Biological Terrorism

A biological terrorism event could have a large impact on the general population and health care system. The impact of an infectious disaster will most likely be great to emergency departments, and the collaboration between emergency and infectious disease specialists will be critical in developing an effective response. A bioterrorism event is a disaster that requires specific preparations beyond the usual medical disaster planning. An effective response would include attention to infection control issues and plans for large-scale vaccination or antimicrobial prophylaxis. This article addresses some general issues related to preparing an effective response to a biological terrorism event. It will also review organisms and toxins that could be used in biological terrorism, including clinical features, management, diagnostic testing, and infection control.

[1]  D. Bravata,et al.  Anthrax: a systematic review of atypical presentations. , 2006, Annals of emergency medicine.

[2]  K. Chua,et al.  Treatment of acute Nipah encephalitis with ribavirin , 2001, Annals of neurology.

[3]  S. Belknap,et al.  Discriminating inhalational anthrax from community-acquired pneumonia using chest radiograph findings and a clinical algorithm. , 2007, Chest.

[4]  D. Talan,et al.  Tuberculosis infection-control practices in United States emergency departments. , 1995, Annals of emergency medicine.

[5]  M. McCarron,et al.  Castor bean intoxication. , 1990, Annals of emergency medicine.

[6]  David R Franz,et al.  Medical Aspects of Chemical and Biological Warfare , 1997 .

[7]  L. Rotz,et al.  Recommendations for using smallpox vaccine in a pre-event vaccination program. Supplemental recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Healthcare Infection Control Practices Advisory Committee (HICPAC). , 2003, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[8]  D A Henderson,et al.  Smallpox: clinical and epidemiologic features. , 1999, Medicine and health, Rhode Island.

[9]  N. Jewell,et al.  Human botulism immune globulin for the treatment of infant botulism. , 2006, The New England journal of medicine.

[10]  M. Hugh-jones,et al.  The Sverdlovsk anthrax outbreak of 1979. , 1994, Science.

[11]  M. Meltzer,et al.  The economic impact of a bioterrorist attack: are prevention and postattack intervention programs justifiable? , 1997, Emerging infectious diseases.

[12]  Philip K. Russell,et al.  Smallpox as a biological weapon: medical and public health management. Working Group on Civilian Biodefense. , 1999, JAMA.

[13]  A. Kaufmann,et al.  Principles for emergency response to bioterrorism. , 1999, Annals of emergency medicine.

[14]  D. Raoult,et al.  Epidemiologic features and clinical presentation of acute Q fever in hospitalized patients: 323 French cases. , 1992, The American journal of medicine.

[15]  D. Kyriacou,et al.  Emergency department sentinel surveillance for emerging infectious diseases. , 1995, Annals of emergency medicine.

[16]  Douglas K Owens,et al.  Systematic Review: A Century of Inhalational Anthrax Cases from 1900 to 2005 , 2006, Annals of Internal Medicine.

[17]  T. Monath Yellow fever: a medically neglected disease. Report on a seminar. , 1987, Reviews of infectious diseases.

[18]  J. Barbera,et al.  Weapons of mass destruction events with contaminated casualties: effective planning for health care facilities. , 2000, JAMA.

[19]  L. Bevanger,et al.  Agglutinins and antibodies to Francisella tularensis outer membrane antigens in the early diagnosis of disease during an outbreak of tularemia , 1988, Journal of clinical microbiology.

[20]  J. Bartlett,et al.  Death due to bioterrorism-related inhalational anthrax: report of 2 patients. , 2001, JAMA.

[21]  M. Maslow,et al.  Hantavirus pulmonary syndrome in the United States , 2001, Current infectious disease reports.

[22]  W. H. A T Y O U N E E D T O K N Anthrax vaccine , 1998, The Medical letter on drugs and therapeutics.

[23]  A. Osterhaus,et al.  Evaluation of two commercially available immunoassays for the detection of hantavirus antibodies in serum samples. , 2000, Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology.

