Anthrax | Botulism | Plague | Smallpox | Tularemia
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Facts about Anthrax See also Anthrax
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 essentialdelay 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.
AMA Message to Physicians on Anthrax Updated October 15, 2001
Anthrax JAMA May 12, 1999 (
Anthrax ( NY City Dept. of Health Bio-Threat Website )
Anthrax - Background ( Center for Nonproliferation Studies )
Facts about Botulism
Botulinum Toxin as a Biological Weapon: Medical and Public Health Management [JAMA. February 28, 2001;285:1059-1070]
Botulism is a muscle-paralyzing disease caused by a toxin made by a bacterium called Clostridium botulinum.
There are three main kinds of botulism:
· Foodborne botulism occurs when a person ingests pre-formed toxin that leads to illness within a few hours to days. Foodborne botulism is a public health emergency because the contaminated food may still be available to other persons besides the patient.
· Infant botulism occurs in a small number of susceptible infants each year who harbor C. botulinum in their intestinal tract.
· Wound botulism occurs when wounds are infected with C. botulinum that secretes the toxin.
With foodborne 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. Foodborne botulism can occur in all age groups.
A supply of antitoxin against botulism is maintained by CDC. 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.
Botulism ( NY City Dept of Health )
Facts about Pneumonic Plague
Plague as a Biological Weapon: Medical and Public Health Management [JAMA. May 3, 2000;283:2281-2290]
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.
Plague ( NY City Dept of Health )
Facts about Smallpox http://www.bt.cdc.gov/agent/smallpox/index.asp
Smallpox as a Biological Weapon: Medical and Public Health Management [JAMA. 1999;281:2127-2137]
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.
In people exposed to smallpox, the vaccine can lessen the severity of or even prevent illness if given within 4 days after exposure. Vaccine against smallpox contains another live virus called vaccinia. The vaccine does not contain smallpox virus.
The United States currently has an emergency supply of smallpox vaccine.
There is no proven treatment for smallpox but research to evaluate new antiviral agents is ongoing. Patients with smallpox can benefit from supportive therapy (intravenous fluids, medicine to control fever or pain, etc.) and antibiotics for any secondary bacterial infections that occur.
Smallpox ( NY City Dept of Health )
Smallpox Manifestations and Survival during the Boston Epidemic of 1901 to 1903 Ann Intern Med. Dec. 17, 2002;137:993-1000.
as a Biological Weapon: Medical and Public Health Management [JAMA
June 6, 2001;Vol. 285 No. 21]
Tularemia ( NY City Dept of Health )
Centers for Disease Control and Prevention
1600 Clifton Rd., Atlanta, GA 30333, USA