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Science and Technology Resources on the Internet

Biological and Chemical Terrorism Information for Healthcare Professionals

Rachelle Ramsey
Graduate Student, University of Illinois at Urbana-Champaign
Reference Specialist, Washington-Centerville Public Library, Centerville, Ohio
rramsey@uiuc.edu

With the new century has come a new reality for people around the world: There is no place safe from the threat of biological terrorist activity. Ricin, a deadly poison with no known antidote or vaccine, was discovered in the home of terrorists in England, while four letters mailed in the United States in 2001 were found to contain anthrax. Twenty-three people contracted the disease and five died. The people of Japan were victims of terrorism in 1995 when Sarin gas was released into the Tokyo subway system. Twelve people died and more than 5,000 were injured. Saddam Hussein is suspected of having chemical weapons manufactured in Iraq,and though none have yet been found, it seems safe to assume that terrorists from Iraq or any other nation have the means of producing chemical and/or biological weapons.

Healthcare providers need up-to-date, reliable information on the types of agents and diseases they could be faced with during any type of chemical or biological event. This webliography provides links to information on biological and chemical agents as well as current news of importance to the medical community. Included are resources for treatment of diseases caused by these weapons and links to information on the make-up of these agents.

While bioterrorism has been the topic of recent webliographies (Perkins 2002, and Hinegardner and May 2003), those articles have concentrated on general resources. This webliography provides access to information about specific biological and chemical agents, and a more comprehensive list of general resources than the other publications."

Overviews and News

Chemical and Biological Arms Control Institute
{www.cbaci.org/}

CBACI is a private, nonprofit, nonpartisan policy research organization established in 1993 to address the challenges to global security and stability in the early 21st century, with a special, but not exclusive focus on the elimination of chemical and biological weapons. The institute focuses on research, analysis, technical support, training, and education. This site includes the report, "Bioterrorism in the United States: Threat, Preparedness, and Response,? which seeks to contribute to the development and application of a framework for establishing national requirements for an effective response to threats. There are also links to other recent CBACI reports.

{Chemical and Biological Information Analysis Center}
www.cbiac.apgea.army.mil/

The Chemical and Biological (CB) Defense Information Analysis Center generates, acquires, processes, analyzes, and disseminates CB Science and Technology Information (STI) in support of the Combatant Commanders, warfighters, the Reserve Components, the CB Defense Research, Development, and Acquisition community, and other federal, state, and local government agencies. The CBIAC maintains a collection of, and online access to, journals, magazines and newsletters pertaining to chemical and biological defense topics and information processing technology.

{Henry L. Stimson Center Chemical and Biological Weapons Nonproliferation Project}
www.stimson.org/cbw/?SN=CB2001112951

This site includes news in the chem-bio field as well as links to information on chemical and biological weapons issues. "The Chemical and Biological Weapons Nonproliferation Project examines the panoply of issues associated with chemical and biological weapons. Since 1993, the project has focused on issues related to the Chemical Weapons Convention, as well as the Biological & Toxin Weapons Convention,and issued reports on topics including weapons destruction technologies, the utility of export controls, terrorism involving chemical and biological weapons, and the status of chemical and biological weapons programs in various countries."

Compendium of Bioterrorism Agents Preparedness
{www.acme-assn.org/bio/biocomp.pdf}

This site provides a web-based library of medical resources for health care professionals. This initiative is a comprehensive overview of resource material, in all its formats, that can be made readily available. The 152-page Compendium will be an ongoing and constantly improving project.

Confronting Bioterrorism: Physicians on the Front Line
{http://www.mayoclinicproceedings.com/content/77/7/661.full.pdf+html}

A Special Report issued in the Mayo Clinic Proceedings, July 2002, Vol 77.
"This article provides a general overview of the pathophysiology, clinical presentation, diagnosis, and management of patients infected with the 6 highest priority agents that could potentially be used in bioterrorism. The diseases discussed include anthrax, smallpox, tularemia, plague, botulism,and viral hemorrhagic fevers."

Mayo Clinic.com Infectious Disease Center
{http://www.mayoclinic.com/health/infectious-disease/ID99999}

"Biological, chemical weapons: Arm yourself with information," a report provided by the Mayo Clinic on biological and chemical weapons provides information anthrax, smallpox, plague, botulism and tularemia as well as links to other sources of information.

