Just a Brief Article found here.

http://www.health.state.mo.us/MoEpi/MOEPI215.html#bioterrorism

Notice that our gov has seen fit to not prepare for this eventuallity by stockpiling appropriate vacines or antibiotics.

LM

Bioterrorism: A Public Health Issue

Reprinted with permission from the Disease Control Bulletin, Volume 1, Issue 4, 1999 published by the Vermont Department of Health.

Biological warfare has existed for centuries. Examples include the Mongols catapulting plague-infested bodies into Caffa to break a siege in 1346 and in 1763, blankets used by smallpox victims being given to American Indians at Fort Pitt. During World War II and the "Cold War" era, many nations, including the United States, had active biological weapons research programs, and there is evidence of some limited biological weapons use during that war.

A 1972 international agreement to ban biological w eapons was ratified by 140 nations, but included no verification mechanism. Evidence supports violation of this treaty. In 1979 an accidental release of anthrax in Sverdlovsk, Russia, occurred from a secret bioweapons plant. At least 66 people working or living downwind from the facility died of pulmonary anthrax. In 1992, Russian president Boris Yeltsin admitted that the Soviets had an active biological weapons program until that year. Currently at least 17 nations are believed to have offensive biologic al weapons programs.1

Bioterrorism-the use of biological agents to intentionally produce disease in susceptible populations to meet terrorist aims-has become an increasing concern throughout the world, including the United States. Information on how to construct chemical or biological weapons is available on the Internet. While still requiring a high level of expertise and financial resources, advances in biotechnology have made the production and dissemination of pathogenic organisms or chemical toxins a real possibility.

For example, Aum Shinrikyo, a Japanese cult, is known for having released sarin gas in a Tokyo subway in 1995. Over 5,500 people sought medical treatment; 20 percent were hospitalized and 12 people died. The cult was found to have facilities producing bot h chemical and biological weapons, and had attempted the release of botulinum toxin and anthrax spores without success.

No one can say for sure how likely it is that a bioterrorist attack will occur in the United States in the next several years, though some believe it is a significant threat, particularly related to concerns regarding doomsday cult reactions to the mil lennium.

There is agreement, however, that it is essential for the government, public health community, and medical profession to be prepared for this type of health emergency, just as it is necessary to be prepared for natural disasters. It is tempting to believe that Vermont [insert your state here] is not at any risk for being the target of such an attack. However, it is not possible to be sure that an event will not happen here. An attack could be focused at a site considered less well prepared to respond. In addition, Vermont could be affected by an event occurring in New York City, Boston, or even distant parts of the country.

Bioterrorism preparedness also includes the ability to respond appropriately to threats such as anthrax hoaxes. Nationally, anthrax threats increased dramatically after publicity of the arrest in February, 1998 of a white supremacist who had threatened to release anthrax in Las Vegas.2 Vermont was among states experiencing anthrax hoaxes this year.

Early detection of a bioterrorist attack is crucial. Some agents cause diseases that could have relatively short incubation periods, and have high mortality rates when proper treatment is not initiated early in the course of infection. Morbidity and mo rtality can be greatly reduced by early identification, prophylaxis of those exposed, and appropriate early treatment of the infected. For agents that can be transmitted from person-to-person, it is obviously even more crucial to identify the disease early. To detect unusual illnesses caused by intentionally

released agents, a high index of suspicion must be maintained, and suspicious illnesses should be reported before they are confirmed. This may enable the Health Department to detect trends in what appears at first to be sporadic disease.

The initial detection of an unannounced bioterrorist attack would rely on both the diagnostic capabilities of physicians and other health care providers, and the ability of public health surveillance to detect unusual patterns of disease. The following situations could suggest a bioterrorism event, and should be reported to the Health Department:

1.Single, definitively diagnosed or strongly suspected case of illness due to a potential bioterrorist agent occurring in a patient with no known risk factor. 2.Cluster of patients presenting with a similar syndrome that includes unusual disease characteristics or unusually high morbidity or mortality without an obvious etiology. 3.Unexplained increase in a common syndrome above seasonally expected levels.

