SIGHTINGS


 
US Army Newest
Bio Warfare Handbook -
Types, Risks, Precautions
1-4-99
 
PART THREE
 
 
Eczema - Generic term for inflammatory conditions of the skin, particularly with vesiculation in the acute stage, typically erythematous, edematous, papular, and crusting; followed often by lichenification and scaling and occasionally by duskiness of the erythema and, infrequently, hyperpigmentation; often accompanied by sensations of itching and burning.
 
Edema - An accumulation of an excessive amount of watery fluid in cells, tissues, or serous cavities.
 
Enanthem, enanthema - A mucous membrane eruption, especially one occurring in connection with one of the exanthemas.
 
Encephalitis, pl. encephalitides - Inflammation of the brain.
 
Endotoxemia - Presence in the blood of endotoxins.
 
Endotracheal intubation - Passage of a tube through the nose or mouth into the trachea for maintenance of the airway during anesthesia or for maintenance of an imperiled airway.
 
Enterotoxin - A cytotoxin specific for the cells of the intestinal mucosa.
 
Epistaxis - Profuse bleeding from the nose.
 
Epizootic - 1. Denoting a temporal pattern of disease occurrence in an animal population in which the disease occurs with a frequency clearly in excess of the expected frequency in that population during a given time interval.
 
2. An outbreak (epidemic) of disease in an animal population; often with the implication that it may also affect human populations.
 
Erythema - Redness of the skin due to capillary dilatation.
 
Erythema multiforme - An acute eruption of macules, papules, or subdermal vesicles presenting a multiform appearance, the characteristic lesion being the target or iris lesion over the dorsal aspect of the hands and forearms; its origin may be allergic, seasonal, or from drug sensitivity, and the eruption, although usually self-limited (e.g., multiforme minor), may be recurrent or may run a severe course, sometimes with fatal termination (e.g., multiforme major or Stevens-Johnson syndrome).
 
Erythrocyte - A mature red blood cell.
 
Erythropoiesis - The formation of red blood cells.
 
Exanthema - A skin eruption occurring as a symptom of an acute viral or coccal disease, as in scarlet fever or measles.
 
Extracellular -Outside the cells.
 
Extraocular - Adjacent to but outside the eyeball.
 
Fasciculation - Involuntary contractions, or twitchings, of groups (fasciculi) of muscle fibers, a coarser form of muscular contraction than fibrillation.
 
Febrile - Denoting or relating to fever.
 
Fomite - Objects, such as clothing, towels, and utensils that possibly harbor a disease agent and are capable of transmitting it.
 
Formalin - A 37% aqueous solution of formaldehyde.
 
Fulminant hepatitis - Severe, rapidly progressive loss of hepatic function due to viral infection or other cause of inflammatory destruction of liver tissue.
 
Generalized vaccinia - Secondary lesions of the skin following vaccination which may occur in subjects with previously healthy skin but are more common in the case of traumatized skin, especially in the case of eczema (eczema vaccinatum). In the latter instance, generalized vaccinia may result from mere contact with a vaccinated person. Secondary vaccinial lesions may also occur following transfer of virus from the vaccination to another site by means of the fingers (autoinnoculation).
 
Glanders - A chronic debilitating disease of horses and other equids, as well as some members of the cat family, caused by Pseudomonas mallei; it is transmissible to humans. It attacks the mucous membranes of the nostrils of the horse, producing an increased and vitiated secretion and discharge of mucus, and enlargement and induration of the glands of the lower jaw.
 
Granulocytopenia -Less than the normal number of granular leukocytes in the blood.
 
Guarnieri bodies - Intracytoplasmic acidophilic inclusion body's observed in epithelial cells in variola (smallpox) and vaccinia infections, and which include aggregations of Paschen body's or virus particles.
 
Hemagglutination - The agglutination of red blood cells; may be immune as a result of specific antibody either for red blood cell antigens per se or other antigens which coat the red blood cells, or may be nonimmune as in hemagglutination caused by viruses or other microbes.
 
Hemagglutinin - A substance, antibody or other, that causes hemagglutination.
 
Hematemesis - Vomiting of blood.
 
Hemopoietic - Pertaining to or related to the formation of blood cells.
 
Hematuria - Any condition in which the urine contains blood or red blood cells.
 
Hemodynamic - Relating to the physical aspects of the blood circulation.
 
Hemolysis -Alteration, dissolution, or destruction of red blood cells in such a manner that hemoglobin is liberated into the medium in which the cells are suspended, e.g., by specific complement-fixing antibodies, toxins, various chemical agents, tonicity, alteration of temperature.
 
