Found a good "Pestilence & Plague" link? Let Us Know!

Some of the more prevalent varieties of P&P. Decontamination and treatment protocols, as well as methods of protecting against infection, continued on page 2.

All Topics/Misc.

The California Department of Health Services (CDHS) Pandemic Influenza Preparedness and Response Plan: The plan outlines the roles and strategies of CDHS in coordinating the public health response to a pandemic with local health departments, the healthcare community, the federal government, and other key partners. Scarey.

Infectious Diseases Emerging and Re-emerging Infectious Diseases. New microorganisms capable of causing disease in humans continue to be detected (see examples in Table 1). Whether an emerging microorganism develops into a public health threat depends on factors related to the microorganism and its environment, or the infected human and his/her environment. Such factors include ease of transmission between animals and people and among people, potential for spread beyond the immediate outbreak site, severity of illness, availability of effective tools to prevent and control the outbreak, and ability to treat the disease. Some of the new agents detected in the past 25 years are now genuine public health problems on a local, regional or global scale.

Epidemics & Plagues: An epidemic is generally a widespread disease that affects many individuals in a population. An epidemic may be restricted to one locale or may even be global (pandemic). An outbreak of a disease is defined as being epidemic, however, not by how many members or what proportion of the population it infects but by how fast it is growing. When each infected individual is infecting more than one other individual, so that the number of infected individuals is growing exponentially, the disease is in an epidemic state. Thus even if the number of people affected is small, the phenomenon may still be called an epidemic, although for small epidemics the term "outbreak" is more often used.

Video: "The History of Bioterrorism" Describes the role of Category A agents—such as plague —as weapons of bioterrorism

Words of Wisdom About Gas, Germs, and Nukes By SFC Red Thomas, Armor Master Gunner - U.S. Army (Ret) 10.19.01. Since the media have decided to scare everyone with predictions of chemical, biological, or nuclear warfare on our turf I decided to write a paper and keep things in their proper perspective. I am a retired military weapons, munitions, and training expert.

Bio-Terror Survival Pretty good article centering on anthrax and small pox. Cheesy site, too much advertising, but no pop-ups.

United States Army Medical Research Institute of Infectious Diseases (USAMRIID):

U.S. Department of State Fact Sheets on Chemical-Biological Warfare

Nunn-Lugar-Domenici Domestic Preparedness & WMD Civil Support Teams The Nunn-Lugar-Domenici Domestic Preparedness Program began in FY97 to train first responders -- fire, police, and emergency medical technicians -- in 120 of the largest cities in the country. Recently, the 120 cities that were designated recipients of Nunn-Lugar-Domenici Domestic Preparedness Program have been expanded and amended to a mixture of 157 cities and counties to replace the original 120 cities.

USFA - HAZMAT Guide for First Responders, 1999 The resources on this page will assist First Responders in safely responding to a hazardous materials incident. Resources are also provided for personnel who will assume the Incident Commander role in hazardous materials emergencies above the initial response.

Protection Against Chemical Weapons OPCW Fact File based on "A FOA Briefing Book on Chemical Weapons"

Dr. Kanatjan Alibekov (Ken Alibek) "Plague War" on PBS's Frontline, aired October 13, 1998

Biotechnology and Genetic Engineering: Implications for the Development of New Warfare Agents 1996 Office of Counterproliferation and Chemical and Biological Defense, Office of the Secretary of Defense

The Wonderful World of Diseases website is about more than just diseases: it covers many other "human conditions" that plague and intrigue us.

Identifying Chemical and Biological Agents Learn the characteristics of these substances and their effects. Chemical/biological agents are defined as toxic substances, pathogens or toxins that are used to kill or incapacitate people, animals or plants, or to damage equipment. The use of these agents dates as far back as 429 B.C. when the Spartans ignited pitch and sulphur creating toxic vapors in the Peloponnesian War. This article discusses the types of chemical and biological agents and their effects. See also: Chemical Agents Chart (.pdf) requires Adobe Acrobat.

