Editorials

Resources in the War Against Bioterrorism



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Am Fam Physician. 2001 Nov 15;64(10):1676-1680.

As highlighted in “Inside AFP” in the previous issue of American Family Physician,1 the American Academy of Family Physicians (AAFP) has taken action in response to the recent terrorist attacks in the United States. Three weeks after the September 11 tragedy, the AAFP's Annual Scientific Assembly featured a lecture on bioterrorism, which is available on the AAFP Web site,2 and more continuing medical education activities relating to bioterrorism are being planned. In this issue, we highlight information from the Centers for Disease Control and Prevention (CDC) to help physicians become prepared for potential bioterrorist attacks (see page 1761).3,4

We have also considered featuring original articles on biologic, chemical, and radiologic weapons of mass destruction. However, the process of writing, reviewing, revising, and editing an article typically takes many months, and we want to offer our readers the most current, reliable, and comprehensive information immediately available. To expedite this process, we have compiled a list of authoritative Web site resources on these subjects.

It is essential that family physicians be prepared to respond to issues surrounding biologic warfare. Family physicians will, in many cases, be the first to triage victims of suspected or actual bioterrorist attacks. In addition, many patients will approach their family physician with questions about exposure to germ or chemical weapons, signs and symptoms of disease, and how to protect themselves and their family members against such threats. It is important for physicians to be familiar with CDC policy for diagnostic testing and reporting of possible exposure to agents used as biologic weapons, and to review prophylaxis and management recommendations. The CDC bioterrorism Web site (www.bt.cdc.gov) features the most recent Biological and Chemical Terrorism Strategic Plan for Preparedness.5 Several other sites offer comprehensive summaries of sample collection methods, vaccines, chemotherapy, and chemoprophylaxis for agents used as biologic weapons.

Next, we must educate our patients and ourselves to instill the proper awareness of exotic diseases that pose a threat. At the same time, we must remain pragmatic. Family physicians may be called on to distinguish a rash of chickenpox from that of smallpox; to counsel patients with influenza-like symptoms who request testing for anthrax; and to inform patients about proper immunization protocols. We must explain to patients why it is not appropriate for them to stockpile antibiotics and why it is important for them to receive a timely influenza vaccination. We should be able to answer their questions thoughtfully while recognizing the importance of allaying their fears.

Finally, we must be prepared to dispel myths about bioterrorism to be able to prevent epidemic hysteria. Indeed, mass psychogenic illness may be indistinguishable from illness caused by true bioterrorist infection.6  A powerful defense against bioterrorism is accurate and timely information for physicians and patients. We recommend the resources in the accompanying table as a starting point for family physicians to obtain up-to-date continuing medical education about bioterrorism.

Web Resources on Bioterrorism

Government Resources

Centers for Disease Control and Prevention (CDC): www.bt.cdc.gov.

This Web site features the April 2000 Biological and Chemical Terrorism Strategic Plan for Preparedness, including an algorithm of disease reporting strategies. Fact sheets on diseases, frequently asked questions, and news updates are also presented. See www.bt.cdc.gov/roleofclinlab.asp for helpful reference materials.

National Domestic Preparedness Office: www.ndpo.gov/blueprint.pdf. This Web site features information on domestic preparedness for terrorist attacks.

National Emergency Management Association: www.nemaweb.org/sdp/Best_Practices/index.cfm.

This Web site provides online documents outlining Emergency Response Plans in four states.

Office of Justice Programs (OJP)/Office for Domestic Preparedness (ODP): www.ojp.usdoj.gov/odp.

This Web site describes ODP's State and Local Domestic Preparedness Training and Technical Assistance Program.

U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID): www.usamriid.army.mil/education/bluebook.html.

This Web site features the 4th edition of the Bluebook (USAMRIID's Medical Management of Biological Casualties Handbook). This document is an excellent source of practical clinical information, with comprehensive charts of bioweapon agent characteristics, detailed diagnostic and management recommendations, and concise disease information pages.

Medical Organizations

American College of Physicians (ACP)–American Society of Internal Medicine (ASIM): www.acponline.org/bioterro.

The ACP–ASIM Web site lists bioterrorism news information, journal article links, and other relevant Web resources.

Centers for Disease Control and Prevention (CDC): www.medscape.com/webcast/anthrax

This Web cast titled “Anthrax: What Every Clinician Should Know” was presented by a panel of experts from the CDC on October 18, 2001.

American Medical Association (AMA): www.ama-assn.org.

The AMA Web site currently features a “Dealing with Disaster” section and links to the Journal of the American Medical Association. The JAMA Web site (www.jama.ama-assn.org) includes five consensus statements on biologic weapons (anthrax, smallpox, plague, botulinum toxin, and tularemia) by the Working Group on Civilian Biodefense. These articles can be downloaded free of charge.

Johns Hopkins Center for Civilian Biodefense Studies: www.hopkins-biodefense.org.

The Johns Hopkins Center for Civilian Biodefense Studies has established this comprehensive Web site, which includes links to journal articles and information on bioterrorism preparedness and response (e.g., “How to Handle Anthrax Threat Letters”).

New England Journal of Medicine: www.nejm.org.

See the following articles from the New England Journal of Medicine (subscription required):

Khan AS, Ashford DA. Ready or not—preparedness for bioterrorism. N Engl J Med 2001;345:287–9.

