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Biological Attack
General Guidance
Be alert to the following:
Groups of individuals becoming ill around the same time. Sudden increase of illness in previously healthy individuals. Sudden increase in the following non-specific illnesses:
Pneumonia, flu-like illness, or fever with atypical features
Bleeding disorders Unexplained rashes and mucosal or skin irritation, particularly in adults Neuromuscular illness like muscle weakness and paralysis Diarrhea
Simultaneous disease outbreaks in human and animal or bird populations. Unusual temporal or geographic clustering of illness (for example, patients who attended the same public event, live in the same part of town, etc.)
Decontamination:
Decontamination of patients usually not required for biological agents. Clothing removal and biosafety bagging is recommended. Handle equipment used according to standard infection control practices.
Anthrax
Incubation - 2 to 6 days Range - 2 days to 8 weeks Symptoms - flu-like symptoms, nausea, vomiting, abdominal pain, fever, respiratory distress Transmission & precautions - aerosol inhalation, no person-to-person transmission, standard precautions
Botulism
Incubation - 12 to 72 hours Range - 2 hours to 8 days Symptoms - difficulty swallowing or speaking, symmetric descending weakness, respiratory dysfunction, no sensory dysfunction, no fever Transmission & precautions - aerosol inhalation, food ingestion, no person-to-person transmission, standard precautions
Plague
Incubation - 1 to 3 days by inhalation Symptoms - Sudden onset of fever, chills, headache, myalgia,
Pneumonic: cough, chest pain, dyspnea, fever Bubonic: painful lymph nodes Transmission & precautions - person to person transmission in pneumonic forms, droplet precautions until patient treated for at least 3 days
Tularemia "pneumonic"
Incubation - 2 to 5 days Range - 1 to 21 days Symptoms- Fever, cough, chest tightness, pleuritic pain, hemoptysis rare Transmission & precautions - Inhalation of agents, no person to person transmission but laboratory personnel at risk, standard precuations
Smallpox
Incubation - 12 to 14 days Range - 7 to 17 days Symptoms - high fever and myalgia, itching, abdominal pain, delirium, rash on face extremities, hands and feet which can be confused with chickenpox which has a less uniform rash Transmission & precautions - person to person transmission, airborne precautions, negative pressure, clothing and surface decontamination.
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