It is important for the medical community to be familiar with the epidemiology, diagnosis, and symptoms of plague so it can deliver an appropriate and calm response should the unthinkable happen. Although most medical practitioners will be familiar with the plague in its most common form, many might not recognize any of the alternative forms that could be used in bioterrorism. Therefore, any delay could potential cause thousands, if not millions, of lives. The potential for this instance of bioterrorism are immense in terms of the damage it can do. Thus all regional CDC location must be specially training to spot these conditions as soon as they arise as well as be equipped with the necessary treatments.
Bioterrorism
Case Study on Bioterrorism
Create a scenario of a hypothetical bioterrorist attack involving botulism or plague. Your scenario should include characteristics that are more indicative of an intentional outbreak than a natural outbreak.
Yersinia pestis is the causative agent of plague, an enzootic vectorborne disease usually infecting rodents (rats) and fleas and humans can become infected after being bitten by fleas that have fed on infected rodents; in humans, the disease usually occurs in the form of bubonic plague (Riedel, 2005). However, there are many other forms of this disease that can also be created artificially. In some cases, the infection can spread without the need for infestation and through oral pathways. This from of the disease can be spread to the lungs via the bloodstream and causes secondary pneumonic plague.
Plague is also recognized as a potential agent of bioterrorism because of the person-to-person transmission has been described for pneumonic plague but is rare in primary bubonic plague. Bubonic plague can usually be treated successfully with antibiotics; however, pneumonic plague develops rapidly and carries a high fatality rate despite immediate treatment with antibiotics. For these reasons it has been a potential threat as a biologic weapon for many years. If one of these agents would be released in a city such as New York City, the condition could spread rapidly.
2. Describe how the outbreak characteristics would have been different in the above scenario if the outbreak had been natural rather than intentional.
The natural forms of the bubonic plague are easily treatable by antibiotics. However, it is likely that a form of the plague that was used for a bioterrism incident would be significantly different from the naturally occurring form of the disease. One consensus study performed by the Center for Disease Control (CDC) found that an aerosolized plague weapon could cause fever, cough, chest pain, and hemoptysis with signs consistent with severe pneumonia 1 to 6 days after exposure; Rapid evolution of disease would occur in the 2 to 4 days after symptom onset and would lead to septic shock with high mortality without early treatment and prophylaxis with streptomycin or gentamicin or the tetracycline or fluoroquinolone classes of antimicrobials would be advised (Inglesby, 2000). Therefore, even though there are treatments available, these treatments would unlikely be readily available at most treatment centers and therefore this type of bioterrorism could cause severe damage before the needed treatments are onsite.
3. Describe how the federal/local government should respond to the specific hypothetical bioterrorist attack.
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