[24]  M. Mair,et al.  Smallpox vaccination in 2003: key information for clinicians. , 2003, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[25]  C E Haley,et al.  An outbreak of Shigella dysenteriae type 2 among laboratory workers due to intentional food contamination. , 1997, JAMA.

[26]  D. Pauze,et al.  Clinical presentation of inhalational anthrax following bioterrorism exposure: report of 2 surviving patients. , 2001, JAMA.

[27]  Philip K. Russell,et al.  Tularemia as a biological weapon: medical and public health management. , 2001, JAMA.

[28]  H. Artsob,et al.  Hemorrhagic Fever Viruses as Biological Weapons , 2009 .

[29]  J. P. Davis,et al.  A massive outbreak in Milwaukee of cryptosporidium infection transmitted through the public water supply. , 1994, The New England journal of medicine.

[30]  G. Griffiths,et al.  Quantification of ricin toxin using a highly sensitive avidin/biotin enzyme-linked immunosorbent assay. , 1988, Journal - Forensic Science Society.

[31]  E. Segura,et al.  An unusual hantavirus outbreak in southern Argentina: person-to-person transmission? Hantavirus Pulmonary Syndrome Study Group for Patagonia. , 1997, Emerging infectious diseases.

[32]  D. Talmor,et al.  Augmentation of hospital critical care capacity after bioterrorist attacks or epidemics: Recommendations of the Working Group on Emergency Mass Critical Care‡ , 2005, Critical care medicine.

[33]  Diagnosis and management of foodborne illnesses: a primer for physicians. , 2001, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[34]  C. P. Quinn,et al.  Bioterrorism-related inhalational anthrax: the first 10 cases reported in the United States. , 2001, Emerging infectious diseases.

[35]  Considerations for distinguishing influenza-like illness from inhalational anthrax. , 2001, MMWR. Morbidity and mortality weekly report.

[36]  M. Brummer‐Korvenkontio,et al.  Complex-specific immunoglobulin M antibody patterns in humans infected with alphaviruses , 1986, Journal of clinical microbiology.

[37]  Gina Pugliese,et al.  Anthrax as a Biological Weapon: Medical and Public Health Management , 1999 .

[38]  P. Padula,et al.  Hantavirus pulmonary syndrome outbreak in Argentina: molecular evidence for person-to-person transmission of Andes virus. , 1998, Virology.

[39]  Update: Investigation of bioterrorism-related anthrax, 2001. , 2001, MMWR. Morbidity and mortality weekly report.

[40]  J. Brown,et al.  Misidentification of Brucella species with use of rapid bacterial identification systems. , 1993, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[41]  R. Fagan,et al.  Vulvar vaccinia infection after sexual contact with a military smallpox vaccinee--Alaska, 2006. , 2007, MMWR. Morbidity and mortality weekly report.

[42]  J. Duchin,et al.  Hantavirus Pulmonary Syndrome: A Clinical Description of 17 Patients with a Newly Recognized Disease , 1994 .

[43]  D. Waag,et al.  In Vitro Antibiotic Susceptibilities ofBurkholderia mallei (Causative Agent of Glanders) Determined by Broth Microdilution and E-Test , 2001, Antimicrobial Agents and Chemotherapy.

[44]  R. G. Darling,et al.  Threats in bioterrorism. I: CDC category A agents. , 2002, Emergency medicine clinics of North America.

[45]  J. Jui,et al.  Emergency physicians' perspectives on smallpox vaccination. , 2003, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[46]  R. L. Guerrant,et al.  Escherichia coli O157:H7. , 1995, The New England journal of medicine.

[47]  R. Rothman,et al.  Respiratory Hygiene in the Emergency Department , 2007, Journal of Emergency Nursing.

[48]  P. Jahrling,et al.  Clinical recognition and management of patients exposed to biological warfare agents. , 1997, JAMA.

