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 LaytonScott Lillibridge, Gary J. Nabel, Michael T. Osterholm, Trish M. Perl, Philip Russell, Kevin Tonat

Research output: Contribution to journalReview articlepeer-review

594 Scopus citations


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
JournalJAMA - Journal of the American Medical Association
Issue number18
StatePublished - May 8 2002
Externally publishedYes

ASJC Scopus subject areas

  • General Medicine


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