Hemolytic Uremic Syndrome - Hemolytic anemia and thrombocytopenia occurring with acute renal failure.
 
Hemoptysis - The spitting of blood derived from the lungs or bronchial tubes as a result of pulmonary or bronchial hemorrhage.
 
Hepatic - Relating to the liver.
 
Heterologous - 1. Pertaining to cytologic or histologic elements occurring where they are not normally found.
 
2. Derived from an animal of a different species, as the serum of a horse is heterologous for a rabbit.
 
Hyperemia - The presence of an increased amount of blood in a part or organ.
 
Hyperesthesia - Abnormal acuteness of sensitivity to touch, pain, or other sensory stimuli.
 
Hypotension - Subnormal arterial blood pressure.
 
Hypovolemia - A decreased amount of blood in the body.
 
Hypoxemia - Subnormal oxygenation of arterial blood, short of anoxia.
 
Idiopathic - Denoting a disease of unknown cause.
 
Immunoassay - Detection and assay of substances by serological (immunological) methods; in most applications the substance in question serves as antigen, both in antibody production and in measurement of antibody by the test substance.
 
In vitro - In an artificial environment, referring to a process or reaction occurring therein, as in a test tube or culture media.
 
In vivo - In the living body, referring to a process or reaction occurring therein.
 
Induration - 1. The process of becoming extremely firm or hard, or having such physical features.
 
2. A focus or region of indurated tissue.
 
Inguinal - Relating to the groin.
 
Inoculation - Introduction into the body of the causative organism of a disease.
 
Leukopenia - The antithesis of leukocytosis; any situation in which the total number of leukocytes in the circulating blood is less than normal, the lower limit of which is generally regarded as 4000-5000 per cu mm.
 
Lumbosacral - Relating to the lumbar vertebrae and the sacrum.
 
Lumen, pl. lumina - The space in the interior of a tubular structure, such as an artery or the intestine.
 
Lymphadenopathy - Any disease process affecting a lymph node or lymph nodes.
 
Lymphopenia - A reduction, relative or absolute, in the number of lymphocytes in the circulating blood.
 
Macula, pl. maculae - 1. A small spot, perceptibly different in color from the surrounding tissue. 2. A small, discolored patch or spot on the skin, neither elevated above nor depressed below the skin's surface.
 
Mediastinitis - Inflammation of the cellular tissue of the mediastinum.
 
Mediastinum - The median partition of the thoracic cavity, covered by the mediastinal pleura and containing all the thoracic viscera and structures except the lungs.
 
Megakaryocyte - A large cell with a polyploid nucleus that is usually multilobed; megakaryocytes are normally present in bone marrow, not in the circulating blood, and give rise to blood platelets.
 
Melena - Passage of dark-colored, tarry stools, due to the presence of blood altered by the intestinal juices.
 
Meningism - A condition in which the symptoms simulate a meningitis, but in which no actual inflammation of these membranes is present.
 
Meningococcemia - Presence of meningococci (N. meningitidis) in the circulating blood.
 
Meninges - Any membrane; specifically, one of the membranous coverings of the brain and spinal cord.
 
Microcyst - A tiny cyst, frequently of such dimensions that a magnifying lens or microscope is required for observation.
 
Microscopy - Investigation of minute objects by means of a microscope.
 
Moribund - Dying; at the point of death.
 
Mucocutaneous -Relating to mucous membrane and skin; denoting the line of junction of the two at the nasal, oral, vaginal, and anal orifices.
 
Myalgia - Muscular pain.
 
Mydriasis - Dilation of the pupil.
 
Narcosis - General and nonspecific reversible depression of neuronal excitability, produced by a number of physical and chemical agents, usually resulting in stupor rather than in anesthesia.
 
Necrosis - Pathologic death of one or more cells, or of a portion of tissue or organ, resulting from irreversible damage.
 
Nephropathia epidemica - A generally benign form of epidemic hemorrhagic fever reported in Scandinavia.
 
Neutrophilia - An increase of neutrophilic leukocytes in blood or tissues; also frequently used synonymously with leukocytosis, inasmuch as the latter is generally the result of an increased number of neutrophilic granulocytes in the circulating blood (or in the tissues, or both).
 
Nosocomial - Denoting a new disorder (not the patient's original condition) associated with being treated in a hospital, such as a hospital-acquired infection.
 
Oliguria - Scanty urine production.
 
Oropharynx - The portion of the pharynx that lies posterior to the mouth; it is continuous above with the nasopharynx via the pharyngeal isthmus and below with the laryngopharynx.
 