{Medem Learning Center: Bioterrorism}
{http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZPF5U3WSC&sub_cat=0}

These articles from the Nation's Medical Societies provide answers to some of the most commonly asked questions about the threats posed by biological agents.

MedLine Plus: Biodefense and Bioterrorism
www.nlm.nih.gov/medlineplus/biodefenseandbioterrorism.html

News concerning bioterrorism from the U.S. National Library of Medicine and the National Institutes of Health. The site includes information on coping with anxiety, alternative therapy, prevention/screening, and other topics.

Terrorism and Bioterrorism: Nursing Preparedness
www.icn.ch/matters_bio.htm

This International Council of Nurses policy paper on Disaster Preparedness outlines "actions, including risk assessment and multi-disciplinary management strategies, as critical to the delivery of effective responses to the short, medium, and long-term health needs of a disaster-stricken population."

Ready.gov: From the U.S. Department of Homeland Security
http://www.ready.gov/

This government web site provides information on how to prepare for and react to a terrorist event. The site includes basic information on biological and chemical threats; making a kit for emergency situations; as well as how to react if an explosion, radiation threat, or nuclear blast occurs.

AAP: The Youngest Victims: Disaster Preparedness to Meet Children's Needs
{https://www.aap.org/en-us/Documents/disasters_youngest_victims_disaster_preparedness.pdf}

A Report from the American Academy of Pediatrics on meeting the treatment and mental health needs of children.

Public Health Emergency Preparedness

These web sites provide checklists, reports, and information on preparing for and responding to bioterrorism events which are geared toward healthcare professionals.

Agency for Healthcare Research Quality (AHRQ) Unveils Hospital Bioterrorism Preparedness Tool
{https://archive.ahrq.gov/news/press/pr2002/bioterrpr.htm}

The agency has developed a needs study available for hospital administrators to download and use as a checklist for assessing their capacity to handle potential victims of bioterrorist attacks or for evaluating existing emergency plans.

Bioterrorism Readiness Plan: A Template for Healthcare Facilities
{http://www.cdc.gov/ncidod/dhqp/pdf/bt/13apr99APIC-CDCBioterrorism.PDF}

A reference document and initial template to facilitate preparation of bioterrorism readiness plans for individual institutions. This template was created by the Association for Professionals in Infection Control and Epidemiology in cooperation with the Centers for Disease Control and Prevention.

Nursingworld: Bioterrorism and Disaster Response
{www.nursingworld.org/news/disaster/}

This site provides information from the American Nurses Association on how nurses can "better care for their patients, protect themselves and prepare their hospitals and communities to respond to acts of bioterrorism. Links to articles and organizations that have made major contributions on the subject of bioterrorism are provided."

Internet Resources: Center for the Study of Bioterrorism
www.bioterrorism.slu.edu/

This site, sponsored by the St. Louis University School of Public Health, provides links to professional organizations for health professionals such as the Association for Professionals in Infection Control and Epidemiology which provide bioterrorism web links resources.

Emergency Responders Resources: Terrorism Response
www.cdc.gov/niosh/topics/emres/terrorresp.html

Information from the National Institute for Occupational Safety and Health on topics include Safeguarding Building Ventilation, Anthrax, Chemical Hazards, Bloodborne Infectious Disease, and World Trade Center Response.

Centers for Disease Control and Prevention Programs in Brief: Bioterrorism and Public Health Preparedness
{www.cdc.gov/programs/bio.htm}

CDC's Programs in Brief each include a statement of the public health issue or problem, describe CDC's or ATSDR's activities and accomplishments, and identify steps for moving forward. Topics linked from this page consist of Anthrax Vaccine, Academic Centers for Public Health Preparedness, Epidemic Intelligence Service (EIS),Laboratory Readiness, Laboratory Response to Biological Terrorism, Laboratory Response to Chemical Terrorism, National Public Health Performance Standards, Public Health Law, Public Health Workforce Development, Select Agent Program, Smallpox Vaccination and Response Plan, Terrorism Preparedness and Emergency Response, and Training for Public Health Professionals.