Tutorial: Chemical and Biological Agents Chemical and biological (CB) agents pose a threat to U.S. and allied military forces.  Unfortunately, what strictly used to be a military risk has now become a concern to the civilian population—brought about by terrorist groups and other factions with developed CB capabilities.  As a result, national, state and local authorities have initiated domestic preparedness against CB terrorism.  Although the probability of a terrorist CB attack is low, it’s important to have an understanding of the potentially devastating and far-reaching effects of these agents.

Meningococcal Epidemic Meningococcal Disease. Meningococcal meningitis is characterized by sudden onset of intense headache, fever, nausea, vomiting, photophobia, and stiff neck. Neurological signs include lethargy, delirium, coma and/or convulsions. Infants may have illness without sudden onset and stiff neck. Even when the disease is diagnosed early and adequate therapy instituted, the case fatality rate is between 5% and 10% and may exceed 50% in the absence of treatment. In addition to the mortality associated with meningococcal meningitis 15% and 20% of those who survive will suffer with neurological sequelae (e.g. deafness, mental retardation) as a result of their illness. A less common but more severe (often fatal) form of meningococcal disease is meningococcal septicemia which is characterized by rapid circulatory collapse and a hemorrhagic rash.

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Anthrax

Anthrax & Anthrax Vaccine CDC pages with tons of info...

HOW TO HANDLE ANTHRAX AND OTHER BIOLOGICAL AGENT THREATS - CDC.gov Many facilities in communities around the country have received anthrax threat letters.  Most were empty envelopes; some have contained powdery substances.  The purpose of these guidelines is to recommend procedures for handling such incidents.

Clinical and Epidemiologic Principles of Anthrax Theodore J. Cieslak and Edward M. Eitzen, Jr., Journal of Emerging Infectious Diseases, Vol. 5, No. 4 (July-Aug. 1999)

Anthrax: A Possible Case History Thomas V. Inglesby, Journal of Emerging Infectious Diseases, Vol. 5, No. 4 (July-Aug. 1999)

Anthrax as a Weapon of Terrorism and Difficulties Presented in Response to its Use Defence Journal, December 1998

The Official DOD Anthrax Information Website Department of Defense, Information on troop vaccination, anthrax the disease, and anthrax the threat.

Clinical Anthrax: Primer for Physicians

Photo of Cutaneous Anthrax on JAMA website

Anthrax as a Biological Weapon, 2002: Updated Recommendations for Management
[JAMA 287(17),2002]

Anthrax as a Biological Weapon: Medical & Public Health Management (1999)
[JAMA 281(18),1999]

Anthrax as a Biological Weapon: Medical & Public Health Management by Thomas V. Inglesby, Donald A. Henderson, John G. Bartlett, Michael S. Ascher, Edward Eitzen, Arthur M. Friedlander, Jerome Hauer, Joseph McDade, Michael T. Osterholm, Tara O'Toole, Gerald Parker, Trish M. Perl, Philip K. Russell, Kevin Tonat for the Working Group on Civilian Biodefense JAMA. May 12, 1999; 281(18) The first in a series of six consensus statements published by the Working Group on Civilian Biodefense outlining protocols for dealing with the deliberate release of an infectious pathogen.

Anthrax for the Pulmonary Physician by John Bartlett, Thomas V. Inglesby, Luciana Borio Pulmonary and Critical Care  Update-Online;16: Lesson 1. 2002 Online, didactic article intended for pulmonary and critical care physicians. The article addresses the epidemiology of anthrax, the diagnostic evaluation and management of inhalational anthrax, and the rationale for antibiotic selection and duration.

Anthrax Awareness and Precautions Bacillus Anthracis are single-cell organisms that cause anthrax. A bacterial disease, anthrax occurs in domesticated and wild animals, including goats, sheep, cattle, horses and deer. For anthrax to be effective as a covert agent, it must be aerosolized into very small particles. This is difficult to do, and requires a great deal of technical skill and special equipment. If these small particles are inhaled, life-threatening lung infection can occur, but prompt recognition and treatment are effective. See also: Centers for Disease Control and Prevention (CDC) FAQ's on Anthrax and Anthrax FAQ's

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Bird Flu

Bird Flu & Avian influenza Avian influenza (also known as bird flu) is a type of influenza virulent in birds. It was first identified in Italy in the early 1900s and is now known to exist worldwide.

