October 25, 2001
KNOW THE FACTS! PREPAREDNESS IN CASE OF BIOTERRORISM
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The tragic events of September 11, 2001, have everybody worried about new terrorist acts, including those that involve infectious diseases. The Infectious Diseases Division at Washington Hospital Center is active in preparing for such an emergency, and we wanted to pass on some of the available information so that you can make good decisions for yourself and your family.
What is bioterrorism?
The word “bioterrorism” describes the use of infections or chemicals as a terrorist weapon. These substances can cause illness and death. The threat can affect more people by its ability to cause fear, even terror, among those communities who believe they may be the target of one of these of weapons. While the idea of bioterrorism can make you feel worried or frightened, the “success” of this type of weapon can be greatly reduced if you learn some basic facts and don’t let your fear stop you from going about your normal life. A specific plan for managing bioterrorism has not been spelled out to the public because there are different types of substances which could be used. Each of these need to be addressed in a different way. Health care professionals and government officials are alert to the possibilities and would announce the appropriate actions to take if an attack were discovered.
How might a bioterrorist attack happen?
The type of bioterrorist attack that you hear most discussed is an aerosolized attack; that means the infection would be transmitted through the air. Such an attack would be odorless, tasteless and colorless. The first sign of such an attack might be an unusual number of people getting sick in a short period of time, or the appearance of an illness which is rarely seen. Doctors will now be watching for signs of unusual illnesses so they can be caught quickly and the community can be alerted. Getting early treatment, or preventing further spread of a disease between family and friends, are the important goals. A gas mask will only protect you if you are wearing it at the exact moment a bioterrorist attack happens. By the time people get sick, the infection is no longer in the air.
How will I know if a bioterrorist attack has happened?
Your doctors and the public health system are always on watch for unusual illnesses or unusual patterns of disease. This watch is even more intense now. We all have to trust that the surveillance will identify a bioterrorist agent quickly. Once a bioterrorist attack is suspected, the FBI and other local and national groups will provide information to the public through TV, the radio and newspapers.
What if I think I've been exposed to a bioterrorism attack?
The first thing to remember is not to panic. Anybody can get sick with a cold, the flu, or even a lung infection, and most of those getting sick will not be victims of bioterrorism. Flu season will still come this year. There are some symptoms that should make you call a doctor. These include:
A. Fever and diarrhea, especially bloody diarrhea
B. Fever, chest pain, severe cough (lung infection, pneumonia)
C. Fever and a rash
D. Fever and a severe headache, bizarre behavior, or loss of consciousness
Again, these symptoms can happen with a lot of infections; they do not equal bioterrorism, but they do need medical attention.
If a bioterrorist attack is suspected by a reliable source, then you may be directed to take antibiotics, depending on the exact type of infection. The government has large supplies of antibiotics in the National Pharmaceutical Stockpile (NPS). NPS is a large reserve of antibiotics, antidotes and medical supplies that can be brought to an affected area within 12 hours of an attack. We do not recommend that you get antibiotics to keep at home, or that you start taking antibiotics unless a bioterrorist attack has been identified. Different germs need different antibiotics and antibiotics can have side effects and so should not be taken without medical supervision.
What is anthrax?
Anthrax is a disease caused by a bacteria (germ) called Bacillus anthracis. It usually affects animals or people who take care of animals. A bioterrorist attack might release anthrax into the air, causing inhalation anthrax. Inhalation anthrax happens when people breathe in anthrax spores. Anthrax is not contagious and cannot be passed from person-to-person. Between 2 to 60 days after someone is exposed to anthrax, the spores start multiplying and cause fever, flu-like symptoms, and difficulty breathing. If untreated, death can occur in 90% of those infected. But there are antibiotics which are effective if taken before symptoms start or at the very beginning of symptoms.
Because this type of infection is so rare, any case which is identified will be closely studied. Doctors will notify public health officials, and areas where the patient has been will be tested. Other people who are also likely to have been exposed will be notified and informed where to go to be tested and treated. In an anthrax outbreak, not everyone who was exposed at the same time will get sick at the same time. Once health officials believe someone has been exposed, that person will need to be on antibiotics for several weeks to be sure that they don’t become ill.
What is smallpox?
Smallpox is a virus that causes a fever and a rash, similar to chickenpox but much more severe. In the past, outbreaks of smallpox caused the death of 1 out of every 3 people infected. Smallpox was wiped out around the world in 1978; since then, the virus is only found in a few research labs. Smallpox can be passed from person-to-person but only when the rash is present. About 2 weeks after someone is exposed, they would become sick and develop a rash. There is no medicine to treat smallpox but there is a vaccine. The vaccine will protect a person from getting smallpox and stops the spread of the disease. It protects a person even if given 2-3 days after exposure. Because the vaccine can have serious side effects, it is only recommended if there is an attack of smallpox.
Because smallpox does not occur anymore, any case of smallpox would be believed to be related to bioterrorism. A patient with a smallpox rash would have to be kept away from others and family members would be vaccinated to prevent their getting the disease. Like in the case of anthrax, doctors would notify public health officials. They would then look to find out where the person came in contact with the virus and notify those at risk so that they could also be vaccinated.
What is plague?
Plague is a disease caused by a bacteria called Y pestis bacillus. The disease is known to be passed to humans from rodents (such as rats) by flea bites. Several worldwide outbreaks of plague have been recorded in history and there have been nearly 400 cases of plague in the U.S. in the past 50 years. A bioterrorist might release plague into the air causing the rare “pneumonic” type, which affects the lungs and intestines. Plague can be spread from person- to-personthrough respiratory (breathing) droplets. Between 1 to 6 days after someone is exposed, they would develop fever, cough, and difficulty breathing, sometimes with blood in the secretions. There are antibiotics to treat plague. In order to be effective, they must be started as soon as someone is known to have been exposed, or immediately after symptoms begin to be effective. There is no vaccine available to protect against pneumonic plague.
If any cases of plague are discovered, the public health system would notify the public. Those believed to be exposed would be informed where to go for proper treatment.
Is it safe for me to drink tap water?
It would be very difficult to contaminate our drinking water. First, we use huge amounts of water every day so that any germs put into the drinking supply would be diluted (present only in very small amounts). Second, our water is filtered and chlorine is added which kills most harmful germs.
Division of Infectious Diseases
Also see our section on Bioterrorism under "Terrorism Update" on the left vertical navigation bar.