CDC Strategic National Stockpile
{https://www.cdc.gov/phpr/stockpile/}

The pharmaceutical stockpile program was created to ensure the availability and rapid deployment of life-saving pharmaceuticals, antidotes, other medical supplies, and equipment necessary to counter the effects of nerve agents, biological pathogens, and chemical agents. This web site gives details of the program.

NIAID Biodefense
{https://www.niaid.nih.gov/research/biodefense}

This web site for National Institute of Allergy and Infectious Diseases Biodefense Research includes information on biodefense-related information for biomedical researchers, the public, and the media. There are also links to current biodefense-related news.

{President Details Project Bioshield.}
www.whitehouse.gov/news/releases/2003/02/20030203.html

President Bush announced in February 2003 Project Bioshield, an effort to develop and make available modern, effective drugs and vaccines to protect against attack by biological and chemical weapons or other dangerous pathogens.

Ready.gov Useful Links
{http://www.ready.gov/america/other/links.html}

Provides a list of State Emergency Agencies, including contact information.

The U.S. Army Medical Research Institute of Infectious Diseases.
www.usamriid.army.mil/

Home page for USAMRIDD,the Department of Defense's lead laboratory for medical aspects of biological warfare defense. "USAMRIID conducts research to develop vaccines, drugs and diagnostics for laboratory and field use. In addition to developing medical countermeasures, USAMRIID formulates strategies, information, procedures, and training programs for medical defense against biological threats."

TOXNET
http://toxnet.nlm.nih.gov/

A cluster of databases on toxicology, hazardous chemicals, and related areas from the National Library of Medicine.

{Bioterrorism and CAM: What the Public Needs to Know}
http://nccam.nci.nih.gov/health/alerts/bioterrorism/

The National Center for Complementary and Alternative Medicine's web site with information on prevention and treatment of disease caused by biological weapons. "As a component of the National Institutes of Health, the nation's lead agency for medical research, NCCAM is charged with exploring--in the context of rigorous science--CAM approaches and practices, and giving the American public reliable information about the safety and effectiveness of CAM practices."

Agents, Diseases, and Threats

The CDC has compiled an Emergency Preparedness and Response web site to provide information on how to respond to chemical, biological and other terrorist threats. The first three sites below are indexes to specific agents diseases and threats, within the overall web site.

CDC Agents, Diseases, and Threats
{https://emergency.cdc.gov/agent/agentlist.asp}

A comprehensive listing of agents, diseases and threats compiled by the CDC. The listing provides information and resources on many of the agents listed from Abrin to Yersinia pestis.

Biological Agents
{https://emergency.cdc.gov/agent/agentlist.asp}

The biological agents listed have been placed into three categories by the CDC. Category A Diseases/Agents are high-priority agents and include organisms that pose a risk to national security. Category B Diseases/Agents are the second highest priority agents and include those that are moderately easy to disseminate; result in moderate morbidity rates and low mortality rates; and require specific enhancements of CDC's diagnostic capacity and enhanced disease surveillance. Category C Diseases/Agents are the third highest priority agents and include emerging pathogens that could be engineered for mass dissemination in the future because of availability; ease of production and dissemination; and potential for high morbidity and mortality rates and major health impact.

Chemical Agents
{https://emergency.cdc.gov/agent/agentlistchem.asp}

Chemical agents listed include Biotoxins, Blister Agents/Vesicants, Blood Agents, Caustics (Acids), Choking/Lung/Pulmonary Agents, Incapacitating Agents, Long-Acting Anticoagulants, Metals, Nerve Agents, Organic Solvents, Riot Control Agents/Tear Gas, Toxic Alcohols, and Vomiting Agents.

Common Agents

Anthrax:

Considered to be a potential agent for use in biological warfare, Anthrax is an acute infectious disease caused by the spore-forming bacterium Bacillus anthracis. Anthrax most commonly occurs in wild and domestic lower vertebrates (cattle, sheep, goats, camels, antelopes, and other herbivores), but it can also occur in humans who have been exposed to infected animals or tissue from infected animals.

Division of Bacterial and Mycotic Disease Anthrax Disease Information
{http://www.cdc.gov/nczved/dfbmd/disease_listing/anthrax_gi.html}

Frequently asked questions about Anthrax.