The CDC has listed several potential agents of particular concern, including Bacillus anthracis (anthrax), smallpox virus, Yersinia pestis (plague), Clostridium botulinum toxin, and Francisella tularensis (tularemia). Identification of these agents would be difficult because they are not expected, many have non-specific presenting symptoms, and health care providers are not familiar with them. The clinical features of anthrax and smallpox, two agents most frequently mentione d as possible bioterrorism agents, are described below. The information below is from the U.S. Army Medical Research Institute of Infectious Diseases3, and two recently published consensus statements.4-5

Anthrax: Bacillus anthracis is a rod-shaped, gram-positive sporulating organism; the spores are the usual infective form. While primarily a zoonotic disease, human illness can occur in people working with animals or animal products. While anthrax can occur in cutaneous or gastrointestinal forms, inhalational anthrax is the chief bioterrorism concern.

After an incubation period averaging one to six days, inhalational anthrax presents as fever, malaise, fatigue, cough, mild chest discomfort and possibly vomiting or abdominal pain. This stage lasts for hours or days. In untreated patients, there may or may not be a brief period of improvement; the patient then abruptly develops severe respiratory distress with dyspnea, diaphoresis, stridor, and cyanosis. Shock and death occur within 24-36 hours after onset of severe symptoms. Physical findings are initially nonspecific; as disease progresses, the chest x-ray may reveal a widened mediastinum with or without pleural effusions. Bacillus anthracis can be detected by Gram stain of blood and by blood culture, but often not until late in the course of illness.

Treatment with antibiotics early in the course of symptoms is crucial; once patients have developed significant symptoms, the mortality rate is high. Most naturally occurring strains of anthrax are sensitive to penicillin, however, the possibility of a penicillin-resistant strain must be considered. A recently published consensus statement "Anthrax as a Biological Weapon: Medical and Public Health Management"4, recommends ciprofloxacin for treatment or prophylaxis of exposed adults and child ren until susceptibility to penicillin is confirmed. Anthrax is not transmitted person-to-person. Prophylaxis for those exposed to aerosolized anthrax would require a 60 day antibiotic regimen, though shorter duration may be recommended if anthrax vaccine is used in conjunction with antibiotic. For individuals involved in an incident with threatened exposure to anthrax, personal decontamination is rarely if ever needed unless the individual has had direct contact with the substance alleged to be anthrax.

Smallpox: Smallpox was declared eradicated by the World Health Organization in 1980. Two repositories were approved to hold the remaining variola virus. These two reference laboratories are the Centers for Disease Control and Prevention (CDC) in Atlanta and a laboratory in Moscow. However, during the past several years allegations have been made that smallpox virus was weaponized in the Soviet Union, and there is concern that virus stores may have been moved to additional sites. Routine vaccinat ion for smallpox in the United States was discontinued among civilians in 1972. The immune status of individuals vaccinated before that time is not certain, but immunity is believed to decline substantially within 10 years of vaccination. Thus, worldwide there is high susceptibility to this infection.5

Smallpox is caused by variola virus, which is an Orthopox virus. Transmission is person to person by respiratory discharges (droplet nuclei or aerosols), by direct contact with skin lesions, or contact with contaminated bedding or clothing. The incubation period averages 12-14 days (range 7-17 days). Individuals are not infectious until onset of rash.

Smallpox infection begins with abrupt onset of fever, malaise, rigors, vomiting, headache and backache. During this stage of illness about 10 percent of lighter-skinned patients have an erythematous rash. Lesions appear two to three days later. As oppo sed to chickenpox, smallpox lesions are more numerous on the face and extremities, occur on the palm, and develop synchronously. Mortality is approximately 30 percent; death is thought to occur from toxemia associated with circulating immune complexes and soluble variola antigens.5 Two other clinical presentations, hemorrhagic-type smallpox and flat-type or malignant smallpox, occur in approximately 10 percent of cases and have a high mortality rate. Laboratory confirmation of infection would b e essential and would need to be performed at the CDC's biosafety level 4 laboratory.

There is currently no chemotheraputic agent known to be effective in the treatment of smallpox; only supportive care could be provided. Potential antiviral agents are undergoing investigation. Prophylaxis for individuals known to be exposed would be va ccination, which should provide some level of protection if given within four days of exposure. The supply of stockpiled vaccine in the United States is limited and estimated to be sufficient for vaccinating six to seven million people.5 Serious complications can occur in vaccinated individuals, requiring the use of vaccinia immune globulin (VIG). Availability of VIG is also extremely limited. Both smallpox vaccine and VIG would only be made available by the CDC through state health departments .

