Anthrax is very rare. It is an infectious bacterium (germ) that most commonly occurs in hoofed mammals (cattle, pigs, sheep, goats, but can also affect people. Until recently, it has been a disease of those in contact with dead animals or animal products; but given recent events with anthrax threat letters, bacteria may be contained in a powdery substance.

Anthrax can be spread three ways: (1) through cutaneous (skin) contact with infected animal products or unknown substances; (2) through eating contaminated, undercooked meat; and (3) through breathing (inhalation) anthrax bacteria.

The symptoms depend on how a person is exposed to the disease.

• Cutaneous (skin) anthrax may start as a blister-like lesion that eventially forms an ulcer with a black center. Bacteria can enter the body through cuts or breaks in the skin when handling infected animals or products.
• Intestinal symptoms may develop after eating infected meat or drinking contaminated water. A person may have nausea, vomiting, diarrhea and fever.
• Breathing or inhalation of anthrax may cause cold-like symptoms which may progress to severe breathing problems and shock. This is the most severe form of the disease.

Usually within 2-7 days after exposure to the bacteria.

No. It is not spread from person to person.

Certain antibiotics (Penicillin, Ciprofloxacin, Doxycycline) can be used as indicated. All forms of the disease must be treated promptly.

1. Wash with soap and water if exposed to bacteria/unknown substance. Pets can also be washed with soap and water.
2. Clothes should be changed if contaminated, and placed in plastic bags.
3. Take oral antibiotics if given for a known exposure.

Botulism is a serious illness caused by a toxin (poison) produced by Clostridium botulinum bacteria.

Botulism occurs occasionally around the world and is considered to be a potential agent for use in biological warfare since it can be spread in the air.

There are four main kinds of botulism:

1. Foodborne botulism occurs when a person eats contaminated food.
2. Inhalation botulism occurs when a person inhales (breathes) the toxin.
3. Wound botulism occurs when wounds are infected with this bacteria.
4. Infant botulism occurs in a small number of infants who have this bacteria in their intestinal tract.

Botulism is not spread from one person to another.

• Blurred vision, double vision, dizziness, drooping eyelids, slurred speech, difficulty swallowing, muscle weakness that starts from the shoulders and then goes down to the lower body.
• Symptoms start within 6 hours to 2 weeks.

Infants appear tired, feed poorly, are constipated, have a weak cry and poor muscle tone.

Yes. Foodborne botulism often comes from home canned food, like beans, jams, ect. Please follow correct canning procedures for cooking temperatures and refrigeration. Wound botulism can be prevented by promptly seeking medical care for infected wounds.

Botulism is diagnosed by laboratory tests that can detect the toxin.

Supportive care and hospitalization may be necessary. An antitoxin is given to neutralize the poison.

No. There is nothing special to do in the home. Surfaces should be cleaned with soap and water. Regular practices like hand washing should be followed.

Brucellosis is a disease caused by the bacteria (germs) of the genus Brucella. It is also known as undulant fever or Bangs disease.

Brucellosis is considered to be a potential agent for use in biological warfare, since it can be spread (carried) in air. Brucellosis-contaminated food could also be used in biological warfare.

Brucellosis is not very common in the United States, but common in countries where animal disease control programs have not reduced the amount of disease. Brucellosis can occur in three different ways:

1. eating or drinking something that is contaminated with Brucella,
2. inhaling (breathing in) Brucella, or
3. having the bacteria enter the body through skin wounds

• Symptoms that are similar to the flu, including fever, sweats, headaches, back pains, and physical weakness.
• Severe infections of the central nervous system or lining of the heart may occur. Brucellosis can also cause long lasting or chronic symptoms that include recurrent fevers, joint pain, and fatigue.
• There is no specific time period between exposure to Brucellosis and occurrence of symptoms.

Direct person-to-person spreading of Brucellosis is rare. Mothers who are breast feeding may transmit the infection to their infants. Sexual transmission has also been reported. Direct contact with the open wound of a patient can also cause transmission of the disease.

Do not eat unpasteurized milk, cheese, or ice cream while traveling. Hunters and farmers should use rubber gloves when handling dead animals. Caregivers of Brucellosis patients with open wounds should wear gloves.

Brucellosis is diagnosed by laboratory tests on samples of blood or bone marrow.

