurrence. It can be identify the number of disease or quantity of outbreaks in abundant areas according to Zip-code, city, state or region. Health department and human services play important and critical role over medical and public health response to bioterrorism. Center for Disease Control and Prevention CDC takeover effort of nation and public health to detect the response to a bioterrorist events. Certain federal, states, provinces and other local communities are improving their health of population capacities to reply-back to various sort of outbreaks or emergencies. Review Article Threats of bioterrorism in public health, Epidemiological clue, Detection and Safety pre-cautions for outbreaks Shahzeb Khan1* and Iqra Rafi que2 1Faculty of Health Sciences, Department of Microbiology, Hazara University Mansehra 21300, KPK, Pakistan 2Department of Genetics, Hazara University Mansehra, Pakistan Received: 22 October, 2019 Accepted: 23 November, 2019 Published: 25 November, 2019 *Corresponding author: Shahzeb khan, Faculty of Health Sciences, Department of Microbiology, Hazara University Mansehra 21300, KPK, Pakistan, Tel: +923489100228; E-mail:

(brucellosis) were recently removed from the list of most likely agents but remain a possible agent along with Coxiella burnetti (Q fever), Burkholderia pseudomallei (glanders), agents of viral encephalitis, Staphylococcal, mycotoxins enterotoxin, and ricin [2].
Bioterrorists agents can be genetically modifi ed organisms that are commonly resist to various well-known drugs and vaccines, these are highly contagious and can harm massive population. A small outbreak of illness can be initial caution for much more severe attack, recognition and identifi cation of agents and its properties can prevent the death rates by develop of suitable vaccines and antibiotics for particular organisms. It can save the thousands of population lives. Medical staff must be aware from epidemiological skill of attack and must have knowledge about outbreaks of disease [3].

Epidemiological features
• Within hours or days disease or illness spreads rapidly in normal population with increasing their numbers.
• During in short duration epidemic curve is rises or falls.
• Receiving huge number of cases from single geographical location.
• Those Patient bestowing severe illness that is uncommon with sign and symptom and could be bioterrorism attack.
• Diseases will have been found rarely in those population who remain or stayed at home as compare to outdoor population due to less exposure to disease outbreaks.

Microbiology and clinical features of bioterrorism agents
Suspected micro-organisms or bioterrorism agents are discussed below, also included those organism or toxins which are considered as potential biological weapons. The CDC has not yet issued recommendations for specimen processing and presumptive identifi cation for these agents, since they are considered less likely to be used by terrorists than the agents already discussed. Recommendations for dealing with these agents may be articulated as the CDC's bioterrorism preparedness program moves forward [2].

Viral Hemorrhagic Fever (VHF)
Hemorrhagic fever is much serious or life threatening syndrome, could be caused by mostly viruses. BSl-4 has facilities to equip these agents and can be diagnose by culture or non-culture techniques, which also include immunological, immunohistological, serological and nucleicacid amplifi cation methods. Specimen is draw from patients carefully and transport it to the preferred laboratories [2].

Anthrax
The incubation period of causative agent is relatively massive that's about 2-44 days, many cases are reported in 1-2 weeks from period of exposure while in few countries the incubation period is reported as vary such as In united states during outbreak of disease the distribution or frequency of incubation period was limited it was about 2-7 days. Nonspecifi c prodromal period of anthrax is reported from hours to few days [5].

Tularemia
Tularemia has typical incubation period as well as narrow when individual is exposed to aerosol of F. tularensis, with nonspecifi c febrile illness or without symptoms of respiratory. In 3-6 days progression of disease is rapid become life threatening that is lead to pneumonitis. Mostly patients are with narrow incubation period is met with rapid progression by which result cases are much complicated in the acute exposure. F. tularensis is slow growing bacteria, also fastidious organism may tale 2-5days after the exposure while organism is detectable when it's complete their incubation period. After recognition or identifi cation special sort of antibiotics are recommended to individual for the recovery of health [5].

