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Conference Summary
Bioterrorism-Related Bacillus
anthracis Public Health Research Priorities
Bradley A. Perkins and David A. Ashford
Centers for Disease Control and Prevention, Atlanta, Georgia, USA
During the 2001 anthrax bioterrorism investigation, several areas were
identified in which additional research may improve public health response.
The disciplines and specific expertise required to approach many of these
areas are varied and reside in multiple entities in the federal government
and elsewhere. To identify, prioritize, and coordinate short-term Bacillus
anthracis bioterrorism research for public health response, the Centers
for Disease Control and Prevention (CDC) convened a meeting in Atlanta
on December 10–11, 2001, to obtain input on research priorities and improve
coordination with federal partners and other stakeholders. One hundred
thirty-two representatives from the Department of Health and Human Services
(CDC, Food and Drug Administration, and National Institutes of Health),
Environmental Protection Agency, Department of Defense, Department of
Energy, Department of Justice, U.S. Postal Service, state health departments,
universities, and other organizations participated in the meeting.
The meeting format consisted of two plenary sessions. In the first plenary
session experts provided summaries of key topic areas. Background talks
were given on evaluation of B. anthracis–containing powders or
substances; epidemiologic investigation; environmental assessment; surveillance;
diagnosis; treatment; postexposure prophylaxis; and remediation.
After the first plenary session, participants were divided into eight
preassigned working groups, covering the following topics: 1) evaluation
of B. anthracis–containing powders or substances; 2) epidemiologic
investigation; 3) environmental assessment; 4) surveillance; 5) diagnosis;
6) treatment; 7) postexposure prophylaxis; and 8) remediation. During
the second plenary session, each group presented interim results to the
larger group of participants. In two working group sessions, the topic-specific
groups identified their three top research priorities and prepared a brief
written report describing proposed activities.
For evaluation of B. anthracis–containing powders or substances,
the top three priorities were 1) rapid analysis of anthrax-containing
powder: particle size distribution and matrix characteristics; 2) measurement
of particle reaerosolization of different anthrax powder preparations;
and 3) development of an in vitro model for the study of cutaneous anthrax
by human cell culture. For epidemiologic investigation, priorities were
1) analysis of individual host risk factors for anthrax infection; 2)
exposure reconstruction and risk characterization; and 3) review of unexamined
or previously unpublished (potentially classified) animal data related
to dose response. For environmental assessment, the top priorities were
1) validation and standardization of sampling and sample analysis techniques;
2) evaluation of risk of disease in contaminated environments; and 3)
determination of risk of reaerosolization. For surveillance, priorities
were 1) expanded veterinary surveillance and integration
with human health information; 2) use of alternative sources of
data in the surveillance for bioterrorism-related events; and 3) design
and validation of surveillance systems to detect complex contamination
or release scenarios. For diagnosis, priorities were 1) identification
of the earliest detectable event in the continuum from exposure to anthrax
to disease (using animal models); 2) evaluation of antigen-detection assays;
and 3) development of a library of B. anthracis subtypes. For treatment,
priorities were 1) investigation of the role of immune and antitoxin therapies;
2) expanded investigation of antibiotic therapies in animal models; and
3) development of other animal models. For postexposure prophylaxis, priorities
were 1) evaluation of adherence, barriers to adherence, and adverse events
associated with long-term use of antimicrobial agents; 2) pediatric anthrax
vaccine safety and immunogenicity studies; and 3) animal challenge studies
to optimize postexposure prophylaxis in humans. For remediation, the top
three priorities were 1) evaluation of remediation agents; 2) development
of risk-based decision templates for sampling and remediation; and 3)
reaerosolization studies and agent- and space-specific scenarios.
This meeting defined a framework and set specific priorities for additional
research needed to improve public health response to B. anthracis–related
bioterrorism. Explanations of why the research was considered important,
what the research would be, how it would be carried out, who could do
it, and when it could begin are available online from URL: http://www.cdc.gov/ncidod/dbmd/diseaseinfo/files/MeetingReport_BTPriorities_Dec1011.pdf).
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