Appendix K
Glossary and Acronyms

GLOSSARY

This glossary is intended to define terms encountered throughout this report as well as some terms that are commonly used in the public health arena. This glossary is not all-inclusive. New terms and new usages of existing terms will emerge with time and with advances in technology. The definitions for the terms presented here were compiled from a multitude of sources.


Antibiotic:

Class of substances or chemicals that can kill or inhibit the growth of bacteria. Originally antibiotics were derived from natural sources (e.g., penicillin was derived from molds), but many currently used antibiotics are semisynthetic and are modified by the addition of artificial chemical components.

Antibiotic resistance:

Property of bacteria that confers the capacity to inactivate or exclude antibiotics or a mechanism that blocks the inhibitory or killing effects of antibiotics.

Antimicrobial agents:

Class of substances that can destroy or inhibit the growth of pathogenic groups of microorganisms, including bacteria, viruses, parasites, and fungi.

Antiphagocytic:

Counteracting or opposing phagocytosis, the process by which a cell engulfs particles such as bacteria, aged red blood cells, or foreign matter.

ALT (alanine aminotransferase):

An enzyme normally present in liver and heart cells that is released into the bloodstream when the liver or heart is damaged.

AST (aspartate aminotransferase):

An enzyme normally present in liver and heart cells that is released into blood when the liver or heart is damaged.



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Biological Threats and Terrorism: Assessing the Science and Response Capabilities - Workshop Summary Appendix K Glossary and Acronyms GLOSSARY This glossary is intended to define terms encountered throughout this report as well as some terms that are commonly used in the public health arena. This glossary is not all-inclusive. New terms and new usages of existing terms will emerge with time and with advances in technology. The definitions for the terms presented here were compiled from a multitude of sources. Antibiotic: Class of substances or chemicals that can kill or inhibit the growth of bacteria. Originally antibiotics were derived from natural sources (e.g., penicillin was derived from molds), but many currently used antibiotics are semisynthetic and are modified by the addition of artificial chemical components. Antibiotic resistance: Property of bacteria that confers the capacity to inactivate or exclude antibiotics or a mechanism that blocks the inhibitory or killing effects of antibiotics. Antimicrobial agents: Class of substances that can destroy or inhibit the growth of pathogenic groups of microorganisms, including bacteria, viruses, parasites, and fungi. Antiphagocytic: Counteracting or opposing phagocytosis, the process by which a cell engulfs particles such as bacteria, aged red blood cells, or foreign matter. ALT (alanine aminotransferase): An enzyme normally present in liver and heart cells that is released into the bloodstream when the liver or heart is damaged. AST (aspartate aminotransferase): An enzyme normally present in liver and heart cells that is released into blood when the liver or heart is damaged.

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Biological Threats and Terrorism: Assessing the Science and Response Capabilities - Workshop Summary ATR (anthrax toxin receptor): A type I membrane protein with an extracellular Von Willebrand factor A domain that binds directly to PA. Attenuated: To reduce the severity of (a disease) or virulence or vitality of a pathogenic agent. Bacteremia: The presence of bacteria in the bloodstream. Bacteria: Microscopic, single-celled organisms that have some biochemical and structural features different from those of animal and plant cells. Basic research: Fundamental, theoretical, or experimental investigation to advance scientific knowledge, with immediate practical application not being a direct objective. Benchmark: For a particular indicator or performance goal, the industry measure of best performance. The benchmarking process identifies the best performance in the industry (health care or non-health care) for a particular process or outcome, determines how that performance is achieved, and applies the lessons learned to improve performance. Benign prostatic hypertrophy: Nonmalignant (noncancerous) enlargement of the prostate gland, a common occurrence in older men. Blepharospasm: Tonic spasm of the orbicularis oculi muscle, producing more or less complete closure of the eyelids. Broad-spectrum antibiotic: An antibiotic effective against a large number of bacterial species. It generally describes antibiotics effective against both gram-positive and gram-negative classes of bacteria. BSL (biosafety level): Specific combinations of work practices, safety equipment, and facilities designed to minimize the exposure of workers and the environment to infectious agents. Biosafety level 1 applies to agents that do not ordinarily cause human disease. Biosafety level 2 is appropriate for agents that can cause human disease, but whose potential for transmission is limited. Biosafety level 3 applies to agents that may be transmitted by the respiratory route, which can cause serious infection. Biosafety level 4 is used for the diagnosis of exotic agents that pose a high risk of life-threatening disease, which may be transmitted by the aerosol route and for which there is no vaccine or therapy. BT (bioterrorism): Terrorism using biological agents. Biological diseases and the agents that might be used for terrorism have been listed by the CDC and comprise viruses, bacteria, rickettsiae, fungi, and biological toxins. These agents have been classified according to the degree of danger each agent is felt to pose into one of three categories: A, B, and C (see definitions below). Category A Biological Disease: High-priority agents include organisms that pose a risk to national security because they can be easily disseminated or transmitted person-to-person, cause high mortality, with potential for major public health impact, might cause public panic and social disruption, and require

