title: Plague as a biological weapon: medical and public health management. Working Group on Civilian Biodefense.
abstract: OBJECTIVE
  The Working Group on Civilian Biodefense has developed consensus-based recommendations for measures to be taken by medical and public health professionals following the use of plague as a biological weapon against a civilian population.
  
  
  METHODS
  The working group included 25 representatives from major academic medical centers and research, government, military, public health, and emergency management institutions and agencies.
  
  
  METHODS
  MEDLINE databases were searched from January 1966 to June 1998 for the Medical Subject Headings plague, Yersinia pestis, biological weapon, biological terrorism, biological warfare, and biowarfare. Review of the bibliographies of the references identified by this search led to subsequent identification of relevant references published prior to 1966. In addition, participants identified other unpublished references and sources. Additional MEDLINE searches were conducted through January 2000.
  
  
  METHODS
  The first draft of the consensus statement was a synthesis of information obtained in the formal evidence-gathering process. The working group was convened to review drafts of the document in October 1998 and May 1999. The final statement incorporates all relevant evidence obtained by the literature search in conjunction with final consensus recommendations supported by all working group members.
  
  
  CONCLUSIONS
  An aerosolized plague weapon could cause fever, cough, chest pain, and hemoptysis with signs consistent with severe pneumonia 1 to 6 days after exposure. Rapid evolution of disease would occur in the 2 to 4 days after symptom onset and would lead to septic shock with high mortality without early treatment. Early treatment and prophylaxis with streptomycin or gentamicin or the tetracycline or fluoroquinolone classes of antimicrobials would be advised.
authors.affiliation: Center for Civilian Biodefense Studies, Johns Hopkins University Schools of Medicine, Baltimore, MD 21202, USA. tvi@jhsph.edu
authors.forename: T V
authors.initials: TV
authors.lastname: Inglesby
authors.forename: D T
authors.initials: DT
authors.lastname: Dennis
authors.forename: D A
authors.initials: DA
authors.lastname: Henderson
authors.forename: J G
authors.initials: JG
authors.lastname: Bartlett
authors.forename: M S
authors.initials: MS
authors.lastname: Ascher
authors.forename: E
authors.initials: E
authors.lastname: Eitzen
authors.forename: A D
authors.initials: AD
authors.lastname: Fine
authors.forename: A M
authors.initials: AM
authors.lastname: Friedlander
authors.forename: J
authors.initials: J
authors.lastname: Hauer
authors.forename: J F
authors.initials: JF
authors.lastname: Koerner
authors.forename: M
authors.initials: M
authors.lastname: Layton
authors.forename: J
authors.initials: J
authors.lastname: McDade
authors.forename: M T
authors.initials: MT
authors.lastname: Osterholm
authors.forename: T
authors.initials: T
authors.lastname: O'Toole
authors.forename: G
authors.initials: G
authors.lastname: Parker
authors.forename: T M
authors.initials: TM
authors.lastname: Perl
authors.forename: P K
authors.initials: PK
authors.lastname: Russell
authors.forename: M
authors.initials: M
authors.lastname: Schoch-Spana
authors.forename: K
authors.initials: K
authors.lastname: Tonat
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001694:Biological Warfare / Q000517:prevention & control*; D002959:Civil Defense; D003666:Decontamination; D004189:Disaster Planning; D006801:Humans; D017053:Infection Control; D010930:Plague / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D010931:Plague Vaccine; D014754:Violence; D014774:Virulence; D015010:Yersinia pestis / Q000472:pathogenicity
chemical_list: D000900:Anti-Bacterial Agents; D010931:Plague Vaccine