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Botulinum

The Pathogenic Clostridia © 2002 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology: The clostridia are ancient organisms that live in virtually all of the anaerobic habitats of nature where organic compounds are present, including soils, aquatic sediments and the intestinal tracts of animals. Most of the clostridia are saprophytes but a few are pathogenic for humans. Those that are pathogens have primarily a saprophytic existence in nature and, in a sense, are opportunistic pathogens. Clostridium tetani and Clostridium botulinum produce the most potent biological toxins known to affect humans. As pathogens of tetanus and food-borne botulism, they owe their virulence almost entirely to their toxigenicity. Other clostridia, however, are highly invasive under certain circumstances.

Positive test for terror toxins in Iraq SARGAT, Iraq, April 4 —  MSNBC.com tests reveal evidence of the deadly toxins ricin and botulinum at a laboratory in a remote mountain region of northern Iraq allegedly used as a terrorist training camp by Islamic militants with ties to the al-Qaida terrorist network. The U.S. Central Intelligence Agency is conducting its own tests at the same area, but has not yet released the results, according to officials in northern Iraq.

Is nation ready for botulinum attack? Experts fear trouble ahead (CNN.com) WASHINGTON (AP) -- Easy to find and easy to produce, botulinum toxin is the most poisonous natural substance on Earth. In the hands of a bioterrorist, a single gram -- the weight of a paper clip -- could kill more than 1 million people.

Botulinum Toxin: From Poison to Medicinal Agent by Jiri Patocka and Miroslav Splino. Botulinum toxin is very strong poison produced by the microorganism Clostridium botulinum. C. botulinum is classified as a single species but consists of at least three genetically distinguishable groups of organisms. These are alike in their abilities to produce neurotoxins with similar pharmacological activities [1] but diverse serologic properties (toxin types A, B, C, D, E, F, and G). These types are defined by the International Standards for Clostridium botulinum Antitoxin [2]. Botulinum toxins are the causative agents of botulism, a potentially fatal condition of neuromuscular paralysis. Botulism is characterized by symmetric, descending, flaccid paralysis of motor and autonomic nerves, usually beginning with the cranial nerves. Blurred vision, dysphagia, and dysarthria are common initial complaints. The diagnosis of botulism is based on compatible clinical findings; history of exposure to suspect foods; and supportive ancillary testing to rule out other causes of neurological dysfunction that mimic botulism, such as stroke, Guillain-Barré syndrome, and myasthenia gravis. Treatment includes supportive care and trivalent equine antitoxin, which reduces mortality if administered early.

Botulinum Toxin Fact Sheet Botulinum toxin poses a major bioweapons threat because of its extreme potency and lethality; its ease of production, transport and misuse; and the potential need for prolonged intensive care in affected persons. Botulinum toxin is the single most poisonous substance known.

Botulinum Toxin as a Biological Weapon: Medical & Public Health Management An aerosolized or foodborne botulinum toxinweapon would cause acute symmetric, descending flaccid paralysiswith prominent bulbar palsies such as diplopia, dysarthria,dysphonia, and dysphagia that would typically present 12 to72 hours after exposure. Effective response to a deliberaterelease of botulinum toxin will depend on timely clinical diagnosis,case reporting, and epidemiological investigation. Persons potentiallyexposed to botulinum toxin should be closely observed, and thosewith signs of botulism require prompt treatment with antitoxinand supportive care that may include assisted ventilation forweeks or months. Treatment with antitoxin should not be delayedfor microbiological testing.

Clostridium botulinum is an anaerobic, Gram-positive, spore-forming rod that produces a potent neurotoxin. The spores are heat-resistant and can survive in foods that are incorrectly or minimally processed. Seven types (A, B, C, D, E, F and G) of botulism are recognized, based on the antigenic specificity of the toxin produced by each strain. Types A, B, E and F cause human botulism. Types C and D cause most cases of botulism in animals. Animals most commonly affected are wild fowl and poultry, cattle, horses and some species of fish. Although type G has been isolated from soil in Argentina, no outbreaks involving it have been recognized.