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Biological Threats and Terrorism: Assessing the Science and Response Capabilities - Workshop Summary special action for public health preparedness. These diseases include: anthrax, botulism, plague, smallpox, tularemia, and viral hemorrhagic fevers. Category B Biological Disease: Second-highest priority agents include those that are moderately easy to disseminate, cause moderate morbidity and low mortality, and require specific enhancements of CDC’s diagnostic capacity and enhanced disease surveillance. These agents/diseases include: Q fever, brucellosis, glanders, ricin toxin, epsilon toxin, and staph toxin. Category C Biological Disease: Third-highest priority agents include emerging pathogens that could be engineered for mass dissemination in the future because of availability, ease of production and dissemination, and potential for high morbidity and mortality and major health impact. These agents/diseases include Nipah virus, hantavirus, tickborne hemorrhagic fever viruses, tickborne encephalitis viruses, yellow fever, and tuberculosis. CBER (Center for Biologics Evaluation and Research): A center of the FDA which regulates biological products including blood, vaccines, therapeutics and related drugs, and devices according to statutory authorities. CDC (Centers for Disease Control and Prevention): A public health agency of the U.S. Department of Health and Human Services whose mission is to promote health and quality of life by preventing and controlling disease, injury, and disability. CDER (Center for Drug Evaluation and Research): A center of the FDA whose mission it is to promote and protect public health by assuring that safe and effective drugs are available to Americans. CDRH (Center for Devices and Radiological Health): A center of the FDA whose mission it is to provide reasonable assurance of the safety and effectiveness of medical devices and by eliminating unnecessary human exposure to radiation emitted from electronic products. Chimeric: Relating to, derived from, or being a genetic chimera or its genetic material. Clinical practice guidelines: Systematically developed statements that assist practitioners and patients with decision making about appropriate health care for specific clinical circumstances. Clinical research: Investigations aimed at translating basic, fundamental science into medical practice. Clinical trials: As used in this report, research with human volunteers to establish the safety and efficacy of a drug, such as an antibiotic or a vaccine. Clinicians: One qualified or engaged in the clinical practice of medicine, psychiatry, or psychology, as distinguished from one specializing in laboratory or research techniques in the same fields. CMV (cytomegalovirus): One of a group of highly host-specific herpesviruses that infect humans, monkeys, or rodents with the production of unique large cells bearing intranuclear inclusions. Cutaneous: Related to the skin.