There is no vaccine available for humans for Brucellosis.

Cyanide is a fast acting, deadly chemical that can be a colorless gas or crystal. Cyanide gas is sometimes described as having a "bitter almond" smell, but it does not always have an odor and not everyone can detect odor.

Cyanide is naturally present in some foods (peach pits) and is contained in cigarette smoke. It has become a current issue because it is considered a potential warfare agent.

Cyanide can enter water, soil, or air from natural processes, industrial activities, or deliberately to harm people. People may be exposed by breathing air, drinking water, eating food or touching soil that contains cyanide. Smoking cigarettes is probably one of the major sources of exposure for people who do not work in cyanide-related industries.

Cyanide gas is most dangerous in enclosed places where the gas will be trapped. It evaporates and disperses quickly in open places. It is less heavy than air, so it will rise. It prevents the body from getting oxygen so that cells die.

If exposed to a small amount of cyanide by breathing it, the following symptoms occur within minutes:

• Fast Breathing
• Restlessness
• Dizziness
• Weakness
• Headache
• Upset stomach and vomiting; and
• Rapid heart rate.

Exposure to large amounts of cyanide by any means may cause these symptoms:

• Convulsions;
• Low blood pressure;
• Slow heart rate;
• Loss of consciousness;
• Lung injury; and
• Respiratory failure leading to death.

Survivors of serious cyanide poisoning may develop symptoms like Parkinson's Disease.

First, get fresh air by leaving the area where the cyanide was released. If you can not leave the area, stay as low to the ground as possible. Remove any clothing that has liquid cyanide on it. Seal the clothing in a plastic bag and then seal the bag in another plastic bag. If your eyes are burning and site is blurred, rinse eyes with water for 10 to 15 minutes. Wash any cyanide from the skin with soap and water. If you have swallowed cyanide do not induce vomitting or give fluids to drink. In all instances, seek medical attention as soon as possible.

Cyanide poisoning is treated with antidotes. Supportive care and hospitalization may be necessary to minimze the effects of the poisoning.

A dirty bomb (also called a radiological dispersion device [RDD] is made of explosives, such as dynomite, and radioactive powder or pellets. The purpose of a dirty bomb is to blast radioactive material into the air around the explosion, causing buildings and people to be exposed.

Dirty bombs could be used in a terrorist attack to frighten people and leave buildings unusable for a long period of time.

The most harmful radioactive materials are found in nuclear power plants but increased security makes if difficult to get the materials from this source. There is a chance that the materials could come from low-level radioactive sources, such as hospitals, construction sites, and food irradiation plants.

The greatest danger of the dirty bomb comes from the blast itself. It is difficult to tell how much radiation might be present if the source of the radiation is unknown. If a low-level radioactive material was used, not enough radiation would be present to cause severe illness from exposure to radiation.

Humans cannot see, smell, feel or taste radiation. If you are not severely hurt by the initial blast, you should:

1. Leave the immediate area on foot. Do not take buses, subways or trains because they may be contaminated.
2. Go inside the nearest building to reduce your exposure to any radioactive material.
3. Remove your clothes as soon as possible and put them in a sealed bag.
4. Take a shower or wash yourself as best as possible.
5. Be on the lookout for information from emergency and other medical personnel. Keep televison or radios tuned to local news networks. If radioactive material was released, you will be told where to report for radiation monitoring and blood tests. You will also be told what to do to protect your health.

Taking potassium iodide (KI) would probably not be beneficial for dirty bomb exposure, since it is not known at the time of the explosion what radioactive iodine was used. Taking KI is not recommended unless there is a risk of exposure to radioactive iodine. KI will only protect a person from radioactive materials and it will not protect other parts of the body from exposure to radiation. Follow the instructions of healthcare teams that are taking care of the situation.

Nerve agents are man-made chemicals that were originally produced as insecticides, and later for military use. The four major nerve agents are tabun (GA), sarin (GB), soman (GD) and VX. GA, GB and GD are clear, odorless, colorless, tasteless liquids that can mix with water and most solvents. VX is a clear, amber colored, odorless oily liquid that can mix with water and dissolves in all solvents. VX is the least likely of the agents to change into a vapor.

Nerve agents could be used in a military or terrorist attack.

