Bioterrorism viruses

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Familiarity with the infectious agents of highest priority can expedite diagnosis and initial management leading to a successful public health response to such an attack. The first to notice could be a hospital laboratory seeing unusual strains of organisms, an epidemiologist keeping track of hospital admissions or even pharmacists distributing more antibiotics than usual.

A bioterrorist attack may be difficult to distinguish from a naturally occurring infectious disease outbreak. A single diagnosed or strongly suspected case of smallpox, inhalational anthrax, cutaneous anthrax with no known risk factors compatible with naturally-occurring disease , viral haemorrhagic fever in a patient with no international travel history or more than one case of pneumonic plague, pneumonic tularaemia with at least one laboratory confirmed case, no known compatible risk factors and occurring in a brief time period or a higher than expected number of unexplained morbidity and mortality in a brief time period within a defined geographic region should point towards possibility of a bioterrorist attack [ 9 ].

Public health emergency preparedness and response to bioterrorist attack: The responsibilities of public health agencies are surveillance of infectious diseases, detection and investigation of outbreaks, identification of etiologic agents and their modes of transmission and the development of prevention and control strategies.

The measures needed to prevent and control emerging infections are strikingly similar to those needed to check the threat of bioterrorism. Maintaining effective disease surveillance and communication systems are fundamental components of an adequate public health infrastructure.

Ensuring adequate epidemiologic and laboratory capacity are prerequisites to effective surveillance systems. Syndrome surveillance has been used for early detection of outbreaks to follow the size, spread and tempo of outbreaks, to monitor disease trends and to provide reassurance that an outbreak has not occurred.

Syndrome surveillance systems seek to use existing health data in real time to provide immediate analysis and feedback to those charged with investigation and follow-up of potential outbreaks.

The model of large scale exposure to the agents of bioterrorism by use of vaccines and antibiotics has dramatic potential for saving lives and expense [ 10 , 11 , 12 ].

The public health approach to bioterrorism must begin with the development of local and state-level plans. Close collaboration between the clinical and public health communities is also critical.

To effectively respond to an emergency or disaster, health departments must engage in preparedness activities. Completion of the following five phases of activities prior to an incident are essential for successful response to a bioterrorist attack [ 13 ]:. These include evaluation of the laboratory facilities and upgrading the same, evaluating the hospital preparedness in emergency response and case management in case of an imminent attack, conduct training of health professionals, rapid response team RRT and quick response medical team QRMT who would be the first responders, work out the legal provision and their implications, ensure that requirement of safe drinking water is met, ensure availability of adequate stocks of medicines and vaccines, coordinate with security organization, organize mock drills for health professionals, government departments, animal husbandry, security, law enforcing and other agencies so as to assess their preparedness levels to act in case of an attack, prepare contact details so that communications is unhampered during an attack.

Public should be kept aware about imminent attacks so that voluntary reporting is encouraged. It is important to carry out review of situation based on current information of threat perception.

Early detection and rapid investigation by public health epidemiologist is critical in determining the scope and magnitude of the attack and to implement effective interventions.

The activities in this phase include rapid epidemiological investigations, quick laboratory support for confirmation of diagnosis, quarantine, isolation, keeping health care facilities geared for impending casualty management and evolving public health facilities for control. In order to achieve them, following steps can be followed:. Case finding by local and state public health officials through alerts to multiple potential reporting sources.

Data analysis for epidemiologic investigation and contact tracing activities in a coordinated manner. For diseases transmissible from person-to-person, all possible contacts are identified and interviewed All clinical and epidemiologic information is entered into a database. The damage done to the public health facilities and the essential items utilized during the response phase are replenished. Public advisories are issued regarding restoration of normalcy.

The RRTs compile and analyze data to identify the deficiencies experienced in the implementation of the response measures. The necessary modifications are then incorporated in the contingency plan for future [ 11 ]. Bioterrorism remains a legitimate threat both from domestic and international terrorist groups. From a public health perspective, timely surveillance, awareness of syndromes resulting from bioterrorism, epidemiologic investigation capacity, laboratory diagnostic capacity and the ability to rapidly communicate critical information on a need to know basis to manage public communication through the media are vital.

