November 2001 • POST-ASSEMBLY EDITION
Family physicians critical to giving 'education, reassurance and presence,' says Assembly bioterrorism lecturer
BY CINDY MCCANSE
"My children and your children, and you and I, and our families and our communities have all become potential targets for terrorists," warned Jonathan Temte, M.D., Ph.D., during a special bio-terrorism presentation at the Scientific Assembly in Atlanta.
Jonathan Temte, M.D., Ph.D.Temte, assistant professor in the family medicine department at the University of Wisconsin, Madison, and infectious disease researcher, addressed more than 1,000 people at the Oct. 6 session. Since the events of Sept. 11, he noted, "What used to be in the imagination of authors is now front-page news."
In light of this all-too-real threat, family physicians must know what to look for. (For Temte's listing of the CDC's top bioterrorism candidates, go to http://www.aafp.org/fpr/assembly/saturday/1.html.)
But even when you know what you're looking for, that doesn't guarantee you'll know when you're looking at it, Temte added, reading off the symptoms that characterize the initial clinical presentation of inhalational anthrax.
"Fever, cough, myalgia and malaise. Now how many patients do you have in your practice who present with those symptoms?" he asked. The same holds for the first signs and symptoms of smallpox, Temte went on. "In my practice, this looks like any number of rash illnesses."
From that point, however, patients with these illnesses take a rapid and drastic downturn. For patients with some of these diseases, little is available in the way of treatment.
For example, only a single investigational drug -- cidofovir -- exists to treat smallpox, said Temte. Anthrax vaccine and antibiotic therapy may be of benefit in patients exposed to Bacillus anthracis -- the bacterium that causes anthrax -- but only if administered promptly after exposure. After that, only supportive measures are available to manage the disease.
So, how to avoid these illnesses in the first place? What preventive measures are available? Again, the answers aren't always reassuring.
Given that the World Health Organization declared smallpox to have been eradicated in 1980, production of the vaccinia vaccine against it was curtailed long ago and has only recently begun again. Clinical trials on the new vaccine aren't scheduled to begin until next year, and the timing of delivery of the initial shipment ordered by the U.S. government remains uncertain. At present, only 14 million doses of the older vaccine remain frozen in storage.
Anthrax vaccine availability is also deemed inadequate to deal with a significant bioterroristic event, although release of additional doses could come as soon as next year.
The real answer, said Temte, is to encourage vigilance among physicians in the community. "Look for things out of season," he said, "influenza, for example, in July." Look, too, he said, for things out of context, out of sequence, out of range.
Another key role for FPs, according to Temte, will be establishing and maintaining contact with public health officials. "We need to know what their perspective is, and they need to know what ours is," he said. He advised family physicians to form interactive partnerships with public health agencies to enable development and easy dissemination of treatment protocols.
But perhaps most critical for family physicians is to realize that there are significant psychosocial consequences that would accompany any biological attack: "Bioterrorism response isn't entirely limited to an infectious threat," Temte said. "This is where we need to be out there giving education, reassurance and presence."
FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
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