Ask NOAH about Anthrax
{http://www.noah-health.org/en/infectious/anthrax/index.html}

Information from New York Online Access to Health on Anthrax, including transmission and diagnosis: prevention; care and treatment and more.

Anthrax Bioterrorism Q and A
{www.aap.org/advocacy/releases/anthraxqa.htm}

This site provides information from the American Academy of Pediatrics, including the effects of anthrax on children.

ClinicalTrials.gov on Anthrax
http://clinicaltrials.gov/ct/gui/action/FindCondition?ui=D000881&recruiting=true

This site provides a listing of all trials involving anthrax.

Botulism:

Botulism is a muscle-paralyzing disease caused by a toxin made by a bacterium called Clostridium botulinum. A supply of antitoxin against botulism is maintained by CDC.

Facts about Botulism
{https://emergency.cdc.gov/agent/botulism/factsheet.asp}

Facts from the CDC.

Medline Plus: Botulism
www.nlm.nih.gov/medlineplus/botulism.html

This site gives an overview of the disease plus information on clinical trials, prevention and screening, specific conditions, effects on children, and links to other organizations providing information on botulism.

ClinicalTrials.gov on Botulism
http://clinicaltrials.gov/ct/gui/screen/BrowseAny;jsessionid=2CF4526A88535225D3F85B4254B14728?recruiting=true&path=%2Fbrowse%2Fby-condition%2Faz%2FB%2FD001906%2BBotulism

This site provides information on all clinical trials involving botulism.

Cyanide:

Cyanide is a rapidly acting, potentially deadly chemical that can exist in various forms. Poisoning caused by cyanide depends on the amount of cyanide a person is exposed to, the route of exposure, and the length of time that a person is exposed.

CDC on Cyanide.
{https://emergency.cdc.gov/agent/cyanide/}

This site provides fact about cyanide; information for first responders; a toxicology profile; medical management guidelines.

Hemorrhagic fever viruses:

HFVs are a diverse group of organisms, each of which belong to one of four distinct families. Hemorrhagic fever viruses are all capable of causing a clinical diseases associated with fever and bleeding disorder, classically referred to as viral hemorrhagic fever (VHF).

Viral Hemorrhagic Fevers
{http://www.upmc-biosecurity.org/website/focus/agents_diseases/fact_sheets/vhf.html}

Information from the Center for Biosecurity on HFV, including a link to "Hemorrhagic Fever Viruses as Biological Weapons" from the Journal of the American Medical Association.

Special Pathogens Branch: Diseases
www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/vhf.htm

Information from the CDC on VHF, including transmission, prevention, and treatment.

Plague:

Plague is caused by the bacteria Yersinia pestis (Y pestis). Given the availability of Y pestis in microbe banks around the world, reports that techniques for mass production and aerosol dissemination of plague have been developed, the high fatality rate in untreated cases and the potential for secondary spread, a biological attack with plague is a serious concern.

Plague
{http://www.upmc-biosecurity.org/website/focus/agents_diseases/fact_sheets/plague.html}

Information from the Center for Biosecurity on Plague, including a fact sheet, bibliography and an article from JAMA.

Medical Library: Plague
{www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZHMEZPNSC&sub_cat=19}

Information from Medem, including geographic distribution, treatment, prevention and more.

Ricin:

Ricin is a poison that can be made from the waste left over from processing castor beans. It would take a deliberate act to make ricin and use it to poison people. Accidental exposure to ricin is highly unlikely.

CDC Facts About Ricin.
{http://emergency.cdc.gov/agent/ricin/}

Fact Sheet on how Ricin works; how Ricin poisoning is treated; what to do if you are exposed to Ricin and more.

Smallpox:

Smallpox is a serious, contagious, and sometimes fatal infectious disease. There is no specific treatment for smallpox disease, and the only prevention is vaccination. In the aftermath of September and October, 2001, there is heightened concern that the variola virus might be used as an agent of bioterrorism. For this reason, the U.S. government is taking precautions for dealing with a smallpox outbreak.

{CDC Smallpox Overview}
https://www.cdc.gov/smallpox/index.html

Information on the disease; the symptoms; and the different stages of the smallpox virus.