Pneumonic plague
Yersinia pestis is causative agent of pneumonic plague that is transmit through aerosol droplets, typical incubation period.
Which ranges from 1-4 days of exposure with relatively short Blood and sputum are used to culture for particular disease and grow best within 24-48 hours, specimen process needs special attention to carryon. Conformation is done by special test which is avail for reference laboratories. Symptoms of the disease is life-threatening in early stage but can be treat with antibiotics in febrile patients [5].

Clostridium botulinum
They are gram +ve rod shaped organism, producing toxin

Recognition of bioterrorism via Information system
Verity of information systems are used to detect the occurrence of disease or syndrome, dominated syndromic system. Importance of the system is to identify the data of outbreaks and storage of disease information that helpful in control of life threatening diseases via automatic monitoring system, detection or occurrence of disease in various groups.
The launch of particular system is to collect the information or data for disease syndrome or occurrence. It can be identify the number of disease or quantity of outbreaks in abundant areas according to Zip-code, city, state or region. These system have installed been in USA for the evaluation of outbreaks resulted from bioterrorism attacks. Data must be stored through proper registration or standardized pathway which is release by center for disease control CDC in the form of 'Report' team working on outbreaks are responsible for data entry and having knowledge about disease syndrome and surveillance [7].

Molecular-based detection of suspected bioterrorist agents
Rapid molecular detection of blood can used to be fulfi l the rapid diagnosis which is necessary for biodefence. Blood or other body fl uid can be used to detect the bacterial species that is suspected as bioterrorists, from these selected agents mortality rate might be reduced by prompt treatment. If the diagnostic assays are subcontract to reference laboratories inresult treatment can be delay, bioterrorism agents can infect the blood stream meanwhile bacterial species are in progress of life-threatening disease [8].
Sensitive assay is used to detect the bacterial DNA such as Bacillus anthracis DNA can be extract by phenol-chloroform according to standard, Burkholderia mallei and Yersinia pestis. 16s rRna genes is used for the identifi cation as specifi c-DNA sequence, these specifi c sequences are conserved sequences and in PCR for it uses a universal primers. For detection of Specifi c pathogen and sensitivity real-time PCR is suitable or well because it is conducted in hermetically sealed wells which is widely reduce the risk of cross-contamination therefore, it does not need to perform the post-PCR analysis. PCR have been developed for numerous specifi c agents on the basis of nucleicacid sequences and properties [9].

Relationship between medicine and public health
Public health and medicine is typical response to bioterrorism attack or outbreaks it is formed relationship among. Outbreak of disease is fi rst recognized or diagnosed by physicians in emergency room currently working in hospitals. It include medical personals who exposed to suspected bioterrorist agents in fl awless sense, by the passage of time communication systems become track specifi c disease outbreaks that is quickly occur and isolated accurately. There is no valuable data of patients but who will charged in hospital they will conformed as outbreak illness [10].
Governor should be make agencies for the determination of bioterrorism attack because bioterrorism can be in different sort such as biological, chemical and nuclear attacks which will conducted by an agency in proper way or channel. They will required special tailored defense system to detect the outbreaks in such manner. Public health policy should be make at national wise or national security level or should be trained the physicians, nurses and other medical professionals for bioterrorism attacks. Provide them suitable or proper diagnostic procedure and laboratories where they will conduct or treat patients easily, preparation of vaccines and drugs to prevent the attack and must be stored in future outbreaks [11].

Strategies for bioterrorism planned by CDCs
Health department and human services play important and critical role over medical and public health response to bioterrorism. Center for Disease Control and Prevention CDC takeover effort of nation and public health to detect the response to a bioterrorist events. Certain federal, states, provinces and other local communities are improving their health of population capacities to reply-back to various sort of outbreaks or emergencies [12]. Provide easiest pathway and quick detection of bioterrorist agents and diagnosis of disease in hospitals and laboratories to improve the health of population in communities [13].