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Biological Threats and Terrorism: Assessing the Science and Response Capabilities - Workshop Summary Cyanosis: The bluish color of the skin and the mucous membranes due to insufficient oxygen in the blood. Cyclic AMP: A very close structural relative of adenosine monophosphate (AMP) containing an additional ester linkage between the phosphate and ribose units. It can act as a secondary messenger for several hormones and also plays a role in the transcription of some genes. Cynomolgus monkeys: A macaque (Macaca fascicularis synonym M. cynomolgus) of southeastern Asia, Borneo, and The Philippines that is often used in medical research. Cytokines: A small protein released by cells that has a specific effect on the interactions between cells, on communications between cells, or on the behavior of cells. The cytokines includes the interleukins, lymphokines, and cell signal molecules, such as tumor necrosis factor and the interferons, which trigger inflammation and respond to infections. Cytosol: The liquid medium of the cytoplasm. Dark Winter: An exercise portraying a fictional scenario depicting a covert smallpox attack on U.S. citizens which was held at Andrews Air Force Base, near Washington, D.C., on June 22–23, 2001. DARPA (Defense Advanced Research Projects Agency): The DoD’s central research and development organization which manages and directs selected projects, and pursues research and technology where risk and payoff are both very high and where success may provide dramatic advances for traditional military roles and missions. DNIs (dominant negative inhibitors): Mutant forms of the protective antigen that block translocation of the virulence factors across the plasma membrane. DoD (Department of Defense): DoD trains and equips the armed forces through three military departments—the Army, Navy, and Air Force whose primary job is to train and equip their personnel to perform warfighting, peacekeeping, and humanitarian/disaster assistance tasks. Dyspnea: Difficult or labored breathing; shortness of breath. Dystonia: Involuntary movements and prolonged muscle contraction, resulting in twisting body motions, tremor, and abnormal posture. These movements may involve the entire body, or only an isolated area. EF (edema factor): One of two enzymes making up the anthrax toxin. After being cleaved by a protease, protective antigen (PA) binds to this toxic enzyme and mediates its transportation into the cytosol where it exerts its pathogenic effect. EIS (Epidemic Intelligence Service): A unique, two-year postgraduate program of service and on-the-job training for health professionals interested in the practice of epidemiology.

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Biological Threats and Terrorism: Assessing the Science and Response Capabilities - Workshop Summary ELISA (enzyme-linked immunosorbent assay): A rapid immunochemical test utilized to detect substances that have antigenic properties, primarily proteins. ELISA tests are generally highly sensitive and specific. Emerging infections: Any infectious disease that has come to medical attention within the last two decades or for which there is a threat that its prevalence will increase in the near future (IOM, 1992). Many times, such diseases exist in nature as zoonoses and emerge as human pathogens only when humans come into contact with a formerly isolated animal population, such as monkeys in a rain forest that are no longer isolated because of deforestation. Drug-resistant organisms could also be included as the cause of emerging infections since they exist because of human influence. Some recent examples of agents responsible for emerging infections include human immunodeficiency virus, Ebola virus, and multidrugresistant Mycobacterium tuberculosis. Endemic: Disease that is present in a community or common among a group of people; said of a disease continually prevailing in a region. Endocytosis: The uptake by a cell of particles that are too large to diffuse through its wall. Epi-X (Epidemic Information Exchange): A system developed by the CDC which enables federal, state, and local epidemiologists, laboratorians, and other members of the public health community to instantly notify colleagues and experts of urgent public health events, review information on outbreaks and unusual health events through an easily searchable database, and rapidly communicate with colleagues through e-mail, Internet, and telecommunications capabilities. Etiology: Science and study of the causes of diseases and their mode of operation. FDA (U.S. Food and Drug Administration): A public health agency of the U.S. Department of Health and Human Services charged with protecting American consumers by enforcing the Federal Food, Drug, and Cosmetic Act and several related health laws. FEMA (Federal Emergency Management Agency): An independent agency of the federal government founded in 1979. Its mission is to reduce loss of life and property and protect the nation’s critical infrastructure from all types of hazards through a comprehensive, risk-based, emergency management program of mitigation, preparedness, response, and recovery. Formulary: List of drugs approved for the treatment of various medical indications. It was originally created as a cost-control measure, but it has been used more recently to guide the use of antibiotics on the basis of information about resistance patterns. GEIS (Global Emerging Infections Surveillance and Response System): A system designed to strengthen the prevention of, surveillance of, and response to infectious diseases that are a threat to military personnel and families, reduce

