Bioterrorism

The following was developed to help respond to common questions asked about bioterrorism preparedness in Connecticut and prepared by the State Department of Public Health (DPH).

What is Bioterrorism?
Bioterrorism is the intentional use of infectious biological agents, or germs, to cause illness.

How Has the Connecticut Department Of Public Health (DPH) Been Preparing to Address the Possibility Of a Bioterrorist Attack in Connecticut?
The Connecticut DPH regularly asks all healthcare providers in Connecticut to be alert for any unusual disease clusters, and to immediately report such occurrences to the both the local and state health departments. Additionally, we are working with acute care hospitals on a system to quickly detect an increase in unusual illnesses that might suggest the release of a biological agent. The quicker a bioterrorist attack would be detected, the sooner a response would be implemented.

Response Information
The response would emphasize ensuring that appropriate medical care and prevention services are provided while enabling law enforcement officials to do their work. This would be done by coordinating efforts with local, state, and federal agencies; alerting and providing guidance to hospitals and the medical care community; and communicating with the public. Rapid communication systems have been developed over the past 3 years that enable coordination between all these groups.

What is Anthrax?
Anthrax is an acute infectious disease caused by the spore-forming bacterium Bacillus anthracis. Anthrax most commonly occurs in hoofed mammals, but can also infect humans. In humans, it is primarily an occupational disease identified in persons who have contact with dead animals or animal products such as wool, hair, and hides.

Spread
Symptoms of disease vary depending on how the disease was contracted, but usually occur within 7 days after exposure. Anthrax can be spread 3 ways:
  • Through breathing in (inhalation) anthrax spores
  • Through cutaneous (skin) contact with infected animal products (e.g., wool, hair, hides) or contaminated soil
  • Through ingesting contaminated, undercooked meat
Inhalation Symptoms
Initial symptoms of inhalation anthrax are mild and not specific and may include fever, malaise and mild cough or chest pain. After several days, the symptoms may progress to severe breathing difficulties and shock. After the onset of severe symptoms, inhalation anthrax is usually fatal. However, early antibiotic treatment increases the chances for survival, and treatment of persons exposed to anthrax who show no signs of infection may prevent severe illness.

Skin Contact Symptoms
Cutaneous (skin) anthrax is marked by a boil-like lesion that appears and eventually forms an ulcer with a black center.

Ingestion Symptoms
Initial symptoms of intestinal anthrax include:
  • Fever
  • Loss of appetite
  • Nausea
  • Vomiting
These are followed several days later by abdominal pain, vomiting of blood, and severe diarrhea.

Investigation
In the event of a bioterrorist attack with anthrax, a rapid investigation would be conducted to determine the time and place of the release, and to identify persons who were exposed who need antibiotics to prevent illness. As indicated above, the federal government has stockpiled antibiotics, and could deliver these medications rapidly to Connecticut if they were needed on a large scale.

Action If You've Been Exposed
In the absence of a public health advisory, if you believe you may have been exposed to anthrax from a concrete source (e.g., envelope with powder), the prudent action is to report this to local law enforcement officials who will rapidly investigate the situation. If a determination is made that an exposure to anthrax was likely, then taking of antibiotics will be advised.

Is Anthrax Contagious?
Anthrax is not spread from person to person. Those who come into contact with persons sick with anthrax cannot acquire the disease.

What is Smallpox?
Smallpox, a severe viral infection that affects only humans, was eliminated from the world in 1977. Symptoms include:
  • Aches
  • Distinctive rash
  • Fever
  • Vomiting
Vaccine
Smallpox can be prevented with smallpox vaccination, which was discontinued in the United States in 1972. Persons who have been vaccinated against smallpox in the past probably have only limited, if any, antibody protection against this disease. There is no known treatment for smallpox, although approximately 2/3 of those infected with this virus have survived previous outbreaks.

Outbreak
Smallpox vaccine is not commercially available to those who may want it. In the event of an outbreak, the Centers for Disease Control and Prevention (CDC) has clear guidelines to swiftly provide vaccine to people exposed to the disease. The vaccine is securely stored by the CDC for use in the case of an outbreak. Plans are currently in progress to increase the current stockpile of this vaccine.

Is Smallpox Contagious?
Smallpox can be spread from person to person. Most transmission occurs after the patient develops a fever and a rash. Although there is no treatment for the disease, a vaccine taken even 4 to 5 days after exposure can prevent a fatal outcome. In addition to providing protection, the vaccine against smallpox also stops spread of the disease.