Tularemia:

Francisella tularensis, the organism that causes tularemia, is one of the most infectious pathogenic bacteria known, requiring inoculation or inhalation of as few as 10 organisms to cause disease. It is considered to be a dangerous potential biological weapon because of its extreme infectivity, ease of dissemination, and substantial capacity to cause illness and death.

Tularemia
{http://www.upmc-biosecurity.org/website/focus/agents_diseases/fact_sheets/tularemia.html}

Information from the Center for Biosecurity on Tularemia.

CDC FAQ About Tularemia.
{https://www.cdc.gov/tularemia/faq/}

Answers to basic questions on Tularemia.

Nerve Agents

ATSDR HazDat Database
www.atsdr.cdc.gov/hazdat.html

Provides access to the HazDat Database, a project of the Agency for Toxic Substances and Disease Registry. The "Hazardous Substance Release/Health Effects Database, is the scientific and administrative database developed to provide access to information on the release of hazardous substances from Superfund sites or from emergency events and on the effects of hazardous substances on the health of human populations."

{ATSDR ToxFaqs: Hazardous Substance Fact Sheets}
www.atsdr.cdc.gov/toxfaq-m.html

The ATSDR ToxFAQs is a series of summaries about hazardous substances developed by the ATSDR Division of Toxicology. The site includes an index of the substances.

Mustard Gas:

Mustard gas, made in large amounts during World Wars I and II, refers to several manufactured chemicals, including sulfur mustard, that do not occur naturally in the environment. It can cause skin burns, blisters, and death.

{ATSDR:ToxFaqs on Mustard Gas.}
http://www.atsdr.cdc.gov/toxfaqs/TF.asp?id=904&tid=184

Sarin:

Sarin is a human-made chemical warfare agent classified as a nerve agent. Nerve agents are the most toxic and rapidly acting of the known chemical warfare agents. Sarin is a clear, colorless, and tasteless liquid that has no odor in its pure form. However, sarin can evaporate into a vapor (gas) and spread into the environment.

CDC: Sarin
www.bt.cdc.gov/agent/sarin/index.asp

This site provides facts about Sarin and information for First Responders.

VX:

VX is a human-made chemical warfare agent classified as a nerve agent. Nerve agents are the most toxic and rapidly acting of the known chemical warfare agents. VX is odorless and tasteless and is an oily liquid that is amber in color and very slow to evaporate.

CDC on VX
www.bt.cdc.gov/agent/vx/index.asp

FAQs about VX, including toxicology information.

Treatment of Diseases Caused by Biological Weapons

USAMRIID Education
{http://stinet.dtic.mil/cgi-bin/GetTRDoc?AD=ADA416772&Location=U2&doc=GetTRDoc.pdf}}

USAMRIID's Medical Management of Biological Casualties Handbook, 4th ed., is "a reference for the health care provider on the front lines, whether on the battlefield or in a clinic, who needs basic summary and treatment information quickly."

Anthrax Vaccine:

Offers to Treat Diseases Caused by Biological Weapons: What You Need to know
{www.ftc.gov/bcp/conline/pubs/alerts/bioalrt.htm}

A consumer alert article from the Federal Trade Commission.

Anthrax Vaccine Immunization Program
www.anthrax.osd.mil/

Home page for the program, created by the Department of Defense, that includes information on the threat, the disease, and the vaccine. There's also an education toolkit and a resource center. The education toolkit contains a toolkit for clinicians that provides information anthrax and the vaccine while the resource center includes forms related to the program, images of anthrax, information in policies and other helpful items.

{Report Brief: The Anthrax Vaccine: Is it safe? Does it Work?}
www.iom.edu/file.asp?id=4150

A downloadable report brief from the Institute of Medicine of the National Academies. This summary is for health professionals and policy makers.

Smallpox Vaccination:

CDC Smallpox Vaccination
www.bt.cdc.gov/agent/smallpox/vaccination/index.asp

Information for clinicians and health professionals from the CDC.

References

Hinegardner, Patricia G. and May, Alexa. 2002. Selected Bioterrorism Websites for the Healthcare Community and Consumer. Internet Reference Services Quarterly 6 (3/4): 1-15.

Perkins, Eva. 2002. Bioterrorism Resources on the Internet: A Primer. Searcher 10 (3). [Online] Available: http://www.infotoday.com/searcher/mar02/perkins.htm [Nov. 6, 2003].

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