Microbiology Laboratory Guidebook 3rd Edition/1998. (PDF) CHAPTER 14. METHODS FOR THE DETECTION OF CLOSTRIDIUM BOTULINUM. TOXINS IN MEAT AND POULTRY PRODUCTS. L. Victor Cook. 

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Cholera & Dysentery

Cholera Cholera is an acute intestinal infection caused by the bacterium Vibrio cholerae. It has a short incubation period, from less than one day to five days, and produces an enterotoxin that causes a copious, painless, watery diarrhea that can quickly lead to severe dehydration and death if treatment is not promptly given. Vomiting also occurs in most patients. Most persons infected with V. cholerae do not become ill, although the bacterium is present in their feces for 7-14 days. When illness does occur, more than 90% of episodes are of mild or moderate severity and are difficult to distinguish clinically from other types of acute diarrhea. Less than 10% of ill persons develop typical cholera with signs of moderate or severe dehydration.

Dysentery Dysentery may be simply defined as diarrhea containing blood. Although several organisms can cause dysentery, Shigella are the most important. Shigella dysenteriae type 1 (Sd1), also known as the Shiga bacillus, is the most virulent of the four serogroups of Shigella. Sd1 is the only cause of epidemic dysentery. In addition to bloody diarrhea, the illness caused by Sd1 often includes abdominal cramps, fever and rectal pain. Less frequent complications of infection with Sd1 include sepsis, seizures, renal failure and the haemolytic uraemic syndrome. Approximately 5-15% of Sd1 cases are fatal.

Flesh Eating Bacteria

Flesh-Eating Bacteria: Facts Behind the Bug Necrotizing fasciitis is a bacterial infection. These bacteria attack the soft tissue, usually in an extremity following minor trauma. There are also many cases of this occurring after surgery, and most often abdominal surgery. The name "flesh-eating-bacteria" is a little sensational, but essentially, the bacteria do "eat flesh." They attack the subcutaneous (soft) tissue, which then becomes gangrenous. Infection moves swiftly, usually under the skin, where it is unobservable. Once tissue becomes necrotic (dead), it has to be removed.

Necrotizing Fasciitis: Pathophysiology and Treatment by Anne Fink BSN, RN and Gail Deluca MS, RN-c, CNP Medical-Surgical Nursing Journal - Online CE

Necrotizing Fasciitis This is a brief, but very informative fact sheet.

Necrotizing Fasciitis Clinical Resources A very thorough index of articles from the University of Alabama, which requires a registration with a login and password.

Severe Invasive Group A Streptococcal Infections: A Subject Review (RE9804) American Academy of Pediatrics

Outbreak of Invasive Group A Streptococcus Associated with Varicella in a Childcare Center -- Boston, Massachusetts, 1997

Avoiding Contagion with Necrotizing Fasciitis Dr. Harold Oster, ivillagehealth.com

Group A Streptococcal (GAS) Disease

Invasive Group A Strep New York State Department of Health Communicable Disease Fact Sheet

Group A Streptococcal Infections National Institute of Allergy and Infectious Diseases

Epidemiologic Notes and Reports Nursing Home Outbreaks of Invasive Group A Streptococcal Infections -- Illinois, Kansas, North Carolina, and Texas

Streptococcal Toxic-Shock Syndrome: Spectrum of Disease, Pathogenesis, and New Concepts in Treatment

Nosocomial Group A Streptococcal Infections Associated with Asymptomatic Health-Care Workers -- Maryland and California, 1997

INVASIVE GROUP A STREPTOCOCCUS IN TWO SIBLINGS: A CASE FOR ANTIBIOTIC PROPHYLAXIS OF CLOSE CONTACTS Canadian Population and Public Health Branch

Role of CT in Necrotizing Fasciitis of the Head and Neck

NECROTIZING FASCIITIS OF THE HEAD AND NECK Troy A. Callender, MD December 31, 1992

Necrotizing fasciitis after Plastibell circumcision

Hyperbaric Oxygen Therapy In Necrotizing Fasciitis: Panacea, Useful Adjunct, or Nostrum?

