Pandemics are large-scale outbreaks of infectious disease that can greatly increase morbidity and mortality over a wide geographic area and cause significant economic, social, and political disruption. Evidence suggests that the likelihood of pandemics has increased over the past century because of increased global travel and integration, urbanization, changes in land use, and greater exploitation of the natural environment (Jones and others 2008; Morse 1995). These trends likely will continue and will intensify. Significant policy attention has focused on the need to identify and limit emerging outbreaks that might lead to pandemics and to expand and sustain investment to build preparedness and health capacity (Smolinsky, Hamburg, and Lederberg 2003). The international community has made progress toward preparing for and mitigating the impacts of pandemics. The 2003 severe acute respiratory syndrome (SARS) pandemic and growing concerns about the threat posed by avian influenza led many countries to devise pandemic plans (U.S. Department of Health and Human Services 2005). Delayed reporting of early SARS cases also led the World Health Assembly to update the International Health Regulations (IHR) to compel all World Health Organization member states to meet specific standards for detecting, reporting on, and responding to outbreaks (WHO 2005). The framework put into place by the updated IHR contributed to a more coordinated global response during the 2009 influenza pandemic (Katz 2009). International donors also have begun to invest in improving preparedness through refined standards and funding for building health capacity (Wolicki and others 2016). Despite these improvements, significant gaps and challenges exist in global pandemic preparedness. Progress toward meeting the IHR has been uneven, and many countries have been unable to meet basic requirements for compliance (Fischer and Katz 2013; WHO 2014). Multiple outbreaks, notably the 2014 West Africa Ebola epidemic, have exposed gaps related to the timely detection of disease, availability of basic care, tracing of contacts, quarantine and isolation procedures, and preparedness outside the health sector, including global coordination and response mobilization (Moon and others 2015; Pathmanathan and others 2014). These gaps are especially evident in resource-limited settings and have posed challenges during relatively localized epidemics, with dire implications for what may happen during a full-fledged global pandemic. For the purposes of this chapter, an epidemic is defined as “the occurrence in a community or region of cases of an illness . . . clearly in excess of normal expectancy” (Porta 2014). A pandemic is defined as “an epidemic occurring over a very wide area, crossing international boundaries, and usually affecting a large number of people” (Porta 2014). Pandemics are, therefore, identified by their geographic scale rather than the severity of illness. For example, in contrast to annual seasonal influenza epidemics, pandemic influenza is defined as “when a new influenza virus emerges and spreads around the world, and most people do not have immunity” (WHO 2010). This chapter does not consider endemic diseases—those that are constantly present in particular localities or regions. Endemic diseases are far more common than pandemics and can have significant negative health and economic impacts, especially in low- and middle-income countries (LMICs) with weak health systems. Additionally, given the lack of historical data and extreme uncertainty regarding bioterrorism, this chapter does not specifically consider bioterrorism-related events, although bioterrorism could hypothetically lead to a pandemic. This chapter covers the following findings concerning the risks, impacts, and mitigation of pandemics as well as knowledge gaps:

It is well documented that long-standing focus on public health emergency preparedness medical countermeasures (MCMs) distribution and mass dispensing capabilities for mitigation of bioterrorism incidents and a lack of real-world opportunities to test national preparedness for large-scale emergencies has hindered development of a body of evidence-based practices in the United States. To encourage jurisdictions seeking innovative opportunities for continuous improvement, we describe instances when the MCM capabilities were used to address smaller-scale, more-frequent public health emergencies such as disease outbreaks, natural disasters, or routine influenza vaccination. We argue that small-scale events represent a critical opportunity that state, local, tribal, and territorial entities can utilize for greater gains in MCM operational readiness than through exercises or planned reviews. By using and evaluating MCM capabilities during a real response, jurisdictions can advance preparedness science and support the translation of research into practice, thereby increasing their capacity to scale up for larger, rarer, higher-consequence emergencies.

Hydroxyapatite nanoparticles (HAP-NPs) were rendered fluorescence by doping with Eu(III) ion. The resulting fluorescent NPs are shown to be viable probes for sensitive and selective determination of dipicolinic acid (DPA), a major constituent of bacterial spores as used in bioterrorism. It is found that the addition of DPA to solutions of such HAP-NPs result in an enhancement of fluorescence due to the coordination of DPA with the Eu(III) dopant. The assay allows DPA to be detected in the 0.1 to 40 μM concentration range and with a 77 nM detection limit. The assay was applied to the detection of spores of Bacillus subtilis. The attractive properties of the probe make it a promising candidate for used in rapid detection of pathogenic bacterial spores. Graphical abstract Fluorescent hydroxyapatite nanoparticles (HAP-NPs) are shown to be a viable probe for detection of dipicolinic acid, a major constituent of bacterial spores. The red asterisks represent the fluorescence intensity of the HAP-NPs.

It has been 11 years since the World Organisation for Animal Health (OIE) published a Scientific and Technical Review on bioterrorism, which was entitled 'Biological disasters of animal origin: The role and preparedness of veterinary and public health services'. Highlights of this issue included an overview and history of biological agent use, details of the threats that were prevalent at the time, a description of the available capabilities/tools to respond to such a threat, and a summary of the requirements/recommendations for ensuring preparedness to address the changing landscape over the next 20 years. Since the 2006 review, much in our world has changed. Although many of the same challenges related to biological agents remain, others have emerged. The world has experienced an increase in social unrest and war, and this has led to increased food insecurity and the displacement of entire populations of people from their homelands. We have witnessed an increase in the occurrence and severity of emerging pathogens (the Ebola virus outbreak in West Africa, 2014; the Zika virus outbreak in the Americas and Caribbean, 2015), an increase in antimicrobial resistance, and technological advances that have resulted in the ability to more easily produce a genetically engineered biological agent/weapon.