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Biological Threats and Terrorism: Assessing the Science and Response Capabilities - Workshop Summary medical readiness, or present a risk to U.S. national security. Its purpose is to create a centralized coordination and communication hub to help organize DoD resources and link with U.S. and international efforts. Glycoprotein: A molecule that consists of a carbohydrate plus a protein. Gram-negative: Gram-negative bacteria lose the crystal violet stain (and take the color of the red counterstain) in Gram’s method of staining. Gram-positive: Gram-positive bacteria, such as anthrax, retain the color of the crystal violet stain in the Gram stain. This is characteristic of bacteria that have a cell wall composed of a thick layer of a particular substance (called peptidologlycan). HAN (Health Alert Network): A project of the CDC intended to ensure communications capacity at all local and state health departments, ensure capacity to receive distance learning offerings from CDC, and ensure capacity to broadcast and receive health alerts at every level. Hemolytic: Referring to hemolysis, the destruction of red blood cells which leads to the release of hemoglobin from within the red blood cells into the blood plasma. Hybridoma: A cell hybrid resulting from the fusion of a cancer cell and a normal lymphocyte (a type of white blood cell). Hypoxia: Low oxygen content or tension; deficiency of oxygen in the inspired air. Immunogenicity: The property that endows a substance with the capacity to provoke an immune response or the degree to which a substance possesses this property. Immunomodulator: A chemical agent (as methotrexate or azathioprine) that modifies the immune response or the functioning of the immune system (as by the stimulation of antibody formation or the inhibition of white blood cell activity). Incidence: The frequency of new occurrences of disease within a defined time interval. Incidence rate is the number of new cases of a specified disease divided by the number of people in a population over a specified period of time, usually one year. IND (Investigational New Drug) Application: An application submitted by a sponsor to the FDA prior to human testing of an unapproved drug or of a previously approved drug for an unapproved use. Infection: The invasion of the body or a part of the body by a pathogenic agent, such as a microorganism or virus. Under favorable conditions the agent develops or multiplies, the results of which may produce injurious effects. Infection should not be confused with disease. IPV (inactivated polio vaccine): A vaccine for polio given as a shot in the arm or leg. The polio virus in IPV has been inactivated (killed). Also called the Salk vaccine.

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Biological Threats and Terrorism: Assessing the Science and Response Capabilities - Workshop Summary LD50: The amount of a toxic agent that is sufficient to kill 50 percent of a population of animals usually within a certain time. Also called median lethal dose. Leukocytosis: Increase in the number of white blood cells. Level A Laboratory: Early detection of covert release. Primarily hospital laboratories with certified biological safety cabinet as a minimum biosafety requirement. These laboratories have the ability to rule out specific agents from clinical specimens and to forward organisms or specimens to higher-level laboratories. Level B Laboratory: Core Capacity. State and county public health agency laboratories with BSL-2 biosafety facilities but which incorporate BSL-3 practices and maintain the proficiency to adequately perform confirmatory testing and characterize drug susceptibility. These laboratories have the ability to rule in specific agents, perform environmental testing and to forward organisms or specimens to higher-level laboratories. BSL-3 facilities are recommended but not required. Level C Laboratory: Advanced Capacity. Rapid detection using nucleic acid amplification technology, molecular typing for comparison, and toxicity testing. Advanced capacity laboratories with BSL-3 facilities and proficiency sufficient to amplify, type, and perform toxicity testing. These laboratories will evaluate reagents and tests in order to facilitate transfer for use in Level B laboratories. Can conduct all tests performed in levels A and B laboratories. Level D Laboratory: Can conduct all tests performed in levels A, B, and C laboratories. In addition, can detect genetic recombinants and bank isolate, and possesses BSL-3 and BSL-4 bio-containment facilities. These are highly specialized Federal laboratories with unique experience, ability to develop new tests and methods, and capability to securely maintain a bank of biological and threat agents. LF (lethal factor): One of two enzymes making up the anthrax toxin. After being cleaved by a protease, protective antigen (PA) binds to this toxic enzyme and mediates its transportation into the cytosol where it exerts its pathogenic effect. Lethal factor is the crucial pathogenic enzyme and is the killer in the toxin. Listeria monocytogenes: A bacteria that can cause encephalitis, meningitis, blood-borne infection, and death. It is especially hazardous for pregnant women (posing a threat of miscarriage or stillbirth), newborn babies, the elderly, and immune-deficient patients. It causes about 28% of deaths due to food poisoning. Lymph adenitis: Inflammation of lymph nodes. Macrophages: A type of white blood cell that ingests foreign material. Macrophages are key players in the immune response to foreign invaders such as infectious microorganisms. MAD (mutual assured destruction): The ability to kill 25 percent of a country’s population and destroy 50 percent of its industry with nuclear weapons. The theory holds that countries would not strike with nuclear weapons if they knew their opponent could strike back and destroy them.

