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Accessed July 12, 2006. • Centers for Disease Control and Prevention. Guideline for Isolation Precautions in Hospitals. Available at: http://www.cdc.gov/ncidod/dhqp/gl_isolation.html. Accessed July 12, 2006. • Centers for Disease Control and Prevention. The History of Bioterrorism (Video). Available at: http://www.bt.cdc.gov/training/historyofbt/index.asp. Accessed August 17, 2006. • Centers for Disease Control and Prevention. Laboratory Response Network. Available at: http://www.bt.cdc.gov/lrn/. Accessed July 12, 2006. • Centers for Disease Control and Prevention. Laboratory Response to Suspicious Substances. Available at: http://www.bt.cdc.gov/labissues/substanceresponse.asp. Accessed August 7, 2006. • Centers for Disease Control and Prevention. Notice to readers: Update: interim recommendations for antimicrobial prophylaxis for children and breastfeeding mothers and treatment of children with anthrax. MMWR. 2001; 40(45):1014-1016. • Centers for Disease Control and Prevention. Plague Diagnosis. Available at: http://www.cdc.gov/ncidod/dvbid/plague/diagnosis.htm. Accessed July 19, 2006. • Centers for Disease Control and Prevention. Programs in Brief: Select Agent Program. Available at: http://www.cdc.gov/programs/php07.htm. Accessed August 17, 2006. • Centers for Disease Control and Prevention. The Public Health Response to Biological and Chemical Terrorism. Interim Planning Guidance for State Public Health Officials, July 2001. Available at: http://www.bt.cdc.gov/Documents/Planning/PlanningGuidance.PDF. Accessed July 12, 2006. • Centers for Disease Control and Prevention. Recognition of illness associated with the intentional release of a biologic agent. MMWR. 2001; 50(41):893-897. • Centers for Disease Control and Prevention. Smallpox Response Plan and Guidelines (version 3.0). Available at: http://www.bt.cdc.gov/agent/smallpox/response-plan/index.asp. Accessed July 13, 2006. • Centers for Disease Control and Prevention. Smallpox Vaccination. Information for Health Professionals. Available at: http://www.bt.cdc.gov/agent/smallpox/vaccination/index.asp. Accessed August 17, 2006. • Centers for Disease Control and Prevention. Smallpox Vaccine Administration Video. Available at: http://www.bt.cdc.gov/agent/smallpox/vaccination/administrationvideo/index.asp. Accessed July 12, 2006. • Centers for Disease Control and Prevention. Specimen Shipping and Packing. Available at: http://www.cdc.gov/ncidod/srp/specimens/shipping-packing.html. Accessed August 7, 2006. • Centers for Disease Control and Prevention. State and Local Health Department Web Sites. Available at: http://www.cdc.gov/other.htm#states. Accessed July 12, 2006. • Centers for Disease Control and Prevention. Strategic National Stockpile. Available at: http://www.bt.cdc.gov/stockpile/. Accessed July 13, 2006. • Centers for Disease Control and Prevention. Use of anthrax vaccine in the United States. MMWR. 2000; 49(RR-15):1-20. • Centers for Disease Control and Prevention. Vaccinia (smallpox) vaccine. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2001. MMWR. 2001; 50(RR- 10):1-25. 85
• Centers for Disease Control and Prevention. Special features of VHFs. Available at: http://www.cdc.gov/ncidod/dvrd/spb/mnpages/vhfmanual/anx2.pdf. Accessed July 19, 2006. • Cono J, Casey CD, Bell DM. Smallpox vaccination and adverse events: Guidance for clinicians. MMWR. 2003; 52(RR-04):1-28. • Council of State and Territorial Epidemiologists. Current State and Territorial Epidemiologists. Available at: http://www.cste.org/members/state_and_territorial_epi.asp. Accessed July 12, 2006. • Davis CJ. Nuclear blindness: an overview of the biological weapons programs of the former Soviet Union and Iraq. Emerg Infect Dis. 1997;278(5):351–356. • Dennis DT, Inglesby TV, Henderson DA, et al. Tularemia as a biological weapon: medical and public health management. JAMA. 2001;285:2763-2773. • Franz DR, Jahrling PB, Friedlander AM, et al. Clinical recognition and management of patients exposed to biological warfare agents. JAMA. 1997:278; 399–411. • Fritz SB, Singer AM, Revan VB, et al. Bioterrorism: relevance to allergy and immunology in clinical practice. J Allergy Clin Immunol. 2002;109(2):214–228. • Garner JS, Hospital Infection Control Practices Advisory Committee. Guideline for isolation precautions in hospitals. Infect Control Hosp Epidemiol. 1996;17:53–80, and Am J Infect Control. 1996;24:24–52. • Henderson DA, Inglesby TV, Bartlett JG, et al. Smallpox as a biological weapon: medical and public health management. JAMA. 1999;281:2127–2137. • Inglesby TV, Henderson DA, Bartlett JG, et al. Anthrax as a biological weapon: medical and public health management. JAMA. 1999;281:1735–1745. • Inglesby TV, Dennis DT, Henderson DA, et al. Plague as a biological weapon: medical and public health management. JAMA. 2000;283:2281–2290. • Kadlec RP, Zelicoff AP, Vrtis AM. Biologic weapons control: prospects and implications for the future. JAMA. 1997;288:351–356. • Kolavic SA, Kimura A, Simons SL, et al. An outbreak of Shigella dysenteriae Type 2 among laboratory workers due to intentional food contamination. JAMA. 1997;278:396–398. • McGovern TW, Christopher GW, Eitzen EM. Cutaneous manifestations of biological warfare and related threat agents. Arch Derm. 1 999;135(3):311–322. • Meffert, JJ. Biological warfare from a dermatologic perspective. Curr Allergy Asthma Rep. 2003; 3:304–310. • National Child Traumatic Stress Network. Resources for Parents and Caregivers. Available at: http://www.nctsnet.org/nccts/nav.do?pid=ctr_aud_prnt. Accessed July 13, 2006. • Noah DL, Huebner KD, Darling RG, et al. The history and threat of biological warfare and terrorism. Emerg Med Clin No Am. 2002;20:255–271. • Olson KB. Aum Shinrikyo: once and future threat? Emerg Infect Dis. 1999;5(4):513–516. • Patt HA, Feign RD. Diagnosis and management of suspected cases of bioterrorism: a pediatric perspective. Pediatrics. 2002;109(4);685–692. • Public Health Security and Bioterrorism Preparedness and Response Act of 2002. Washington, DC: U.S. Congress; 2002. Available at: http://www.fda.gov/oc/bioterrorism/PL107-188.html. Accessed August 17, 2006. 86
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Bioterrorism and Other Public Healt
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Contents Chapter 1. Introduction ..
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Q Fever............................
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Basic Principles...................
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Chapter 9. Integrating Terrorism an