• Air- People can be exposed through their skin, eyes, or breathing contaminated air.
• Water- People can be exposed by drinking contaminated water or getting the contaminated water on their skin.
• Food- People can be exposed by eating contaminated food.

A person may not know they have been exposed because nerve agents have no smell. The following symptoms happen within seconds to hours after a person has been exposed: Runny nose; watery eyes; small, pinpoint pupils; eye pain; blurred vision; drooling and excessive sweating; cough; chest tightness; rapid breathing; diarrhea; increased urination; confusion; drowsiness; weakness; headache; upset stomach; vomiting and or stomach pain; slow or fast heart rate; low or high blood pressure. Exposure to large doses of nerve agents can cause loss of consciousness, convulsions, paralysis and death.

• Leave the building where the nerve agent has been released as quickly as possible and get to fresh air.
• If the nerve agent was released outside, go to the highest ground possible. Nerve agents are heavier than air and will sink to low-lying areas.
• Remove all clothing that has the nerve agent on it and seal the clothing in a plastic bag. Put the sealed bag into a second sealed plastic bag.
• Rinse the eyes with plain water for 10-15 minutes if they are burning and vision is blurred.
• Wash all exposed areas of the skin with large amounts of soap and water.
• If the nerve agent was swallowed, do not induce vomitting or give them fluids to drink. Seek medical treatment right away.
• Call 911 and explain what has happened and follow all medical orders.

Nerve agent exposure can be treated with antidotes and supportive medical care. The most important thing is to follow the steps above to decontaminate the exposed person and get medical treatment as soon as possible.

Q fever is a disease caused by the bacterium (germ) Coxiella burnetii.

Q fever is considered to be a potential agent for use in biological warfare since it can be spread (carried) in air.

Q fever usually occurs when a person inhales (breathes in) air contaminated with Coxiella burnetii. Since cattle, sheep and goats carry this germ, most cases come from breathing air that contains barnyard dust contaminated by dried wastes of infected herd animals. Humans can catch the disease very easily, and only a few organisms may be required to cause infection.

• High fevers (up to 105 degrees), severe headache, discomfort, fatigue, muscle aches, confusion, sore throat, chills, sweats, cough, nausea, vomiting, diarrhea, abdominal pain, and chest pain. Fever usually lasts for 1 to 2 weeks. Weight loss can occur and last for some time.
• The time period between exposure to Q fever and occurence of the symptoms is from 10 days to 3 weeks.

Q fever is not likely to spread directly from person to person.

If you are exposed to contaminated or possibly contaminated materials wash with soap and water. Use only pasteurized milk and milk products. Facilities housing sheep and goats should restrict their access and appropriately dispose of all birth products. Appropriate procedures for bagging, autoclaving, and washing of laboratory clothing should be used. Imported animals should be quarantined.

Q fever is diagnosed by laboratory tests on blood samples.

Antibiotic treatment is usually successful if given within the first 3 days of illness.

There is no vaccine for Q fever available in the United States.

Ricin is a poison that can be made from the left over waste of processed castor beans. It can be in the form of a powder, mist, and pellet or dispersed in water as a weak acid. Very hot or very cold temperatures do not affect it.

Ricin is considered to be a potential chemical warfare agent.

Ricin can be breathed in as a mist or powder. It can be put deliberately in the water and food supply and can be swallowed. Pellets of Ricin or Ricin mixed in a liquid can be injected into the body. As little as 500 micrograms (the size of a pin head) is enough Ricin to kill an adult by injection. A much greater amount is needed to kill an adult by inhalation or swallowing. Ricin works by getting inside the cells of a person's body and stopping the cells from making the proteins they need, which kills the cells.

• Inhalation: Within a few hours of exposure-fever, coughing, tightness in the chest, difficult breathing, upset stomach, muscle aches. Within the next few hours of exposure-the lungs become swollen and hot, excess fluid builds up in the lungs, breathing is even more difficult and the skin might turn blue.
• Swallowing: Vomiting, bloody diarrhea. Eventually, the liver, spleen and kidneys might stop working.
• Injection: The muscles and lymph nodes near the injection site die; vomiting, bloody diarrhea; the liver, kidneys and spleen stop working.

Death results within 36 to 48 hours of exposure. If the person lives longer than 5 days without complications, they will probably not die.

