Plague as a biological weapon - Medical and public health management

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. Participants The working group included 25 representatives from major acade mic medical centers and research, govern ment, military, public health, and emergency management institutions and agencies. Evidence MEDLINE databases were searched from January 1966 to June 1998 for the Medical Subject Headings plague, Yersinia pestis, biological weapon, b iological terrorism, biological warfare, and biowarfare, Review of the bibl iographies of the references identified by this search led to subsequent id entification of relevant references published prior to 1966. In addition, p articipants identified other unpublished references and sources. Additional MEDLINE searches were conducted through January 2000. Consensus Process The first draft of the consensus statement was a synthesi s of information obtained in the formal evidence-gathering process. The wor king group was convened to review drafts of the document in October 1998 an d May 1999. The final statement incorporates all relevant evidence obtained by the literature search in conjunction with final consensus recommendatio ns supported by all working group members. Conclusions An aerosolized plague weapon could cause fever, cough, chest pa in, 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 a fter symptom onset and would lead to septic shock with high mortality witho ut early treatment. Early treatment and prophylaxis with streptomycin or ge ntamicin or the tetracycline or fluoroquinolone classes of antimicrobials w ould be advised.