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Toxic Exposures

9. Chemical Exposures

9.4. Biologic Exposures

Biologic agents used as warfare have significant potential to affect large portions of the population. Symptoms develop more insidiously and delayed with these agents than with chemical agents and, therefore, patients will present at different times and locations. Unlike chemical disasters, a hot zone can be extremely difficult, if not impossible, to establish.

With a child, the situation is further complicated by the fact that depending on the age, the ability to accurately describe the symptoms and their onset may be difficult. Many therapies for biologic warfare agents have not been studied in children and therapeutic dosing may need to be adjusted to the child’s size. When a biologic agent is suspected, consult the Centers for Disease Control and Prevention (CDC) website at www.bt.cdc.gov for treatment and prophylactic guidelines pertaining to children. Also immediately notify state and local health officials so that an investigation into the possible outbreak can begin and appropriate infection control measures can be instituted. The CDC has categorized biologic agents into classes based on their ease of use, ability to cause harm, and ease of transmission (Box 5).

BOX 5. CDC classification of potential bioweapons

  1. Easy transmission, high mortality rates, potential for major public impact, potential to cause public panic and social disruption. Pose the greatest risk to national safety.
    1. Anthrax (Bacillus anthracis)
    2. Smallpox (Variola major)
    3. Plague (Yersinia pestis)
    4. Tularemia (Francisella tularensis)
    5. Hemorrhagic fever viruses (Ebola, Lassa, Machupo and Marburg)
    6. Botulinum toxin (Clostridium botulinum toxin)
  2. Moderately easy to disseminate, low mortality rate.
    1. Brucellosis (Brucella spp.)
    2. Episilon toxin of Clostridium perfringens
    3. Food safety threats (Salmonella spp., E. coli 0157:H7, Shigella spp.)
    4. Glanders and Melioidosis (Bukholderia mallei and pseudomallei)
    5. Psittacosis (Chlamydia psittaci)
    6. Q fever (Coxiella burnetti)
    7. Ricin toxin (Ricinus communis; castor, bean)
    8. Staphylococcal enterotoxin B
    9. Typhus fever (Rickettsia prowazekii)
    10. Viral encephalitis (alphaviruses, eastern equine encephalitis, western equine encephalitis)
    11. Water safety threats (Vibrio cholerae, Cryptosporidium parvum)
  3. Emerging pathogens that could be engineered for mass dissemination, easy to produce, have potential for high morbidity and mortality rates
    1. Nipah virus
    2. Hanta virus