Research Biological Warfare Article 3 Probiotics Basics Bioterrorism fears tackled in special grand rounds at Fairchild By MICHELLE BRANDT Man infected by the bacterium called Bacillus anthracis called anthrax COPYRIGHT - WHO October 24, 2001 More than 30,000 people are enjoying a sporting event in a San Jose arena when a truck drives along a nearby highway and releases an unknown aerosol. Two days later, people around the county have become ill with a high fever and cough, flooding local hospitals. Within five days, hundreds have died, local medical services are overwhelmed and the president has declared San Jose a disaster area - the victim of a bioterrorist attack.

Biological warfare table of contents 14 anthrax smallpox 13 anthrax 12 bioweapons 11 tularemia 10 biological war 9 bioterror agents 8 biological war 7 anthrax detect 6 anthrax decont. 5 anthrax clean 4 decontaminate 3 bioterrorism 2 symptoms 1 decontaminate 1 anthrax 2 success 3 kill anthrax 4 challenges 5 questions 6 public health

This is the scenario that Shelley Salpeter, MD, a clinical professor of medicine at Stanford and director of Medicine Consultation Services at Santa Clara Valley Medical Center, spelled out during her specially scheduled grand rounds lecture, "Physician Preparedness for Bioterrorism," last Thursday. Salpeter, who works closely with the Santa Clara Department of Public Health on bioterrorism issues, spoke to a standing-room-only audience at Fairchild Auditorium about bioterrorism and medical preparedness.

"Bioterrorism is not something we were ever taught about; these are agents that we've had no clinical experience with," Salpeter said in a conversation before her lecture. She said she conceived her talk, which she dubbed "Bioterrorism 101," so physicians would understand the current threat of bioterrorism, be familiar with the clinical aspects and treatment of certain agents and better prepare themselves in the event of an attack. Salpeter planned the subject months ago but said "there is a new sense of urgency" surrounding this topic.

During her talk, Salpeter provided detailed information - including symptoms, diagnostic tools, treatment and mortality rate - for six primary biological agents of concern: plague, anthrax, viral hemorrhagic fevers (such as ebola), tularemia, smallpox and botulinum toxin. She said plague, smallpox and hemorrhagic fevers can be transmitted from person to person - which means they need to be handled carefully by physicians - and the plague, which killed 12 million people in China in 1894, is considered the most invasive and virulent disease known.

Salpeter provided a brief history of the use of these agents in warfare, explaining that some agents have been used for thousands of years, and that Japan was the first country to have a modern biological warfare program. She reported that Richard Nixon abolished the use of biological warfare in the United States in 1969, shortly before 78 nations signed a treaty agreeing to do the same, and that the Soviet Union ended its large program in 1991. Salpeter said the Soviet Union built up a massive arsenal of biological weapons, including large quantities of weapons-grade smallpox - and there is evidence that certain biological agents have been available for sale in former Soviet countries.

Salpeter said 17 countries are known to have biological weapons. Prior to Sept. 11, there had been 130 potential or actual bioterrorist incidents worldwide. These events were either hoaxes, failed attempts or small-scale attacks, but Salpeter said given certain factors, including the availability of advanced technologies, barriers preventing a mass attack appear to be eroding.

Salpeter discussed recent anthrax incidents during the lecture, including a scare in which a man thought he saw another passenger place white powder into an air vent during an airplane flight into San Jose. The "powder" turned out to be confetti from a greeting card. Salpeter said the false alarm put the public health department and hospitals on alert. "This was an excellent opportunity for us to sit down and make sure we have protocols to handle situations like this," she said.

Salpeter went on to discuss the country's preparedness for detecting and responding to bioterrorism and outlined the role of law enforcement, public health departments and clinicians. If there was a known attack, she said the FBI and law enforcement officers would be the first to respond and would then notify public health department and local hospitals. But in cases of a covert attack, clinicians would be the first to respond - which means they need to be prepared.

"We have two jobs," Salpeter said, referring to the role of clinicians. "We need to know what we can do to limit casualties and death and we need to be knowledgeable about the issue so there is not a panic."

Salpeter detailed physicians' responsibilities, which include watching for unusual symptoms and symptoms that appear in atypical patients (such as young and healthy individuals) or multiple cases. She said she thinks the likelihood of a mass bioterrorist event remains rare - but it's important that physicians always look for signs. "We must keep the rare zebras in the back of our minds while we take care of the normal horses," she said.

Salpeter instructed physicians who suspect bioterrorist activity to isolate patients with communicable diseases and to notify their local public health department immediately. She said public health departments are now working on protocols for bioterrorist events and will use their fax alert systems to keep physicians informed of any new guidelines or developments.

Physicians who wish to receive updates and warnings through the Santa Clara public health department's fax alert system should send an e-mail with their fax number to healthofficer@hhs.co.santa-clara.ca.us.

This news release came from the Stanford Report.

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