Osteomyelitis - Inflammation of the bone marrow and adjacent bone.
 
Pancytopenia - Pronounced reduction in the number of erythrocytes, all types of white blood cells, and the blood platelets in the circulating blood.
 
Pandemic - Denoting a disease affecting or attacking the population of an extensive region, country, continent; extensively epidemic.
 
Papule - A small, circumscribed, solid elevation on the skin.
 
Parasitemia -The presence of parasites in the circulating blood; used especially with reference to malarial and other protozoan forms, and microfilariae.
 
Passive immunity - Providing temporary protection from disease through the administration of exogenously produced antibody (i.e., transplacental transmission of antibodies to the fetus or the injection of immune globulin for specific preventive purposes).
 
PCR - see below for polymerase chain reaction.
 
Percutaneous - Denoting the passage of substances through unbroken skin, for example, by needle puncture, including introduction of wires and catheters.
 
Perivascular - Surrounding a blood or lymph vessel.
 
Petechia, pl. petechiae - Minute hemorrhagic spots, of pinpoint to pinhead size, in the skin, which are not blanched by pressure.
 
Pharyngeal - Relating to the pharynx.
 
Pharyngitis - Inflammation of the mucous membrane and underlying parts of the pharynx.
 
Phosgene - Carbonyl chloride; a colorless liquid below 8.2°C, but an extremely poisonous gas at ordinary temperatures; it is an insidious gas, since it is not immediately irritating, even when fatal concentrations are inhaled.
 
Photophobia - Morbid dread and avoidance of light. Photosensitivity, or pain in the eyes with exposure to light, can be a cause.
 
Pleurisy - Inflammation of the pleura.
 
Polymerase chain reaction - An in vitro method for enzymatically synthesizing and amplifying defined sequences of DNA in molecular biology. Can be used for improving DNA-based diagnostic procedures for identifying unknown BW agents.
 
Polymorphonuclear - Having nuclei of varied forms; denoting a variety of leukocyte.
 
Polyuria - Excessive excretion of urine.
 
Presynaptic - Pertaining to the area on the proximal side of a synaptic cleft.
 
Prophylaxis, pl. prophylaxes - Prevention of disease or of a process that can lead to disease.
 
Prostration - A marked loss of strength, as in exhaustion.
 
Proteinuria - Presence of urinary protein in concentrations greater than 0.3 g in a 24-hour urine collection or in concentrations greater than 1 g/l in a random urine collection on two or more occasions at least 6 hours apart; specimens must be clean, voided midstream, or obtained by catheterization.
 
Pruritus - Syn: itching.
 
Ptosis, pl. ptoses - In reference to the eyes, drooping of the eyelids.
 
Pulmonary edema -Edema of the lungs.
 
Pyrogenic - Causing fever.
 
Retinitis - Inflammation of the retina.
 
Retrosternal - Posterior to the sternum.
 
Rhinorrhea - A discharge from the nasal mucous membrane.
 
Sarin - A nerve poison which is a very potent irreversible cholinesterase inhibitor and a more toxic nerve gas than tabun or soman.
 
Scarification -The making of a number of superficial incisions in the skin. It is the technique used to administer tularemia and smallpox vaccines.
 
Septic shock - 1. shock associated with sepsis, usually associated with abdominal and pelvic infection complicating trauma or operations; 2. shock associated with septicemia caused by Gram-negative bacteria.
 
Sequela, pl. sequelae - A condition following as a consequence of a disease.
 
Shigellosis - Bacillary dysentery caused by bacteria of the genus Shigella, often occurring in epidemic patterns.
 
Soman - An extremely potent cholinesterase inhibitor, similar to sarin and tabun.
 
Sterile abscess - An abscess whose contents are not caused by pyogenic bacteria.
 
Stridor - A high-pitched, noisy respiration, like the blowing of the wind; a sign of respiratory obstruction, especially in the trachea or larynx.
 
Superantigen - An antigen that interacts with the T cell receptor in a domain outside of the antigen recognition site. This type of interaction induces the activation of larger numbers of T cells compared to antigens that are presented in the antigen recognition site.
 
Superinfection - A new infection in addition to one already present.
 
Tachycardia - Rapid beating of the heart, conventionally applied to rates over 100 per minute.
 
Teratogenicity -The property or capability of producing fetal malformation.
 
Thrombocytopenia - A condition in which there is an abnormally small number of platelets in the circulating blood.
 
Toxoid - A modified bacterial toxin that has been rendered nontoxic (commonly with formaldehyde) but retains the ability to stimulate the formation of antitoxins (antibodies) and thus producing an active immunity. Examples include Botulinum, tetanus, and diphtheria toxoids.
 
