Identifying and managing casualties of biological terrorism
- Amesh A Adalja, MD, FACP
Amesh A Adalja, MD, FACP
- Senior Associate
- UPMC Center for Health Security
- Clinical Assistant Professor, Department of Critical Care Medicine and Department of Emergency Medicine
- Adjunct Instructor, Department of Medicine’s Division of Infectious Diseases
- University of Pittsburgh School of Medicine and UPMC
- Section Editors
- Peter F Weller, MD, MACP
Peter F Weller, MD, MACP
- Editor-in-Chief — Infectious Diseases
- Section Editor — Tropical Medicine
- William Bosworth Castle Professor of Medicine
- Harvard Medical School
- Professor of Immunology and Infectious Diseases
- Harvard T. H. Chan School of Public Health
- Richard D Zane, MD
Richard D Zane, MD
- Section Editor — Emergency Medical Services/Disaster Medicine
- Professor and Chair of Emergency Medicine
- University of Colorado School of Medicine
Terrorism can come in many forms. Biological events have the potential to be more readily disseminated and destructive than chemical or nuclear weapons . The United States Congressional Office of Technology Assessment has estimated that a 100 kg payload of aerosolized anthrax spores, if released upwind of Washington, DC, could result in 130,000 to 3 million deaths, matching the lethality of the hydrogen bomb . Lethal amounts of biological agents are relatively easy to manufacture, conceal, transport, and release. However, there is a growing consensus that manufacture of biological agents requires some amount of tacit knowledge, thus limiting the scope of individuals who have the capacity to initiate a large-scale attack .
As with emerging infectious diseases, detection and control of biological attacks depend upon a strong and flexible public health system at the local, state and federal levels. Additionally, well-trained and vigilant front line health professionals are required, especially in detecting covert biological attacks. Primary health care providers will likely be the first to observe and report any unusual illness patterns in the event of such an attack.
This topic will address the history of bioterrorism, the organisms of greatest concern, and the immediate management of persons with possible exposure.
Treatment of established infections, such as anthrax, is discussed in the topics dedicated to those pathogens.
Chemical terrorism is discussed separately. (See "Chemical terrorism: Rapid recognition and initial medical management".)
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- HISTORICAL PERSPECTIVE
- Evidence of prior bioterrorism
- - United States
- - Worldwide
- THE ROLE OF REGULATORY AGENCIES
- OVERVIEW OF DETECTION AND RESPONSE
- SURVEILLANCE AND DETECTION
- The role of the clinician
- Organisms of concern
- Toxins of concern
- PUBLIC HEALTH NOTIFICATION
- CONFIRMATION AND DIAGNOSTIC TESTING
- DECONTAMINATION (OVERT EXPOSURE)
- Personal decontamination
- Environmental decontamination
- What type of prophylaxis should be given?
- - Chemoprophylaxis
- - Antitoxins
- - Immunization
- INFECTION CONTROL
- PSYCHOLOGICAL CONSIDERATIONS
- EMERGENCY RESOURCES
- SUMMARY AND RECOMMENDATIONS