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B-1 APPENDIX B Biological Threat Information
B -2 Disease Transmit Man to Man Infective Dose (Aerosol) Incubation Period Duration of Illness Lethality (approx. case fatality rates) Persistence of Organism** Vaccine Efficacy (aerosol exposure) Inhalation anthrax No 8,000-50,000 spores 1-6 days 3-5 days (usually fatal if untreated) High Very stable - spores remain viable for > 40 years in soil 2 dose efficacy against up to 1,000 LD50 in monkeys Brucellosis No 10-100 organisms 5-60 days (usually 1-2 months) Weeks to months <5% untreated Very stable No vaccine Cholera Rare 10-500 organisms 4 hours - 5 days (usually 2-3 days) > 1 week Low with treatment, high without Unstable in aerosols & fresh water; stable in salt water No data on aerosol Glanders Low Assumed low 10-14 days via aerosol Death in 7-10 days in septicemic form > 50% Very stable No vaccine Pneumonic Plague High 100-500 organisms 2-3 days 1-6 days (usually fatal) High unless treated within 12-24 hours For up to 1 year in soil; 270 days in live tissue 3 doses not protective against 118 LD50 in monkeys Tularemia No 10-50 organisms 2-10 days (average 3-5) > 2 weeks Moderate if untreated For months in moist soil or other media 80% protection against 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 (10-100 organisms) 7-17 days (average 12) 4 weeks High to moderate Very stable Vaccine protects against large doses in primates Venezuelan Equine Encephalitis Low 10-100 organisms 2-6 days Days to weeks Low Relatively unstable TC 83 protects against 30- 500 LD50 in hamsters Viral Hemorrhagic Fevers Moderate 1-10 organisms 4-21 days Death between 7-16 days High for Zaire strain, moderate with Sudan Relatively unstable - depends on agent No vaccine Botulism No 0.001 Î¼g/kg is LD50 for type A 1-5 days Death in 24-72 hours; lasts months if not lethal High without respiratory support For weeks in nonmoving water and food 3 dose efficacy 100% against 25-250 LD50 in primates Staph Enterotoxin B No 0.03 Î¼g/person incapacitation 3-12 hours after inhalation Hours < 1% Resistant to freezing No vaccine Ricin No 3-5 Î¼ g/kg is LD50 in mice 18-24 hours Days - death within 10-12 days for ingestion High Stable No vaccine T-2 Mycotoxins No Moderate 2-4 hours Days to months Moderate For years at room temperature No vaccine 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. TABLE B-1 Biological Warfare Characteristics
B -3 DISEASE VACCINE CHEMOTHERAPY (Rx) CHEMOPROPHYLAXIS (Px) COMMENTS Anthrax Bioport vaccine (licensed) 0.5 mL SC @ 0, 2, 4 wk, 6, 12, 18 mo then annual boosters Ciprofloxacin 400 mg IV q 12 h, or Doxycycline 200 mg IV, then 100 mg IV q 12 h Ciprofloxacin 500 mg PO bid x 4 wk If unvaccinated, begin initial doses of vaccine Potential alternates for Rx: gentamicin, erythromycin, and chloramphenicol Penicillin 4 million units IV q 4 h Doxycycline 100 mg PO bid x 4 wk plus vaccination PCN for sensitive organisms only Cholera Oral rehydration therapy during period of high fluid loss NA Vaccine not recommended for routine protection in endemic areas (50% efficacy, short term) Tetracycline 500 mg q 6 h x 3 d Alternates for Rx: erythromycin, Wyeth-Ayerst Vaccine 2 doses 0.5 mL IM or SC @ 0, 7-30 days, boosters Q 6 months 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 Tetracycline 500 mg PO q 6 h x 5-7 d continued at least 2 d after afebrile Tetracycline 500 mg PO qid x 5 d (start 8-12 d post-exposure) Currently testing vaccine to determine the necessity of skin testing prior to use. IND 610 - inactivated whole cell vaccine given as single 0.5 ml s.c. injection Doxycycline 100 mg PO q 