Public Health Preparedness

What is it?
What are "bio-weapons?"
What are some types of biowarfare agents?
If I get sick, how will I know if it  is from a bioweapon or just the "flu?"
What can your Health Department do?
How can I personally protect myself and my family?

What is it?
Bioterrorism is the intentional or threatened use bacteria, viruses, toxins and chemicals as a weapon to sicken, kill or scare, (terrify) a perceived enemy.

What are Bioweapons?  
Bioweapons are the devices and methods for indiscriminately delivering a harmful agents to usually large groups of people.

What are some types of Biowarfare agents?
Among the bacteria, viruses, toxins and chemical agents that can be used as biological agents are:

Bacteria, Viruses, Toxins and Chemicals

Anthrax is a bacteria shaped like tiny rods. It exists naturally, where it can be found in the soil in a "spore" form, which means it can last for a long time until activated, usually when livestock are grazing over soil contaminated with it. Until it was developed for use as a weapon, it usually only caused disease among people handling a lot of animal hides and was once even known as "woolsorter's disease". It can infect the skin, lungs, or (rarely) the digestive tract.

When it affects the skin, "symptoms may appear 12 hours to 5 days after exposure to the bacteria. A skin infection begins as a red-brown bump that enlarges, with considerable swelling at the edges. The bump blisters and hardens, then the center breaks open and oozes a clear fluid before forming a black scab (eschar). Lymph nodes in the affected area may swell, and the person may feel ill, sometimes experiencing muscle aches, headache, fever, nausea, and vomiting." (Merck Manual).

In the lungs, illness "results from inhaling the spores of the anthrax bacterium. The spores multiply in the lymph nodes near the lung. The lymph nodes then start to break down and bleed, spreading the infection to nearby structures in the chest. Infected fluid builds up in the lungs and in the space between the lungs and the chest wall. At first, the symptoms are vague and similar to those of influenza. However, the fever worsens, and in a few days severe breathing difficulties develop, followed by shock and coma. Infection of the brain and its meninges (meningoencephalitis) may also occur." (Merck Manual)

Mortality can be high but with current vaccination and antibiotics, it would be expected to be lower.

Smallpox is caused by the Variola virus and is an acute, sometimes fatal disease. It causes high fever and a distinctive progressive skin rash along with fatigue, head, and backaches. Smallpox is spread from person to person from bodily fluids or droplets of saliva for instance or from contaminated objects such as bedding or clothing.

The incubation period in smallpox is from 7 to 17 days followed by red lesions that form pustules then crust after two more weeks. Mortality can be up to 30%.

Vaccination against smallpox can be effective anytime before and within the first few days after exposure. The Smallpox vaccine is not actually made from the smallpox virus but from a related virus called vaccinia which can protect against actual smallpox with usually only one pustule at the vaccination site on the arm.

Unlike most vaccinations involving an injection, the smallpox vaccine is applied with a "bifurcated needle" which holds a tiny droplet of the vaccine between the forks. This is then pricked onto the skin of the shoulder to introduce the vaccine just through the skin. A single pustule should form and crust and while this vaccine is relatively safe, there are certain people who should not receive it. In a voluntary vaccination program, those with certain skin conditions, weakened immune systems, transplants, HIV, cancer treatments, on steroids,  pregnant and breastfeeding women and those under age 18, or those allergic to any of the vaccine components should not receive this vaccination. However, in an exposure situation, there are no contraindications and everyone should be vaccinated.

After vaccination, care must be taken with the single pustule on the arm so as not to spread the vaccinia virus, which could be harmful to the eyes, groin, or other parts of the body.  Clean dressings are to be kept over the site and a strict "do not touch" rule should be observed until the scab is completely gone.

Plague is an old disease caused by a bacteria found in rodents. It can spread to man by flea bites from infected animals and then from person to person from droplets such as coughing from a lung-infected person. It causes enlarged lymph nodes, fever and pneumonia and can have a mortality of up to 60% if left untreated by antibiotics.

Tularemia is an acute infectious disease that causes local ulcerative lesions such as the hands or fingers, swollen lymph nodes and profound systemic symptoms such as pneumonia. Mortality can be 30-60% if untreated.

Ebola or Hemorragic Fever is a filovirus that can cause severe, often fatal disease. It has an unknown host in nature but can spread rapidly from man-to-man and has a high mortality. It can have a typical viral onset such as fever and aches but progresses with internal and external bleeding and subsequent organ failure. Mortality can be 50 to 80 percent.

Viral Encephalitis can cause inflammation of the brain with fever, headache, vomiting, neck stiffness and seizures.

Brucellosis is a bacteria found in cattle, hogs, sheep, goats, dogs and other animals and causes acute fever with subsequent relapsing stages. It has a low mortality but can be chronic.

Q Fever is caused by the bacterium Coxiella burnetii which lives in domestic and wild animals and ticks. It can be contracted by coming into contact with materials that have been contaminated and breathed in or ingested.It can cause pneumonia but is usually not fatal.

Toxins

Botulinum causes the neuromuscular poisoning known as "botulism" from the clostridium botulinum bacteria. This bacteria can form a spore that can be highly heat resistant and aerosolized. Mortality can be up to 60%, usually from respiratory collapse.

Ricin is a toxin from the castor plant that can cause respiratory or gastrointestinal poisoning with an unknown mortality rate.

Chemicals

Lethal chemicals that can be released as a gas or sprayed as an aerosol are divided into types such as Nerve Agents like Tabun  Sarin    and Soman;   Blister Agents like Mustard Gas and Phosgene, and Blood or Pulmonary Agents like Cyanide and Chloropicrin. Mortality rates can be highly variable depending on weather, chemical state, and degree of exposure. Portals of entry include breathing, skin exposure, or ingestion. Many chemical weapons work very fast but can persist in the environment for long periods of time.

If I get sick, how will I know if it  is from a bioweapon or just the "flu?"

Local medical professionals are on higher alert to look for illness patterns that suggest an intentional outbreak.  It is unlikely that such an attack would happen in our remote area but certain numbers and patterns of cases could be cause for Public Health action.

What can your Health Department do?

How can I personally protect myself and my family? 

Don't panic! These can be times for concern but needless worry and upset will cause far more distress and illness than the threat of bioterrorism. Chances are very small that you personally will ever be affected by a bioweapon attack and going about your normal business is the very best way to personally combat the fear that others might try to instill. Do your part! Stay cool.

Other good resources of information can be found at the Center for Disease Control and the US Government:

http://www.bt.cdc.gov/
http://www.fda.gov/cber/cntrbio/cntrbio.htm