Tin D, Pepper M, Hart A, Hertelendy A, Ciottone G. 21(3). 51 - 54. (Journal Article)
Abstract
Background: Terrorist attacks are growing in frequency, increasing concerns about chemical warfare agents (CWAs). Asphyxiants (e.g., cyanide), opioids (e.g., carfentanyl), and nerve agents (e.g., ricin) represent some of the most lethal CWAs. Our aim was to define the epidemiology of CWA use in terrorism and detail specific agents used to allow for the development of training programs for responders. Methods: The open-source Global Terrorism Database (GTD) was searched for all chemical attacks from January 1, 1970, to December 31, 2018. Attacks were included when they fulfilled the terrorism-related criteria as set forth in the internal Codebook of the GTD. Events meeting only partial criteria were excluded. Results: A total of 347 terrorism-related chemical events occurred, with 921 fatalities and 13,361 nonfatal injuries (NFIs) recorded during the study period. South Asia accounted for nearly 30% (101 of 347) of CWA attacks, with 73 of 101 occurring in Afghanistan. The Taliban was implicated in 40 of 101 events utilizing a mixture of agents, including unknown chemical gases (likely representing trials of a number of different chemicals), contamination of water sources with pesticides, and the use of corrosive acid. The largest death toll from a single event (200 fatalities) was attributed to a cult-related mass murder in the Kasese District of Uganda in March 2000. East Asia sustained the highest NFI toll of 7,007 as a result of chemical attacks; 5,500 were attributed to the Tokyo subway sarin gas attack of 1995 by Aum Shinrikyo. Conclusion: The use of CWAs remains a concern given the rising rate of terrorist events. First responders and healthcare workers should be aware of potential chemical hazards that have been used regionally and globally and should train and prepare to respond appropriately.
Keywords: chemical warfare agents; terrorist attacks; counter-terrorism medicine
Koo AY, Rodgers DK, Johnson KA, Gordon LL, Mease LE, Couperus KS. 21(3). 60 - 65. (Journal Article)
Abstract
Objectives: Lab companies developed serology tests for antibody detection of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) with United States Food and Drug Administration (FDA) emergency use authorization. Antibody detection uses purified proteins of SARS-CoV-2 to determine antibody binding via enzyme-linked immunosorbent assay, chemiluminescent immunoassay (CLIA), or colloidal gold-based immunochromatographic assay. With the advent of coronavirus disease 2019 (COVID-19), nucleic acid amplification technology (NAAT) SARS-CoV-2 testing for active infection was not widely available to healthy, active-duty Soldiers. The purpose of this surveillance survey was to determine the prevalence of prior SARS-CoV-2 infection and symptoms of COVID-19 within a mechanized infantry brigade. Materials and Methods: Active-duty military Servicemembers (= 18 years) from a mechanized infantry brigade provided serum samples for testing for the Elecsys® Anti-SARS-CoV-2 qualitative antibody test from June to September 2020 at Joint Base Lewis McChord (JBLM). In addition, participants filled out a questionnaire for symptoms and exposure to COVID-19 from January to September 2020. The surveillance team collected and analyzed antibody testing results and questionnaires from participants for antibody positivity rates and symptom prevalence. Results: A total of 264 participants were tested, with one (0.4%) participant testing positive for the SARS-CoV-2 antibody. On the questionnaire, 144 of 264 (54.5%) endorsed symptoms of COVID-19 from January to September 2020. The most common symptoms were headache (35%), rhinorrhea (34%), cough (35%), and sore throat (31%). A total of 31 respondents (12%) had been quarantined as a trace contact to a COVID-19 positive patient. Conclusions: While there are limitations inherent to SARS-CoV-2 antibody testing and the survey, prevalence of prior SARS-CoV-2 infection is low. In this sample, symptoms for COVID-19 were prevalent with significant days of duty lost. Prevalence of prior SARS-CoV-2 infection in this sample may be generalizable to the larger brigade. Prevalence of symptoms of possible COVID-19 are not generalizable to the larger brigade. There is utility to further studies of SARS-CoV-2 antibody prevalence in military populations for purposes of vaccination triaging and deployment readiness.
Keywords: COVID-19; SARS-CoV-2; antibody; Army Infantry Brigade; vaccines; vaccination; prevalence