Bioterrorism
Helping you be prepared
Contact Information
Tony Buel
Health Department Director
636-583-7309
DHSS MO Dept Situation Room
1-800-392-0272
Biological Nat'l Response Center
1-800-424-8802
Hazardous Chemicals
911
Bioterrorism Agents
Franklin County Public health is working to ensure that we are prepared and will help to minimize the impact of an attack should it occur.
A biological attack is the deliberate release of germs or other biological substances that can make a person sick. Many agents must be inhaled or eaten, while others may enter through a cut in the skin. Some biological agents, such as anthrax, do not cause contagious diseases. Others, like the smallpox virus, can result in infectious diseases.
This web page gives information on common bioterrorism agents and what you need to know – and do – should a bioterrorism event occur.
Anthrax
What is Anthrax?
Anthrax is an acute infectious disease caused by the spore-forming bacterium Bacillus anthracis. Anthrax most commonly occurs in hoofed mammals and can infect humans.
Signs and Symptoms:
Symptoms of disease vary depending on how the disease was contracted, but usually occur within seven 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.
Cutaneous anthrax symptoms occur after the bacteria enter through a cut on the skin. This is the most common type of anthrax infection, and typically occurs after contact with animal hides or hair, bone, and wool. Symptoms include an itchy sore which may blister and form a black ulcer.
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 person(s) ill with anthrax, such as household contacts, friends, or coworkers, unless they also were also exposed to the same source of infection.
What is the treatment for exposure to Anthrax?
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 can also prevent infection. Vaccination against anthrax is not recommended for the general public to prevent disease and is not available.
How should I handle a suspicious package?
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Do not shake or empty the contents of any suspicious package or envelope.
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Do not carry the package or envelope, show it to others or allow others to examine it.
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Put the package or envelope down on a stable surface; do not sniff, touch, taste, or look closely at it or at any contents which may have spilled.
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Alert others in the area about the suspicious package or envelope. Leave the area, close any doors, and take actions to prevent others from entering the area. If possible, shut off the ventilation system.
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Immediately wash hands with soap and water to prevent spreading potentially infectious material to face or skin. Seek additional instructions for exposed or potentially exposed persons.
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If at work, notify a supervisor, a security officer, or a law enforcement official. If at home, contact the local law enforcement agency.
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If possible, create a list of persons who were in the room or area when this suspicious letter or package was recognized and a list of persons who also may have handled this package or letter. Give this list to both the local public health authorities and law enforcement officials.
Anthrax FAQs for Healthcare Workers and Providers
How is anthrax diagnosed?
Anthrax is diagnosed by isolating B. anthracis from the blood, skin lesions, or respiratory secretions, or by measuring specific antibodies in the blood of persons with suspected cases.
In patients with symptoms compatible with anthrax, providers should confirm the diagnosis by obtaining the appropriate laboratory specimens based on the clinical form of anthrax that is suspected (i.e., cutaneous, inhalation, or gastrointestinal).
What are the standard diagnostic tests used by the laboratories?
Presumptive identification to identify to genus level (Bacillus family of organisms) requires Gram stain and colony identification.
Presumptive identification to identify to species level (B. anthracis) requires tests for motility, lysis by gamma phage, capsule production and visualization, hemolysis, wet mount and malachite green staining for spores.
Confirmatory identification of B. anthracis carried out by CDC may include phage lysis, capsular staining, and direct fluorescent antibody (DFA) testing on capsule antigen and cell wall polysaccharide.
When is a nasal swab indicated?
Nasal swabs and screening may assist in epidemiologic investigations but should not be relied upon as a guide for prophylaxis or treatment. Epidemiologic investigation in response to threats of exposure to B. anthracis may employ nasal swabs of potentially exposed persons as an adjunct to environmental sampling to determine the extent of exposure.
Is there an X-ray for detecting anthrax?
A chest X-ray can be used to help diagnose inhalation anthrax in people who have symptoms. It is not useful as a test for determining anthrax exposure or for people with no symptoms.
Can someone get anthrax from contaminated mail, equipment or clothing?
In the mail handling processing sites, B. anthracis spores may be aerosolized during the operation and maintenance of high-speed, mail sorting machines potentially exposing workers. In addition, these spores could get into heating, ventilating, or air conditioning (HVAC) systems.
Botulism
Botulism is a muscle-paralyzing disease caused by a toxin made by a bacterium called Clostridium botulinum.