Tracheitis - Inflammation of the lining membrane of the trachea.
 
Urticaria - An eruption of itching wheals, usually of systemic origin; it may be due to a state of hypersensitivity to foods or drugs, foci of infection, physical agents (heat, cold, light, friction), or psychic stimuli.
 
Vaccine - A suspension of attenuated live or killed microorganisms (bacteria, viruses, or rickettsiae), or fractions thereof, administered to induce immunity and thereby prevent infectious disease.
 
Vaccinia - An infection, primarily local and limited to the site of inoculation, induced in man by inoculation with the vaccinia (coxpox) virus in order to confer resistance to smallpox (variola). On about the third day after vaccination, papules form at the site of inoculation which become transformed into umbilicated vesicles and later pustules; they then dry up, and the scab falls off on about the 21st day, leaving a pitted scar; in some cases there are more or less marked constitutional disturbances.
 
Varicella - An acute contagious disease, usually occurring in children, caused by the varicella-zoster virus, a member of the family Herpesviridae, and marked by a sparse eruption of papules, which become vesicles and then pustules, like that of smallpox although less severe and varying in stages, usually with mild constitutional symptoms; incubation period is about 14 to 17 days. Syn: chickenpox
 
Variola - Syn: smallpox.
 
Variolation - The historical practice of inducing immunity against smallpox by "scratching" the skin with the purulency from smallpox skin pustules. The first inoculation for smallpox is said to have been done in China about 1022 B.C.
 
Viremia - The presence of virus in the bloodstream.
 
Virion - The complete virus particle that is structurally intact and infectious.
 
Zoonosis - An infection or infestation shared in nature by humans and other animals that are the normal or usual host; a disease of humans acquired from an animal source.
 
Appendix B: Patient Isolation Precautions
 
 
 
Standard Precautions
 
Handwashing after patient contact.
 
Use of gloves when touching blood, body fluids, secretions, excretions and contaminated items.
 
Use of mask, eye protection, and gown during procedures likely to generate splashes or sprays of blood, body fluids, secretions or excretions
 
Handle contaminated patient-care equipment and linen in a manner that prevents the transfer of microorganisms to people or equipment.
 
Practice care when handling sharps and use a mouthpiece or other ventilation device as an alternative to mouth-to-mouth resuscitation when practical.
 
Place the patient in a private room when feasible if they may contaminate the environment.
 
Airborne Precautions
 
Standard Precautions plus:
 
Place the patient in a private room that has negative air pressure, at least six air changes/hour, and appropriate filtration of air before it is discharged from the room.
 
Use of respiratory protection when entering the room.
 
Limit movement and transport of the patient. Use a mask on the patient if they need to be moved.
 
Droplet Precautions
 
Standard Precaution plus:
 
Place the patient in a private room or with someone with the same infection. If not feasible, maintain at least 3 feet between patients.
 
Use of a mask when working within 3 feet of the patient.
 
Limit movement and transport of the patient. Use a mask on the patient if they need to be moved.
 
Contact Precautions
 
Standard Precautions plus:
 
Place the patient in a private room or with someone with the same infection if possible.
 
Use of gloves when entering the room. Change gloves after contact with infective material.
 
Use of gown when entering the room if contact with patient is anticipated or if the patient has diarrhea, a colostomy or wound drainage not covered by a dressing.
 
Limit the movement or transport of the patient from the room.
 
Ensure that patient-care items, bedside equipment, and frequently touched surfaces receive daily cleaning.
 
Dedicate use of noncritical patient-care equipment to a single patient, or cohort of patients with the same pathogen. If not feasible, adequate disinfection between patients is necessary.
 
Appendix C: Comparative Lethality of Selected Toxins
 
And Chemical Agents in Laboratory Mice
 
AGENT LD50 MOLECULAR SOURCE
 
(m g/kg) WEIGHT
 
Botulinum toxin 0.001 150,000 Bacterium
 
Shiga toxin 0.002 55,000 Bacterium
 
Tetanus toxin 0.002 150,000 Bacterium
 
Abrin 0.04 65,000 Plant (Rosary Pea)
 
