Bioterrorism Agents
Table of Contents
General
Hemorrhagic
Fever Viruses as Biological Weapons
Weapons
disseminating a number of HFVs could cause an outbreak of an
undifferentiated febrile illness 2 to 21 days later, associated with
clinical manifestations that could include rash, hemorrhagic diathesis,
and shock. The mode of transmission and clinical course would vary
depending on the specific pathogen. Diagnosis may be delayed given
clinicians' unfamiliarity with these diseases, heterogeneous clinical
presentation within an infected cohort, and lack of widely available
diagnostic tests. Initiation of ribavirin therapy in the early phases of
illness may be useful in treatment of some of these viruses, although
extensive experience is lacking. There are no licensed vaccines to treat
the diseases caused by HFVs. JAMA 2002;287:2391-2405.
Bioterrorism
Agent Information
Individual professionals, APIC chapters, regional task forces of
multidisciplinary participants, and other interested parties have
contributed these bioterrorism agent fact sheets to the APIC
Bioterrorism Working Group. Numerous agents are discussed, with intended
audiences including healthcare providers, patients, visitors, families,
the public, as well as many also being appropriate for various media.
One group of fact sheets is written in English and translated into
Spanish!
Potential
Biological Weapons Threats
The list of agents that could pose the greatest public health risk in
the event of a bioterrorist attack is short. However, although short,
the list includes agents that, if acquired and properly disseminated,
could cause a difficult public health challenge in terms of our ability
to limit the numbers of casualties and control the damage to our cities
and nation. Emerging Infectious Diseases, CDC 1999;5(4);253-527.
Agents: Anthrax
Anthrax as a
Biological Weapon, 2002: Updated Recommendations for
Management
This
revised consensus statement presents new information based on the
analysis of the anthrax attacks of 2001, including developments in the
investigation of the anthrax attacks of 2001; important symptoms, signs,
and laboratory studies; new diagnostic clues that may help future
recognition of this disease; current anthrax vaccine information;
updated antibiotic therapeutic considerations; and judgments about
environmental surveillance and decontamination. JAMA 2002;287:2236-2252.
Anthrax as a
Biological Weapon
This report contains specific consensus recommendations regarding the
diagnosis of anthrax, indications for vaccination, therapy for those
exposed, postexposure prophylaxis, decontamination of the environment,
and additional research needs. JAMA 1999;281:1735-1745.
Anthrax: Case
Details Plus Diagnostic and Public Health Management
Information
On October 4, 2001,
the Florida Department of Health and the U.S. Department of Health and
Human Services announced that a 63-year-old male hospitalized in
Floridawas diagnosed with
anthrax, with evidence of mediastinal and central nervous system
involvement. The diagnosis was confirmed by the Centers for Disease
Control and Prevention (CDC), by several different laboratory
methodologies, including polymerase chain reaction testing of blood and
cerebrospinal fluid. Antibiotic susceptibilities are pending and should
be available later today.
Read this alert from the New York City Department of Health for
complete information about the case. The alert also offers valuable
advice for handling public concerns regarding bioterrorism, provides
information on clinical recognition and management of suspected
bioterrorist events and reviews key clinical points on inhalational
anthrax.
Clinical and
Epidemiologic Principles of Anthrax
Anthrax is one of the great infectious diseases of antiquity. The fifth
and sixth plagues in the Bible's book of Exodus may have been outbreaks
of anthrax in cattle and humans, respectively. The "Black Bane," a
disease that swept through Europein the 1600s
causing large numbers of human and animal deaths, was likely anthrax. In
1876, anthrax became the first disease to fulfill Koch's postulates
(i.e., the first disease for which a microbial etiology was firmly
established), and 5 years later, in 1881, the first bacterial disease
for which immunization was available. Large anthrax outbreaks in humans
have occurred throughout the modern era—more than 6,000 (mostly
cutaneous) cases occurred in
Zimbabwebetween
October 1979 and March 1980, and 25 cutaneous cases occurred in
Paraguayin
1987 after the slaughter of a single infected cow. Emerging Infectious
Diseases, CDC 1999;5(4):552-555.