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Table 5.4 Nerve agent triage and do
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There are many gaps in knowledge, e
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injured or killed (see also Chapter
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Head injury is common in children.
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In situations of disaster, caregive
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maintaining and securing the airway
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• Schonfeld DJ. In times of crisi
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Types of Disasters Chapter 2. Syste
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problems noted above for flooding,
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Federal Response The United States
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The scope of ESF #8 is broad and in
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• Centers for Disease Control and
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Table 2.1 Types of disasters, hazar
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Medical staffs need to know what wi
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information, health and safety educ
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y private physicians. Approximately
Page 45 and 46: even required (particularly if a pe
Page 47 and 48: ICS structure is hierarchical. For
Page 49 and 50: • Provide community education so
Page 51 and 52: • Provide for crisis counseling.
Page 53 and 54: incident command officer is most of
Page 55 and 56: Figure 3.1 National Response Plan D
Page 58 and 59: Background History of Bioterrorism
Page 60 and 61: Epidemiology of a Terrorist Attack
Page 62 and 63: and may be watery, purulent, or blo
Page 64 and 65: fluid in these vesicles. A painless
Page 66 and 67: determined to be due to an agent of
Page 68 and 69: cared for using standard precaution
Page 70 and 71: may be providing longer term and mo
Page 72 and 73: The vaccine has a number of common
Page 74 and 75: Vaccination Large-scale vaccination
Page 76 and 77: cutaneous lesions; however, previou
Page 78 and 79: common food source is identified du
Page 80 and 81: treated people experience some degr
Page 82 and 83: treatment for plague meningitis. An
Page 84 and 85: Smallpox is spread most commonly in
Page 86 and 87: focal, intensely suppurative necros
Page 88 and 89: Control measures. Some viruses that
Page 90 and 91: Control measures. Person-to-person
Page 92 and 93: Signs and symptoms. The incubation
Page 94 and 95: currently used for individuals trav
Page 98 and 99: • Roffey R, Tegnell A, Elg HF. Bi
Page 100 and 101: Figure 4.2. Neurological signs, bot
Page 102 and 103: Figure 4.4. Physical distribution o
Page 104 and 105: Figure 4.6. Varicella lesions Note:
Page 106 and 107: Figure 4.8a. Febrile rash illness a
Page 108 and 109: Table 4.1. Early clinical signs and
Page 110 and 111: Table 4.2. Infection control transm
Page 112 and 113: Table 4.3. Diagnostic procedures, i
Page 114 and 115: Table 4.4a. Diagnostic tests for an
Page 116 and 117: Table 4.6. Treatment recommendation
Page 118 and 119: Introduction Chapter 5. Chemical Te
Page 120 and 121: likely manifest as an acute onset o
Page 122 and 123: exposures (Table 5.3). For an in-de
Page 124 and 125: Neuromuscular effects. At the neuro
Page 126 and 127: children. Finally, routine administ
Page 128 and 129: Treatment Management of cyanide poi
Page 130 and 131: Sulfur mustard is stockpiled both i
Page 132 and 133: decontamination is therefore extrem
Page 134 and 135: Pulmonary Agents Toxic industrial c
Page 136 and 137: Type I agents, the significance of
Page 138 and 139: After dispersal of riot control age
Page 140 and 141: • Kales SN, Christiani DC. Acute
Page 142 and 143: • Gray EA, Love JW, Arnold JL. CB
Page 144 and 145: Table 5.2. Chemical weapons - Summa
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Table 5.3 Representative classes of
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Table 5.4. Nerve agent triage and d
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Table 5.5. Clinical effects from su
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Table 5.7. Medical treatment of rio
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Chapter 6. Radiological and Nuclear
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from ground zero. For weapons large
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(1000 rem), resulting in four fatal
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cooling systems at Mayak exploded,
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pediatric practices. This put infan
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energy, releasing two photons of ex
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need to be shielded, although the a
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adioactive isotope of potassium. Ba
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An integrated, interactive human bo
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Biodosimetry and Radiological Terro
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primitive/progenitor cells and othe
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permits bacterial translocation and
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To assess radiation dose, a researc
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status? 4. Conduct an initial surve
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explosion, when it is concentrated
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Skin pathway. Although intact skin
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personnel should also take a wipe s
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• Geiger-Mueller or G-M counters
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• Protective clothing— Disposab
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Decontamination priorities are as f
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These effects can occur anywhere fr
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manifestations of ARS may range fro
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Neutropenia: Viral and Fungal Infec
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The main reason for targeting pregn
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No significant side effects from it
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axilla, groin, and skin folds. Radi