[49]  D. Raoult,et al.  Treatment of Q fever , 1993, Antimicrobial Agents and Chemotherapy.

[50]  T. Ksiazek,et al.  Laboratory diagnosis of Nipah and Hendra virus infections. , 2001, Microbes and infection.

[51]  Uring January Update: adverse events following civilian smallpox vaccination--United States, 2003. , 2003, Canada communicable disease report = Releve des maladies transmissibles au Canada.

[52]  Jerome Hauer,et al.  Anthrax as a biological weapon, 2002: updated recommendations for management. , 2002, JAMA.

[53]  T J Cieslak,et al.  Biological warfare : A historical perspective , 1997 .

[54]  Gina Pugliese,et al.  Plague as Biological Weapon , 2000, Infection Control & Hospital Epidemiology.

[55]  A. Bauernfeind,et al.  Molecular Procedure for Rapid Detection ofBurkholderia mallei and Burkholderia pseudomallei , 1998, Journal of Clinical Microbiology.

[56]  Management of patients with suspected viral hemorrhagic fever. , 1988, MMWR supplements.

[57]  N. Hupert,et al.  Anticipating demand for emergency health services due to medication-related adverse events after rapid mass prophylaxis campaigns. , 2007, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[58]  L. Bush,et al.  Index case of fatal inhalational anthrax due to bioterrorism in the United States. , 2001, The New England journal of medicine.

[59]  Kenneth D. Mandl,et al.  Validation of Syndromic Surveillance for Respiratory Infections , 2006, Annals of Emergency Medicine.

[60]  M. Homma,et al.  Microagglutination test for early and specific serodiagnosis of tularemia , 1990, Journal of clinical microbiology.

[61]  J. Millar The chest film findings in 'Q' fever--a series of 35 cases. , 1978, Clinical radiology.

[62]  R. Gaynes,et al.  Biological and chemical terrorism: strategic plan for preparedness and response. , 2000 .

[63]  J. Childs,et al.  Genetic identification of a hantavirus associated with an outbreak of acute respiratory illness. , 1993, Science.

[64]  J F Waeckerle,et al.  Emergency physicians and biological terrorism. , 1999, Annals of emergency medicine.

[65]  Julie A. Pavlin,et al.  Medical Management of Biological Casualties Handbook [Third Edition] , 1998 .

[66]  E. Vitetta,et al.  RiVax, a recombinant ricin subunit vaccine, protects mice against ricin delivered by gavage or aerosol. , 2007, Vaccine.

[67]  R. Tauxe,et al.  A large community outbreak of salmonellosis caused by intentional contamination of restaurant salad bars. , 1997, JAMA.

[68]  K. Mead,et al.  An evaluation of portable high-efficiency particulate air filtration for expedient patient isolation in epidemic and emergency response , 2004, Annals of Emergency Medicine.

[69]  C D Treser,et al.  Hospital preparedness for victims of chemical or biological terrorism. , 2001, American journal of public health.

[70]  John E. Bennett,et al.  Principles and practice of infectious diseases. Vols 1 and 2. , 1979 .

[71]  K. Tham,et al.  An emergency department response to severe acute respiratory syndrome☆ , 2003, Annals of Emergency Medicine.

[72]  Takeshi Kurata,et al.  Molecular Investigation of the Aum Shinrikyo Anthrax Release in Kameido, Japan , 2001, Journal of Clinical Microbiology.

[73]  K. Chua,et al.  The presence of Nipah virus in respiratory secretions and urine of patients during an outbreak of Nipah virus encephalitis in Malaysia. , 2001, The Journal of infection.

[74]  P. Small,et al.  Management of tuberculosis in the United States. , 2001, The New England journal of medicine.

[75]  J. A. Mobley Biological warfare in the twentieth century: lessons from the past, challenges for the future. , 1995, Military medicine.