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Hemorrhagic Fever

Viral Hemorrhagic Fevers Fact Sheet (What are viral hemorrhagic fevers?) Viral hemorrhagic fevers (VHFs) refer to a group of illnesses that are caused by several distinct families of viruses. In general, the term "viral hemorrhagic fever" is used to describe a severe multisystem syndrome (multisystem in that multiple organ systems in the body are affected).  Characteristically, the overall vascular system is damaged, and the body's ability to regulate itself is impaired.  These symptoms are often accompanied by hemorrhage (bleeding); however, the bleeding is itself rarely life-threatening. While some types of hemorrhagic fever viruses can cause relatively mild illnesses, many of these viruses cause severe, life-threatening disease.

What is Ebola hemorrhagic fever? Ebola hemorrhagic fever (Ebola HF) is a severe, often-fatal disease in humans and nonhuman primates (monkeys, gorillas, and chimpanzees) that has appeared sporadically since its initial recognition in 1976.

List of Known Cases and Outbreaks of Ebola Hemorrhagic Fever Table Showing Known Cases and Outbreaks, in Chronological Order

Filoviruses Fact Sheet (What are filoviruses?) Filoviruses belong to a virus family called Filoviridae and can cause severe hemorrhagic fever in humans and nonhuman primates. So far, only two members of this virus family have been identified: Marburg virus and Ebola virus. Four species of Ebola virus have been identified: Ivory Coast, Sudan, Zaire, and Reston. Ebola-Reston is the only known filovirus that does not cause severe disease in humans; however, it can be fatal in monkeys.

Infection Control Manual In 1995, an outbreak of Ebola hemorrhagic fever (Ebola HF) affected more than 300 people in and around the city of Kikwit, Democratic Republic of the Congo (formerly, Zaire); approximately 80% of the patients died. More than one-fourth of all the patients were health care workers. After the outbreak, the DRC Ministry of Health, the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) developed practical recommendations for carrying out viral hemorrhagic fever (VHF) isolation precautions in rural health facilities in Africa. These recommendations have been consolidated in a manual for the local health community.

Past Outbreak Postings (since 2000) This section has archived postings of outbreaks that have occured since the year 2000. For information on current outbreaks, please refer to the Special Pathogens home page. To find information on outbreaks that have occurred prior to the year 2000, please visit the Other Resources page.

Marburg Hemorrhagic Fever Fact Sheet Marburg hemorrhagic fever is a rare, severe type of hemorrhagic fever which affects both humans and non-human primates. Caused by a genetically unique zoonotic (that is, animal-borne) RNA virus of the filovirus family, its recognition led to the creation of this virus family. The four species of Ebola virus are the only other known members of the filovirus family.

The Hemorrhagic Fever Viruses as Biological Weapons: Medical & Public Health Management [JAMA 287(18),2002]

The Hemorrhagic Fever Viruses as Biological Weapons:Medical and Public Health Management by Luciana Borio, Thomas V. Inglesby, C.J. Peters, Alan L. Schmaljohn, James M. Hughes, Peter B. Jahrling, Thomas Ksiazek, Karl Johnson, Andrea Meyerhoff, Tara O'Toole, Michael S. Ascher, John Bartlett, Joel G. Breman, Edward Eitzen, Margaret Hamburg, Jerry Hauer, Donald A. Henderson, Richard T. Johnson, Gigi Kwik, Marci Layton, Scott Lillibridge, Gary J. Nabel, Michael T. Osterholm, Trish M. Perl, Philip K. Russell, Kevin Tonat for the Working Group on Civilian Biodefense JAMA. May 8, 2002; 287(18) Consensus recommendations from the Working Group on Civilian Biodefense outlining protocols for dealing with a deliberate release of viral hemorrhagic fever pathogens.