Agents: Botulinum Toxin
Botulinum
Toxin as a Biological Weapon
An aerosolized or foodborne botulinum toxin weapon would cause acute
symmetric, descending flaccid paralysis with prominent bulbar palsies
such as diplopia, dysarthria, dysphonia, and dysphagia that would
typically present 12 to 72 hours after exposure. Effective response to a
deliberate release of botulinum toxin will depend on timely clinical
diagnosis, case reporting, and epidemiological investigation. Persons
potentially exposed to botulinum toxin should be closely observed, and
those with signs of botulism require prompt treatment with antitoxin and
supportive care that may include assisted ventilation for weeks or
months. Treatment with antitoxin should not be delayed for
microbiological testing. JAMA 2001;285:1059-1070.
Agents: Foodborne
The Bad Bug Book: Foodborne
Pathogenic Microorganisms and Natural Toxins
Handbook
This handbook from the US Food & Drug
Administration, Center for Food Safety & Applied Nutrition provides
basic facts regarding foodborne pathogenic microorganisms and natural
toxins. It brings together in one place information from the Food &
Drug Administration, the Centers for Disease Control & Prevention,
the USDA Food Safety Inspection Service, and the National Institutes of
Health. January 1992.
Agents: Plague
Plague as a
Biological Weapon
An aerosolized plague weapon could cause fever, cough, chest pain, and
hemoptysis with signs consistent with severe pneumonia 1 to 6 days after
exposure. Rapid evolution of disease would occur in the 2 to 4 days
after symptom onset and would lead to septic shock with high mortality
without early treatment. Early treatment and prophylaxis with
streptomycin or gentamicin or the tetracycline or fluoroquinolone
classes of antimicrobials would be advised. JAMA
2000;283:2281-2290.
Agents: Smallpox
Smallpox
as a Biological Weapon
In the event of an actual release of smallpox and subsequent epidemic,
early detection, isolation of infected individuals, surveillance of
contacts, and a focused selective vaccination program will be the
essential items of an effective control program. These consensus-based
recommendations for measures to be taken by medical and public health
professionals following the use of smallpox as a biological weapon
against a civilian population are available on-line. Specific
recommendations are made regarding smallpox vaccination, therapy,
postexposure isolation and infection control, hospital epidemiology and
infection control, home care, decontamination of the environment, and
additional research needs. JAMA 1999;281:2127-2137.
Smallpox:
Clinical and Epidemiologic Features
Smallpox is a viral disease unique to humans. To sustain itself, the
virus must pass from person to person in a continuing chain of infection
and is spread by inhalation of air droplets or aerosols. Twelve to 14
days after infection, the patient typically becomes febrile and has
severe aching pains and prostration. Some 2 to 3 days later, a papular
rash develops over the face and spreads to the extremities (Figure 1).
The rash soon becomes vesicular and later, pustular (Figure 2). The
patient remains febrile throughout the evolution of the rash and
customarily experiences considerable pain as the pustules grow and
expand. Gradually, scabs form, which eventually separate, leaving pitted
scars. Death usually occurs during the second week. Emerging Infectious
Diseases, CDC 1999;5(4):537-539.
Smallpox:
An Attack Scenario
Smallpox virus, which is among the most dangerous organisms that might
be used by bioterrorists, is not widely available. The international
black market trade in weapons of mass destruction is probably the only
means of acquiring the virus. Thus, only a terrorist supported by the
resources of a rogue state would be able to procure and deploy smallpox.
An attack using the virus would involve relatively sophisticated
strategies and would deliberately seek to sow public panic, disrupt and
discredit official institutions, and shake public confidence in
government. Emerging Infectious diseases, CDC 1999;5(4):540-546.
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