Information for Patients Concerned About Bioterrorism

What should I do about the Bioterrorism Threat?

The recent events related to the anthrax exposure demonstrate that terrorists will use biological agents. Although the actual threat to any city or population group is low, it is important for everyone to know steps they should take to protect themselves and other family members. The following summarizes some pertinent information, but the information is being updated frequently. Your physician or other health care provider can provide you the most recent guidance.

What organisms can be used as a bioterrorism agent?

Almost any bacterium or virus that causes illness or death can be used as a bioterrorism agent. Examples range from anthrax, with the potential for fatal outcomes, to the salmonella organism that produces self-limited gastrointestinal symptoms with very little or minimal risk of death. As discussed below, there are steps that you can take to protect your health and avoid exposure. Considering the spectrum of possible agents, it is also important to recognize unusual symptoms or symptoms that are more severe than expected in order to seek medical attention promptly.

What steps can I take to prevent exposure or if I suspect I have been exposed?

The following outlines preventive steps, symptoms that should cause you to seek medical attention promptly, what vaccines and treatments are available, and how to respond if a suspected chemical exposure is involved in addition to or instead of a biological agent.

Preventive steps:

Influenza immunizations:

Assure all family members receive annual influenza immunizations. Respiratory symptoms are the initial manifestations of exposure to a number of biological agents. Preventing influenza will help reduce concerns in those that would have developed symptoms had they not had the immunizations. Similarly, a history of immunization will aid health providers in evaluating patients who do develop symptoms. (You may still contract influenza even if immunized. However, large numbers of epidemiologic studies have clearly demonstrated that immunizations will dramatically reduce the number of people who contract influenza.)

Suspicious packages or mail:

If you receive a suspicious package, e.g. a package or envelope with excessive postage, handwritten or poorly typed address, title but no name in address, misspellings of common words, no return address, excessive weight, excessive security material–tape,

other wrapping, unknown sender and marked as "personal" or "confidential", marked with a threat or label, e.g. "Anthrax inside", CDC recommends the following.

1.	Do not shake or open package.

2.	Place the package or envelope in a plastic bag to prevent leakage.

3.	Leave the room, close the door.

4.	Wash hands with soap and water.

5.	Notify police and, if in a building, building monitor.

If package opens and powder spills.

1.	DO NOT attempt to CLEAN UP the powder.

2.	Cover the spilled contents immediately with clothing, paper towels, etc.

3.	Turn off ventilation (heating, air conditioning, fans).

4.	Leave the room and close the door; prevent others from entering.

5.	Remove contaminated clothing and wash all exposed body parts with soap and water.

6.	Notify police and, if in a building, the building supervisor.

Symptoms of concern:

Consult your health provider if you or family members experience:

1.	Abrupt onset of fever, dry (little or no phlegm produced) cough, muscle aches (may resemble "flu"), especially if accompanied by bloody diarrhea, gastrointestinal symptoms or generalized headache. (Several biological agents)

2.	Blurred vision, double vision, dry mouth, muscle weakness, or paralysis. (Botulism)

3.	Unusual skin lesion or lesions. (Several biological agents.) Black, ulcerated skin lesion. (Anthrax)

4.	High fever (101o F or higher), headache, prostration, rash in mouth and/or on face and extremities. (Smallpox)

5.	Bloody diarrhea. (Several biological agents.)

Vaccines and treatment:

Vaccines:

Vaccines are available or under development for a number of potential bioterrorism agents. Guidelines for their use are under continuing review by CDC and other agencies. As with any other vaccine, there are potentials for significant, and possible severe, reactions in some individuals receiving vaccines. Your health provider will be able to advise you of the most recent recommendations regarding vaccine use.

Treatment:

Antibiotics and other treatments are available for many bioterrorism agents. Prompt treatment during the anthrax exposures resulted in many fewer fatalities than would have been predicted on the basis of prior studies. It is important to recognize that treatment programs are different for different organisms, and combinations are now recommended for many. Consequently, it is not appropriate, and could even be harmful, to try to maintain a home "stockpile" of medications. Even if large amounts of medications are needed at once, the government's National Pharmaceutical Stockpile can provide all required medications within hours. This capability was clearly demonstrated during the anthrax exposures.

Other steps:

The information above focuses on bioterrorism, but other threats do exist. The following are steps that can be taken to protect your health in the case of an accidental or deliberate release of hazardous chemicals:

Assure all family members recognize the need to respond rapidly to unusual events, including:

1.	If in a shopping mall, at a work site, or in other crowd situations, evacuate the area immediately and obtain medical evaluation if any of the following occurs (all are suggestive of exposure to a chemical agent or agents but could also be due to relatively harmless conditions):

A.	Sudden occurrence of an unusual odor that permeates the area.

B.	Sudden onset of sneezing, coughing, watery eyes, nasal discharge, or shortness of breath.

C.	Onset of itching or burning of the eyes or skin.

D.	Onset of tremors, twitching of muscles, or other muscular symptoms.

E.	Abrupt onset of nausea, vomiting, urination, defecation.

2.	Flush eyes and skin with water if tearing or burning occurs after one of the above events. Remove all clothing with minimal handling to avoid on-
going or further contamination.

What about gas masks?:

Respirators, such as powered air-purifying respirators with full face-pieces and gas masks will filter most biological agents if they contain the proper filters, if the filters have not deteriorated, and, of particular importance, if they have been properly fitted to the individual who will be using them. However, anyone who has worn a gas mask or other respirator will attest to the fact that, properly fitted, they are quite uncomfortable to wear. Since a major concern in bioterrorism is an unannounced attack, it would be necessary to wear the masks on a 24 hour basis. Finally, improper use can be hazardous in that improper use can result in injury or suffocation, especially for individuals with heart or lung problems. Indeed, some deaths due to improper use of gas masks were reported in Israel during the Gulf War. For these reasons, health organizations do not recommend the use of gas masks.

If you have additional questions or concerns, your health care provider is one of the best sources for information.