Frequently Asked Questions about Bioterrorism

What precautions should the public take regarding the threat of bioterrorism?
The Virginia Department of Health Services is not recommending any specific bioterrorism-related precautions for the public. However, everyone should have a family disaster plan in place. This would include having the following emergency supplies on hand:

• A three-day supply of water and food that won't spoil
• Clothing, blankets, and sleeping bags for all family members
• First Aid Kit, including family's prescription medications
• Battery-powered radio and flashlights with extra batteries
• Extra set of car keys and a credit card, cash, or traveler's checks
• Sanitation supplies
• Special Items for infant, elderly, or disabled family members
• An extra pair of glasses
  
  Having a plan in place is necessary for anyone to respond to an emergency, be it a natural disaster or a terrorist attack.

Are vaccinations recommended in case of a bioterrorism attack?
There are no vaccines being recommended for the public. Please see below for more specific information on anthrax and smallpox vaccines.

What is the health department doing to protect the public from bioterrorism?
While there is little that the Virginia Department of Health can do to prevent an act of bioterrorism, the Department has implemented an enhanced disease surveillance system to rapidly identify any unusual disease events that may be occurring in the state. The VDH is also working closely with agencies and organizations across the state to coordinate response efforts. In case of an attack, pertinent health information would be provided to the public via mass media.

What is smallpox?
Smallpox is a disease caused by the Variola virus. Historically, 1 out of 3 people who contracted the disease died. The disease can spread from person to person. Transmission usually occurs only after the patient develops a fever and rash.

Although there is no effective treatment for the disease, a vaccine against smallpox provides excellent protection and serves to stop the spread of the disease. While many vaccines must be given weeks or months before a person is exposed to infection, smallpox vaccine is different. It protects a person even when given 2 to 3 days after exposure to the disease and may prevent a fatal outcome even when given as late as 4 to 5 days after exposure.

If smallpox is a potential threat to the U.S., why shouldn't we all get vacinated?
As a result of the successful worldwide eradication of smallpox, smallpox vaccine was removed from the commercial market in 1983, and is no longer a licensed product in the United States. The United States Public Health Service maintains an emergency stockpile of approximately 15 million doses.

At the present time, smallpox vaccine is supplied only to certain laboratory workers who are at risk of infection with smallpox-like viruses as a result of their occupation. The Centers for Disease Control and Prevention is authorized to release the vaccine only to these workers under an Investigational New Drug (IND) permit from the Food and Drug Administration (FDA). The IND does not allow release of smallpox vaccine to any other person for any reason.

The vaccine may cause serious side effects. In 1972, the U.S. decided to stop routinely vaccinating its citizens because many people were experiencing side effects, while they had almost no risk of getting smallpox. By 1972, the disease was present only in a few countries of Asia and Africa. Today, health authorities would only recommend vaccination if there were clear evidence that the disease had resurfaced and those in the U.S. were at risk of acquiring infection.

Many people over age 30 have a vaccination scar. Vaccination consists of introducing the virus into the top layers of the skin. Over the following few days, a blister forms at the site of vaccination (usually the upper arm). The arm is sore, and there is fever. Very rarely, some people get a vaccine-related infection of the brain (about 1 case per 300,000 vaccinations); one fourth of these cases are fatal. Other potential negative effects of the vaccine are a severe skin reaction, spread of the vaccine virus (known as Vaccinia) to other parts of the body, and spread of the Vaccinia virus to other people.

The Federal government, including the Centers for Disease Control and Prevention, is concerned about the threat of bioterrorism. Plans for a response to such an event are being developed at many levels of the government. These plans do not include wide spread use of smallpox vaccine at this point. The benefit and risk of reintroduction of smallpox vaccine are continuing to be examined.

For additional information, consult the current U.S. Public Health Service's Advisory Committee on Immunization Practices recommendations on smallpox vaccination, or visit our Smallpox Fact Sheet or Smallpox Medical Management Guidelines.

If I was vaccinated against smallpox before 1980, am I still protected?
Probably not. Vaccination has been shown to wear off in most people after 10 years but may last longer if the person has been successfully vaccinated on multiple occasions. If health authorities determine that you have been exposed to smallpox or are at risk of infection, they would recommend that you be re-vaccinated immediately.

