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Last Updated

02 Nov 2002

Source: Dow Jones Newswires, May 7, 2002.

Medical Journal Sets Guidelines On Bioterrorist Attacks

CHICAGO (AP) -- A bioterrorist attack using Ebola or other so-called bleeding viruses could be especially insidious because the early symptoms seem so ordinary and there is no vaccine or approved drug treatment, experts say in new guidelines for doctors.

The guidelines, published in this week's Journal of the American Medical Association, aim to help doctors recognize biological warfare agents that most have only read about in medical books but that seem more menacing after last fall's anthrax-by-mail attacks.

The recommendations deal with hemorrhagic fever viruses, whose most severe symptom is bleeding, under the skin or from body orifices.

The guidelines note that these viruses already have been turned into weapons by the former Soviet Union and the U.S. and could cause widespread illness and death.

Neal Shipley, head of the emergency department at North General Hospital in New York City, said the guidelines are useful for doctors like him who would be on the front line in such an attack, but the advice needs to be accompanied by federal money for training and equipment.

"It's one thing to have the masks and suits sitting in someone's office. It's another thing to have personnel on every shift, 24-7, who know how to use them," Shipley said. As for the possibility of a bioterrorist attack, "we're really crossing our fingers that it doesn't happen."

The guidelines were created by the Working Group on Civilian Biodefense, which is composed of doctors and public health experts from the military, civilian government agencies and universities.

This is the sixth set of bioterrorism guidelines from the group, which previously published recommendations in JAMA for handling anthrax, smallpox and plague.

"Most of our health professionals are unfamiliar with these viruses and would be hard-pressed to provide a quick diagnosis," said Sen. Bill Frist, R-Tenn., a physician who has pushed for bioterrorism preparedness.

Still, health care workers should know a bioterrorist attack using these viruses would not be hopeless, said Luciana Borio of the Johns Hopkins Center for Civilian Biodefense Strategies, where the working group is based.

"We know that mortality can be diminished with good, meticulous medical care," said Borio, lead author of the guidlines. That would include steps to reduce fever and blood pressure, and the use of ventilators and anti-seizure drugs if needed.

But first doctors need to know what they are dealing with. Victims of Ebola and other hemorrhagic viruses, such as Marburg, Yellow fever and Rift Valley fever, can show early, flu-like symptoms within two to 21 days that can include fevers, facial redness, lethargy and headaches.

The more serious, telltale symptoms such as bleeding may take longer to develop. But there is no routine diagnostic test. Blood samples would have to be sent to one of only two federal laboratories nationwide that can test for the viruses.

Suspected victims would need to be hospitalized and isolated from other patients. Because of the highly contagious body secretions, health care workers would need heavy face masks or shields and goggles, double gloves and impermeable hospital gowns.

Ribavirin, a drug approved by the Food and Drug Administration for another ailment, is useful in only some types of hemorrhagic viruses and it is not widely available, according to the guidelines.