Bioterrorism FAQs

Amy K. Erickson

Pharmacy Today. 2001;7(11) 

In This Article

Biological diseases that pose a risk to national security

Biological Agent Symptoms Incubation Period Vaccine Chemotherapy Chemoprophylaxis Comments
Anthrax
(Bacillus anthracis)
Inhalation: Flu-like symptoms occur within 7 days and progress to severe breathing problems and shock

Cutaneous: Discolored itchy patches of skin become swollen lesions with depressed centers

1-5 days Bioport vaccine 0.5 mL SC at 0, 2, and 4 weeks, and 6, 12, and 18 months; annual boosters Ciprofloxacin 400 mg I.V. every 12 hours
OR

Doxycycline 100 mg I.V. every 12 hours

AND

One or two additional antimicrobialsa
Ciprofloxacin 500 mg orally twice daily for 60 days
OR

Doxycycline 100 mg orally twice daily for 60 days

If unvaccinated, begin initial doses of vaccine

At press time, all doses of vaccine were contracted to DOD and were not available fsor civilian use.
Botulinum toxin
(Clostridium botulinum)
Blurred vision, muscle weakness that always descends through the body, and paralysis of breathing muscles

Whole-body paralysis can last for months

1-5 days DOD pentavalent toxoid for serotypes A-E (IND): 0.5 mL deep SC at 0, 2, and 12 weeks; yearly boosters DOD heptavalent equine despeciated antitoxin for serotypes A-G (IND): 1 vial (10 mL) I.V.
OR

CDC trivalent equine antitoxin for serotypes A, B, E (licensed)

NA The toxin may be used as a biological weapon in aerosolized or food-borne forms.

Skin test for hypersensitivity before equine antitoxin administration.

Plague
(Yersinia pestis)
Fever, headache, weakness, and cough productive of bloody or watery sputum

Can cause death without early treatment

2-3 days Greer inactivated vaccine is no longer available Streptomycin 30 mg/kg/day IM in 2 divided doses for 10-14 days
OR

Gentamicin 5 mg/kg or I.V. once daily for 10-14 days

OR

Ciprofloxacin 400 mg I.V. every 12 hours until clinically improved, then 750 mg orally twice daily for 10-14 days

Doxycycline 100 mg orally twice daily for 7 days or duration of exposure
OR

Ciprofloxacin 500 mg orally twice daily for 7 days

Chloramphenicol for plague meningitis is required: 25 mg/kg I.V., then 15 mg/kg four times daily for 14 days.

Alternate therapy: trimethoprim- sulfamethoxazole.

Smallpox
(Variola major)
High fever, fatigue, head and back aches

Characteristic rash follows in 2-3 days

7-17 days Wyeth calf lymph vaccinia

vaccine: 1 dose by scarification

No current therapy other than supportive; Cidofovir (effective in vitro); animal studies ongoing Vaccine immune globulin 0.6 mL/kg IM within 3 days of exposure, best within 24 hours Pre- and postexposure vaccination recommended if > 3 years since last vaccine.
Tularemia
(Francisella tularensis)
Inhalation can cause fever and pneumonia- like symptoms

Rarely fatal if treated with antibiotics

2-10 days Live attenuated vaccine (IND); single 0.1mL dose by scarification Streptomycin 7.5-10 mg/kg IM twice daily for 10-14 days

OR

Gentamicin 3-5 mg/kg/day for 10-14 days

OR

Ciprofloxacin 400 mg I.V. every12 hours until improved then 500 mg orally every 12 hours for 10-14 days

OR

Ciprofloxacin 750 mg orally every 12 hours for 10-14 days

Doxycycline 100 mg orally twice daily for 14 days
OR

Tetracycline 500 mg orally four times daily for 14 days

Ciprofloxacin 500 mg orally every 12 hours for 14 days

Culture is difficult and potentially dangerous.
Viral hemorrhagic fevers Initial signs and symptoms:

Fever, fatigue, dizziness, muscle aches, and exhaustion

Severe cases: Bleeding under the skin, in internal organs, or from body orifices like the mouth, eyes, or ears

4-21 days AHF Candid #1 vaccine (x-protection for BHF) (IND)
RVF inactivated vaccine (IND)
Ribavirinb (CCHF/Lassa)

30 mg/kg IV initial dose; then 16 mg/kg I.V. every 6 hours for 4 days; then 8 mg/kg I.V. every 8 hours for 6 days

OR

Passive antibody for AHF, BHF, Lassa fever, and CCHF

NA Aggressive management of secondary infections and hypotension is important.

AHF = Argentine hemorrhagic fever; BHF = bovine hemorrhagic fever; CCHF = Congo-Crimean hemorrhagic fever; DOD = U.S. Department of Defense; IM = intramuscular; IND = investigational new drug; RVF = Rift Valley fever; SC = subcutaneous.
aRifampin, vancomycin, penicillin, ampicillin, chloramphenicol, imipenem, clindamycin, and clarithromycin.
bVirazole (ICN)
Adapted from: Appendix D: BW agent vaccines, therapeutics and prophylactics. In: USAMRIID's Medical Management of Biological Casualties Handbook. 4th ed. Fort Detrick, Md: U.S. Army Medical Research Institute of Infectious Diseases; February 2001. Available at: www.usamriid.army.mil/education/bluebook/appxd.pdf. Accessed October 18, 2001.
Franz DR, et al. Clinical recognition and management of patients exposed to biological warfare agents. JAMA. 1997;278:399-411
Public Health Emergency Preparedness & Response. Centers for Disease Control and Prevention Web site. Available at: www.bt.cdc.gov/agent/agentlist.asp.

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