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Followup Care, Including Risk of Ca
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artificial because followup in almo
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adioactive material in an accident.
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131, canned milk or other milk prod
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home immediately after the incident
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• National Council on Radiation P
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• U.S. Nuclear Regulatory Commiss
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Radiation Detection, PPE, Monitorin
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• National Council on Radiation P
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• Peter RU, Gottlober P. Manageme
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Recommendations for State and Local
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Figure 6.2. Environmental exposure
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Figure 6.4. Bone marrow irradiated
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Figure 6.6. Classic Andrews diagram
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Figure 6.8. Examples of radiation s
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Figure 6.10. Localized radiation ef
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Table 6.2. Biodosimetry based on ac
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Table 6.4. Diagnostic steps in acut
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Table 6.6. Dose assessment summary
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Table 6.8. Antibiotics for treatmen
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Table 6.10. Radionuclide specific t
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Introduction Chapter 7. Blast Terro
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Spalling effect. When a blast wave
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Clinical findings and diagnosis. Cl
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highest position. Because of the pr
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perilymph in the membranous labyrin
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• Hemoptysis. • Subcutaneous em
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management and immediately involve
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considered (see Chapter 4, Biologic
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• Circumstances (weather conditio
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Bibliography Explosives, Incendiary
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Trauma Systems and Planning/Mitigat
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Table 7.2 Spectrum of primary blast
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Table 7.3 Principles of Advanced Tr
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Determine the severity of the burn
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Chapter 8. Mental Health Issues Men
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• Amnesia for important parts of
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Treatment. Treatment should be guid
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• Before notifying the family, br
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• Be conscious of nonverbal commu
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sadness, anger, guilt, or a sense o
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was mean to my father yesterday and
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these roles, they should work close
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• Lack of availability of trauma-
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The structure provided by a preexis
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necessarily meet the children’s n
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Make Psychological Contact Tune in
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A communications goal of “educati
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• Schonfeld D. Crisis interventio
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Chapter 9. Integrating Terrorism an
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Chain of command. A chain of comman
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The chain of command established by
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Advice for families of children wit
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Quarantine procedures. Quarantine p
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Chapter 10. Working with Government
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need under the 12 Emergency Service
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ecognizes that community clinicians
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Chapter 11. Conclusion This report
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Planning for special medical needs
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Table 11.1 Environmental constraint
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Table 11.2 Pediatric medical compla
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• The post-storm environment is h
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Acronyms AAP American Academy of Pe
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RIA RTG SCIWORA SEB SI SNS SSRI STA
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Appendix A. Pediatric Terrorism and
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1. List which biological agents (mi
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19. Identify chemical terrorism tox
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39. Provide followup care, being mi
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Learning Objectives: At the end of
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Lead Editors Appendix B. List of Co
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James Tsung, MD, FAAP Attending Phy
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Gerald S. Braley, PhD Major, United
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Kobi Peleg, PhD Michael Stein, MD J
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Lou E. Romig MD, FAAP, FACEP Childr
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Maternal & Child Health Bureau Dan
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