Ensuring adequate supply of drugs, laboratory reagents, antitoxins and vaccines is essential. National Center for Biotechnology Information , U. Med J Armed Forces India. Published online Jul Author information Article notes Copyright and License information Disclaimer.

S Das: moc. Received Feb 16; Accepted May 5. This article has been cited by other articles in PMC. Abstract The intentional release or threat of release of biologic agents i. Introduction The threat of biological warfare seems remote to most industrialized and developing nations. Table 1 Classification of agents of bioterrorism. Open in a separate window. Table 2 Agents of Bioterrorism.

Table 3 Clinical syndromes caused by bioterrorism agents [ 2 , 7 , 9 ]. Inhalational Anthrax. Abrupt fever, respiratory distress, chest pain.

Treatment is with Ciproflox mg 12 hourly or Doxycycline mg 12 hourly or Clindamycin mg thrice daily for 60 days Prophylaxis post exposure: Ciproflox mg 12 hourly or Doxycycline mg 12 hourly for 60 days. Anthrax vaccine i. Small Pox Fever with papular rash that begins on the face and extremities and uniformly progresses to vesicles and pustules; Clinical with laboratory confirmation; Treatment: Supportive.

Prophylaxis: Vaccinia immunization i. Botulism Acute bilateral descending flaccid paralysis beginning with cranial nerve palsies. Electromyography EMG : augmented muscle action poten toxin assays of serum, faeces or gastric aspirate can be done. Treatment: Supportive, Equine antitoxin. Prophylaxis: Administration of antitoxin.

Brucellosis Irregular fever, chills, malaise, headache and pleuritic chest pain. Treatment: Streptomycin intramuscular or intravenous 1. Prophylaxis: Doxycycline mg 12 hourly. Formalin Fixed Vaccine. Viral Haemorrhagic Fevers Fever with mucous membrane bleeding, petechiae, thrombocytopenia and hypotension. Definitive testing available. Treatment: Supportive Ribavirin in recommended doses.

Prophylaxis: Vaccine for yellow fever. Serologic testing available. Treatment: Supportive Prophylaxis: Attenuated cell-culture propagated live vaccine.

TC only partially effective. Tularaemia Typhoidal, Pneumonic Fever, chills, rigors, headache, myalgias, sore throat; Substernal discomfort, dry cough. Definitive testing available, Treatment: Streptomycin 1 g 12 hourly for 14 days Prophylaxis: Doxycycline mg 12 hourly for 14 days iii. Ricin Aerosolized Fever, chest pain and cough progressing to respiratory distress and hypoxemia not improving with antibiotics.

Chest radiograph shows Pulmonary Oedema, ELISA test on sputum or immunohistoichemical techniques for direct tissue analysis to confirm diagnosis. Treatment: Supportive. No antitoxin yet available.

No Prophylaxis available. T2 Mycotoxin Abrupt mucocutaneous and airway irritation including skin pain and blistering , eye pain and tearing , gastrointestinal bleeding, vomiting, and diarrhea and airway dyspnea and cough Treatment: Supportive. Prophylaxis: No Prophylaxis available presently. Staphylococcal entrotoxin B Acute onset of fever, chills, headache, non-productive cough and myalgia with a normal chest radiograph. Profuse watery diarrhoea, if ingested. Enterotoxins may be detected in environmental samples using a variety of antibody-based tests.

Treatment: Supportive therapy. Conclusion Bioterrorism remains a legitimate threat both from domestic and international terrorist groups. Conflicts of Interest None identified. References 1. Sharma R.

India wakes up to threat of bioterrorism. Microbial Bioterrorism. Harrison's Principle of Internal Medicine. McGraw Hill; New York: Centres for Diseases Control and Prevention.

Emergency Preparedness and Response: Bioterrorism Overview. Gupta ML, Sharma A. Pneumonic plague, northern India. Emerg Infect Dis.