Diphtheria toxin 0.10 62,000 Bacterium
 
Maitotoxin 0.10 3,400 Marine Dinoflagellate
 
Palytoxin 0.15 2,700 Marine Soft Coral
 
Ciguatoxin 0.40 1,000 Marine Dinoflagellate
 
Textilotoxin 0.60 80,000 Elapid Snake
 
C. perfringens toxins 0.1 - 5.0 35-40,000 Bacterium
 
Batrachotoxin 2.0 539 Arrow-Poison Frog
 
Ricin 3.0 64,000 Plant (Castor Bean)
 
alpha-Conotoxin 5.0 1,500 Cone Snail
 
Taipoxin 5.0 46,000 Elapid Snake
 
Tetrodotoxin 8.0 319 Puffer Fish
 
alpha-Tityustoxin 9.0 8,000 Scorpion
 
Saxitoxin 10.0 (Inhal 2.0) 299 Marine Dinoflagellate
 
VX 15.0 267 Chemical Agent
 
SEB (Rhesus/Aerosol) 27.0 (ED50~pg) 28,494 Bacterium
 
Anatoxin-A(s) 50.0 500 Blue-Green Algae
 
Microcystin 50.0 994 Blue-Green Algae
 
Soman (GD) 64.0 182 Chemical Agent
 
Sarin (GB) 100.0 140 Chemical Agent
 
Aconitine 100.0 647 Plant (Monkshood)
 
T-2 Toxin 1,210.0 466 Fungal Mycotoxin
 
Appendix D.
 
[INSERT ATTACHMENT HERE: IMAGE22.GIF]
 
kilogram ton
 
Aerosol toxicity in LD50 (see Appendix C) vs. quantity of toxin required to provide a theoretically effective open-air exposure, under ideal meteorological conditions, to an area 100 km2 . Ricin, saxitoxin and botulinum toxins kill at the concentrations depicted. (Patrick and Spertzel, 1992: Based on Cader K.L., BWL Tech Study #3, Mathematical models for dosage and casualty resulting from single point and line source release of aerosol near ground level, DTIC#AD3 10-361, Dec 1957)
 
Appendix E: Differential Diagnosis of Chemical Nerve Agent, Botulinum
 
Toxin and SEB Intoxication following Inhalation Exposure
 
Chemical Nerve Agent Botulinum Toxin SEB
 
Time to Symptoms Minutes Hours (12-48) Hours (1-6)
 
Nervous Convulsions, Progressive Headache
 
Muscle twitching paralysis Muscle aches
 
Cardiovascular Slow heart rate Normal rate Normal or Rapid
 
Heart Rate
 
Respiratory Difficult breathing, Normal, then Nonproductive cough
 
airways constriction progressive Severe cases;chest
 
paralysis pain/difficult breathing
 
Gastrointestinal Increased motility, Decreased Nausea, vomiting and/or
 
pain, diarrhea motility diarrhea
 
Ocular Small pupils Droopy eyelids May see "red eyes"
 
(conjuntival injection)
 
Salivary Profuse, watery Normal; difficulty May be slightly increased
 
saliva swallowing quantities of saliva
 
Death Minutes 2-3 days Unlikely
 
Response to Yes No Atropine may reduce
 
Atropine/2PAM-Cl gastrointestinal symptoms
 
Appendix F: Specimens for Laboratory Diagnosis
 
Face or Acute & Nasal Blood Convalescent
 
Agent Swab1 Culture Smear Sera Stool Urine Other
 
Anthrax + + Pleural and + - - Lesion aspirates
 
CS fluids
 
mediastinal
 
lymph node
 
spleen
 
Brucellosis + + - + - - Bone marrow and
 
spinal fluid
 
cultures;
 
tissues, exudates
 
Cholera - - - + +
 
Plague + + Sputum + - - Lymph node, buboes, CSF, and
 
sputum culture
 
Tularemia + - +2 + - -
 
Q-fever - 4 Lesions + Lung, spleen,
 
lymph cultures
 
__________________________________________________
 
1Within 18-24 hours
 
2Fluorescent antibody test on infected lymph node smears. Gram stain has little value.
 
3Virus isolation from blood in appropriate containment.
 
4C. burnetti can persist for days in blood and resists desiccation. EDTA anticoagulated blood
 
preferred. Culturing should not be done except in BL3 containment.
 
 
 
Face or Acute & Nasal Blood Convalescent
 
Agent Swab1 Culture Smear Sera Stool Urine Other
 
Congo-Crimean - 3 - + - - Liver
 
Hemorrhagic Fever
 
VEE - 3 - + - CSF
 
Clostridial + Wound + + -
 
Toxins tissues
 
SEB Toxin + - - + + + Lung
 
Ricin Toxin + - - + Spleen, lung,
 
kidney
 
1Within 18-24 hours
 
2Fluorescent antibody test on infected lymph node smears. Gram stain has little value.
 