12 h x 5-7 d continued at least 2 d after afebrile Doxycycline 100 mg PO bid x 5 d (start 8-12 d post-exposure) Glanders No vaccine available Antibiotic regimens vary depending on localization and severity of disease Post-exposure prophylaxis may be tried with TMP-SMX No large therapeutichuman trials have been conducted due to the rarity of naturally occurring disease. Plague Greer inactivated vaccine (FDA licensed) is no longer available. Streptomycin 30 mg/kg/d IM in 2 divided doses x 10â14 d or Gentamicin 5 mg/kg or IV once daily x 10-14 d, or Ciprofloxacin 400 mg IV q 12 h until clinically improved then 750 mg PO bid for 10â14 d Doxycycline 100 mg PO bid x 7 d or duration of exposure Ciprofloxacin 500 mg PO bid x 7 d Chloramphenicol for plague meningitis is required 25 mg/kg IV, then 15 mg/kg qid x 14 d Doxycycline 200 mg IV then 100 mg IV bid, until clinically improved then 100 mg Tetracycline 500 mg PO qid x 7 d Alternate Rx: trimethoprim- sulfamethoxazole PO bid for total of 10-14 d Brucel- losis No human vaccine available Doxycycline 200 mg/d PO plus rifampin 600 mg/d PO x 6 wk Doxycycline 200 mg/d PO plus rifampin 600 mg/d PO x 6 wk Trimethoprim-sulfamethoxazole may be substituted for rifampin; however, relapse may reach 30% Ofloxacin 400/rifampin 600 mg/d PO x 6 wks TABLE B-2 Biological Warfare Agents â Vaccine, Therapeutics, and Prophylaxis (continued)
B -4 DISEASE VACCINE CHEMOTHERAPY (Rx) CHEMOPROPHYLAXIS (Px) COMMENTS Tularemia IND - Live attenuated vaccine: single 0.1 ml dose by scarification Streptomycin 7.5-10 mg/kg IM bid x 10-14 d Doxycycline100 mg PO bid x 14 d 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 improve, then 500 mg PO q 12hx10- 14 d Ciprofloxacin 500 mg PO q 12h for 14 d Ciprofloxacin 750 mg PO q 12h, 10- 14 d Viral encephali- tides VEE DOD TC-83 live attenuated vaccine (IND): 0.5 mL SCx1 dose Supportive therapy: analgesics and anticonvulsants prn TC-83 reactogenic in 20%, No seroconversion in 20%, Only effective against sub types 1A, 1B, and 1C VEE DOD C-84 (formalin inactivated TC-83) (IND): 0.5 mL SC for up to 3 doses C-84 vaccine used for non- responders to TC-83 EEE inactivated (IND): 0.5 mL SC at 0 & 28 d EEE and WEE inactivated vaccines are poorly WEE inactivated (IND): 0.5 mL SC at 0, 7, and 28 d Immunogenic. Multiple immunizations are required Viral Hemorrhagic Fevers AHF Candid #1 vaccine (x-protection for BHF) (IND) Ribavirin (CCHF/Lassa) (IND) 30 mg/kg IV initial dose; then 16 mg/kg IV q 6h x 4 d; then 8 mg/kg IV q 8hx 6 d NA NA Aggressive supportive care and management of hypotension very important RVF inactivated vaccine (IND) Passive antibody for AHF, BHF, Lassa fever, and CCHF Smallpox Wyeth calf lymph vaccinia vaccine (licensed): 1 dose by scarification No current Rx other than supportive; Cidofovir (effective in vitro); animal studies ongoing Vaccinia immune globulin 0.6 mL/kg IM (within 3d of exposure, best within 24 h) Pre and post exposure vaccination recommended if > 3 years since last vaccine Botulism DOD heptaval entequine despeciated antitoxin for serotypes A-G (IND): 1 vial (10 mL) IV NA Skin test for hypersensitivity before equine antitoxin administration DOD pentavalent toxoid for serotypes A-E (IND): 0.5 ml deep SC @ 0, 2 & 12 wk, then yearly boosters CDC trivalent equine antitoxin for serotypes A, B, E (licensed) NA Staphylo- coccus Enterotoxin B No vaccine available Ventilatory support for inhalation exposure NA Ricin No vaccine available Inhalation: supportive therapy G-I : gastric lavage,super activated charcoal, cathartics NA T-2 Mycotoxins No vaccine available Decontamination of clothing and skin TABLE B-2 (continued)