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Background

Biological pathogens released intentionally or accidentally, or naturally occurring, can result in disease or death.

Human exposure to these agents may occur through inhalation, skin (cutaneous) exposure, or ingestion of contaminated food or water. Following exposure, physical symptoms may be delayed and sometimes confused with naturally occurring illnesses. Biological warfare agents may persist in the environment and cause problems some time after their release.

The agents below fall into four major groups, three classes of microorganisms - bacteria, rickettsia, and viruses, plus bacterial toxins, which are poisonous chemicals produced by bacteria. Incubation period, duration of illness, symptoms, means of transmission, treatment, and prognosis, are among the types of information included.

space Diseases

Smallpox (Variola virus)

Smallpox infection was eliminated from the world in 1977.

Smallpox is caused by Variola virus. The incubation period is about 12 days (range: 7 to 17 days) following exposure. Initial symptoms include high fever, fatigue, and head and back aches. A characteristic rash, most prominent on the face, arms, and legs, follows in 2-3 days. The rash starts with flat red lesions that evolve at the same rate. Lesions become pus-filled and begin to crust early in the second week. Scabs develop and then separate and fall off after about 3-4 weeks. The majority of patients with smallpox recover, but death occurs in up to 30% of cases.

Smallpox is spread from one person to another by infected saliva droplets that expose a susceptible person having face-to-face contact with the ill person. Persons with smallpox are most infectious during the first week of illness, because that is when the largest amount of virus is present in saliva. However, some risk of transmission lasts until all scabs have fallen off.

Routine vaccination against smallpox ended in 1972. The level of immunity, if any, among persons who were vaccinated before 1972 is uncertain; therefore, these persons are assumed to be susceptible.

Vaccination against smallpox is not recommended to prevent the disease in the general public and therefore is not available.
From Facts About Smallpox by the Centers for Disease Control and Prevention

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Anthrax (bacillus anthracis)

Anthrax is an acute infectious disease caused by the spore-forming bacterium Bacillus anthracis. Anthrax most commonly occurs in hoofed mammals and can also infect humans.

Symptoms of disease vary depending on how the disease was contracted, but usually occur within 7 days after exposure. The serious forms of human anthrax are inhalation anthrax, cutaneous anthrax, and intestinal anthrax.

Initial symptoms of inhalation anthrax infection may resemble a common cold. After several days, the symptoms may progress to severe breathing problems and shock. Inhalation anthrax is often fatal.

The intestinal disease form of anthrax may follow the 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.

In persons exposed to anthrax, infection can be prevented with antibiotic treatment.

Early antibiotic treatment of anthrax is essential-delay lessens chances for survival. Anthrax usually is susceptible to penicillin, doxycycline, and fluoroquinolones.

An anthrax vaccine also can prevent infection. Vaccination against anthrax is not recommended for the general public to prevent disease and is not available.
From Facts About Anthrax by the Centers for Disease Control and Prevention

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ANIMALS AND ANTHRAX

Plague, Bubonic (Yersinia pestis)

Plague is an infectious disease of animals and humans caused by the bacterium Yersinia pestis. Y. pestis, is found in rodents and their fleas in many areas around the world.

Pneumonic plague occurs when Y. pestis infects the lungs. The first signs of illness in pneumonic plague are fever, headache, weakness, and cough productive of bloody or watery sputum. The pneumonia progresses over 2 to 4 days and may cause septic shock and, without early treatment, death.

Person-to-person transmission of pneumonic plague occurs through respiratory droplets, which can only infect those who have face-to-face contact with the ill patient.

Early treatment of pneumonic plague is essential. Several antibiotics are effective, including streptomycin, tetracycline, and chloramphenicol. There is no vaccine against plague. Prophylactic antibiotic treatment for 7 days will protect persons who have had face-to-face contact with infected patients.
From Facts About Pneumonic Plague by the Centers for Disease Control and Prevention

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Brucellois (Brucella suis)

Brucellosis is an infectious disease caused by the bacteria of the genus Brucella. These bacteria are primarily passed among animals, and they cause disease in many different vertebrates. Various Brucella species affect sheep, goats, cattle, deer, elk, pigs, dogs, and several other animals. Humans become infected by coming in contact with animals or animal products that are contaminated with these bacteria. In humans brucellosis can cause a range of symptoms that are similar to the flu and may include fever, sweats, headaches, back pains, and physical weakness. Sever infections of the central nervous systems or lining of the heart may occur. Brucellosis can also cause long-lasting or chronic symptoms that include recurrent fevers, joint pain, and fatigue.
From What is brucellosis? by the Centers for Disease Control and Prevention

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Tularemia (Francisella tularensis)

“A plague-like disease of rodents, transmissible to man. It is caused by Francisella tularensis and is characterized by fever, chills, headache, backache, and weakness.”
Medical Subject Headings. Bethesda (MD): National Library of Medicine, 2001.