If I Was Vaccinated Against Smallpox Before 1980, Am I Still Protected?
Vaccination has been shown to wear off in most people after 10 years, but may last longer if a person has been successfully vaccinated on multiple occasions. If it were determined that you were exposed to smallpox, vaccination would be recommended for you immediately. In addition to a stockpile of vaccine that already exists, the Federal government recently announced plans to accelerate production of a new smallpox vaccine.

Is Connecticut Prepared to Detect and Respond to an Attack With Biologic Agents Such as Anthrax or Smallpox?
Yes, we are much more prepared than we were 3 years ago. The key is for physicians and other health care providers to recognize these diseases when they occur and report them to the Department of Public Health. The DPH outbreak investigation unit will then begin work immediately to help determine who has been exposed and what to do to limit the number of people who become ill - much as is currently done for non-intentional outbreaks of illness. Resources from the Centers for Disease Control are immediately available to help, and the FBI will intervene as soon as it is suspected that there was an intentional effort to expose people to infectious agents.

If There Were an "Incident," Would There Be Enough Antibiotics Available to Treat People Exposed to Anthrax or Vaccine Available to Protect People Against Smallpox?
Because large amounts of medical supplies, antibiotics and vaccines could be needed, a special national stockpile of these items has been created. Special "push packs" of these supplies can be delivered anywhere in the U.S. within 12 hours and usually in much less time. This national resource saves each community from having to stockpile its own supplies.

Do We Have Communication Systems That Enable Critical Information to Be Shared With Hospitals, Health Departments and Doctors?
In the past 3 years, mass fax and computer-based networks have been developed that allow for rapid transfer of important information from the state to all local health departments, hospitals and media networks. These networks have been used for transfer of breaking information about West Nile Virus and to exchange information in the immediate aftermath of the World Trade Center explosions.

Should Connecticut Residents Buy Gas Masks to Protect Themselves & Their Families?
The Connecticut DPH strongly discourages purchasing gas masks for protection against biological agents. Gas masks are intended for short-term use and would only provide protection if worn at the time of a known release. Unless a mask was worn all the time, which is impractical as well as dangerous, it would not protect against the covert release of biological agents. Masks also need to be fitted properly. Improper use of gas masks can cause serious injury or even death by accidental suffocation, especially among persons with underlying heart or lung disease.

Should Connecticut Residents Stockpile Antibiotics to Protect Themselves Against Bioterrorism?
The Connecticut DPH strongly recommends against stockpiling antibiotics, as the use of antibiotics in the absence of evidence indicating a bioterrorist attack is not without risk. Inappropriate use of antibiotics may cause the development of antibiotic-resistant strains of common bacterial diseases. In addition, using antibiotics without a doctor’s prescription may cause serious adverse reactions including: diarrhea, abdominal symptoms, rash, allergic reactions, and potentially dangerous interference with other medications. Individuals who stockpile antibiotics would also be more likely to use medications that have expired. Additionally, stockpiling could lead to shortages of national supplies for routine or emergency use.

A large stockpile of pharmaceuticals - including antibiotics that are effective against the most likely bacterial bioterrorist agents - has been amassed by the federal government and would be rapidly available for distribution in the event of a bioterrorist attack.

Are the State's Water Supplies Safe From Bioterrorism?
Most bioterrorism experts agree that reservoirs are an unlikely target for bioterrorists. Methods already in place to filter and clean the drinking water supply are considered effective against most biological agents. Chlorine, for example, protects drinking water from other water-borne bacteria and would neutralize most biological agents. Additionally, the large quantity of water in Connecticut's water supply would significantly dilute a biological agent, limiting its potential to do harm.

Is There Anything Specific That Connecticut Residents Can Do to Prepare For a Possible Bioterrorist Attack?
The best way for a family to be safe is to be as prepared as possible before any disaster strikes. Consistent with long-standing guidelines on disaster preparedness, including natural disasters such as hurricanes or blizzards, families should plan to provide necessities for themselves for a 3 to 4-day period, in the event that they have to remain inside their home for their safety. Information on family disaster planning can be found at the Red Cross Emergency Planning website.

Protection & Notification
The Connecticut DPH, along with other government agencies and health institutions, will do everything possible to protect public health. Were a bioterrorist event to occur in Connecticut, the public would be informed immediately through the news media of measures that could be taken to protect their health. If antibiotics or vaccines were recommended, instructions would be provided on who should receive them and where to receive these medications.

More Information
If you have specific questions regarding bioterrorism, please contact your local health or police department, or call the Department of Public Health at 860-509-8000. Additional information on bioterrorism preparedness responding to public health emergencies can be found at the Connecticut Department of Health website.