List of VHFs that SPB works with The Special Pathogens Branch works with Biosafety Level 4 (BSL-4) viruses. These viruses are highly pathogenic and require handling in special laboratory facilities designed to contain them. Our mission focuses mainly on viral hemorrhagic fevers (VHFs), such as Ebola hemorrhagic fever, Lassa fever, hantavirus pulmonary syndrome (HPS), and hemorrhagic fever with renal syndrome (HFRS). Our work also includes the study of other emerging viral disease agents that do not cause hemorrhagic fever, but require BSL-4 handling, such as Nipah virus and tick-borne encephalitis virus.

Lassa Fever Fact Sheet Lassa fever is an acute viral illness that occurs in West Africa. The illness was discovered in 1969 when two missionary nurses died in Nigeria, West Africa. The cause of the illness was found to be Lassa virus, named after the town in Nigeria where the first cases originated. The virus, a member of the virus family Arenaviridae, is a single-stranded RNA virus and is zoonotic, or animal-borne. See also: "Lassa" Online Video & Lassa Fever Slideset

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Other Bacterial

Escherichia coli is a bacterium that is a common inhabitant of the gut of warm blooded animals, including man. Most strains of E. coli are harmless, however, some strains, such as E. coli O157:H7, can cause severe foodborne disease and are referred to as enterohaemorrhagic E .coli (EHEC). This pathogen produces toxins, known as verotoxins or Shiga-like toxins because of their similarity to the toxins produced by Shigella dysenteriae. The organism can grow from around 7-10C to 50C, with an optimum temperature of 37C. Some EHEC can grow in acidic foods, down to a pH of 4.4, and in foods with a minimum water activity (Aw) of 0.95. It is destroyed by thorough cooking of foods until all parts reach a temperature of 70C or higher. The designation “O157:H7” in the name of this bacterium refers to specific chemical compounds that are found on its surface that distinguishes it from other strains of E. coli.

Salmonella MULTI-DRUG RESISTANT SALMONELLA TYPHIMURIUM: It was in 1885 that Daniel E. Salmon, U.S. veterinary surgeon, discovered the first strain of Salmonella. Today, there are 2213 known strains and the book is not closed. Over the years, antibiotic resistant strains have developed that are difficult to control and there is a body of evidence in the scientific literature suggesting the possibility that some of these strains may have emerged due to use of antibiotics in intensive animal husbandry. Recent years saw a dramatic rise both in terms of incidence and severity of cases of human salmonellosis; compared to 1980 some countries in Europe witnessed a staggering 20-fold increase in incidence in the last 10 - 15 years.

Typhoid Typhoid fever is contracted when people eat food or drink water that has been infected with Salmonella typhi. It is recognized by the sudden onset of sustained fever, severe headache, nausea and severe loss of appetite. It is sometimes accompanied by hoarse cough and constipation or diarrhea. Case-fatality rates of 10% can be reduced to less than 1% with appropriate antibiotic therapy. Paratyphoid fever shows similar symptoms, but tends to be milder and the case-fatality rate is much lower. The annual occurrence of typhoid fever is estimated at 17 million cases, with approximately 600,000 deaths. Some strains of Salmonella typhi are resistant to antibiotics.

Pfiesteria

PFIESTERIA HYSTERIA? - OR A REAL THREAT TO MARINE LIFE? Not too long but very interesting article.

Pfiesteria & Harmful Algal Blooms in the Mid-Atlantic. Pfiesteria piscicida, a tiny marine organism identified in the last decade in estuaries in North Carolina and Delaware and in the Chesapeake Bay and its tributaries, has been blamed for killing fish and causing health problems in humans. It has been the subject of national press coverage and the cause of considerable confusion and speculation. While questions about its effects and impacts remain, thanks to the diligent work of a number of marine scientists we now know much more about this complicated organism.

Background Information on Pfiesteria The toxic dinoflagellate, Pfiesteria piscicida, has been implicated as the primary causative agent of major fish kills and fish disease events (finfish and shellfish; 10 to 10 finfish) in North Carolina estuaries, coastal areas, and aquaculture operations. Pfiesteria and closely related toxic species ("Pfiesteria-like complex") have also been confirmed in fish kill/disease areas and aquaculture facilities outside North Carolina from the mid-Atlantic to the Gulf Coast. Fish kills caused by P. piscicida usually occur in the warmest part of the year, and often precede low dissolved oxygen levels in the estuaries.

