Tularemia 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 if tularemia is used as a biological weapon against a civili an population. Participants The working group included 25 representatives from academic me dical centers, civilian and military governmental agencies, and other publi c health and emergency management institutions and agencies. Evidence MEDLINE databases were searched from January 1966 to October 2000, using the Medical Subject Headings Francisella tularensis, Pasteurella tul arensis, biological weapon, biological terrorism, bioterrorism, biological warfare, and biowarfare. Review of these references led to identification o f relevant materials published prior to 1966, In addition, participants ide ntified other references and sources. Consensus Process Three formal drafts of the statement that synthesized inf ormation obtained in the formal evidence-gathering process were reviewed by members of the working group. Consensus was achieved on the final draft. Conclusions A weapon using airborne tularemia would likely result 3 to 5 da ys later in an outbreak of acute, undifferentiated febrile illness with inc ipient pneumonia, pleuritis, and hilar lymphadenopathy. Specific epidemiolo gical, clinical, and microbiological findings should lead to early suspicio n of intentional tularemia in an alert health system; laboratory confirmati on of agent could be delayed. Without treatment, the clinical course could progress to respiratory failure, shock, and death. Prompt treatment with st reptomycin, gentamicin, doxycycline, or ciprofloxacin is recommended. Proph ylactic use of doxycycline or ciprofloxacin may be useful in the early post exposure period.