Bioterrorism and Me By: Members of the J300 class in the History of Public Health Indiana University Bloomington Spring 2005 Table of Contents Contact Information............................................................................ 5 Home Preparations.............................................................................. 5 Introduction.......................................................................................... 6 Jessica Mackey, Julia Thomas, Kyle Carmichael Table 1 Summary of Symptoms and Incubation Period (time from exposure to onset of symptoms)................................................. 8 Tarrah Beavin, Chris Erickson, and Jon Pollock Part 1 Diseases Category A Diseases Anthrax ................................................................................... 10 Tyler Christman and Julia Thomas Botulism .................................................................................. 13 R. Cory James, Matthew Frano, and John Keucher Plague ....................................................................................... 16 Emily Stachowicz and Tarrah Beavin Smallpox................................................................................... 18 Jessica Mackey, Sangeeta Sakaria, and Peter Cheun Tularemia (Rabbit Fever)....................................................... 21 Kevin Kruse and Neal Patel Viral Hemorrhagic Fevers...................................................... 23 Theo Lutz, Elisabeth Benoit, Melissa Fanning Category B diseases Glanders................................................................................... 26 Matthew Frano, Sangeeta Sakaria Venezuelan Equine Encephalitis (VEE)................................ 28 James Riley West Nile Virus....................................................................... 30 Kyle Carmichael Part 2 Biological and Chemical Toxins Biological toxins Ricin............................................................................ 34 R. Cory James SEB (Staphylococcal Enterotoxin B)....................... 36 R. Cory James T-2 (Trichothecene Mycotoxin)................................ 38 R. Cory James Chemical toxins 2 Blister agents (Mustard Gas).................................... 40 Kyle Mardis Blood agents (Arsine and Cyanide)......................... 43 Jon Pollock Nerve Agents G agents (Sarin, Soman, and Tabun........... 45 Jake Agee VX Nerve Gas............................................... 47 Chris Erickson Part 3 Targets, Delivery Methods, and Responses Targets................................................................................... 49 Kyle Mardis The Delivery of Pathogens and Toxins............................... 51 Neal Patel, Kevin Kruse, and Julia Thomas Evacuation and Taking Shelter........................................... 53 Kyle Mardis Compliance........................................................................... 54 Theo Lutz Treatment tips for emergency situations........................... 55 Tarrah Beavin Indicators that a terrorist attack may have occurred....... 59 adapted by Acknowledgments We want to thank the following people for helping us in revising earlier drafts of this booklet: Joni Albright, MPA formerly Indiana State Assistant Health Commissioner Rachel Miller Public Health Coordinator Monroe County, Indiana Kyle A. Perkinson Public Health Coordinator Sullivan County, Indiana Scott F. Wetterhall, MD, MPH Senior Program Director, RTI International, Atlanta And for financial help with printing and distributing this booklet, we want to thank: John Bodnar Chair History Department Catherine Larson Dean College of Arts & Sciences Charlie Nelms Vice President for Student Development and Diversity A note on how we came to do this project On the first day of our class each student discussed how he or she wanted to live a useful life. Some planned to do pro bono work in their occupations, others wanted to train to be physicians or public health experts. Everyone wanted to make a difference. Among topics taken up during the semester were some dealing with public implications of tobacco use, road safety, and biological and chemical weapons, and we also studied how people learn about health issues. When this bioterrorism project was suggested, many students reacted by seeing it as a good first step to begin helping other people. In the discussion about whether the class would actually undertake this project, class members decided that by putting together this pamphlet they would be contributing to one of the goals of public health, which is to educate citizens so that they know ahead of time what choices they can make in an emergency. Here's what we found out about how ordinary people can recognize and deal with hazards posed by bioterrorism. 4 Contact Information Police Fire Ambulance 911 Poison Control Center 1-800-222-1222 Department of Home land Security Citizens Line 1-202-282-8000 Centers for Disease Control public response hotline 1-800-CDC-INFO Indiana Public Health Office 1-317-233-8000 emergency number 1-317-233-1325 Home Preparations There are many decisions to be made to prepare home and work for a bioterrorist attack. We have not tried to discuss these decisions or the specific steps that should be considered, but decided instead to refer readers to some web pages that do cover these issues: healthandenergy.com/preparing_for_terrorist_attacks.htm homebuying.about.com/cs/saferooms/a/disaster_kit.htm www.backwoodshome.com/articles2/arnet74.html, which discusses disaster preparation in general www.vdes.state.va.us/library/famdis.cfm 5 Introduction Jessica Mackey, Julia Thomas, Kyle Carmichael Chemical and biological warfare --CBW-- has been employed for hundreds, and probably thousands, of years in ways that might now be considered “primitive.” Modern advances in science and technology make warfare by such means a greater threat today. The new CBW weapons are deadlier, and there are now more opportunities for using them. They have been employed occasionally in wars between nations, and more systematically during World War I. Since the 1990s these weapons have also been used by terrorist groups in attacks on their enemies and in attempts to draw attention to their objectives. Biological terrorism --bioterrorism for short-- is one of the main threats of the 21st century because terrorist groups have learned out to obtain and deploy biological and chemical weapons. And America is a likely target for an attack. Bioterrorism remains for many people an unknown area. The country as a whole needs to take some steps to enhance protection. Since September 11, 2001 much has been done to plan and organize national defenses. These defenses are essential, but they often seem to be at too great a distance from individuals. Individuals, too, need to plan to defend themselves. The goals of this pamphlet are to explain how to recognize what are regarded as the leading bioterrorist threats, and to provide suggestions about what to do in the event of an attack. Our aim is to inform rather than to alarm. The main premise of this pamphlet is that everyone can learn how to recognize the diseases and toxins likeliest to be used in bioterrorism, and everyone can learn some useful steps to take against each specific disease and toxin. Early detection of terrorist attacks will save lives, quite dramatically for some agents. That means that individuals need to know how to recognize and detect the weapons of bioterrorism, or at least when to be suspicious that such weapons have been used. And it means getting in touch immediately with local and national authorities. Bioterrorism is the use of bacteria or viruses or a chemical compound with the intent of making people ill or causing death. These diseases and chemicals can be spread through the air or water, and by direct contact. Following a categorization introduced by the Centers for Disease Control, we distinguish two groups of diseases. Category A diseases are the most dangerous and the likeliest to be used in bioterrorist attacks. Category B diseases are less lethal and are less likely to be used, but they are still considered dangerous disease agents. Terrorists may elect to use biotoxins and chemical weapons as well as diseases, selecting toxins that cause sickness or death in a large proportion of the people who come into contact with them, and which have a more or less immediate effect. The biotoxins, such as ricin, SEB, and T-2, use live organisms to make chemicals. Other weapons are made from chemical agents. There is no sharp dividing line between biotoxins and chemicals. 6 Each chapter below discusses a particular disease or toxin, or aspects of bioterrorism that concern individuals, such as likely targets, delivery methods, and how to respond. The chapters on diseases and toxins are organized in a way meant to help readers find topics and obtain information quickly. Many diseases and compounds could be used as weapons. Here we select those that are widely considered the likeliest ones to be used. For a bacteria, virus or chemical compound to threaten us, it must be easily produced and transported, and it must either be powerful enough to affect many people or able to cause disease or injury with unusually small doses. Diseases and agents that are difficult to detect immediately are also attractive for use in bioterrorism. One chapter is devoted to each disease or compound, giving a brief overview. Each chapter explains how to recognize a disease or agent, and what to do with yourself, others, and your belongings if an attack is