3Virus isolation from blood in appropriate containment.
 
4C. burnetti can persist for days in blood and resists desiccation. EDTA anticoagulated blood
 
preferred. Culturing should not be done except in BL3 containment.
 
Appendix G: BW Agent Lab Identification
 
Immunoassays
 
Agent Gold Standard Antigen Capture IgG IgM PCR Animals
 
Aflatoxins Mass spectroscopy
 
Alpha Toxin ELISA X
 
Alphaviruses Virus isolation/neutralization X X X X X
 
Arboviruses Virus isolation/IFA X X X X X
 
Bacillus anthracis IFA/Std. Microbiology X (PA) X X X X
 
Bacillus globigii Std. Microbiology X
 
Bacillus thuringiensis Std. Microbiology
 
Bot Toxin Mouse neutralization X (A Toxin) * X
 
Brucella sp. IFA/Std. Microbiology X X X X X
 
C. burnetii IFA/Std. Microbiology/serology X X
 
C. perfringens
 
Clostridium sp. Std. Microbiology
 
F. tularensis IFA/Std. Microbiology X X X
 
____________________________________________________
 
*Toxin gene detected
 
ELISA - enzyme-linked immunosorbent assays
 
IFA - indirect or direct immunofluorescence assays
 
Std. Micro./serology - standard microbiological techniques available, including electron microscopy
 
Immunoassays
 
Agent Gold Standard Antigen Capture IgG IgM PCR Animals
 
Filoviruses Virus isolation/neutralization X X X X X
 
Hantaviruses Virus isolation/IFA X X X X X
 
Orthopox Viruses Virus isolation/IFA X X X
 
Ricin Toxin ELISA X X X
 
Saxitoxin Bioassay (neutralizing antibodies) X
 
SEA Toxin *
 
SEB Toxin ELISA X * X
 
Shigella sp. Std. Microbiology
 
Tetrodotoxins Bioassay (neutralizing antibodies) X
 
Vibrio cholerae Std. Microbiology/serology X X X X
 
Yersinia pestis IFA/Std. Microbiology X (F1) X X X X
 
______
 
*Toxin gene detected
 
ELISA - enzyme-linked immunosorbent assays
 
IFA - indirect or direct immunofluorescence assays
 
Std. Micro./serology - standard microbiological techniques available, including electron Microscopy
 
Appendix H
 
BW Agents: Characteristics
 
Disease Transmit Man to Man Infective Dose
 
(Aerosol) Incubation Period Duration of Illness Lethality Lethality
 
Persistence of Organism
 
Persistence of Organism
 
Vaccine Efficacy
 
 
 
(aerosol exposure) Inhalation anthrax No
 
8,000-50,000 spores 1-6 days 3-5 days (usually fatal if untreated) High High
 
Very stable - spores remain viable
 
Very stable - spores remain viable
 
for 40 years in soil
 
for 40 years in soil
 
2 dose efficacy against
 
2 dose efficacy against
 
200-500 LD50 in monkeys Brucellosis No 10 -100 organisms 5-60 days
 
(usually 1-2 months) Weeks to months <5% untreated
 
 
 
No vaccine Cholera Rare 10-500 organisms 4 hours -
 
5 days (usually 2-3 days) 1 week Low with treatment, high without high without
 
Unstable in aerosols & fresh water;
 
Unstable in aerosols & fresh water;
 
stable in salt water
 
stable in salt water
 
No data on aerosol Glanders
 
 
10-14 days via aerosol
 
50%
 
 
 
No vaccine Pneumonic Plague High < 100 organisms 2-3 days 1-6 days
 
(usually fatal) High unless treated within 12-24 hours
 
hours
 
For up to 1 year in soil; 270 days in
 
For up to 1 year in soil; 270 days in
 
live tissue
 
live tissue
 
3 doses not protective against
 
3 doses not protective against
 
118 LD50 in monkeys Tularemia No 10-50 organisms 1-21 days (average 3-5) 2 weeks Moderate if untreated
 
untreated
 
For months in moist soil or other
 
For months in moist soil or other
 
media
 
media
 
80% protection against
 
 
 
1-10 LD50 Q Fever Rare 1-10 organisms 2-14 days (average 7) Weeks Very low Very low
 
For months on wood and sand
 
For months on wood and sand
 
94% protection against 3,500
 
94% protection against 3,500
 
LD50 in guinea pigs Smallpox High Assumed low
 
(10-100 organisms) 7-17 days (average 12) 4 weeks High to moderate High to moderate
 