CDCs reference laboratories
Initiation of bioterrorist attacks CDCs had limited source to test the pathogens which are listed as critical biological agents such as botulinum, tularemia, plagues, viral hemorrhagic fever and smallpox these all are listed as biological weapons were used in bioterrorism attacks. Additionally CDCs has now ability to test anthrax toxins and these biological agents can be transmit among individuals and responsible for high mortality rate. New labs and staff must be provided to national capacities to triage strategies and for rapid identifi cation of disease outbreaks. There are 50 labs exists for public health in which plagues, tularemia and anthraxis are testing, CDCs are provide certain laboratories by which some tests are perform and some are nor [13].

CDCs research improvement
In-collaboration of CDC with NIH national institute of health are Investing in research and vaccines production against the life-threatening biological agents. They discover and release vaccine against the smallpox virus and get award from Cambridge. Massive quantity of vaccines are produced in initial step, approximately 40 million doses were delivered but later vaccines production need to be raised. Numerous organization are working at that duration such as NIH, CDC, FDA and DDHS, these organization are also currently working on the vaccines production and development against for following biological hazard agents such as Clostridium botulinum, Francisella tularensis, Bacillus anthracis, Variola major and Yersinia pestis.

Bio-safety or safety precautions for bioterrorism
Laboratory isolation precautions: Transmission of bioterrorist agents cannot spread from individual to individual generally but can be transmit through aerosolization of agents among population. Patients with suspected illness of bioterrorism attack or having such symptoms must be facilitated with healthcare, standard precautions must be utilized. As we know the transmission of disease can be reduced by standard precautions, it is planned for recognized and unrecognized source of infection. Direct body fl uid like blood, mucus membrane, secretion and excretion can be prevented by standard precautions, routinely it applies in medical practices for patients care [6].
Washing hands: Hands should be washed-out with antiseptics after dealing patients body fl uids, such as blood, excretion and secretion these fl uids can contaminate the hands and can be source of infection for others. Glove must be remove after when done to check or touch to patients, antimicrobial soap should be apply for washing hands [6].
Use of gloves: Gloves should be used when dealing or touching the patients and even examine the patients. Glove should be properly discard after examine the patients specimen due to contamination, which act as source of infections. Wash hands after performing procedures or clinical examination [6].
Masks or face shields: Mask and eyes protection must be apply to protect from body fl uid or specimen of patients, disposable mask should worn [6]. to suspected patient to prevent the population with due attack of bioterrorism, equipment must be protective and appropriate that is operating by healthcare facilitators for patient diagnosis and/or specimen isolation. Stuff should be immunized with proper dose who are dealing with smallpox exposed patients [14].

Microbiological Laboratories Precautions (MLPs)
The role of microbiology laboratories is critical or key in the control of biological agents. American society for microbiology Bioterrorism attacks are identifi ed by microbiology laboratory personals due to availability of tools and investigation knowledge [15]. The National Committee for Clinical Laboratory

Standards (NCCLS), and Clinical and Laboratory Standards
Institute (CLSI) developed guideline and detection of biological attacks by testing the antimicrobial susceptibility and interpretation patterns. These organization should access be given to microbiological labs to identify organism at genotypic level. Implementation of control measures, room selection and patients treatment are involving in clinical decisions, this can be done by rapid diagnostic testation. Safety precautions, immunization and prophylaxis are include in control barrier, microbiologists must provide guideline, rapid diagnostic test result to patients and control to avoid the disease or outbreaks.
These report of rapid diagnostic test, importance of agents and epidemiological clues are must be reported to public health agencies to develop strategies for control and safety precautions [14].

Conclusion and Recommendation
Bioterrorism or bio-war is does not something new that is go away, its need high technology to end the bioterrorist attack Install modifi ed and advance information systems in hospital, laboratories and other public healthcare center. Appropriate reporting system and data-bases should be progress in cities, states and national even at international level where data must be avail and provide procedures for control of bioterrorism attack and outbreaks.