Pfiesteria facts. Pfiesteria piscicida (fee-STEER-ee-uh pis-kuh-SEED-uh), first discovered in 1988, occurs naturally in the environment.

The Cell from Hell, from Micscape Magazine (in the UK), provides some thoughts on Pfiesteria.

The Chesapeake Bay Program has information about Pfiesteria.

A Congressional Research Service report, Pfiesteria and Related Harmful Blooms: Natural Resource and Human Health Concerns is available. The report examines the science of Pfiesteria and the policy implications of Federal, state, and local responses.

Pfiesteria piscicida / Pfiesteria shumwayae, from the Maryland Department of Natural Resources covers these Pfiesteria-related topics: who's involved, areas affected, chronology, who to contact; provides press releases, technical information and fact sheets. Also provides access to various reports, including the Report of the Governor's Blue Ribbon Citizens Pfiesteria Action Commmission (the Hughes Report).

Fish Health, Fungal Infections, and Pfiesteria: The Role of the U.S. Geological Survey (USGS) provides information on USGS investigations of Pfiesteria in the Chesapeake Bay region. Also see a related press release (9/26/97).

Microscopic Murderer: Pollution May be Motivating Pfiesteria to Kill Fish by the Thousands is a new environmental fact sheet produced by the Academy of Natural Sciences (August 1998).

No Hysteria Over Pfiesteria is information from Pamlico County, North Carolina.

The North Carolina Department of Environment and Natural Resources offers a question and answer fact sheet on Pfiesteria. There's also a glossary of terms related to the topic.

Pfiesteria and Agriculture, from the University of Maryland College of Agriculture and Natural Resources, provides information on the topic, including a white paper (revised November 1997) (HTML version) (PDF version) developed by the college.

Pfiesteria piscicida Bibliography of the scientific literature was produced by the Water Quality Information Center at the National Agricultural Library. Also, many Pfiesteria piscicida articles are included in a list of publications provided by the North Carolina State University Center for Applied Aquatic Ecology.

Surveillance for Possible Estuary-Associated Syndrome---Six States, 1998--1999 is an article in Morbidity and Mortality Weekly (May 05, 2000 / 49(17);372-3) from the Centers for Disease Control and Prevention.

Pfiesteria research information is provided by the Virginia Institute of Marine Science. The Virginia Marine Resources Commission also offers links to Pfiesteria Information.

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Plague

CDC Plague Home Page Plague is an infectious disease of animals and humans caused by a bacterium named Yersinia pestis. People usually get plague from being bitten by a rodent flea that is carrying the plague bacterium or by handling an infected animal. Millions of people in Europe died from plague in the Middle Ages, when human homes and places of work were inhabited by flea-infested rats. Today, modern antibiotics are effective against plague, but if an infected person is not treated promptly, the disease is likely to cause illness or death.

Plague Manual: Epidemiology, Distribution, Surveillance & Control Communicable Surveillance & Response (CSR), World Health Organization. On their site

The Black Plague (1348-1350) General Information Primary Sources General Information: HWC, The Black Death : The BEST source on the Plague (23 pages)

Q & A About Plague Provided by the Division of Vector-Borne Infectious Diseases, NCID, CDC

Consensus Statement: Plague as a Biological Weapon: Medical & Public Health Management JAMA 2000;283(17):2281-2290.

Plague: Diagnosis From the CDC Plague Home Page, provided by the Division of Vector-Borne Infectious Diseases, NCID, CDC

Recognition of Illness Associated with the Intentional Release of a Biologic Agent MMWR 2001 Oct 19;50(41):893-897.