Very stable
 
Very stable
 
Vaccine protects against large
 
Vaccine protects against large
 
doses in primates Venezuelan Equine Encephalitis Low 10-100 organisms 1-5 days Days to weeks Low Low
 
Relatively unstable
 
Relatively unstable
 
TC 83 protects against 30-500
 
TC 83 protects against 30-500
 
LD50 in hamsters Viral
 
Hemorrhagic
 
Fevers Moderate 1-10 organisms 4-21 days Death between 7-16 days High for Zaire strain, moderate with Sudan
 
Sudan
 
Relatively unstable
 
Relatively unstable
 
No vaccine Botulism No 0.001 m g/kg is LD50 for type A 1-5 days Death in 24-72 hours; lasts months if not lethal High without respiratory support
 
support
 
For weeks in nonmoving water and food food
 
3 dose efficacy 100% against
 
3 dose efficacy 100% against
 
25-250 LD50 in primates Staph Enterotoxin B No 30 µ g/person incapacitation 3-12 hours after inhalation Hours < 1% < 1%
 
Resistant to freezing
 
Resistant to freezing
 
No vaccine Ricin No 3-5 m g/kg is LD50 18-24 hours Days - death within 10-12 days for ingestion High High
 
Stable
 
Stable
 
No vaccine T-2 Mycotoxins No Moderate 2-4 hours Days to months Moderate For years at room temperature For years at room temperature
 
No vaccine
 
 
Appendix I
 
BW Agents: Vaccines, Therapeutics and Prophylactics
 
DISEASE VACCINE CHEMOTHERAPY (Rx) CHEMOTHERAPY (Rx)
 
CHEMOPROPHYLAXIS (Px)
 
CHEMOPROPHYLAXIS (Px)
 
COMMENTS Anthrax Michigan Biologic Products Institute vaccine (licensed) 0.5 mL SC @ 0, 2, 4 wk, 6, 12, 18 mo then annual boosters Ciprofloxacin 400 mg IV q 8-12 h Ciprofloxacin 500 mg PO bid x 4 wk If unvaccinated, begin initial doses of vaccine doses of vaccine
 
Potential alternates for Rx: gentamicin, erythromycin, and
 
Potential alternates for Rx: gentamicin, erythromycin, and
 
chloramphenicol
 
Doxycycline 200 mg IV, then 100 mg IV q 8-12 h Doxycycline 100 mg PO bid x 4 wk plus vaccination plus vaccination
 
 
Penicillin 2 million units IV q 2 h plus streptomycin 30 mg/kg IM qd (or gentamicin)
 
PCN for sensitive organisms only
 
Cholera Wyeth-Ayerst Vaccine 2 doses 0.5 mL IM or SC @ 0, 7-30 days, then boosters Q 6 months Oral rehydration therapy during period of high fluid loss
 
Vaccine not recommended for routine protection in
 
Vaccine not recommended for routine protection in
 
endemic areas (50% efficacy, short term)
 
Tetracycline 500 mg q 6 h x 3 d
 
 
Alternates for Rx: erythromycin,
 
Doxycycline 300 mg once, or 100 mg q 12 h x 3 d
 
trimethoprim and sulfamethoxazole, and furazolidone
 
 
Ciprofloxacin 500 mg q 12 h x 3 d
 
Quinolones for tetra/doxy resistant strains
 
 
Norfloxacin 400 mg q 12 h x 3 d
 
Q Fever IND 610 - inactivated whole cell vaccine given as
 
single 0.5 ml s.c. injection Tetracycline 500 mg PO q 6 h x 5-7 d Tetracycline start 8-12 d post-exposure x 5 d
 
x 5 d
 
Currently testing vaccine to determine the necessity of skin
 
Currently testing vaccine to determine the necessity of skin
 
testing prior to use.
 
 
Doxycycline 100 mg PO q 12 h x 5-7 d Doxycycline start 8-12 d post-exposure x 5 d
 
x 5 d
 
Glanders No vaccine available Sulfadiazine 100 mg/kg in divided doses x 3 weeks may be effective
 
TMP-SMX may be effective Post-exposure prophylaxis may be tried with TMP-SMX
 
TMP-SMX
 
No large therapeutic human trials have been conducted
 
No large therapeutic human trials have been conducted
 
owing to the rarity of naturally occurring disease.
 
