Hemorrhagic fever viruses as biological weapons

Medical and public health management

Luciana Borio, Thomas Inglesby, C. J. Peters, Alan L. Schmaljohn, James M. Hughes, Peter B. Jahrling, Thomas Ksiazek, Karl M. Johnson, Andrea Meyerhoff, Tara O'Toole, Michael S. Ascher, John Bartlett, Joel G. Breman, Edward M. Eitzen, Margaret Hamburg, Jerry Hauer, D. A. Henderson, Richard T. Johnson, Gigi Kwik, Marci Layton & 6 others Scott Lillibridge, Gary J. Nabel, Michael T. Osterholm, Trish M. Perl, Philip Russell, Kevin Tonat

Research output: Contribution to journalArticle

519 Citations (Scopus)

Abstract

Objective: To develop consensus-based recommendations for measures to be taken by medical and public health professionals if hemorrhagic fever viruses (HFVs) are used as biological weapons against a civilian population. Participants: The Working Group on Civilian Biodefense included 26 representatives from academic medical centers, public health, military services, governmental agencies, and other emergency management institutions. Evidence: MEDLINE was searched from January 1966 to January 2002. Retrieved references, relevant material published prior to 1966, and additional sources identified by participants were reviewed. Consensus Process: Three formal drafts of the statement that synthesized information obtained in the evidence-gathering process were reviewed by the working group. Each draft incorporated comments and judgments of the members. All members approved the final draft. Conclusions: Weapons disseminating a number of HFVs could cause an outbreak of an undifferentiated febrile illness 2 to 21 days later, associated with clinical manifestations that could include rash, hemorrhagic diathesis, and shock. The mode of transmission and clinical course would vary depending on the specific pathogen. Diagnosis may be delayed given clinicians' unfamiliarity with these diseases, heterogeneous clinical presentation within an infected cohort, and lack of widely available diagnostic tests. Initiation of ribavirin therapy in the early phases of illness may be useful in treatment of some of these viruses, although extensive experience is lacking. There are no licensed vaccines to treat the diseases caused by HFVs.

Original languageEnglish (US)
Pages (from-to)2391-2405
Number of pages15
JournalJournal of the American Medical Association
Volume287
Issue number18
StatePublished - May 8 2002
Externally publishedYes

Fingerprint

Biological Warfare Agents
Fever
Public Health
Viruses
Consensus
Hemorrhagic Disorders
Weapons
United States Public Health Service
Hemorrhagic Shock
Ribavirin
Exanthema
Routine Diagnostic Tests
MEDLINE
Disease Outbreaks
Emergencies
Vaccines
Population

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Borio, L., Inglesby, T., Peters, C. J., Schmaljohn, A. L., Hughes, J. M., Jahrling, P. B., ... Tonat, K. (2002). Hemorrhagic fever viruses as biological weapons: Medical and public health management. Journal of the American Medical Association, 287(18), 2391-2405.

Hemorrhagic fever viruses as biological weapons : Medical and public health management. / Borio, Luciana; Inglesby, Thomas; Peters, C. J.; Schmaljohn, Alan L.; Hughes, James M.; Jahrling, Peter B.; Ksiazek, Thomas; Johnson, Karl M.; Meyerhoff, Andrea; O'Toole, Tara; Ascher, Michael S.; Bartlett, John; Breman, Joel G.; Eitzen, Edward M.; Hamburg, Margaret; Hauer, Jerry; Henderson, D. A.; Johnson, Richard T.; Kwik, Gigi; Layton, Marci; Lillibridge, Scott; Nabel, Gary J.; Osterholm, Michael T.; Perl, Trish M.; Russell, Philip; Tonat, Kevin.

In: Journal of the American Medical Association, Vol. 287, No. 18, 08.05.2002, p. 2391-2405.