Dixon TC, Meselson M, Guillemin J, Hanna PC. Medical progress: anthrax. N Engl J Med 1999;341:815–26.

Breman JG, Henderson DA. Poxvirus dilemmas—monkeypox, smallpox, and biologic terrorism. N Engl J Med 1998;339: 556–9.

Other Useful Resources

eMedicine: www.emedicine.com.

The “In the News” section on this Web site features links to information on chemical, biologic, and nuclear warfare.

Medical NBC Online: www.nbc-med.org/others/Default.html

This site provides news summaries and Web links to helpful resources on bioterrorism.

Web Resources on Bioterrorism

View Table

Web Resources on Bioterrorism

Government Resources

Centers for Disease Control and Prevention (CDC): www.bt.cdc.gov.

This Web site features the April 2000 Biological and Chemical Terrorism Strategic Plan for Preparedness, including an algorithm of disease reporting strategies. Fact sheets on diseases, frequently asked questions, and news updates are also presented. See www.bt.cdc.gov/roleofclinlab.asp for helpful reference materials.

National Domestic Preparedness Office: www.ndpo.gov/blueprint.pdf. This Web site features information on domestic preparedness for terrorist attacks.

National Emergency Management Association: www.nemaweb.org/sdp/Best_Practices/index.cfm.

This Web site provides online documents outlining Emergency Response Plans in four states.

Office of Justice Programs (OJP)/Office for Domestic Preparedness (ODP): www.ojp.usdoj.gov/odp.

This Web site describes ODP's State and Local Domestic Preparedness Training and Technical Assistance Program.

U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID): www.usamriid.army.mil/education/bluebook.html.

This Web site features the 4th edition of the Bluebook (USAMRIID's Medical Management of Biological Casualties Handbook). This document is an excellent source of practical clinical information, with comprehensive charts of bioweapon agent characteristics, detailed diagnostic and management recommendations, and concise disease information pages.

Medical Organizations

American College of Physicians (ACP)–American Society of Internal Medicine (ASIM): www.acponline.org/bioterro.

The ACP–ASIM Web site lists bioterrorism news information, journal article links, and other relevant Web resources.

Centers for Disease Control and Prevention (CDC): www.medscape.com/webcast/anthrax

This Web cast titled “Anthrax: What Every Clinician Should Know” was presented by a panel of experts from the CDC on October 18, 2001.

American Medical Association (AMA): www.ama-assn.org.

The AMA Web site currently features a “Dealing with Disaster” section and links to the Journal of the American Medical Association. The JAMA Web site (www.jama.ama-assn.org) includes five consensus statements on biologic weapons (anthrax, smallpox, plague, botulinum toxin, and tularemia) by the Working Group on Civilian Biodefense. These articles can be downloaded free of charge.

Johns Hopkins Center for Civilian Biodefense Studies: www.hopkins-biodefense.org.

The Johns Hopkins Center for Civilian Biodefense Studies has established this comprehensive Web site, which includes links to journal articles and information on bioterrorism preparedness and response (e.g., “How to Handle Anthrax Threat Letters”).

New England Journal of Medicine: www.nejm.org.

See the following articles from the New England Journal of Medicine (subscription required):

Khan AS, Ashford DA. Ready or not—preparedness for bioterrorism. N Engl J Med 2001;345:287–9.

Dixon TC, Meselson M, Guillemin J, Hanna PC. Medical progress: anthrax. N Engl J Med 1999;341:815–26.

Breman JG, Henderson DA. Poxvirus dilemmas—monkeypox, smallpox, and biologic terrorism. N Engl J Med 1998;339: 556–9.

Other Useful Resources

eMedicine: www.emedicine.com.

The “In the News” section on this Web site features links to information on chemical, biologic, and nuclear warfare.

Medical NBC Online: www.nbc-med.org/others/Default.html

This site provides news summaries and Web links to helpful resources on bioterrorism.

Margaret Gourlay, M.D., is the 2001–2002 editorial fellow with American Family Physician. Jay Siwek, M.D., is professor and chair of the Department of Family Medicine at Georgetown University School of Medicine, Washington, D.C. He is also the editor of American Family Physician.

Address correspondence to Margaret Gourlay, M.D., Department of Family Medicine, 212 Kober-Cogan Hall, Georgetown University Medical Center, 3800 Reservoir Rd. NW, Washington, D.C. 20007 (e-mail: mlg22@georgetown.edu).

REFERENCES

1. Wright J. Inside AFP. Am Fam Physician. 2001;64:1668.

2. Temte JL. Bioterrorism: a family practice perspective. Retrieved October 2001 from: AFP.org/assembly/2001/lectures/bioterror/index.html.

3. Centers for Disease Control and Prevention. Update: Investigation of anthrax associated with intentional exposure and interim public health guidelines, October 2001. MMWR Morb Mortal Wkly Rep. 2001;50:889–93.

4. Centers for Disease Control and Prevention. Recognition of illness associated with the intentional release of a biologic agent. MMWR Morb Mortal Wkly Rep October 19. , 2001;50:893–7.

5. Biological and chemical terrorism: strategic plan for preparedness and response. Recommendations of the CDC Strategic Planning Workgroup. MMWR. 2000;49(RR-4):1–14.

6. Jones TF, Craig AS, Hoy D, Gunter EW, Ashley DL, Barr DB, et al. Mass psychogenic illness attributed to toxic exposure at a high school. N Engl J Med. 2000;342:96–100.


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