 Oct. 19, 2002 |
| ASSEMBLY EDITION • SAN DIEGO |
Many family physicians attending "The Reality of Bioterrorism" yesterday were there to learn how to better answer the questions they have been inundated with since last year's anthrax attacks.
 "All we can do is educate those around us," says Raymond Weinstein, M.D., who delivered a three-hour course on bioterrorism on Friday. |
But one attendee, Lee Carter, M.D., of Scottsville, Ky., was taking the three-hour course because he has suddenly found himself on the frontlines of the war on bioterrorism. Because of his certification in emergency medicine, Carter was selected by his county leadership to receive and select other medical personnel to receive vaccinia -- the vaccine used to protect against smallpox.
Such a task is not to be taken lightly. According to Raymond Weinstein, M.D., Dale City, Va., the bioterrorism expert who delivered the lecture, vaccinia is the most dangerous vaccine there is. There is danger not only to the person inoculated, but also to all others coming in contact with that person. Any patient who's immunocompromised or has eczema is at risk of harm from vaccinia, said Weinstein. Those inoculated must be confined for three weeks.
"My personal feeling is, if there are no cases of smallpox reported, my family is not getting the vaccine," said Weinstein.
But smallpox is just one of many agents that can be used in an attack, said Weinstein, chair of the Greater Prince William Chem-Bio Counterterrorism Committee and consultant to the Department of Defense and the Army Medical Command.
Biological weapons can be an efficient way to wreak havoc on society, said Weinstein. Terrorists look for agents that are cheap to produce, easy to weaponize and highly contagious and that have a short incubation period. It's also advantageous for an agent to have "brand-name" recognition, that is, diseases whose names strike fear -- smallpox, anthrax, botulinum, plague and Hantavirus, to name a few.
The use of biological weapons can be traced back as far as the sixth century B.C., said Weinstein, when Assyrians poisoned enemy wells with fungus. Fast forward a couple millennia, when smallpox was spread to Native Americans via infected blankets bestowed by the English in the 17th century.
More recently, a bioterrorist attack was carried out in 1984 in Oregon by commune members who poisoned area salad bars with salmonella, hoping to subvert local elections. Over 750 cases of severe enteritis developed, marking a terrible failure of the public health system to the community, said Weinstein. The cause was found out a year later.
But "everyone wants to know about anthrax," said Weinstein. As an agent of destruction, anthrax is not the best choice, he said, noting that for all the efforts of last year's mailer, "only" 11 people died. Person-to-person transmission of anthrax is rare, and the disease is treatable when diagnosed early. But anthrax has fear factor in its favor, he said. "You say 'anthrax' and it's like shouting 'fire' in a movie theater."
This is why knowledge is important, said Weinstein. Media reports can be inflammatory and suggest treatments that are inappropriate, he said. "All we can do is educate those around us."
But the reality of bioterrorism is, "it's inevitable," he said.
Primary care physicians should conduct epidemiological surveillance of their patient populations. "If you start seeing large numbers of patients with the same symptoms, ask, 'Is this unusual?'"
Unfortunately, most biological agents initially cause flulike symptoms, so it's important to be able to differentiate. Look for an increase in cases of flulike illnesses, or flulike illnesses lasting longer than normal or causing unusual complications, he said.
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Copyright © 2002 by
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