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Biological Threats and Terrorism: Assessing the Science and Response Capabilities - Workshop Summary Mediastinitis: Inflammation of the mediastinum, a median septum or partition. Monkeypox: A viral disease similar to smallpox still seen as a sporadic disease in parts of Central and West Africa. Monoclonal antibodies: Immunoglobulin molecules secreted from a population of identical cells (i.e., cloned cells). They are homogeneous in structure and binding specificity. Motile: Having spontaneous but not conscious or volitional movement. NCID (National Center for Infectious Diseases): Its mission is to prevent illness, disability, and death caused by infectious diseases in the United States and around the world. NCID conducts surveillance, epidemic investigations, epidemiological and laboratory research, training, and public education programs to develop, evaluate, and promote prevention and control strategies for infectious diseases. NDMS (National Disaster Medical System): Established in partnership with DOD, VA, FEMA, and the Public Health Service Commissioned Corps Readiness Force, a group of more than 7,000 volunteer health and support professionals who can be deployed anywhere in the country to assist communities in providing needed services to disaster victims. NEDSS (National Electronic Disease Surveillance System): A public health initiative to provide a standards-based, integrated approach to disease surveillance and to connect public health surveillance to the burgeoning clinical information systems infrastructure. NIAID (National Institute of Allergy and Infectious Diseases): A division of NIH that provides the major support for scientists conducting research aimed at developing better ways to diagnose, treat, and prevent the many infectious, immunological, and allergenic diseases that afflict people worldwide. NIH (National Institutes of Health): A public health agency of the U.S. Department of Health and Human Services whose goal is to acquire new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold. Nosocomial infection: An infection that is acquired during hospitalization but that was neither present nor incubating at the time of hospital admission, unless it is related to a prior hospitalization, and that may become clinically manifest after discharge from the hospital. NPS (National Pharmaceutical Stockpile) Program: Its mission is to ensure the availability and rapid deployment of life-saving pharmaceuticals, antidotes, other medical supplies, and equipment necessary to counter the effects of nerve agents, biological pathogens, and chemical agents. It stands ready for immediate deployment to any U.S. location in the event of a terrorist attack using a biological toxin or chemical agent directed against a civilian population.

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Biological Threats and Terrorism: Assessing the Science and Response Capabilities - Workshop Summary Office of Homeland Security: Established by the president in 2001, its mission is to develop and coordinate the implementation of a comprehensive national strategy to secure the United States from terrorist threats or attacks. It coordinates the executive branch’s efforts to detect, prepare for, prevent, protect against, respond to, and recover from terrorist attacks within the United States. OPHP (Office of Public Health Preparedness): A newly created office, within the Department of Health and Human Services, which will coordinate the national response to public health emergencies. OPV (oral polio vaccine): A vaccine for polio, given by mouth, and preferred for most children. PA (protective antigen): A protein of anthrax toxin which binds to surface receptors on the host’s cell membranes. PhRMA (Pharmaceutical Research and Manufacturers of America): An association representing leading research-based pharmaceutical and biotechnology companies, which are devoted to inventing medicines that allow patients to live longer, healthier, happier, and more productive lives. Plasmapheresis: A procedure in which the blood is filtered through a special machine to separate the plasma, the liquid portion of the blood, from the blood cells. Plasmids: A self-replicating (autonomous) circle of DNA distinct from the chromosomal genome of bacteria. A plasmid contains genes normally not essential for cell growth or survival. Some plasmids can integrate into the host genome, be artificially constructed in the laboratory, and serve as vectors (carriers) in cloning. Prions: A newly discovered type of disease-causing agent, neither bacterial nor fungal nor viral, and containing no genetic material. A prion is a protein that occurs normally in a harmless form. By folding into an aberrant shape, the normal prion turns into a rogue agent. It then co-opts other normal prions to become rogue prions.They have been held responsible for a number of degenerative brain diseases, including Mad Cow disease, Creutzfeldt Jakob disease, and possibly some cases of Alzheimer’s disease. Prophylactic antibiotics: Antibiotics that are administered before evidence of infection with the intention of warding off disease. Pulmonary edema: Fluid in the lungs. PulseNet: A national network of public health laboratories that perform DNA “fingerprinting” on bacteria that may be foodborne. The network permits rapid comparison of these “fingerprint” patterns through an electronic database at CDC. Push Packages: Caches of pharmaceuticals, antidotes, and medical supplies designed to address a variety of biological or chemical agents. They are positioned in secure regional warehouses ready for immediate deployment to the air-

