Emergencies
Emergency Planning Guide

Information About Biological Attack

• Pay close attention to official instructions if you are alerted to potential exposure to biological agents or if an actual attack has caused broad exposure
  • Places to report for triage or treatment and transportation methods and routes may be announced
  • Delivery of medical services may be altered to respond to changing demands
• If your skin or clothing comes in contact with a visible, potentially infectious substance, remove and bag your clothes and personal items and wash yourself with warm soapy water immediately. Put on clean clothes and seek medical assistance.

Anthrax:

• An acute infectious disease caused by the spore-forming bacterium Bacillus Anthracis, occurs in hoofed mammals and can also infect humans.
• The serious forms of human anthrax are inhalation, cutaneous, and intestinal
• Symptoms vary depending on how the disease was contracted, but usually occur within 7 days after exposure.
• Initial symptoms of inhalation anthrax infection may resemble a common cold. After several days, symptoms progress to severe breathing problems and shock. Inhalation anthrax is often fatal.
• The intestinal form may follow consumption of contaminated food and is characterized by an acute inflammation of the intestinal tract. Initial signs of nausea, loss of appetite, vomiting, and fever are followed by abdominal pain, vomiting of blood, and severe diarrhea.
• Direct person-to-person spread of anthrax is extremely unlikely, if it occurs at all. Therefore, there is no need to immunize or treat contacts of persons ill with anthrax, such as household contacts, friends, or coworkers, unless they also were also exposed to the same source of infection.
• Early antibiotic treatment of anthrax is essential-delay lessens chances for survival.
• An anthrax vaccine also can prevent infection. Vaccination against anthrax is not recommended for the general public to prevent disease and is not available.

Botulism:

• A muscle-paralyzing bacterial disease (Clostridium botulinum)
• Three kinds of botulism:
  • Food borne botulism occurs when a person ingests pre-formed toxin that leads to illness within a few hours to days. Creates a public health emergency because the contaminated food may be available to others.
  • Infant botulism occurs in a small number of susceptible infants who harbor C. botulinum in their intestinal tract.
• With food borne botulism, symptoms begin within 6 hours to 2 weeks (most commonly between 12 and 36 hours) after eating toxin-containing food.
• Symptoms of botulism include:
  • Double vision
  • Blurred vision
  • Drooping eyelids
  • Slurred speech
  • Difficulty swallowing
  • Dry mouth
  • Muscle weakness that always descends through the body: first shoulders are affected, then upper arms, lower arms, thighs, calves, etc.
  • Paralysis of breathing muscles can cause a person to stop breathing and die, unless assistance with breathing (mechanical ventilation) is provided.
• Botulism is not spread from one person to another. Food borne botulism can occur in all age groups.
• CDC maintains a supply of antitoxin against botulism. The antitoxin is effective in reducing the severity of symptoms if administered early in the course of the disease.
• Most patients eventually recover after weeks to months of supportive care.

Plague

• An infectious disease that affects animals and humans, caused by the bacterium Yersinia pestis. This bacterium is found in rodents and their fleas and occurs in many areas of the world, including the United States.
  • Easily destroyed by sunlight and drying. When released into air, the bacterium will survive for up to one hour, depending on conditions.
• Pneumonic plague occurs when Y. pestis infects the lungs.
  • Can spread from person to person through the air.
  • Bacteria can be aerosolized and used in a bioterrorist attack.
  • Inhaling Y. pestis suspended in respiratory droplets from infected victim.
    • Usually requires direct and close contact with the victim
    • May also occur if a person with bubonic or septicemic plague is untreated and the bacteria spread to the lungs.
• Bubonic plague is the most common form of plague.
  • Occurs when an infected flea bites a person or when contaminated materials enter through a break in a person’s skin.
  • Patients develop swollen, tender lymph glands (called buboes), fever, headache, chills, and weakness. Bubonic plague does not spread from person to person.
• Septicemic plage
  • Occurs when plague bacteria multiply in the blood.
  • Can be complication of pneumonic or bubonic plague or can occur alone.
    • When it occurs alone, caused the same ways as bubonic plague; however, buboes do not develop.
    • Patients have fever, chills, prostration, abdominal pain, shock, and bleeding into skin and other organs.
    • Does not spread form person to person.
• Symptoms and treatment
  • First signs of illness are fever, headache, weakness, and rapidly developing pneumonia with shortness of breath, chest pain, cough, and sometimes bloody or watery sputum. The pneumonia progresses for 2 to 4 days and may cause respiratory failure and shock. Without early treatment, patients may die.
  • Early treatment of pneumonic plague is essential.
    • To reduce the chance of death, antibiotics must be given within 24 hours of first symptoms.
    • Antibiotic treatment for 7 days will protect people who have had direct, close contact with infected patients.
    • Wearing a close-fitting surgical mask also protects against infection.
• A plague vaccine is not currently available for use in the United States.

