Environmental Engineering Reference
In-Depth Information
may retain immunity to smallpox, the level of protection is currently unknown.
Smallpox is generally fatal in about 30 percent of infections of unvaccinated
individuals. Given these uncertainties and the significant health risk of smallpox,
the United States and other countries are currently increasing the production of
smallpox vaccine. However, approximately 1 in 1 million people exhibit serious
and potentially fatal complications following vaccination. Thus, if the entire U.S.
population were to be vaccinated, we might expect 100 to 300 deaths from the
vaccine. To avoid this situation, one strategy that is being considered for a bioter-
rorism attack is to limit vaccination to individuals that have come in contact with
the initial (index case) infected individual. Vaccination and training of primary
health care workers and physicians who are most likely to see the first cases in
an attack will also be an important aspect for countering the use of viruses and
bacteria as weapons.
Anthrax
As already noted, anthrax is a concern for use in bioterrorism. Inhalation of
anthrax spores is fatal in approximately 75 percent of untreated cases. Anthrax
consists of several major virulence factors: a polysaccharide capsule and three
separate proteins (toxins) that act in concert to disrupt immune defense systems.
An anthrax vaccine is available and is generally effective, although it is cur-
rently in limited supply (and mostly dedicated to military rather than civilian
use). It has also been observed to cause side effects. Antibiotics such as amoxi-
cillin, ciprofloxacin, and doxycycline are effective against the inhalation form of
anthrax; however, they must be administered prior to spore germination, which
can occur within 48 to 72 hours following exposure and must be continued for
several months. One particular concern is that terrorists may genetically alter
common strains of anthrax to encode antibiotic-resistance genes, a situation that
could pose significant problems for current treatment protocols. Thus, it will be
important to be able to rapidly monitor and analyze the genetic properties of dif-
ferent anthrax strains and to develop new antibiotics. Another promising avenue
stems from the recent identification of the receptor for anthrax lethal factor toxin
as well as high-resolution structural determination of lethal factor and edema fac-
tor. These molecules represent potential targets for rational drug design of new
antibacterial compounds to combat this disease.
NONCOMMUNICABLE DISEASES AND CONDITIONS ASSOCIATED
WITH THE ENVIRONMENT
Background
The terms noncommunicable and noninfectious are used interchangeably. The
major noncommunicable disease deaths in the United States in 2000 were due
to diseases of the heart, malignant neoplasms, cerebrovascular diseases, acci-
dents, atherosclerosis, diabetes mellitus, and chronic liver disease and cirrhosis.
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