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Bioterrorism
Bioterrorism: Guidelines for Medical and Public Health Management
edited by Donald A. Henderson, Thomas V. Inglesby, and Tara O'Toole, 244 pp, with illus, paper, $29.95, ISBN 1-57947-280-X, Chicago, Ill, AMA Press, 2002.
JAMA. 2003;289:1571.
According to a Federal Bureau of Investigation bulletin issued November 15, 2002, "In selecting its next targets, sources suggest Al Qaeda may favor spectacular attacks that meet several criteria: high symbolic value, mass casualties, severe damage to the American economy and maximum psychological trauma." Soon after the tragedies of September 11, 2001,22 cases of anthrax were reported from several cities following distribution of Bacillus anthracis spores via the US mail: The "weapons-grade" spores, it is noted in this bulletin, suggested a high degree of sophistication involving "high spore concentration, uniform particle size, low electrostatic charge, treated to reduce clumping."
Bioterrorism: Guidelines for Medical and Public Health Management tells how we can prepare for such future calamities. It is interesting that the series of articles describing the agents of biologic warfare, gathered and updated for this book, was published in JAMA almost two years before the events of September 11, 2001. The agents most likely to be used by bioterrorists are the organisms or toxins that cause anthrax, smallpox, plague, tularemia, botulism, and viral hemorrhagic fevers.
The premise of the book is that all front-line health care personnel must educate themselves to recognize the clinical presentations of these diseases. Early recognition of such uncommon illnesses can provide an alert to an attack and allow health care personnel to take steps to protect the public and to care for those stricken. "Syndromic surveillance" plans have been announced by many states.
Five chapters describe in great detail the manner in which five cases of anthrax resulting from attacks in 2001 have been identified and treated. We learn, for instance, that the radiological hallmarks of inhalational anthrax are a widened mediastinum, pleural effusions, and pulmonary infiltrates. The case reports are well written and enhanced by excellent photographs.
Subsequent chapters consider the other potential agents of biologic warfare in detail. The comprehensive discussions include historical aspects, epidemiology, clinical features, treatment strategies, and details about available vaccines. The prickly issue of who should receive prophylactic doses of smallpox vaccine (mass vaccination vs "ring" vaccination) is addressed well and summarized with a statement that the program should be "focused and selective." The photographs in each chapter are superb. The final chapter is a sober look at issues concerning large scale quarantine of populations. The bibliography is comprehensive and current.
Readers may also wish to look at the Centers for Disease Control and Prevention bioterrorism Web site (http://www.bt.cdc.gov) and the Centers for the Study of Bioterrorism and Emerging Infections (CSB&EI) site of the Saint Louis University School of Public Health (http://www.bioterrorism.slu.edu), both outstanding resources. Power-Point presentations may be downloaded from each site, and the CSB&EI site has a lecture guide that accompanies the slides. Other useful Web sites are the Johns Hopkins Center for Civilian Biodefense Strategies (http://www.hopkins-biodefense.org), the United States Army Medical Research Institute of Infectious Diseases' Medical Management of Biological Casualties Handbook (http://www.usamriid.army.mil/education/bluebook.html), and the bioterrorism resources Web site at http://www.idsociety.org.
Dr Henderson, principal science advisor to the Secretary of the US Department of Health and Human Services, and his colleagues from Johns Hopkins University Center for Civilian Biodefense Strategies have edited a readable, informative, and timely book. All of us in the health care arena must be alert, educated, and prepared to respond effectively to future threats to our health and way of life. This book tells us how we should prepare and does it extremely well. At $29.95 it is a bargain and should be available in all personal and public libraries.
Anand Panwalker, MD, Reviewer
Wilmington Veterans Affairs Medical Center
Wilmington, Del
Jefferson Medical College
Philadelphia, Pa
Books, Journals, New Media Section Editor: Harriet S. Meyer, MD, Contributing Editor, JAMA; David H. Morse, MS, University of Southern California, Norris Medical Library, Journal Review Editor; adviser for new media, Robert Hogan, MD, San Diego.
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