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Biological Threats and Terrorism: Assessing the Science and Response Capabilities - Workshop Summary field closest to the affected area following a federal decision to release NPS assets. PVIs (polyvalent inhibitors): Chemically synthesized inhibitors that block toxin assembly. Salmonella: A group of bacteria that cause typhoid fever, food poisoning, and enteric fever from contaminated food products. Serotype: The kind of microorganism as characterized by serological typing (testing for recognizable antigens on the surface of the microorganism). Sporulate: To form spores. Strabismus: A condition in which the visual axes of the eyes are not parallel and the eyes appear to be looking in different directions. Stridor: A harsh, high-pitched respiratory sound such as the inspiratory sound often heard in acute laryngeal obstruction. Surveillance systems: Used in this report to refer to data collection and recordkeeping to track the emergence and spread of disease-causing organisms such as antibiotic-resistant bacteria. Tachycardia: A rapid heart rate, usually defined as greater than 100 beats per minute. TOPOFF: An exercise conducted by the Department of Justice which engaged key personnel in the management of mock chemical, biological, or cyberterrorist attacks. So named because it involved the participation of top officials of the U.S. government. Toxoplasma: A genus of sporozoa that are intracellular parasites of many organs and tissues of birds and mammals, including humans. USAMRIID (U.S. Army Medical Research Institute of Infectious Diseases): It is the lead medical research laboratory for the U.S. Biological Defense Research Program which conducts research to develop strategies, products, information, procedures, and training programs for medical defense against biological warfare threats and naturally occurring infectious diseases that require special containment. It is an organization of the U.S. Army Medical Research and Materiel Command (USAMRMC). VA (Department of Veterans Affairs): A cabinet-level department that has the care of veterans as its primary mission and is composed of three administrations: Veterans Health Administration, Veterans Benefit Administration, and National Cemetery Administration. Vaccine: A preparation of living, attenuated, or killed bacteria or viruses, fractions thereof, or synthesized or recombinant antigens identical or similar to those found in the disease-causing organisms, that is administered to raise immunity to a particular microorganism.

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Biological Threats and Terrorism: Assessing the Science and Response Capabilities - Workshop Summary VHF (viral hemorrhagic fevers): A group of illnesses that are caused by viruses of four distinct families: arenaviruses, filoviruses, Bunyaviruses, and flaviviruses. Virulence: The ability of any infectious agent to produce disease. The virulence of a microoganism (such as a bacterium or virus) is a measure of the severity of the disease it is capable of causing. Zoonotic disease or infection: An infection or infectious disease that may be transmitted from vertebrate animals (e.g., a rodent) to humans. ACRONYMS ASM: American Society for Microbiology AVA: Anthrax Vaccine Adsorbed AVIP: Anthrax Vaccine Immunization Program BW: biological warfare BWC: Biological Weapons Convention CFR: Code of Federal Regulations CSF: cerebral spinal fluid DIC: disseminated intravascular coagulation EMSHG: Emergency Management Strategic Healthcare Group ESSENCE: Electronic Surveillance System for the Early Notification of Community-Based Epidemics GIS: Geographic Information Systems GOCO: government-owned, contractor-operated ICS: Incident Command System JCAHO: Joint Commission on Accreditation of Healthcare Organizations JVAP: Joint Vaccine Acquisition Program LRN: Laboratory Response Network MAV: Multiagent Vaccines MBDRP: Medical Biological Defense Research Program NDA: New Drug Application NLS: National Laboratory System NVSL: National Veterinary Services Laboratory OTSG: Office of the Army Surgeon General PCR: polymerase chain reaction PFU: plaque forming units PHLS: Public Health Laboratory Service RHA: recombinant human antitoxin RSVP: Rapid Syndrome Validation Project TED: troop equivalent dose VADAR: Virtually Assured Detection and Response

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Biological Threats and Terrorism: Assessing the Science and Response Capabilities - Workshop Summary VEE: Viral Equine Encephalitis VHA: Veterans Health Administration VIG: vaccinia immune globulin