Pediatric Terrorism and Disaster Preparedness: A ... - PHE Home

Control measures. Some viruses that cause hemorrhagic fever—including Ebola, Marburg,
Lassa fever, and Crimean-Congo hemorrhagic fever viruses—can spread from one person to
another (once an initial person has become infected). This type of secondary transmission of the
virus can occur directly through close contact with infected people or their blood or other body
fluids. Contaminated syringes and needles have been involved in the spread of infection in
outbreaks of Ebola hemorrhagic fever and Lassa fever.
Both standard precautions and contact precautions should be used in caring for patients with
suspected or confirmed VHF. A surgical mask and eye protection should also be worn by those
coming within 3 feet of a patient with suspected or confirmed Lassa fever, Crimean-Congo
hemorrhagic fever, or filovirus infections. Airborne isolation, including use of a HEPA-filtered
respirator, should be used if patients with these conditions have prominent cough, vomiting,
diarrhea, or hemorrhage. Decontamination should be performed using hypochlorite or phenolic
disinfectants.
There are no vaccines to protect against these diseases, except for yellow fever and Argentinean
hemorrhagic fever. For more information about specific VHF illnesses and their management,
see http://www.cdc.gov/ncidod/dvrd/spb/mnpages/vhfmanual/anx2.pdf.
Reporting. These viruses are highly pathogenic and require handling in special laboratory
facilities designed to contain them (Biosafety Level 4 facilities). If VHF is suspected, contact
your State and local health departments immediately. If local and State health departments are
unavailable, contact the CDC at 770-488-7100.
Category B and C Agents
Ricin
Ricin is a potent cytotoxin that can be easily extracted from the beans of the castor plant (Ricinus
communis). Castor beans are processed worldwide in production of castor oil, and ricin-rich
waste mash is a by-product. Ricin can be prepared in liquid, crystalline, or powder form; as an
agent of terrorism, it could be disseminated as an aerosol, injected, or used to contaminate food
or water. Symptoms depend on the route of exposure: respiratory, enteral, or parenteral.
Compared with other biological toxins (e.g., botulinum toxin), ricin has low toxicity, and large
quantities would be required to affect large numbers of people.
Signs and symptoms. Ricin inhibits cellular protein synthesis. Aerosol exposure results in fever,
chest tightness, cough, dyspnea, nausea, and arthralgias after a delay of 4–8 hours. Death after
aerosol exposure has not been reported in people, but animals develop necrosis and severe
alveolar fluid collection. Ingestion of ricin causes necrosis of the GI epithelium with local
necrosis of muscle and regional lymph nodes. Intravascular injection causes minimal pulmonary
perivascular edema.
Diagnosis. Ricin exposure should be suspected if a geographic cluster of individuals develop
acute lung injury. Pulmonary edema develops 1–3 days after exposure (compared with about 12
hours after Staphylococcus enterotoxin B exposure and about 6 hours after phosgene exposure).
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