Here is our last excerpt from the Rand Corporation book, "Individual Preparedness and Response to Chemical, Radiological, Nuclear, and Biological Terrorist Attacks." This piece is on being ready for a biological attack.
See earlier posts in this blog for excerpts on chemical, radiological, and nuclear attack preparedness.
Note that I now have a few copies of the Quick Guide booklet version (26 pages) available for sale at $23, shipping included. It comes with a handy reference card for emergency info on how to react to critical scenarios. Please email me at jcrefuge@safecastle.net if you are interested.
Excerpt - Biological Attack
"Biological attacks can involve two basic types of biological agents: contagious and noncontagious. Contagious agents spread from person to person and include such agents as smallpox, plague, ebola, and dengue fever. Noncontagious agents do not spread from person to person; the primary threat is posed from the initial release of the agent. Such agents include anthrax and tularemia as well as biological toxins. Some agents have the potential to survive in the environment for extended periods of time and cause further risk of exposure if the agent is resuspended into the air. Left untreated, some of the diseases caused by either type of agent have the potential to kill a sizable fraction of those exposed to them. Because biological attacks may not be noticed for several days or weeks, there is no real difference for the individual whether the attack occurs indoors or outdoors."
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"Anthrax. Based on data from the 1979 anthrax release at Sverdlovsk, the mean time between infection with inhalational anthrax and the onset of symptoms is 10 days, with the earliest and latest appearance of symptoms being 3 days and about 40 days after the release. The large variation is thought to result from the ability of anthrax spores to remain in the body for long durations before germinating to produce the toxic vegetative form of the anthrax bacteria. In a large attack, initial symptoms will likely begin to appear in the first week. If the release is undetected, it may take another two days or more before anthrax is suspected and another day before it has been confirmed. After the attack, anthrax spores can remain on the ground and other surfaces indefinitely and, if of high weapon quality, could potentially be resuspended and inhaled, posing further risk of infections. The risk of infection from resuspended spores is highly uncertain but thought to be much less than the risk from exposure of the initial release.
"Smallpox. The incubation period for smallpox averages 12–14 days. After incubation, those infected with smallpox will begin to exhibit the initial flu-like symptoms (e.g., high fever). Roughly two days later, a characteristic rash begins to emerge on the extremities of the body. Smallpox will likely be confirmed a few days later, at which point the outbreak will be announced to the public. This announcement is expected to occur about 16 days after the attack. It could take public health efforts many weeks to stop the spread of smallpox.
"Detection. A biological attack may be perpetrated in a number of ways. If an attack is detected while a biological agent is still being released, measures can be taken to prevent exposure and infection (e.g., moving away from the release and early prophylaxis). At this point, however, government officials are likely to detect an attack only after those who are initially infected report to health care facilities and are diagnosed with the disease.
"Support from Officials/Governments. Because of the gradual nature of biological
weapons effects, the government will play a central role in helping the individual. The medical and public health systems will be instrumental in diagnosing any illness caused by biological weapons, as well as in estimating the time and location of attack. They will investigate whether cases of illness may result from a bioterrorism attack; coordinate the medical response; provide vaccinations and/or antibiotics; and inform the public about when and where to get medical treatment, how to minimize exposure, and whether to relocate. This includes informing the public about whether the biological agent used is contagious or noncontagious.
"Individual’s Primary Needs. Fundamentally, an individual needs access to an environment free of infection-producing agents. If potentially exposed, individuals will also need access to medical evaluation and treatment. Individuals can expect guidance about where to go and what to do. Note that guidance in this area is expected to evolve with time as officials learn more about bioterrorist threats, effective treatments, and public responses."
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Recommended Actions
"1. If symptomatic, immediately go to medical provider specified by public health officials for medical treatment.
Getting medical treatment if symptoms arise is an important action for improving one’s chances of recovery. An individual can expect guidance from officials about the likely symptoms for the specific kind of biological attack that has occurred. Because anthrax is caused by a bacterium, antibiotics are required for treatment and anthrax can be countered with aggressive antibiotic treatment. While it is important to begin antibiotic treatment in these cases as soon as possible, we do not recommend that individuals self-medicate with home supplies of antibiotics for reasons discussed later in this chapter. Although no cure for smallpox exists, chances of survival improve with medical care. In the event of a bioterrorist attack, special treatment facilities may be established, and individuals should follow the guidance of public health officials about where to seek medical treatment.
"2. If informed by public health officials of being potentially exposed, follow their guidance.
• For contagious diseases, expect to receive medical evaluation, surveillance, or quarantine.
⎯ If "in contact" with persons symptomatic with smallpox, obtain vaccination immediately.
• For noncontagious diseases, expect to receive medical evaluation.
⎯ For anthrax, obtain appropriate antibiotics quickly.
"Those individuals potentially exposed in a biological attack are those not showing symptoms but who were either present in the area of the attack or, in the case of a contagious agent, exposed to those who were. The primary concern for these individuals is the heightened probability that they may have been infected but are not yet showing symptoms. These individuals will be identified by public health officials. How precisely this group can be defined will depend on the ability of public health officials to pinpoint the time and place of the attack.