Facts About Pneumonic Plague

FAQ About Plague

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SARs

WHO: Severe Acute Respiratory Syndrome (SARS)

WHO: SARS FAQ

CDC: Severe Acute Respiratory Syndrome (SARS) Documents

Health Canada Sars Site

HealthCanada: Severe Acute Respiratory Syndrome

Health Canada: Learning from SARS - Renewal of Public Health in Canada

BCGSC: British Columbia Genome Sciences Centre - SARS Page [sequence data]

CMAJ: Canadian Medical Association Journal on SARS

New England Journal of Medicine: SARS articles

2003/03/12: WHO: WHO issues a global alert about cases of atypical pneumonia

SLU:CSEI: Centre for the Study of Emerging Infections on SARS

2003/03/15: CDC: Severe Acute Respiratory Syndrome - CDC Issues Health Alert About Atypical Pneumonia 

MedLinePlus: Atypical pneumonia

(website) CNA: SARS Special 

NewScientist: SARS

Guardian(UK) on SARS

CUNY: Government Views of SARS

UVic: SARS Bioinformatics Suite

SARS Bioinformatics Suite

Province of Manitoba Health Department on SARS

Toronto Health Department on SARS

University of Leicester: Coronaviruses & SARS

Softberry: Annotated SARS genome sequence

The Big Picture Book of Viruses: Coronaviridae

Algonomics: List of SARS epitopes

Nature web focus: SARS

SARS Reference

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Smallpox

Smallpox: Clinical and Epidemiologic Features D. A. Henderson, Journal of Emerging Infectious Diseases, Vol. 5, No. 4 (July-Aug. 1999)

Smallpox: An Attack Scenario Tara O'Toole, Journal of Emerging Infectious Diseases, Vol. 5, No. 4 (July-Aug. 1999)

Smallpox as a Biological Weapon: Medical & Public Health Management
[JAMA 281(22),1999]

Smallpox: An Attack Scenario by Tara O'Toole Emerging Infectious Diseases. Jul-Aug 1999; (5)4 Scenario conducted at the First National Symposium on the Medical and Public Health Response to Bioterrorism, convened by the Center for Civilian Biodefense Studies in Crystal City, Virginia on February 16-17, 1999.

Smallpox: Clinical and Epidemiological Features by Donald A. Henderson Emerging Infectious Diseases. Jul-Aug,1999; 5(4) Outlines, for clinicians who have never come in contact with a case of smallpox, the characteristics of the disease.

Smallpox as a Biological Weapon: Medical & Public Health Management by Donald A. Henderson, Thomas V. Inglesby, John G. Bartlett, Michael S. Ascher, Edward Eitzen, Peter B. Jahrling, Jerome Hauer, Marcelle Layton, Joseph McDade, Michael T. Osterholm, Tara O'Toole, Gerald Parker, Trish M. Perl, Philip K. Russell, Kevin Tonat for the Working Group on Civilian Biodefense JAMA. June 9, 1999; 281(22) Consensus recommendations from the Working Group on Civilian Biodefense outline protocols for dealing with a deliberate release of smallpox.

Smallpox FAQ's 3 page .pdf file requires Adobe Acrobat.

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Tuberculosis

Tuberculosis (TB) TB is a contagious disease. Like the common cold, it spreads through the air. Only people who are sick with pulmonary TB are infectious. When infectious people cough, sneeze, talk or spit, they propel TB germs, known as bacilli, into the air. A person needs only to inhale a small number of these to be infected. Left untreated, each person with active TB will infect on average between 10 and 15 people every year. But people infected with TB will not necessarily get sick with the disease. The immune system 'walls off' the TB bacilli which, protected by a thick waxy coat, can lie dormant for years. When someone's immune system is weakened, the chances of getting sick are greater.

Tularemia

Tularemia Fact Sheet 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 as a Biological Weapon: Medical & Public Health Management [JAMA 285(21),2001]

Francisella tularensis is considered a potential bioterrorism agent. An aerosol release would be the most likely method and would result in a large number of pneumonia cases several weeks after exposure.

Why is there concern about tularemia as a bioweapon? Tularemia, in aerosol form, is considered a possible bioterrorist agent. Persons who inhale an infectious aerosol would likely experience severe respiratory illness. Any suspected cases of tularemia inhalation should be immediately reported to local and state health departments.

Tick-Borne Diseases, Tularemia Although numerous animals and insects can carry F tularensis, rabbits and ticks (especially Dermacentor and Amblyomma species) most commonly are implicated in human cases. The deer fly is another classic, although less common, vector.

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