Hemorrhagic fever viruses as biological weapons: medical and public health management.
OBJECTIVE
To develop consensus-based recommendations for measures to be taken by medical and public health professionals if hemorrhagic fever viruses (HFVs) are used as biological weapons against a civilian population.


METHODS
The Working Group on Civilian Biodefense included 26 representatives from academic medical centers, public health, military services, governmental agencies, and other emergency management institutions.


METHODS
MEDLINE was searched from January 1966 to January 2002. Retrieved references, relevant material published prior to 1966, and additional sources identified by participants were reviewed.


METHODS
Three formal drafts of the statement that synthesized information obtained in the evidence-gathering process were reviewed by the working group. Each draft incorporated comments and judgments of the members. All members approved the final draft.


CONCLUSIONS
Weapons disseminating a number of HFVs could cause an outbreak of an undifferentiated febrile illness 2 to 21 days later, associated with clinical manifestations that could include rash, hemorrhagic diathesis, and shock. The mode of transmission and clinical course would vary depending on the specific pathogen. Diagnosis may be delayed given clinicians' unfamiliarity with these diseases, heterogeneous clinical presentation within an infected cohort, and lack of widely available diagnostic tests. Initiation of ribavirin therapy in the early phases of illness may be useful in treatment of some of these viruses, although extensive experience is lacking. There are no licensed vaccines to treat the diseases caused by HFVs.
Borio
Luciana
L
Johns Hopkins Center for Civilian Biodefense Strategies, Johns Hopkins Schools of Medicine and Public Health, 111 Market Pl, Suite 830, Baltimore, MD 21202, USA. Lborio@jhsph.edu
Inglesby
Thomas
T
Peters
C J
CJ
Schmaljohn
Alan L
AL
Hughes
James M
JM
Jahrling
Peter B
PB
Ksiazek
Thomas
T
Johnson
Karl M
KM
Meyerhoff
Andrea
A
O'Toole
Tara
T
Ascher
Michael S
MS
Bartlett
John
J
Breman
Joel G
JG
Eitzen
Edward M
EM
Hamburg
Margaret
M
Hauer
Jerry
J
Henderson
D A
DA
Johnson
Richard T
RT
Kwik
Gigi
G
Layton
Marci
M
Lillibridge
Scott
S
Nabel
Gary J
GJ
Osterholm
Michael T
MT
Perl
Trish M
TM
Russell
Philip
P
Tonat
Kevin
K
D000336:Aerosols; D000998:Antiviral Agents / Q000627:therapeutic use; D001116:Arenaviridae / Q000472:pathogenicity; D001117:Arenaviridae Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D001694:Biological Warfare; D023482:Bioterrorism; D002043:Bunyaviridae / Q000472:pathogenicity; D002044:Bunyaviridae Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D002102:Cadaver; D002959:Civil Defense / Q000592:standards*; D019411:Clinical Laboratory Techniques; D004189:Disaster Planning / Q000592:standards; D004196:Disease Outbreaks / Q000517:prevention & control; D016563:Filoviridae / Q000472:pathogenicity; D018702:Filoviridae Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D018067:Flaviviridae / Q000472:pathogenicity; D018177:Flavivirus Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006482:Hemorrhagic Fevers, Viral / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D017053:Infection Control; D011635:Public Health Administration / Q000592:standards*; D015980:Public Health Practice / Q000592:standards*; D012106:Research; D012254:Ribavirin / Q000627:therapeutic use; D014481:United States; D014765:Viral Vaccines
D000336:Aerosols; D000998:Antiviral Agents; D014765:Viral Vaccines; D012254:Ribavirin