Animal diseases, including zoonoses, have the potential to negatively impact economies, the environment, society and public health. It is currently thought that over 60% of human diseases and over 80% of agents that can be used for bioterrorism are of animal origin. The emergence and spread of animal diseases, including zoonoses, is at an all-time high. This increase in disease emergence and spread is thought to be the result of an increase in intensive farming, global travel, human pressure on ecosystems and social unrest. As new diseases and/or strains emerge, they travel freely and do not respect political borders.

In spite of scientific progress, the world is still facing major biological threats. Not only are there epidemics caused by wildlife pathogens under natural conditions, there are also those caused accidently when researchers handle highly hazardous organisms stored in research laboratories, and those caused when countries use these organisms as biological weapons of war or when criminal groups use them for bioterrorism. Developing countries tend to be more vulnerable to such threats than developed countries owing to the poor resilience of their animal health systems, their advanced state of environmental degradation, their socio-economic fragility and their political instability. The occurrence of emerging and re-emerging diseases (avian influenza, Ebola virus disease) has caused deep concern around the world in recent years and has shown how important it is for countries to strengthen the organisation of their Veterinary Services. The Republic of Haiti is one of the developing countries with the most acute biophysical vulnerability. Over the years, it has experienced a large number of earthquakes, hurricanes, floods, droughts and epidemics that have further weakened a country with already scarce financial resources. However, Haiti is endeavouring to address biological threats by modernising its Veterinary Services and by implementing the animal health standards and guidelines of the World Organisation for Animal Health (OIE) for establishing resilient animal health systems.

Francisella tularensis is a gram-negative organism found in many regions of the world. F. tularensis can cause a fatal, febrile illness, although these natural tularemia infections are rare in the United States. However, the development of F. tularensis as a potential weapon of bioterrorism during the Cold War spurred the development of a live attenuated vaccine, LVS, from F. tularensis subsp. holarctica in the 1960s. Two colony morphology variants, LVS-G and LVS-R, were generated from parental LVS by plate passage and by acridine orange mutagenesis, respectively. In vaccinated mice, LVS-G and LVS-R exhibit altered immunogenicity and protective capacities. While the exact nature of the mutations in these strains was unknown, previous studies indicated that both had altered lipopolysaccharide structures. To better understand the impact of these mutations on LVS' immunogenicity, we sequenced the genomes of LVS-G and LVS-R as well as our parental laboratory stock of LVS, originally obtained from ATCC, and compared these to the F. tularensis subsp. holarctica LVS genome currently deposited in GenBank. The results indicate that the genomic sequence of ATCC LVS is nearly identical to that of the human LVS vaccine. Furthermore, a limited number of genomic mutations likely account for the phenotypes of LVS-G and LVS-R.

We report detection and full-genome characterization of a novel orthopoxvirus (OPXV) responsible for a fatal infection in a cat. The virus induced skin lesions histologically characterized by leukocyte infiltration and eosinophilic cytoplasmic inclusions. Different PCR approaches were unable to assign the virus to a defined OPXV species. Large amounts of typical brick-shaped virions, morphologically related to OPXV, were observed by electron microscopy. This OPXV strain (Italy_09/17) was isolated on cell cultures and embryonated eggs. Phylogenetic analysis of 9 concatenated genes showed that this virus was distantly related to cowpox virus, more closely related to to ectromelia virus, and belonged to the same cluster of an OPXV recently isolated from captive macaques in Italy. Extensive epidemiologic surveillance in cats and rodents will assess whether cats are incidental hosts and rodents are the main reservoir of the virus. The zoonotic potential of this novel virus also deserves further investigation.

Preparedness for bioterrorist attacks and early recognition of specific agents are essential for public health. Emergency departments may play an important role in this field. The large spectrum of bioterrorism involves not only disastrous terrorism with mass casualties, but also microevents using low technology but producing civil unrest, disruption, disease, disabilities, and death. It aims not only to cause mortality and morbidity, but also to lead to social and political disruption. Preparedness appears to be the most potent defense against possible bioterrorist events. In this article, we aim to create awareness against biological agents and underline the importance of emergency departments in this public health problem.

Variola virus is at risk of re-emergence either through accidental release, bioterrorism or synthetic biology. The use of phylogenetics and phylogeography to support epidemic field response is expected to grow as sequencing technology becomes miniaturised, cheap and ubiquitous. In this study, we aimed to explore the use of common VARV diagnostic targets hemagglutinin (HA), cytokine response modifier B (CrmB) and A-type inclusion protein (ATI) for phylogenetic characterisation as well as the representativeness of modelling strategies in phylogeography to support epidemic response should smallpox re-emerge. We used Bayesian discrete-trait phylogeography using the most complete dataset currently available of whole genome (n = 51) and partially sequenced (n = 20) VARV isolates. We show that multi-locus models combining HA, ATI and CrmB genes may represent a useful heuristic to differentiate between VARV Major and subclades of VARV Minor which have been associated with variable case-fatality rates (CFR). Where whole genome sequencing is unavailable, phylogeography models of HA, ATI and CrmB may provide preliminary but uncertain estimates of transmission, while supplementing whole genome models with additional isolates sequenced only for HA can improve sample representativeness, maintaining similar support for transmission relative to whole genome models. We have also provided empirical evidence delineating historic international VARV transmission using phylogeography. Due to the persistent threat of re-emergence, our results provide important research for smallpox epidemic preparedness in the post-eradication era as recommended by the World Health Organisation (WHO).