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Tularemia Could Be Bioweapons Threat.

The highly infectious disease tularemia--also known as rabbit fever--could pose a serious danger if used as a biological weapon, according to a report by the Working Group on Civilian Biodefense. The working group was convened by the

Center for Civilian Biodefense Studies at the Johns Hopkins University Bloomberg School of Public Health. Its report, published in the June 6, 2001, issue of the Journal of the American Medical Association (JAMA), cites a World Health Organization (WHO) study that has projected estimates of 250,000 illnesses and 19,000 deaths if a mass-casualty tularemia biological weapon were used against a modern city of five million people. The working group recommends medical and public-health guidelines and policies to minimize the consequences of an attack.

"This report highlights the need to address the nation's preparedness for possible bio-weapon-induced epidemics," says the reports lead author, David T. Dennis, M.D., M.P.H., a senior researcher with the Division of Vector-Borne Infectious Diseases at the Centers for Disease Control and Prevention (CDC).

According to the report, a tularemia-based bioweapon would trigger cases of pneumonia, pleuritis, and lymph-node disease within three to five days of exposure. Unless treated with effective antibiotics, the disease-could lead to serious illness, including possible respiratory failure, shock, and death.

"Diagnostic testing capabilities exist for tularemia, but they are not widely available. Effective antibiotic treatment regimens also exist, but they are not the antibiotics clinicians would likely prescribe for routine treatment of pneumonia. Given the rarity of tularemia and nonspecific features of the disease, clinicians are not likely to order the needed diagnostic test, nor begin the proper antibiotics until some time into an epidemic," explains Dr. Dennis.

Tularemia is caused by exposure to Francisella tularensis bacteria, which affect both animals and people. The disease is sometimes called "rabbit fever" because it often infects hunters and trappers who are exposed to contaminated animals or meat. Humans also can acquire the disease through the bites of ticks and other insects, through inhalation of infected dust, or through ingestion of contaminated materials. The disease does not, however, spread from person to person. Rabbits, voles, squirrels, and other small animals are natural hosts for tularemia.

Outbreaks commonly occur in Europe and Russia. In the United States, tularemia occurs only rarely An outbreak of tularemia pneumonia did occur, however, in Martha's Vineyard, Massachusetts, in the summer of 2000. Cases of the disease were associated with infected dust from lawn mowing and other landscaping activities.

"One of the priorities that emerges from this analysis is the need to develop simple, widely available, rapid diagnostic tests that could be used to identify persons infected with F. tularensis. We also need a better understanding of how effective new classes of antibiotics would be in treating this old scourge," says Thomas Inglesby, M.D., one of the report's authors and a researcher with the Center for Civilian Biodefense Studies.

In addition, the report recommends testing to rapidly identify the antibiotic susceptibility of tularemia strains. The possibility that genetically induced antibiotic-resistant strains could be used as weapons has made this even more important not only for tularemia, but for other potential weapons as well.

A tularemia vaccine is not currently available for general use, and it is recommended only for laboratory workers who are routinely exposed to the disease. The working group encourages the development of new DNA-based or antibody-based vaccines that could provide fast-acting protection from tularemia both before and after exposure.

Over the past two years, the group has published recommendations in JAMA for responding to potential terrorist use of smallpox, anthrax, plague, and botulism bioweapons. Further reports are anticipated.
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Publication:Journal of Environmental Health
Article Type:Brief Article
Geographic Code:1USA
Date:Sep 1, 2001
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