What is anthrax?
Anthrax is a disease caused by bacteria called Bacillus anthracis. The form of the disease that health authorities are concerned that a bioterrorist attack might produce is inhalational anthrax. Inhalational anthrax occurs when a person breathes in anthrax spores. As early as a day or two after exposure or as late as seven weeks afterward, the spores begin to grow rapidly and the victim develops fever, has difficulty breathing and feels miserable. Death typically occurs within a few days after these symptoms if the person doesn't receive medical treatment. It is believed that antibiotics can stop the disease if they are taken at the time the anthrax spores begin to grow or very soon thereafter.

In the event of a bioterrorist attack, health authorities would conduct a rapid investigation, determine the place and time of the release, and identify individuals who need antibiotics. The federal government has stockpiled antibiotics for large-scale distribution in the event of a bioterrorist attack.

Is anthrax contagious?
No. Anthrax is not contagious. It does not spread from person to person. Healthy people who come into contact with persons sick with anthrax cannot acquire the disease.

Are vaccines for Anthrax available?
Anthrax is a disease found in animals in many places around the world, including the United States. The Anthrax Vaccine is not available commercially except to the military.

For additional information, consult thecurrent U.S. Public Health Service's Advisory Committee on Immunization Practices recommendations on anthrax vaccination, or visit our Anthrax Fact Sheet or Anthrax Medical Management Guidelines.

Should I buy a gas mask?
No. A mask would only protect you if you were wearing it at the exact moment a bioterrorist attack occurred. Unfortunately, a release of a biological agent is most likely to be done "covertly," that is, without anyone knowing it. That means you would not know ahead of time to put on your mask. To wear a mask continuously or "just in case" a bioterrorist attack occurs, is impractical, if not impossible. To work effectively, masks must be specially fitted to the wearer, and wearers must be trained in their use. This is usually done for the military and for workers in industries and laboratories who face routine exposure to chemicals and germs on the job. Gas masks purchased at an Army surplus store or off the Internet carry no guarantees that they will work. More serious is the fact that the masks can be dangerous. There are reports of accidental suffocation when people have worn masks incorrectly, as happened to some Israeli civilians during the Persian Gulf War.

Should I have my own supply of antibiotics ?
There are a number of different germs a bioterrorist might use to carry out an attack. Many antibiotics are effective for a variety of diseases, but there is no antibiotic that is effective against all diseases. Thus, no single pill can protect against all types of biological weapon attacks. Keeping a supply of antibiotics on hand poses other problems because the antibiotics have a limited "shelf life" before they lose their strength. Overuse of antibiotics can result in antibiotic-resistant bacteria.

There is currently no justification for taking antibiotics. Also, it should be known that antibiotics could cause side effects. They should only be taken with medical supervision.

Is it safe for me to drink water from the tap?
It would be extremely difficult for a bioterrorist to contaminate our drinking water supplies to cause widespread illness. There are two reasons. First, huge amounts of water are pumped daily from our reservoirs, most of which is used for industrial and other purposes: very little is actually consumed. Thus, anything deliberately put into the water supply would be greatly diluted. Secondly, water treatment facilities routinely filter the water supply and add chlorine in order to kill harmful germs.

What is the National Pharmaceutical Stockpile (NPS)?
The NPS is a large reserve of antibiotics, chemical antidotes and other medical supplies set aside for emergencies. The CDC reports that it has the capacity to move these stockpiled materials to affected areas in the U.S. within 12 hours of notification. There are a number of different stockpiles, strategically located around the country. In addition to the medical supplies already set aside, the federal government has made agreements with drug manufacturers to make large amounts of additional emergency medicine.

For more information on the NPS, go to http://www.cdc.gov/nceh/nps/default.htm.

What can I do to protect myself and my family?
There are several things you can do:

• Have a general disaster family plan described in the first Q & A above on precautions the public should take.
• For specific threats listen to advice from public health officials broadcast on the radio or on television.
• Report suspicious potential criminal activity to police.
• Report unusual disease or illness symptoms to your local public health department.

What if my fear about bioterrorism is having a serious impact on my family and work life?
Anxiety about personal safety following the terrorist attacks of September 11th is not unusual. If these fears develop to the point that they interfere with normal daily activities, counseling may be beneficial. The Virginia Department of Mental Health, Mental Retardation and Substance Abuse Services Web site has information about available resources, http://www.dmhmrsas.state.va.us/ click on topics under Resources for Coping with Terrorism.

Updated: 10.10.01 by the Virginia Department of Health