There are three main kinds of botulism:
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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. With foodborne botulism, symptoms begin within 6 hours to 2 weeks (most commonly between 12 and 36 hours) after eating toxin-containing food.
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Infant botulism occurs in a small number of susceptible infants each year who harbor C. botulinum in their intestinal tract.
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Wound botulism occurs when wounds are infected with C. botulinum that secretes the toxin.
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.
Signs and Symptoms:
The classic symptoms of botulism include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness. Infants with botulism appear lethargic, feed poorly, are constipated, and have a weak cry and poor muscle tone. These are all symptoms of the muscle paralysis caused by the bacterial toxin. If untreated, these symptoms may progress to cause paralysis of the arms, legs, trunk and respiratory muscles. In foodborne botulism, symptoms generally begin 18 to 36 hours after eating a contaminated food, but they can occur as early as 6 hours or as late as 10 days.
How common is botulism?
In the United States an average of 110 cases of botulism are reported each year. Of these, approximately 25% are foodborne, 72% are infant botulism, and the rest are wound botulism. Outbreaks of foodborne botulism involving two or more persons occur most years and usually caused by eating contaminated home-canned foods. The number of cases of foodborne and infant botulism has changed little in recent years, but wound botulism has increased because of the use of black-tar heroin, especially in California.
How can botulism be treated?
The respiratory failure and paralysis that occur with severe botulism may require a patient to be on a breathing machine (ventilator) for weeks, plus intensive medical and nursing care. After several weeks, the paralysis slowly improves. If diagnosed early, foodborne and wound botulism can be treated with an antitoxin which blocks the action of toxin circulating in the blood. This can prevent patients from worsening, but recovery still takes many weeks. Physicians may try to remove contaminated food still in the gut by inducing vomiting or by using enemas. Wounds should be treated, usually surgically, to remove the source of the toxin-producing bacteria. Good supportive care in a hospital is the mainstay of therapy for all forms of botulism. Currently, antitoxin is not routinely given for treatment of infant botulism.
Botulism FAQs for Healthcare Workers and Providers
What is botulism?
Botulism is a rare but serious paralytic illness caused by a nerve toxin that is produced by the bacterium Clostridium botulinum. There are three main kinds of botulism. Foodborne botulism is caused by eating foods that contain the botulism toxin. Wound botulism is caused by toxin produced from a wound infected with Clostridium botulinum. Infant botulism is caused by consuming the spores of the botulinum bacteria, which then grow in the intestines and release toxin. All forms of botulism can be fatal and are considered medical emergencies. Foodborne botulism can be especially dangerous because many people can be poisoned by eating a contaminated food.
What are the symptoms of botulism?
The classic symptoms of botulism include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness. Infants with botulism appear lethargic, feed poorly, are constipated, and have a weak cry and poor muscle tone. These are all symptoms of the muscle paralysis caused by the bacterial toxin. If untreated, these symptoms may progress to cause paralysis of the arms, legs, trunk and respiratory muscles. In foodborne botulism, symptoms generally begin 18 to 36 hours after eating a contaminated food, but they can occur as early as 6 hours or as late as 10 days.
What kind of germ is Clostridium botulinum?
Clostridium botulinum is the name of a group of bacteria commonly found in soil. These rod-shaped organisms grow best in low oxygen conditions. The bacteria form spores which allow them to survive in a dormant state until exposed to conditions that can support their growth. There are seven types of botulism toxin designated by the letters A through G; only types A, B, E and F cause illness in humans.
How common is botulism?
In the United States an average of 110 cases of botulism are reported each year. Of these, approximately 25% are foodborne, 72% are infant botulism, and the rest are wound botulism. Outbreaks of foodborne botulism involving two or more persons occur most years and usually caused by eating contaminated home-canned foods. The number of cases of foodborne and infant botulism has changed little in recent years, but wound botulism has increased because of the use of black-tar heroin, especially in California.
How is botulism diagnosed?
Physicians may consider the diagnosis if the patient's history and physical examination suggest botulism. However, these clues are usually not enough to allow a diagnosis of botulism. Other diseases such as Guillain-Barré syndrome, stroke, and myasthenia gravis can appear similar to botulism, and special tests may be needed to exclude these other conditions. These tests may include a brain scan, spinal fluid examination, nerve conduction test (electromyography, or EMG), and a tensilon test for myasthenia gravis. The most direct way to confirm the diagnosis is to demonstrate the botulinum toxin in the patient's serum or stool by injecting serum or stool into mice and looking for signs of botulism. The bacteria can also be isolated from the stool of persons with foodborne and infant botulism. These tests can be performed at some state health department laboratories and at CDC.