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Q Fever

“An acute infectious disease caused by Coxiella burnetti. It is characterized by a sudden onset of fever, headache, malaise, and weakness. In humans, it is commonly contracted by inhalation of infected dusts derived from infected domestic animals.”
Medical Subject Headings. Bethesda (MD): National Library of Medicine, 2001.

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Botulism (Clostridium botulinum toxin)

“A disease caused by potent protein neurotoxins produced by Clostridium botulinum which interfere with the presynaptic release of acetylcholine at the neuromuscular junction. Clinical features include abdominal pain, vomiting, acute paralysis (including respiratory paralysis), blurred vision, and diplopia. Botulism may be classified into several subtypes (e.g., food-borne, infant, wound, and others). (From Adams et al., Principles of Neurology, 6th ed, p1208).”
Medical Subject Headings. Bethesda (MD): National Library of Medicine, 2001.

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Viral Hemorrhagic Fevers(VHF)

“A group of viral diseases of diverse etiology but having many similar clinical characteristics; increased capillary permeability, leukopenia, and thrombocytopenia are common to all. Hemorrhagic fevers are characterized by sudden onset, fever, headache, generalized myalgia, backache, conjunctivitis, and severe prostration, followed by various hemorrhagic symptoms.”
Medical Subject Headings. Bethesda (MD): National Library of Medicine, 2001.

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From the National Library of Medicine

Consumer Health Information from MedlinePlus

Current Citations from MEDLINE

National Pharmaceutical Stockpile

The mission of CDC's National Pharmaceutical Stockpile (NPS) Program is to ensure the availability and rapid deployment of life-saving pharmaceuticals, antidotes, other medical supplies, and equipment necessary to counter the effects of nerve agents, biological pathogens, and chemical agents.

Books

Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response.
Committee on R&D Needs for Improving Civilian Medical Response to Chemical and Biological Terrorism Incidents, Institute of Medicine. Washington, D.C. : National Academy Press, 1999.
Available full-text online.

Firepower in the Lab: Automation in the Fight Against Infectious Diseases and Bioterrorism.
Scott P. Layne, Tony J. Beugelsdijk, and C. Kumar N. Patel, Editors. Washington D.C. : Joseph Henry Press,c2001
Available full-text online.

Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents Interim Report on Current Capabilities.
Division of Health Science[s] Policy, Institute of Medicine [and] Board on Environmental Studies and Toxicology, Commission on Life Sciences, National Research Council. Washington, D.C. : National Academy Press, 1998.
Available full-text online.

Living Terrors: What America Needs to Know to Survive the Coming Bioterrorist Catastrophe.
Michael T. Osterholm & John Schwartz. New York : Delacorte Press, c2000.
Germs: Biological Weapons and America's Secret War.
Judith Miller, Stephen Engelberg, William Broad. New York : Simon & Schuster, c2001.

Emergency action for chemical and biological warfare agents.
Ellison DH. Boca Raton, FL:CRC Press; 1999.

Journal Articles

Anon. How would you handle a terrorist act involving weapons of mass destruction? ED Management. 1999;11(11):121-24.

Bravata DM et al. Systematic review: surveillance systems for early detection of bioterrorism-related diseases. Ann Intern Med. 2004 Jun 1;140(11):910-22. Review.

Buehler JW et al. Framework for evaluating public health surveillance systems for early detection of outbreaks: recommendations from the CDC Working Group. MMWR Recomm Rep. 2004 May 7;53(RR-5):1-11.

Franz DR et al. Clinical recognition and management of patients exposed to biological warfare agents. Clinics in Laboratory Medicine. 2001;21(3):435-73.

Khan AS et al. Precautions against biological and chemical terrorism directed at food and water supplies. Public Health Reports. 2001;116(1):3-14.

Kortepeter MG et al. Bioterrorism. Journal of Environmental Health. 2001;63(6):21-24.

MacIntyre AG et al. Weapons of mass destruction events with contaminated casualties. Effective planning for health care facilities. JAMA. 2000;283(2):242-49.

Moser R Jr et al. Preparing for expected bioterrorism attacks. Military Medicine. 2001;166(5):369-74.

Raber E et al. Decontamination issues for chemical and biological warfare agents: how clean is clean enough? International Journal of Environmental Health Research. 2001;11(2):128-48.

Rotz LD et al. Report Summary: Public Health Assessment of Potential Biological Terrorism Agents. Emerging Infectious Diseases. February 2002; Vol. 8, No. 2: 225-230.

U.S. Department of Health & Human Services, Centers for Disease Control and Prevention. Recommendations and Reports. Biological and chemical terrorism: strategic plan for preparedness and response. Recommendations of the CDC Strategic Planning Workgroup. Morbidity and Mortality Weekly Report. 2000; April 21;49(RR-4):1-14.

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Informacìon en Español

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Reference to an external Internet resource on this server does not constitute a recommendation or endorsement by the National Library of Medicine of the services or views described in that resource.

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Last modified on September 30, 2004.