Ricin poisoning is not contagious and cannot be spread from person to person.

There are no tests to tell whether a person has been exposed to Ricin. A possible clue would be that many people who have been close to each other suddenly have a fever, cough, and excess fluid in their lungs, followed by severe breathing problems and death.

There is no antidote for Ricin poisoning. Supportive care and hospitalization may be necessary to minimize the effects of the poisoning.

If you think you might have been exposed to Ricin, please call the regional poison control center at 1-800-222-1222.

Smallpox is an illness caused by the virus Variola.

Smallpox was declared eliminated in 1980 and vaccinations against the illness were stopped. Because smallpox is considered to be a potential agent for use in biological warfare, a detailed nationwide smallpox response plan has been developed by the U.S. government to deal with this possibility.

Smallpox normally spreads from contact with infected persons. Smallpox can also be spread through direct contact with infected body fluids or contaminated objects such as sheets or clothing. It could be spread (carried) in air as a biological weapon.

• Fever, head and body aches, and sometimes vomiting occur for 2-4 days. A rash follows that spreads and becomes raised bumps that crust, scab, and fall off after about three weeks, leaving a pitted scar.
• The time period between exposure to smallpox and occurence of the symptoms is 7-17 days. A person is considered contagious as soon as they develop a fever.

Patients with smallpox should be isolated until the scabs fall off their skin. Caregivers of persons with smallpox should be vaccinated and wear a disposable surgical mask, cap, gloves and gown. Clothing and sheets should be washed in hot water and bleach. Other contaminated sufaces must be disinfected.

Smallpox is diagnosed by healthcare professionals.

Currently, there is no proven treatment for smallpox. Patients with smallpox receive fluids, medicine to control fever and pain, antibiotics for other infections that occur as a result of the smallpox.

The smallpox vaccine is the only way to prevent smallpox. The smallpox vaccine is made with the virus Vaccinia, which is related to smallpox. The vaccine helps the body develop immunity to smallpox. It was successfully used to rid smallpox from the human population. The vaccine lasts for 3-5 years with lessened immunity thereafter. If a person is vaccinated again later, immunity lasts even longer.

People who have a high risk of coming into contact with the virus and those who have been exposed to the virus should be vaccinated. Visit the Centers for Disease Control and Prevention's website for more information: http://www.bt.cdc.gov/agent/smallpox/index.asp

These people should not receive the vaccine unless they have been exposed to smallpox:

• Anyone who is allergic to the vaccine or any of its components;
• Pregnant women and women who are breast feeding;
• Anyone under 12 months of age;
• People who have, or have had, skin conditions, especially eczema and atopic dermatitis (skin rashes);
• People with weakened immune systems, such as those who have received a transplant, are HIV positive, are receiving treatment for cancer, or are taking medications (like steroids) that suppress the immune system. You should also not receive the smallpox vaccine if a doctor has diagnosed you as having a heart condition such as:
• Known coronary disease including:
1. Previous myocardial infarction (heart attack)
2. Angina (chest pain caused by lack of blood flow to the heart)
• Congestive heart failure;
• Cardiomyopathy (heart muscle becomes inflamed and does not work as well as it should);
• Stroke or transient ischemic attack (TIA-a "mini-stroke" that produces stroke-like symptoms but no lasting damage);
• Chest pain or shortness of breath with activity (such as walking up stairs);
• Other heart conditions under the care of a doctor.

The Advisory Committee on Immunization Practices [ACIP} advises against non-emergency use of smallpox vaccine for anyone less than 18 years of age.

The vaccine is given using a two-pronged needle that is dipped into the vaccine solution and holds a drop of the vaccine. The needle is then used to prick the skin a number of times in a few seconds. (Two or three needle punctures for the first vaccination; 15 for revaccination). The pricking is not deep, but will cause a sore spot and one or two drops of blood to form. The vaccine usually is given in the upper arm. If the vaccination is successful, a red and itchy bump develops at the vaccination site in three or four days. In the first week after vaccination, the bump becomes a large blister, fills with pus, and begins to drain. During the second week, the blister begins to dry up and a scab forms. The scab falls off in the third week, leaving a small scar.