How can botulism be treated?
The respiratory failure and paralysis that occur with severe botulism may require a patient to be on a breathing machine (ventilator) for weeks, plus intensive medical and nursing care. After several weeks, the paralysis slowly improves. If diagnosed early, foodborne and wound botulism can be treated with an antitoxin which blocks the action of toxin circulating in the blood. This can prevent patients from worsening, but recovery still takes many weeks. Physicians may try to remove contaminated food still in the gut by inducing vomiting or by using enemas. Wounds should be treated, usually surgically, to remove the source of the toxin-producing bacteria. Good supportive care in a hospital is the mainstay of therapy for all forms of botulism. Currently, antitoxin is not routinely given for treatment of infant botulism.
Plague
Plague is a disease caused by Yersinia pestis (Y. pestis), a bacterium found in rodents and their fleas in many areas around the world.
Signs and Symptoms:
Patients usually have fever, weakness, and rapidly developing pneumonia with shortness of breath, chest pain, cough, and sometimes bloody or watery sputum. Nausea, vomiting, and abdominal pain may also occur. Without early treatment, pneumonic plague usually leads to respiratory failure, shock, and rapid death.
Why are we concerned about pneumonic plague as a bioweapon?
Yersinia pestis used in an aerosol attack could cause cases of the pneumonic form of plague. One to six days after becoming infected with the bacteria, people would develop pneumonic plague. Once people have the disease, the bacteria can spread to others who have close contact with them. Because of the delay between being exposed to the bacteria and becoming sick, people could travel over a large area before becoming contagious and possibly infecting others. Controlling the disease would then be more difficult. A bioweapon carrying Y. pestis is possible because the bacterium occurs in nature and could be isolated and grown in quantity in a laboratory. Even so, manufacturing an effective weapon using Y. pestis would require advanced knowledge and technology.
Is pneumonic plague different from bubonic plague?
Yes. Both are caused by Yersinia pestis, but they are transmitted differently, and their symptoms differ. Pneumonic plague can be transmitted from person to person; bubonic plague cannot. Pneumonic plague affects the lungs and is transmitted when a person breathes in Y. pestis particles in the air. Bubonic plague is transmitted through the bite of an infected flea or exposure to infected material through a break in the skin. Symptoms include swollen, tender lymph glands called buboes. Buboes are not present in pneumonic plague. If bubonic plague is not treated, however, the bacteria can spread through the bloodstream and infect the lungs, causing a secondary case of pneumonic plague.
Can a person exposed to pneumonic plague avoid becoming sick?
Yes. People who have had close contact with an infected person can greatly reduce the chance of becoming sick if they begin treatment within 7 days of their exposure. Treatment consists of taking antibiotics for at least 7 days.
How quickly would someone get sick if exposed to plague bacteria through the air?
Someone exposed to Yersinia pestis through the air—either from an intentional aerosol release or from close and direct exposure to someone with plague pneumonia—would become ill within 1 to 6 days.
Can pneumonic plague be treated?
Yes. To prevent a high risk of death, antibiotics should be given within 24 hours of the first symptoms. Several types of antibiotics are effective for curing the disease and for preventing it. Available oral medications are a tetracycline (such as doxycycline) or a fluoroquinolone (such as ciprofloxacin). For injection or intravenous use, streptomycin or gentamicin antibiotics are used. Early in the response to a bioterrorism attack, these drugs would be tested to determine which is most effective against the particular weapon that was used.
Would enough medication be available in the event of a bioterrorism attack involving pneumonic plague?
National and state public health officials have large supplies of drugs needed in the event of a bioterrorism attack. These supplies can be sent anywhere in the United States within 12 hours.
How is plague diagnosed?
The first step is evaluation by a health worker. If the health worker suspects pneumonic plague, samples of the patient’s blood, sputum, or lymph node aspirate are sent to a laboratory for testing. Once the laboratory receives the sample, preliminary results can be ready in less than two hours. Confirmation will take longer, usually 24 to 48 hours.
Is a vaccine available to prevent pneumonic plague?