Research output: Contribution to journalArticle

Borio, L, Inglesby, T, Peters, CJ, Schmaljohn, AL, Hughes, JM, Jahrling, PB, Ksiazek, T, Johnson, KM, Meyerhoff, A, O'Toole, T, Ascher, MS, Bartlett, J, Breman, JG, Eitzen, EM, Hamburg, M, Hauer, J, Henderson, DA, Johnson, RT, Kwik, G, Layton, M, Lillibridge, S, Nabel, GJ, Osterholm, MT, Perl, TM, Russell, P & Tonat, K 2002, 'Hemorrhagic fever viruses as biological weapons: Medical and public health management', Journal of the American Medical Association, vol. 287, no. 18, pp. 2391-2405.
Borio L, Inglesby T, Peters CJ, Schmaljohn AL, Hughes JM, Jahrling PB et al. Hemorrhagic fever viruses as biological weapons: Medical and public health management. Journal of the American Medical Association. 2002 May 8;287(18):2391-2405.
Borio, Luciana ; Inglesby, Thomas ; Peters, C. J. ; Schmaljohn, Alan L. ; Hughes, James M. ; Jahrling, Peter B. ; Ksiazek, Thomas ; Johnson, Karl M. ; Meyerhoff, Andrea ; O'Toole, Tara ; Ascher, Michael S. ; Bartlett, John ; Breman, Joel G. ; Eitzen, Edward M. ; Hamburg, Margaret ; Hauer, Jerry ; Henderson, D. A. ; Johnson, Richard T. ; Kwik, Gigi ; Layton, Marci ; Lillibridge, Scott ; Nabel, Gary J. ; Osterholm, Michael T. ; Perl, Trish M. ; Russell, Philip ; Tonat, Kevin. / Hemorrhagic fever viruses as biological weapons : Medical and public health management. In: Journal of the American Medical Association. 2002 ; Vol. 287, No. 18. pp. 2391-2405.
@article{492edfd205f542849aa5cd149a8803b6,
title = "Hemorrhagic fever viruses as biological weapons: Medical and public health management",
abstract = "Objective: To develop consensus-based recommendations for measures to be taken by medical and public health professionals if hemorrhagic fever viruses (HFVs) are used as biological weapons against a civilian population. Participants: The Working Group on Civilian Biodefense included 26 representatives from academic medical centers, public health, military services, governmental agencies, and other emergency management institutions. Evidence: MEDLINE was searched from January 1966 to January 2002. Retrieved references, relevant material published prior to 1966, and additional sources identified by participants were reviewed. Consensus Process: Three formal drafts of the statement that synthesized information obtained in the evidence-gathering process were reviewed by the working group. Each draft incorporated comments and judgments of the members. All members approved the final draft. Conclusions: Weapons disseminating a number of HFVs could cause an outbreak of an undifferentiated febrile illness 2 to 21 days later, associated with clinical manifestations that could include rash, hemorrhagic diathesis, and shock. The mode of transmission and clinical course would vary depending on the specific pathogen. Diagnosis may be delayed given clinicians' unfamiliarity with these diseases, heterogeneous clinical presentation within an infected cohort, and lack of widely available diagnostic tests. Initiation of ribavirin therapy in the early phases of illness may be useful in treatment of some of these viruses, although extensive experience is lacking. There are no licensed vaccines to treat the diseases caused by HFVs.",
author = "Luciana Borio and Thomas Inglesby and Peters, {C. J.} and Schmaljohn, {Alan L.} and Hughes, {James M.} and Jahrling, {Peter B.} and Thomas Ksiazek and Johnson, {Karl M.} and Andrea Meyerhoff and Tara O'Toole and Ascher, {Michael S.} and John Bartlett and Breman, {Joel G.} and Eitzen, {Edward M.} and Margaret Hamburg and Jerry Hauer and Henderson, {D. A.} and Johnson, {Richard T.} and Gigi Kwik and Marci Layton and Scott Lillibridge and Nabel, {Gary J.} and Osterholm, {Michael T.} and Perl, {Trish M.} and Philip Russell and Kevin Tonat",
year = "2002",
month = "5",
day = "8",
language = "English (US)",
volume = "287",
pages = "2391--2405",
journal = "JAMA - Journal of the American Medical Association",
issn = "0002-9955",
publisher = "American Medical Association",
number = "18",

}

TY - JOUR

T1 - Hemorrhagic fever viruses as biological weapons

T2 - Medical and public health management

AU - Borio, Luciana

AU - Inglesby, Thomas

AU - Peters, C. J.

