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B-1 APPENDIX B Biological Threat Information
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B-2 TABLE B-1 Biological Warfare Characteristics Disease Transmit Infective Dose Incubation Duration of Illness Lethality (approx. Persistence of Organism** Vaccine Efficacy Man to Man (Aerosol) Period case fatality rates) (aerosol exposure) Inhalation No 8,000-50,000 1-6 days 3-5 days (usually High Very stable - spores remain 2 dose efficacy against up anthrax spores fatal if untreated) viable for > 40 years in soil to 1,000 LD50 in monkeys Brucellosis No 10-100 5-60 days Weeks to months <5% untreated Very stable No vaccine organisms (usually 1-2 months) Cholera Rare 10-500 organisms 4 hours - > 1 week Low with treatment, Unstable in aerosols & fresh No data on aerosol 5 days (usually high without water; stable in salt water 2-3 days) Glanders Low Assumed low 10-14 days via Death in 7-10 days > 50% Very stable No vaccine aerosol in septicemic form Pneumonic High 100-500 2-3 days 1-6 days High unless treated For up to 1 year in soil; 270 days 3 doses not protective Plague organisms (usually fatal) within 12-24 hours in live tissue against 118 LD50 in monkeys Tularemia No 10-50 organisms 2-10 days > 2 weeks Moderate if For months in moist soil or other 80% protection against (average 3-5) untreated media 1-10 LD50 Q Fever Rare 1-10 organisms 10-40 days 2-14 days Very low For months on wood and sand 94% protection against 3,500 LD50 in guinea pigs Smallpox High Assumed low 7-17 days 4 weeks High to moderate Very stable Vaccine protects against (10-100 (average 12) large doses in primates organisms) Venezuelan Low 10-100 organisms 2-6 days Days to weeks Low Relatively unstable TC 83 protects against 30- Equine 500 LD50 in hamsters Encephalitis Viral Moderate 1-10 organisms 4-21 days Death between 7-16 High for Zaire Relatively unstable - depends on No vaccine Hemorrhagic days strain, moderate agent Fevers with Sudan Botulism No 0.001 g/kg is 1-5 days Death in 24-72 High without For weeks in nonmoving water 3 dose efficacy 100% LD50 for type A hours; lasts months respiratory support and food against 25-250 LD50 in if not lethal primates Staph No 0.03 g/person 3-12 hours after Hours < 1% Resistant to freezing No vaccine Enterotoxin B incapacitation inhalation Ricin No 3-5 g/kg is LD50 18-24 hours Days - death within High Stable No vaccine in mice 10-12 days for ingestion T-2 No Moderate 2-4 hours Days to months Moderate For years at room temperature No vaccine Mycotoxins Note: Table source is the Medical Management of Biological Casualties Handbook, from the United States Army Research Institute for Infectious Diseases. **Persistence varies on surfaces, in soil and water, and in open air depending upon many factors including temperature, humidity, exposure to sunlight, etc. Caution should be used to prevent overstatement of the limited persistence data in this table.
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TABLE B-2 Biological Warfare Agents Vaccine, Therapeutics, and Prophylaxis DISEASE VACCINE CHEMOTHERAPY (Rx) CHEMOPROPHYLAXIS (Px) COMMENTS Anthrax Bioport vaccine (licensed) Ciprofloxacin 400 mg IV q 12 h, or Ciprofloxacin 500 mg PO bid x 4 Potential alternates for Rx: 0.5 mL SC @ 0, 2, 4 wk, 6, Doxycycline 200 mg IV, then 100 mg IV q 12 h wk If unvaccinated, begin gentamicin, erythromycin, and 12, 18 mo then annual initial doses of vaccine chloramphenicol boosters Penicillin 4 million units IV q 4 h Doxycycline 100 mg PO bid x 4 wk PCN for sensitive organisms only plus vaccination Cholera Wyeth-Ayerst Vaccine 2 Oral rehydration therapy during period of NA Vaccine not recommended for routine doses 0.5 mL IM or SC @ 0, high fluid loss protection in endemic areas (50% 7-30 days, boosters Q 6 efficacy, short term) months Tetracycline 500 mg q 6 h x 3 d Alternates for Rx: erythromycin, Doxycycline 300 mg once, or 100 mg q 12 h x 3 d trimethoprim and sulfamethoxazole, and furazolidone Ciprofloxacin 500 mg q 12 h x 3 d Quinolones fortetra/doxy