Currently, no plague vaccine is available in the United States. Research is in progress, but we are not likely to have vaccines for several years or more.
Smallpox
Smallpox is a serious, contagious, and sometimes fatal infectious disease. There is no specific treatment for smallpox disease, and the only prevention is vaccination. Smallpox outbreaks have occurred from time to time for thousands of years, but the disease is now eradicated after a successful worldwide vaccination program. The last case of smallpox in the United States was in 1949. The last naturally occurring case in the world was in Somalia in 1977. After the disease was eliminated from the world, routine vaccination against smallpox among the general public was stopped because it was no longer necessary for prevention.
Signs and Symptoms:
The symptoms of smallpox begin with high fever, head and body aches, and sometimes vomiting. A rash follows that spreads and progresses to raised bumps and pus-filled blisters that crust, scab, and fall off after about three weeks, leaving a pitted scar.
If someone comes in contact with smallpox, how long does it take to show symptoms?
After exposure, it takes between 7 and 17 days for symptoms of smallpox to appear (average incubation time is 12 to 14 days). During this time, the infected person feels fine and is not contagious.
Is smallpox fatal?
The majority of patients with smallpox recover, but death may occur in up to 30% of cases. Many smallpox survivors have permanent scars over large areas of their body, especially their face. Some are left blind.
How is smallpox spread?
Smallpox normally spreads from contact with infected persons. Generally, direct and fairly prolonged face-to-face contact is required to spread smallpox from one person to another. Smallpox also can be spread through direct contact with infected bodily fluids or contaminated objects such as bedding or clothing.
How many people would have to get smallpox before it is considered an outbreak?
One confirmed case of smallpox is considered a public health emergency.
Is there any treatment for smallpox?
Smallpox can be prevented through use of the smallpox vaccine. There is no proven treatment for smallpox, but research to evaluate new antiviral agents is ongoing.
Should I get vaccinated against smallpox?
The smallpox vaccine is not available to the public at this time.
Smallpox FAQs for Healthcare Workers and Providers
What should I know about smallpox?
Smallpox is an acute, contagious, and sometimes fatal disease caused by the variola virus (an orthopoxvirus) and marked by fever and a distinctive progressive skin rash. In 1980, the disease was declared eradicated following worldwide vaccination programs. However, in the aftermath of the events of September and October, 2001, the U.S. government is taking precautions to be ready to deal with a bioterrorist attack using smallpox as a weapon. As a result of these efforts: 1) There is a detailed nationwide smallpox response plan designed to quickly vaccinate people and contain a smallpox outbreak. This plan includes the creation of smallpox health care teams that would respond to a smallpox emergency and the vaccination of members of these teams. 2) There is enough smallpox vaccine to vaccinate everyone who would need it in the event of an emergency.
Signs and Symptoms:
The symptoms of smallpox begin with high fever, head and body aches, and sometimes vomiting. A rash follows that spreads and progresses to raised bumps and pus-filled blisters that crust, scab, and fall off after about three weeks, leaving a pitted scar.
Is smallpox fatal?
The majority of patients with smallpox recover, but death may occur in up to 30% of cases. Many smallpox survivors have permanent scars over large areas of their body, especially their face. Some are left blind.
How is smallpox spread?
Generally, direct and fairly prolonged face-to-face contact is required to spread smallpox from one person to another. Smallpox also can be spread through direct contact with infected bodily fluids or contaminated objects such as bedding or clothing. Indirect spread is less common. Rarely, smallpox has been spread by virus carried in the air in enclosed settings such as buildings, buses, and trains. Smallpox is not known to be transmitted by insects or animals.
If people had smallpox previously and survived, are they immune from the disease?
Yes. If they had smallpox before and survived, they are immune to the disease.
When are cases of smallpox infectious?
A person with smallpox is sometimes contagious with onset of fever (prodrome phase), but the person becomes most contagious with the onset of rash. The infected person is contagious until the last smallpox scab falls off.
Is there any treatment for smallpox?
Smallpox can be prevented through use of the smallpox vaccine. There is no proven treatment for smallpox, but research to evaluate new antiviral agents is ongoing. Early results from laboratory studies suggest that the drug Cidofovir may fight against the smallpox virus; currently, studies with animals are being done to better understand the drug’s ability to treat smallpox disease (the use of Cidofovir to treat smallpox or smallpox reactions should be evaluated and monitored by experts at NIH and CDC). Patients with smallpox can benefit from supportive therapy (e.g., intravenous fluids, medicine to control fever or pain) and antibiotics for any secondary bacterial infections that may occur.