Conclusion

The intentional release of a biologic agent would be a public health emergency. Early detection would be essential to minimizing the impact of such an event. Clinical suspicion and prompt reporting by physicians and other health care providers of any u nusual disease clusters or manifestations to the Health Department is key to the early recognition of both natural outbreaks and bioterrorist events.

REFERENCES:

1.Cole LA. The specter of biological weapons. Sci Am 1996:60-65. 2.Tucker JB. Historical trends related to bioterrorism: an empirical analysis. Emerg Infect Dis 1999;5:498-504. 3.US Army Medical Research Institute of Infectious Diseases. Medical Management of Biological Casualties. 3rd ed. Fort Detrick, Frederick Md. US Army Medical Research Institute of Infectious Diseases. 1998. 4.Inglesby TV, Henderson DA, Bartlett JG et al. Anthrax as a biological weapon: medical and public health management: consensus statement. JAMA 1999;281:1735-45. 5.Henderson DA, Inglesby TV, Bartlett JG, et al. Smallpox as a biological weapon: medical and public health management: consensus statement. JAMA 1999:281:2127-37.

-- LM (latemarch@usa.net), December 09, 1999

Answers

Hmmmmm...

The wife M.D. was recently reading an article on Anthrax in one of her journals.

Hmmmmm...

-- nothere nothere (notherethere@hotmail.com), December 09, 1999.

Dear LM,

After a LONG talk with the chief Flight Surgeon of the local FBI SWAT team, I'd like to point out that there really is no way to "stockpile the apropriate drugs" in any meaningful way.

First, one doesn't know WHERE to put the stockpile(s).

Second, the pharmaceutical industry hasn't been able to produce the extremely large quantity of doses one would need to do the stockpile, and still handle the normal flow of these drugs.

Third, it is IMPOSSIBLE to stockpile for all of the LIKELY bioterrorist strains or diseases. Not to mention the POSSIBLE ones.

So we live with a FOF approach and HOPE that there are enough doses available around the country that can be gathered and provided to the needed area(s) if needed.

Chuck, who wishes the answer were different.

-- Chuck, a night driver (rienzoo@en.com), December 09, 1999.

My husband and I were vaccinated for smallpox when we were children.When was the practice discontinued in this country? Is the vaccination effective for our lifetime?I suppose children and young adults are in the greatest danger of contracting this disease.

-- Alice (Alice@hotmail.com), December 09, 1999.

Chuck,

Of course they couldn't stockpile for all the possible agents but there was no attempt to even try to establish contingency plans for 2 of the likely agents, anthrax and small pox. This is not news, this has been a likely scenario for years.

No one willing to take the heat for beginning production of vaccine for smallpox, because after all "it's been eradicated" and the soviets wouldn't be making weapons in violation of a treaty now would they?

Alice,

Good for about 10 years. The last of the routine vacc. 1972 good luck.

-- LM (latemarch@usa.net), December 09, 1999.

A very important warning:

Two important releases from Clark Staten of ERRI. A new warning against anti-US/UN terrorism. (stay alert in Seattle.), interview w/ ex sov biowar scientist.

-- Lewis (aslanshow@yahoo.com), December 09, 1999.

Did anyone see this little dig in the article? Just another Y2K cult thing.

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No one can say for sure how likely it is that a bioterrorist attack will occur in the United States in the next several years, though some believe it is a significant threat, particularly related to concerns regarding doomsday cult reactions to the millennium.

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-- LM (latemarch@usa.net), December 09, 1999.

According to the CDC, those of us who were vaccinated for smallpox as children would still have partial immunity. We can still get the disease, but the infection would be less severe and should be survivable.

-- Sam Mcgee (weisacre@gwtc.net), December 09, 1999.

"Hope is an expensive commodity"...C.J. Peters, Special Pathogens Group, CDC

Based on my research (pretty extensive) there is no reason to believe that an outdated innoculation will have any protective effect...none at all. D.A. Handerson at CDC feels that the world basically has no resistance to smallpox anymore and if anyone would know he would (being the person that direct the WHO eradication program that succeeded in 1974 and the director of the Johns Hopkins Center for Civilian BioDefense Studies). Then too were we dealing with some weaponized bioagent vaccines or antibiotics may have no effect, courtesy of a little gene splicing. Damn...

The best advice on this is "Don't be There"....DCK

-- Don Kulha (dkulha@vom.com), December 09, 1999.