DISEASE VACCINE CHEMOTHERAPY (Rx) CHEMOPROPHYLAXIS (Px)
 
(Px)
 
COMMENTS Plague Greer inactivated vaccine (FDA licensed): 1.0 mL IM; 0.2 mL IM 1-3 mo later; 0.2 mL 5-6 mo after dose 2; 0.2 mL boosters @ 6,12, 18 mo after dose 3 then q 1-2 years Streptomycin 30 mg/kg/d IM in 2 divided doses x
 
10 d (or gentamicin) Doxycycline 100 mg PO bid x 7 d or duration of exposure
 
Ciprofloxacin 500 mg PO bid x
 
7 d 7 d
 
Plague vaccine not protective against aerosol challenge in
 
Plague vaccine not protective against aerosol challenge in animal studies
 
 
Doxy 200 mg IV then 100 mg IV bid x 10-14 d Doxycycline 100 mg PO bid x 7 d
 
Tetracycline 500 mg PO qid x 7 d
 
mg PO qid x 7 d
 
Alternate Rx: trimethoprim-sulfamethoxazole
 
 
Chloramphenicol 1 gm IV qid x 10-14 d
 
Chloramphenicol for plague meningitis
 
Tularemia IND - Live attenuated vaccine: one dose by scarification Streptomycin 30 mg/kg IM qd x 10-14 d Doxycyline 100 mg PO bid x 14 d
 
mg PO bid x 14 d
 
Gentamicin 3-5 mg/kg/d IV x 10-14 d Tetracycline 2 g/d PO x 14 d
 
g/d PO x 14 d
 
Brucellosis No human vaccine available Doxycycline 200 mg/d PO plus rifampin 600-900 mg/d PO x 6 wk Doxycycline and rifampin x 3 wk
 
rifampin x 3 wk
 
Trimethoprim-sulfamethoxazole may be substituted for
 
Trimethoprim-sulfamethoxazole may be substituted for
 
rifampin; however, relapse may reach 30%
 
 
Ofloxacin 400/rifampin 600 mg/d PO x 6 wks
 
Viral encephalitides VEE DOD TC-83 live attenuated vaccine (IND): 0.5 mL SC x1 dose Supportive therapy: analgesics and anticonvulsants prn NA NA
 
TC-83 reactogenic in 20%
 
No seroconversion in 20%
 
Only effective against subtypes 1A, 1B, and 1C
 
VEE DOD C-84 (formalin inactivated TC-83) (IND): 0.5 mL SC for up to 3 doses
 
 
C-84 vaccine used for non-responders to TC-83
 
EEE inactivated (IND):
 
0.5 mL SC at 0 & 28 d
 
EEE and WEE inactivated vaccines are poorly
 
WEE inactivated (IND):
 
0.5 mL SC at 0, 7, and 28 d
 
 
Immunogenic. Multiple immunizations are required
 
DISEASE VACCINE CHEMOTHERAPY (Rx) CHEMOTHERAPY (Rx)
 
CHEMOPROPHYLAXIS (Px)
 
CHEMOPROPHYLAXIS (Px)
 
COMMENTS Viral Hemorrhagic Fevers AHF Candid #1 vaccine
 
(x-protection for BHF) (IND)
 
Ribavirin (CCHF/arenaviruses)
 
30 mg/kg IV initial dose
 
15 mg/kg IV q 6 h x 4 d
 
7.5 mg/kg IV q 8 h x 6 d NA NA
 
Aggresive supportive care and management of
 
Aggresive supportive care and management of
 
hypotension very important
 
RVF inactivated vaccine (IND) Passive antibody for AHF, BHF, Lassa fever, and CCHF
 
Smallpox Wyeth calf lymph vaccinia vaccine (licensed): 1 dose by scarification Cidofovir (effective in vitro) Cidofovir (effective in vitro)
 
Vaccinia immune globulin 0.6 mL/kg IM (within 3 d of exposure, best within 24 h)
 
within 24 h)
 
Pre and post exposure vaccination
 
Pre and post exposure vaccination
 
recommended if 3 years since last vaccine
 
Botulism DOD pentavalent toxoid for serotypes A - E (IND): 0.5 ml deep SC @ 0, 2 & 12 wk, then yearly boosters DOD heptavalent equine despeciated antitoxin for serotypes A-G (IND): 1 vial (10 mL) IV
 
Skin test for hypersensitivity before equine
 
Skin test for hypersensitivity before equine
 
antitoxin administration
 
 
CDC trivalent equine antitoxin for serotypes A, B, E (licensed)
 
StaphylococcusEnterotoxin B No vaccine available Ventilatory support for inhalation exposure
 
Ricin No vaccine available Inhalation: supportive therapy G-I : gastric lavage, superactivated charcoal, cathartics
 
T-2 Mycotoxins No vaccine available
 
Decontamination of clothing and Skin
 
[END]
 
 
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