resistant strains Norfloxacin 400 mg q 12 h x 3 d Q Fever IND 610 - inactivated Tetracycline 500 mg PO q 6 h x 5-7 d Tetracycline 500 mg PO qid x 5 d Currently testing vaccine to determine whole cell vaccine given as continued at least 2 d after afebrile (start 8-12 d post-exposure) the necessity of skin testing prior to single 0.5 ml s.c. injection use. Doxycycline 100 mg PO q 12 h x 5-7 d Doxycycline 100 mg PO bid x 5 d continued at least 2 d after afebrile (start 8-12 d post-exposure) Glanders No vaccine available Antibiotic regimens vary depending on Post-exposure prophylaxis No large therapeutichuman trials have localization and severity of disease may be tried with TMP-SMX been conducted due to the rarity of naturally occurring disease. Plague Greer inactivated vaccine Streptomycin 30 mg/kg/d IM in 2 divided Doxycycline 100 mg PO bid x 7 d Chloramphenicol for plague meningitis (FDA licensed) is no longer doses x 1014 d or Gentamicin or duration of exposure is required available. 5 mg/kg or IV once daily x 10-14 d, or 25 mg/kg IV, then 15 mg/kg qid x 14 d Ciprofloxacin 400 mg IV q 12 h until Ciprofloxacin 500 mg PO bid x 7 d clinically improved then 750 mg PO bid for 1014 d Doxycycline 200 mg IV then 100 mg IV Tetracycline 500 mg PO qid x 7 d Alternate Rx: trimethoprim- bid, until clinically improved then 100 mg sulfamethoxazole PO bid for total of 10-14 d Brucel- No human vaccine available Doxycycline 200 mg/d PO plus rifampin Doxycycline 200 mg/d PO Trimethoprim-sulfamethoxazole may be losis 600 mg/d PO x 6 wk plus rifampin 600 mg/d PO x 6 wk substituted for rifampin; however, relapse may reach 30% Ofloxacin 400/rifampin 600 mg/d PO x 6 wks (continued ) B-3
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TABLE B-2 (continued) B-4 DISEASE VACCINE CHEMOTHERAPY (Rx) CHEMOPROPHYLAXIS (Px) COMMENTS Tularemia IND - Live attenuated Streptomycin 7.5-10 mg/kg IM bid x Doxycycline100 mg PO bid x 14 d vaccine: single 0.1 ml dose by 10-14 d scarification Gentamicin 3-5 mg/kg/d IV x 10-14 d Tetracycline 500 mg PO qid x 14 d Ciprofloxacin 400 mg IV q 12h until Ciprofloxacin 500 mg PO q improve, then 500 mg PO q 12hx10- 12h for 14 d 14 d Ciprofloxacin 750 mg PO q 12h, 10- 14 d Viral VEE DOD TC-83 live Supportive therapy: analgesics and NA TC-83 reactogenic in 20%, No encephali- attenuated vaccine (IND): anticonvulsants prn seroconversion in 20%, Only tides 0.5 mL SCx1 dose effective against sub types 1A, 1B, and 1C VEE DOD C-84 (formalin C-84 vaccine used for non- inactivated TC-83) (IND): 0.5 responders to TC-83 mL SC for up to 3 doses EEE inactivated (IND): 0.5 mL EEE and WEE inactivated vaccines SC at 0 & 28 d are poorly WEE inactivated (IND): Immunogenic. Multiple 0.5 mL SC at 0, 7, and 28 d immunizations are required Viral AHF Candid #1 vaccine Ribavirin (CCHF/Lassa) (IND) NA Aggressive supportive care and Hemorrhagic (x-protection for BHF) (IND) 30 mg/kg IV initial dose; then 16 management of hypotension very Fevers mg/kg IV q 6h x 4 d; then 8 mg/kg IV important q 8hx 6 d RVF inactivated vaccine (IND) Passive antibody for AHF, BHF, Lassa fever, and CCHF Smallpox Wyeth calf lymph vaccinia No current Rx other than supportive; Vaccinia immune globulin 0.6 Pre and post exposure vaccination vaccine (licensed): 1 dose by Cidofovir (effective in vitro); animal mL/kg IM (within 3d of recommended if > 3 years since scarification studies ongoing exposure, best within 24 h) last vaccine Botulism DOD pentavalent toxoid for DOD heptaval entequine despeciated NA Skin test for hypersensitivity serotypes A-E (IND): 0.5 ml antitoxin for serotypes A-G (IND): before equine antitoxin deep SC @ 0, 2 & 12 wk, then 1 vial (10 mL) IV administration yearly boosters CDC trivalent equine antitoxin for NA serotypes A, B, E (licensed) Staphylo- No vaccine available Ventilatory support for inhalation NA coccus exposure Enterotoxin B Ricin No vaccine available Inhalation: supportive therapy G-I : NA gastric lavage,super activated charcoal, cathartics T-2 No vaccine available Decontamination of clothing Mycotoxins and skin