AU - Schmaljohn, Alan L.

AU - Hughes, James M.

AU - Jahrling, Peter B.

AU - Ksiazek, Thomas

AU - Johnson, Karl M.

AU - Meyerhoff, Andrea

AU - O'Toole, Tara

AU - Ascher, Michael S.

AU - Bartlett, John

AU - Breman, Joel G.

AU - Eitzen, Edward M.

AU - Hamburg, Margaret

AU - Hauer, Jerry

AU - Henderson, D. A.

AU - Johnson, Richard T.

AU - Kwik, Gigi

AU - Layton, Marci

AU - Lillibridge, Scott

AU - Nabel, Gary J.

AU - Osterholm, Michael T.

AU - Perl, Trish M.

AU - Russell, Philip

AU - Tonat, Kevin

PY - 2002/5/8

Y1 - 2002/5/8

N2 - Objective: To develop consensus-based recommendations for measures to be taken by medical and public health professionals if hemorrhagic fever viruses (HFVs) are used as biological weapons against a civilian population. Participants: The Working Group on Civilian Biodefense included 26 representatives from academic medical centers, public health, military services, governmental agencies, and other emergency management institutions. Evidence: MEDLINE was searched from January 1966 to January 2002. Retrieved references, relevant material published prior to 1966, and additional sources identified by participants were reviewed. Consensus Process: Three formal drafts of the statement that synthesized information obtained in the evidence-gathering process were reviewed by the working group. Each draft incorporated comments and judgments of the members. All members approved the final draft. Conclusions: Weapons disseminating a number of HFVs could cause an outbreak of an undifferentiated febrile illness 2 to 21 days later, associated with clinical manifestations that could include rash, hemorrhagic diathesis, and shock. The mode of transmission and clinical course would vary depending on the specific pathogen. Diagnosis may be delayed given clinicians' unfamiliarity with these diseases, heterogeneous clinical presentation within an infected cohort, and lack of widely available diagnostic tests. Initiation of ribavirin therapy in the early phases of illness may be useful in treatment of some of these viruses, although extensive experience is lacking. There are no licensed vaccines to treat the diseases caused by HFVs.

AB - Objective: To develop consensus-based recommendations for measures to be taken by medical and public health professionals if hemorrhagic fever viruses (HFVs) are used as biological weapons against a civilian population. Participants: The Working Group on Civilian Biodefense included 26 representatives from academic medical centers, public health, military services, governmental agencies, and other emergency management institutions. Evidence: MEDLINE was searched from January 1966 to January 2002. Retrieved references, relevant material published prior to 1966, and additional sources identified by participants were reviewed. Consensus Process: Three formal drafts of the statement that synthesized information obtained in the evidence-gathering process were reviewed by the working group. Each draft incorporated comments and judgments of the members. All members approved the final draft. Conclusions: Weapons disseminating a number of HFVs could cause an outbreak of an undifferentiated febrile illness 2 to 21 days later, associated with clinical manifestations that could include rash, hemorrhagic diathesis, and shock. The mode of transmission and clinical course would vary depending on the specific pathogen. Diagnosis may be delayed given clinicians' unfamiliarity with these diseases, heterogeneous clinical presentation within an infected cohort, and lack of widely available diagnostic tests. Initiation of ribavirin therapy in the early phases of illness may be useful in treatment of some of these viruses, although extensive experience is lacking. There are no licensed vaccines to treat the diseases caused by HFVs.

UR - http://www.scopus.com/inward/record.url?scp=0037042244&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0037042244&partnerID=8YFLogxK

M3 - Article

VL - 287

SP - 2391

EP - 2405

JO - JAMA - Journal of the American Medical Association

JF - JAMA - Journal of the American Medical Association

SN - 0002-9955

IS - 18

ER -