Why are we even bringing smallpox patients to the hospitals? Why not just keep them at home where they’ve already exposed everyone?
With good infection control practices and rooms with the appropriate air handling features, we can treat patients in the hospital without risking transmission to other patients and staff. The appropriate care and management of smallpox patients will probably require hospitalization.
What kind of personal protective equipment (PPE, especially respiratory) would be necessary for dealing with a smallpox patient?
Airborne and contact isolation precautions should be followed.
Does a HEPA filter remove smallpox virus? Can a makeshift isolation room be created by bringing a portable HEPA filter into a regular private room?
Yes, HEPA filters do remove smallpox virus. HEPA filters are 99.97% efficient at removing particles that are greater than or equal to 0.3 microns in size, but their use will not create an airborne infection isolation room (the precautions recommended for smallpox patients).
The HEPA filter will not change the pressure relationship to the corridor unless the portable filter is set up as a negative pressure device. Self-closing doors will help to maintain the conditions and windows should be closed and sealed. If the HEPA filter is being used only to purify the room air, its effectiveness will vary depending on the size of the room and output of the device. A portable HEPA filter that produces 8 or more air changes per hour results in a 90% reduction of particles in 17 minutes in a room with the doors and windows closed. However, to be consistent with current guidelines for airborne infection isolation rooms, the goal should be 12 or more air changes per hour which would produce a 90% reduction in particles in 11 minutes.
Once a smallpox patient has been identified, what is the response for the hospital or clinic? Do we quarantine?
Until a case is confirmed, the recommendation is the same as for any rash illness, such as measles. Get the suspect patient into a negative air pressure room and gather the name and locating information for those exposed to the patient. If they don't have a negative air pressure room, get them to a facility that does. State and local governments have primary responsibility for isolation and/or quarantine within their borders.
In caring for a patient with smallpox, does the vaccination status of a caregiver affect the N95 mask recommendation?
Anyone caring for a smallpox patient should wear an N95 mask.
If a health care provider has a contraindication or is at a high risk for infection, should they care for patients infected with smallpox?
Ideally, these providers should not be in the vicinity of the patient or performing any patient care.
What are the HIPAC recommendations for health care workers who may be exposed to patients with smallpox or plague?
For smallpox, it is advisable that caregivers use a N95 mask respirator. For plague, a standard surgical mask is fine, and negative pressure rooms are not needed.
Tularemia
What is tularemia?
Tularemia is an infectious disease caused by a hardy bacterium, Francisella tularensis, found in animals (especially rodents, rabbits, and hares).
People can get tularemia many different ways, such as through the bite of an infected insect or other arthropod (usually a tick or deerfly), handling infected animal carcasses, eating or drinking contaminated food or water, or breathing in F. tularensis.
Signs and Symptoms:
Symptoms of tularemia could include sudden fever, chills, headaches, muscle aches, joint pain, dry cough, progressive weakness, and pneumonia. Persons with pneumonia can develop chest pain, bloody spit, and may have trouble breathing or can sometimes stop breathing. Other symptoms of tularemia depend on how a person was exposed to the tularemia bacteria. These symptoms can include ulcers on the skin or mouth, swollen and painful lymph glands, swollen and painful eyes, and a sore throat. Symptoms usually appear 3 to 5 days after exposure to the bacteria but can take as long as 14 days.
Tularemia is not known to be spread from person to person, so people who have tularemia do not need to be isolated.
A vaccine for tularemia is under review by the Food and Drug Administration and is not currently available in the United States.
How do people become infected with the tularemia bacteria?
Typically, persons become infected through the bites of arthropods (most commonly, ticks and deerflies) that have fed on an infected animal, by handling infected animal carcasses, by eating or drinking contaminated food or water, or by inhaling infected aerosols.
Does tularemia occur naturally in the United States?
Yes. It is a widespread disease of animals. Approximately 200 cases of tularemia in humans are reported annually in the United States, mostly in persons living in the south-central and western states. Nearly all cases occur in rural areas and are associated with the bites of infected ticks and biting flies or with the handling of infected rodents, rabbits, or hares. Occasional cases result from inhaling infectious aerosols and from laboratory accidents.