Mild reactions have been experienced, including a sore arm, fever, and body aches. In recent tests, one in three people felt bad enough to miss work, school, or recreational activity or had some trouble sleeping after receiving the vaccine. The vaccine does have some risks. About 1,000 people for every 1 million people vaccinated for the first time experienced serious reactions including an allergic reaction at the site of the vaccination and spread of the vaccinia virus to toher parts of the body and to other people. Rarely, between 14 and 52 people per 1 million vaccinated experienced potentially life-threatening reactions, including eczema vaccinatum, progressive vaccinia, or postvaccinal encephalitis. Based on past experience, it is estimated that between 1 and 2 people out of every 1 million people vaccinated will die as a result of life-threatening reactions to the vaccine.

Vaccinia Immune Globulin (VIG) and cidofovir may help people who have certain serious reactions to the smallpox vaccine. VIG and cidofovir are both administered under the investigational new drug protocol.

Tularemia is a disease caused by the bacterium (germ) Francisella tularensis.

Tularemia is considered to be a potential agent for use in biological warfare, since it can be spread (carried) in air.

Tularemia is naturally found in animals, especially in rodents, rabbits and hares. Every year, approximately 200 people are infected with tularemia in the United States, mostly persons living in the south-central and western states. Nearly all cases occur in rural areas and result from the bites of ticks and biting flies that have fed on an infected animal or with handling of infected animals. Some cases result from inhaling aerosols of tularemia from accidents with laboratories that handle tularemia.

• Skin ulcers, swollen and painful lymph glands, inflamed eyes, sore throat, mouth ulcers, or pneumonia. If tularemia is inhaled (breathed) symptoms include fever, chills, headache, muscle aches, joint pain, dry cough, and weakness.
• The time period between exposure to tularemia and occurence of the symptoms is 3 to 5 days, with a range of 1 to 14 days.

Direct person-to-person spread of tularemia is unlikely to occur.

Heat and common disinfectants will kill Francisella tularensis on surfaces that have been exposed to the body fluids of a person with tularemia.

Tularmia is diagnosed by laboratory tests that can detect the bacterium in blood or sputum (spit).

Early treatment with an antibiotic has been effective for treating tularemia.

A vaccine for tularemia has been used in the past to protect laboratory workers, but it is currently under review by the Food and Drug Administration and not available to the general public.

Viral hemorrhagic fevers (VHF) are a group of illnesses caused by many distinct families of viruses. In general, multiple organ systems in the body are affected. The viruses cause damage to blood vessels and symptoms often include bleeding, though bleeding itself is rarely life threatening. Some of the viruses cause death. Some examples of VHF are yellow fever, Ebola, hemorrhagic fever (HF), Marburg HF, Lassa fever, Argentine HF.

VHF is considered to be a potential agent for use in biological warfare, since it can be spread (carried) in air.

The viruses that cause VHF occur throughout the world. Many, though, are restricted to certain areas. VHF's are carried by animals (especially rodents) and arthropods, such as ticks and mosquitoes. A person can develop VHF when bitten by an infected animal, tick or mosquito, or when they come into contact with an infected animals urine or feces. Some people have developed VHF's through contact with contaminated needles and equipment. A person could also get the disease from inhaling (breathing in) an aerosol containing VHF.

• Fever, fatigue, dizziness, muscle aches, loss of strength, and exhaustion. Patients with severe cases of VHF often show signs of bleeding under the skin, in organs, or from the mouth, eyes, or ears.
• The time period between exposure to VHF and occurrence of the symptoms is 2 to 12 days.

You should avoid close physical contact with people infected with VHF and their body fluids. Caregivers of patients with VHF should wear protective clothing such as gloves, gowns and surgical masks. Instruments and equipment used in caring for patients with VHF should be properly used, disinfected, and disposed. Insect repellant, proper clothing, window screens and other insect barriers should be used to prevent insect bites. Controlling rodent populations, discouraging rodents from entering homes or workplaces, and safely cleaning up rodent nests and droppings also helps to control VHF.

VHF is diagnosed by healthcare professionals.

Supportive care and hospitalization are necessary. Generally, there is no treatment or cure for VHF. An anti-viral drug has been effective in treating Lassa fever and hemorrhagic fever with renal syndrome (HFRS).

Vaccines have been developed for yellow fever and Argentine HF. No vaccines exist for the other VHF.