Smallpox

• Smallpox is a serious, contagious, and sometimes fatal infectious disease.
• No specific treatment for smallpox disease. The only prevention is vaccination.
• The name smallpox is derived from the Latin word for “spotted” and refers to the raised bumps that appear on the face and body of an infected person.
• There are two clinical forms of smallpox.
  • Variola major is the severe and most common form of smallpox, with a more extensive rash and higher fever. Historically, variola major has an overall fatality rate of about 30%; however, flat and hemorrhagic smallpox usually are fatal. There are four types of variola major smallpox:
    • Ordinary (most frequent, accounting for 90% or more of cases);
    • Modified (mild and occurring in previously vaccinated persons);
    • Flat (rare);
    • Hemorrhagic (very severe).
  • Variola minor is a less common presentation of smallpox, and a much less severe disease, with death rates historically of 1% or less.
• Except for laboratory stockpiles, the variola virus has been eliminated. However, in the aftermath of the events of September and October , 2001, there is heightened concern that the variola virus might be used as an agent of bioterrorism.
• Generally, direct and fairly prolonged face-to-face contact is required to spread smallpox from one person to another.
• Smallpox also can be spread through direct contact with infected bodily fluids or contaminated objects such as bedding or clothing.
• Rarely, smallpox has been spread by virus carried in the air in enclosed settings such as buildings, buses, and trains.
• Humans are the only natural hosts of variola. Smallpox is not known to be transmitted by insects or animals.
• A person with smallpox is sometimes contagious with onset of fever (prodrome phase), but the person becomes most contagious with the onset of rash. At this stage the infected person is usually very sick and not able to move around in the community.
• The infected person is contagious until the last smallpox scab falls off.

Tularemia

• Tularemis is an infectious disease caused by a hardy bacterium, Francisella tularensis, found in animals (especially rodents, rabbits, and hares).
• People can get tularemia many different ways, such as through the bite of an infected insect or other arthropod (usually a tick or deerfly), handling infected animal carcasses, eating or drinking contaminated food or water, or breathing in F. tularensis.
• Symptoms of tularemia could include:
  • Sudden fever
  • Chills
  • Headaches
  • Muscle aches
  • Joint pain
  • Dry cough
  • Progressive weakness
  • Pneumonia.
    • Chest pain
    • Bloody spit
    • Trouble breathing or can sometimes stop breathing.
  • Other symptoms of tularemia depend on how a person was exposed to the tularemia bacteria.
  • Ulcers on the skin or mouth
  • Swollen and painful lymph glands
  • Swollen and painful eyes
  • Sore throat
  • Symptoms usually appear 3 to 5 days after exposure to the bacteria, but can take as long as 14 days
• Tularemia is not known to be spread from person to person, so people who have tularemia do not need to be isolated.
• People exposed to F. tularensis should be treated as soon as possible.
• The disease can be fatal if it is not treated with the appropriate antibiotics.
• A vaccine for tularemia is not currently available in the United States.

Viral Hemorrhagic Fevers (Ebola hemorrhagic fever or Ebola HF)

• Ebola HF is a severe, often-fatal disease in humans and nonhuman primates (monkeys, gorillas, and chimpanzees) that has appeared sporadically 1976.
• Disease is caused by infection with Ebola virus, one of two members of a family of RNA viruses called the Filoviridae.
• Four subtypes of Ebola virus, three of which have caused disease in humans:
  • Ebola-Zaire
  • Ebola-Sudan
  • Ebola-Ivory Coast
  • Ebola-Reston has caused disease in primates, but not in humans
• The exact origin, locations, and natural habitat of Ebola virus remain unknown.
  • Researchers believe that the virus is zoonotic (animal-borne), normally maintained in an animal host that is native to the African continent.
  • A similar host is probably associated with Ebola-Reston, which was isolated from infected cynomolgous monkeys that were imported to the United States and Italy from the Philippines.
  • Not known to be native to other continents, such as North America.
• Infections with Ebola virus are acute. There is no carrier state.
• Researchers hypothesize that a patient may be infected through contact with an infected animal.
• After the first case patient in an outbreak setting is infected, the virus can be transmitted in several ways.
  • Direct contact with the blood and/or secretions of an infected person. The virus is often spread through families and friends because they come in close contact with such secretions when caring for infected persons.
  • Contact with objects, such as contaminated needles
• The incubation period for Ebola HF ranges from 2 to 21 days.
• The onset of illness is abrupt and is characterized by:
  • Fever
  • Headache
  • Joint and muscle aches
  • Sore throat
  • Weakness, followed by diarrhea, vomiting, and stomach pain.
  • Rash, red eyes, hiccups, internal and external bleeding may be seen
• Researchers do not understand why some people are able to recover from Ebola HF and others are not. Patients who die usually have not developed a significant immune response to the virus at the time of death.
• There is no standard treatment for Ebola HF. Patients receive supportive therapy.
  • Balancing the patient’s fluids and electrolytes
  • Maintaining oxygen status and blood pressure
  • Treating them for any complicating infections.