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Attachment 7 - Clinical Characteristics of Biological Terrorism Agents

Introduction to this Attachment
This attachment consists of a fact sheet for each of the six disease agents designated as “Category A” by the enters for Disease Control and Prevention (CDC). This means that they are given the highest priority for emergency planning and response purposes. The criteria used to categorize biological terrorism agents are:

The ease of dissemination or transmission from person to person;

The mortality rate and potential for major public health impact;

The putative ability to cause public panic and social disruption; and

The number and nature of any special public health preparedness action(s) required.

The fact sheets are not all-inclusive, but rather are designed to provide a basic set of facts and instructions likely to useful to executive decision makers, public health and health care providers, and response organizations during a bio-emergency, especially if other sources of information, such as the Internet, are not readily available.

Each fact sheet contain the following information:

The disease incubation period;

Early symptoms/prodrome;

Highly suggestive signs/clinical syndrome;

Diagnostic samples needed, and minimum biosecurity level of laboratory;

Diagnostic assay needed, and characteristic findings;

Recommended infection control/transmission prevention precautions for diagnosed or symptomatic patients as well as for potentially exposed or asymptomatic patients;

Adult treatment instructions; ¹

Post-exposure prophylaxis instructions.

Clues to a possible bioterrorism attack
Single cases of disease due to uncommon, non-indigenous agents in patients with no history suggesting an explanation for illness; clusters of patients with similar syndrome with unusual characteristics (e.g., unusual age distribution) or unusually high morbidity and mortality; unexplained increase in the incidence of a common syndrome above seasonally-expected levels (e.g., increase in influenza-like illness during summer.  Any unusual disease pattern should be reported immediately to the Iowa Department of Public Health (IDPH): 800 362-2736 (during normal business hours) or 515-323-4360 (after hours).

Sources of Additional Information
Whenever possible, obtain the most complete and up-to-date information available about any agent(s) suspected or known to be the cause of a bio-emergency.  The URLs for web pages maintained by CDC and IDPH are, respectively:

www.bt.cdc.gov
www.idph.state.ia.us/default.asp

"Standard Precautions" ²
Prevent direct contact with all body fluids (including blood), secretions, excretions, non-intact skin (including rashes), and mucous membranes. Standard Precautions routinely practiced by healthcare providers for all patients include: Hand hygiene, gloves when contact with above, mask/eye protection/face shield while performing procedures that cause splash/spray, and gowns to protect skin and clothing during procedures

¹ Adult treatment and post - exposure prophylaxis recommendations for all disease-causing agents included in this attachment are taken from JAMA consensus statements on key bioterrorism agents, published from May 1999 – June 2001 (see http://jama.ama-assn.org).  These are not official IDPH recommendations; they are provided for information only.  The table also does not include specific recommendations for children or pregnant women – suggested therapy / prophylaxis for these groups may be found in the consensus statements.

² Use this description whenever standard precautions are referred to in this attachment. That may involve splashing/spraying. This recommendation, and all other worker protection precautions provided in this document, is subject to review and approval by the Iowa Division of Labor (IOSHA).

US Patent Numbers 7,720,998 B2, 7,836,207