"Contagious Diseases. For contagious diseases, individuals should expect and closely follow guidance from public health officials about the possible need for medical evaluations, medical surveillance, or quarantine. Doing so helps ensure that if they become symptomatic they are treated quickly for their own safety and that they do not infect others.
"Individuals potentially exposed to smallpox include two groups: those 'in contact' with persons infected with smallpox and those present in the release area at the time of the attack or over the next two days. Because smallpox is thought to be contagious from the time a patient develops a rash until scabs have formed—a period of approximately 12 days that begins 12–16 days after infection—individuals "in contact" with those persons will be offered a smallpox vaccination and should get vaccinated as quickly as possible. A "contact" is an individual who has come into close contact with an infected person while that person is contagious, as well as household members of those contacts. Because there is some uncertainty about exactly when a smallpox patient is contagious, public health officials may specify a different period during which contacts are vulnerable.
"Contact vaccination is effective because smallpox is the only known potential biological weapon for which postexposure vaccination has proven value. Postexposure vaccination can be an effective response because production of protective antibodies in response to the vaccine have been detected as early as 10 days after vaccination, which is shorter than the incubation period. Thus, if given within three to four days after exposure, vaccination could offer complete or partial protection against smallpox. Vaccination four to seven days after exposure likely offers some protection from disease or may modify the severity of disease.
"In the case where a smallpox attack is identified more than seven days after the exposure, vaccination is unlikely for the second group of individuals (those in the area at the time of attack) because their exposure will have occurred too long ago for vaccination to be effective.
"The CDC, in conjunction with state and local governments, has developed procedures for vaccine distribution and administration designed to vaccinate large populations anywhere in the United States on the order of days.
"Noncontagious Diseases. For noncontagious diseases, individuals should expect and closely follow guidance from public health officials about the possible need for medical evaluations. This helps ensure that if they become symptomatic, they are treated quickly.
"Individuals potentially exposed to anthrax include those present in the release area at any time since the attack. This group should begin antibiotic therapy as soon as possible because antibiotics are useful for prevention of anthrax in those who have been infected with anthrax spores. As a postexposure step to prevent the development of inhalational anthrax, the CDC recommends that individuals take a 60-day course of preventive antibiotics because the incubation period for inhalational anthrax among humans may range up to 60 days. Those who have been partially or fully vaccinated should receive at least a 30-day course of antibiotics and continue with the vaccination regimen.
"Through the National Pharmaceutical Stockpile (NPS), the federal government has developed a plan for delivering needed supplies (including antibiotics) into a region when an incident requires a response larger or more sustained than the local community can handle. The NPS consists of an initial stockpile that can be distributed immediately, as well as a vendor-managed inventory component that is to be shipped to arrive at 24 and 36 hours after activation.
"Anthrax vaccine exists, but it is available only for preexposure protection to those at high risk and is not licensed for postexposure use in preventing anthrax. Distributing anthrax vaccine is therefore currently not part of the government’s terrorism response plan. However, because of a potential preventive benefit of combined antimicrobial and vaccine postexposure treatment and the availability of a limited supply of anthrax vaccine for civilian use, the CDC’s Advisory Committee on Immunization Practices has endorsed making anthrax vaccine available in combination with antibiotics under an Investigational New Drug application for persons at risk for inhalational anthrax. What action the government may actually take in another anthrax attack is therefore unclear. In addition to helping prevent the contraction of anthrax, use of the vaccine may reduce the need for long-term antimicrobial therapy, with its associated problems of nonadherence and possible adverse events.
"3. For all others, monitor for symptoms and, for contagious diseases, minimize contact with others.
Given the uncertainties surrounding who may have been infected in a biological attack, even individuals who are not symptomatic and who have no reason to believe they have been exposed to a biological agent should monitor themselves and their family members for signs of infection and be prepared to seek treatment. A common symptom of almost all potential biological agents is the presence of a fever. Thus, if officials announce that a biological attack has occurred in a particular area, it would be prudent for individuals in this group to monitor their temperature daily or as instructed by officials.
"The CDC’s current Smallpox Response Plan consists of isolating confirmed and suspected smallpox cases and vaccinating primary contacts of cases and family members of contacts, but it does not include postexposure vaccination of the general public. While some studies indicate that mass vaccination during an outbreak may be effective, the net benefit of such a policy is still under debate.
"In the case of such contagious agents as smallpox, these individuals should also minimize contact with potentially infected persons by 'shielding' with their families at home. Shielding entails minimizing unessential trips and possibly using a particulate mask when outings (e.g., going to and from work, shopping for food, or seeking medical treatment) are necessary.
"4. Leave anthrax-affected area once on antibiotics if advised to do so by public health officials.
Considerable uncertainty exists about the extent to which anthrax spores released in the air can become resuspended again after they have settled on the ground, thereby presenting a continuing health hazard. If long-term environmental dangers are possible, officials may call for individuals in the affected area to relocate to housing in other areas. If they do call for relocation, it would not have to be done immediately; individuals would have time to secure their homes, but, to prevent spreading spores, they would probably not be allowed to take their belongings with them. For those moving in or out of the affected area, N95 particulate filter masks could be useful if officials believe the risk of infection from resuspension of the spores is significant."
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