Can someone become infected with the tularemia bacteria from another person?
No. People have not been known to transmit the infection to others, so infected persons do not need to be isolated.
Can tularemia be effectively treated with antibiotics?
Yes. After potential exposure or diagnosis, early treatment is recommended with an oral antibiotic from the tetracycline (such as doxycycline) or fluoroquinolone (such as ciprofloxacin) class, or the antibiotics streptomycin or gentamicin, which are given intramuscularly or intravenously. Sensitivity testing of the tularemia bacterium can be done in the early stages of a response to determine which antibiotics would be most effective.
Tularemia FAQs for Healthcare Workers and Providers
What is tularemia?
Tularemia is an infectious disease caused by a hardy bacterium, Francisella tularensis, found in animals (especially rodents, rabbits, and hares).
Signs and Symptoms:
Depending on the route of exposure, the tularemia bacteria may cause skin ulcers, swollen and painful lymph glands, inflamed eyes, sore throat, oral ulcers, or pneumonia. If the bacteria are inhaled, symptoms include the abrupt onset of fever, chills, headache, muscle aches, joint pain, dry cough, and progressive weakness. Persons with pneumonia can develop chest pain, difficulty breathing, bloody sputum, and respiratory failure. 40% or more of persons with the lung and systemic forms of the disease may die if they are not treated with appropriate antibiotics.
How do people become infected with the tularemia bacteria?
Typically, persons become infected through the bites of arthropods (most commonly, ticks and deerflies) that have fed on an infected animal, by handling infected animal carcasses, by eating or drinking contaminated food or water, or by inhaling infected aerosols.
Does tularemia occur naturally in the United States?
Yes. It is a widespread disease of animals. Approximately 200 cases of tularemia in humans are reported annually in the United States, mostly in persons living in the south-central and western states. Nearly all cases occur in rural areas and are associated with the bites of infective ticks and biting flies or with the handling of infected rodents, rabbits, or hares. Occasional cases result from inhaling infectious aerosols and from laboratory accidents.
Why are we concerned about tularemia as a bioweapon?
Francisella tularensis is highly infectious: a small number of bacteria (10-50 organisms) can cause disease. If F. tularensis were used as a bioweapon, the bacteria would likely be made airborne for exposure by inhalation. Persons who inhale an infectious aerosol would generally experience severe respiratory illness, including life-threatening pneumonia and systemic infection, if they were not treated. The bacteria that cause tularemia occur widely in nature and could be isolated and grown in quantity in a laboratory, although manufacturing an effective aerosol weapon would require considerable sophistication.
Can someone become infected with the tularemia bacteria from another person?
No. People have not been known to transmit the infection to others, so infected persons do not need to be isolated.
How quickly would someone become sick if they were exposed to the tularemia bacteria?
The incubation period for tularemia is typically 3 to 5 days, with a range of 1 to 14 days.
What should someone do if they suspect they or others have been exposed to the tularemia bacteria?
Seek prompt medical attention. If a person has been exposed to Francisella tularensis, treatment with tetracycline antibiotics for 14 days after exposure may be recommended.
Local and state health departments should be immediately notified so investigation and control activities can begin quickly. If the exposure is thought to be due to criminal activity (bioterrorism), local and state health departments will notify the CDC, FBI, and other appropriate authorities.
How is tularemia diagnosed?
When tularemia is clinically suspected, the healthcare worker will collect specimens, such as blood or sputum, from the patient for testing in a diagnostic or reference laboratory. Laboratory test results for tularemia may be presumptive or confirmatory. Presumptive (preliminary) identification may take less than 2 hours, but confirmatory testing will take longer, usually 24 to 48 hours.
Can tularemia be effectively treated with antibiotics?
Yes. After potential exposure or diagnosis, early treatment is recommended with an oral antibiotic from the tetracycline (such as doxycycline) or fluoroquinolone (such as ciprofloxacin) class, or the antibiotics streptomycin or gentamicin, which are given intramuscularly or intravenously. Sensitivity testing of the tularemia bacterium can be done in the early stages of a response to determine which antibiotics would be most effective.
How long can Francisella tularensis exist in the environment?
Francisella tularensis can remain alive for weeks in water and soil.
Is there a vaccine available for tularemia?
In the past, a vaccine for tularemia has been used to protect laboratory workers, but it is currently under review by the Food and Drug Administration.