APPENDIX I

APPENDIX I: BW Agents: Vaccines, Therapeutics and Prophylactics

DISEASE	VACCINE	CHEMOTHERAPY (Rx)	CHEMOPROPHYLAXIS (Px)	COMMENTS
Anthrax	Bioport vaccine (licensed) 0.5 mL SC @ 0, 2, 4 wk, 6, 12, 18 mo then annual boosters	Ciprofloxacin 400 mg IV q 8-12 h	Ciprofloxacin 500 mg PO bid x 4 wk If unvaccinated, begin initial doses of vaccine	Potential alternates for Rx: gentamicin, erythromycin, and chloramphenicol
		Doxycycline 200 mg IV, then 100 mg IV q 8-12 h	Doxycycline 100 mg PO bid x 4 wk plus vaccination	-
		Penicillin 2 million units IV q 2 h	-	PCN for sensitive organisms only

Cholera	Wyeth-Ayerst Vaccine 2 doses 0.5 mL IM or SC @ 0, 7-30 days, then boosters Q 6 months	Oral rehydration therapy during period of high fluid loss	-	Vaccine not recommended for routine protection in endemic areas (50% efficacy, short term)
		Tetracycline 500 mg q 6 h x 3 d		Alternates for Rx: erythromycin,
		Doxycycline 300 mg once, or 100 mg q 12 h x 3 d		trimethoprim and sulfamethoxazole, and furazolidone
		Ciprofloxacin 500 mg q 12 h x 3 d		Quinolones for tetra/doxy resistant strains
		Norfloxacin 400 mg q 12 h x 3 d

Q Fever	IND 610 - inactivated whole cell vaccine given as single 0.5 ml s.c. injection	Tetracycline 500 mg PO q 6 h x 5-7 d	Tetracycline start 8-12 d post-exposure x 5 d	Currently testing vaccine to determine the necessity of skin testing prior to use.
-	-	Doxycycline 100 mg PO q 12 h x 5-7 d	Doxycycline start 8-12 d post-exposure x 5 d

Glanders	No vaccine available	Sulfadiazine 100 mg/kg in divided doses x 3 weeks may be effective TMP-SMX may be effective	Post-exposure prophylaxis may be tried with TMP-SMX	No large therapeutic human trials have been conducted owing to the rarity of naturally occurring disease.

DISEASE	VACCINE	CHEMOTHERAPY (Rx)	CHEMOPROPHYLAXIS (Px)		COMMENTS
Plague	Greer inactivated vaccine (FDA licensed): 1.0 mL IM; 0.2 mL IM 1-3 mo later; 0.2 mL 5-6 mo after dose 2; 0.2 mL boosters @ 6,12, 18 mo after dose 3 then q 1-2 years	Streptomycin 30 mg/kg/d IM in 2 divided doses x 10 d (or gentamicin)	Doxycycline 100 mg PO bid x 7 d or duration of exposure Ciprofloxacin 500 mg PO bid x 7 d		Plague vaccine not protective against aerosol challenge in animal studies
		Doxy 200 mg IV then 100 mg IV bid x 10-14 d	Doxycycline 100 mg PO bid x 7 d Tetracycline 500 mg PO qid x 7 d		Alternate Rx: trimethoprim-sulfamethoxazole
		Chloramphenicol 1 gm IV qid x 10-14 d			Chloramphenicol for plague meningitis


Tularemia	IND - Live attenuated vaccine: one dose by scarification	Streptomycin 30 mg/kg IM divided BID x 10-14 d		Doxycyline 100 mg PO bid x 14 d
		Gentamicin 3-5 mg/kg/d IV x 10-14 d		Tetracycline 500 mg PO QID x 14 d

Brucellosis	No human vaccine available	Doxycycline 200 mg/d PO plus rifampin 600-900 mg/d PO x 6 wk		Doxycycline and rifampin x 3 wk	Trimethoprim-sulfamethoxazole may be substituted for rifampin; however, relapse may reach 30%
		Ofloxacin 400/rifampin 600 mg/d PO x 6 wks

Viral encephalitides	VEE DOD TC-83 live attenuated vaccine (IND): 0.5 mL SC x1 dose	Supportive therapy: analgesics and anticonvulsants prn		NA	TC-83 reactogenic in 20% No seroconversion in 20% Only effective against subtypes 1A, 1B, and 1C
	VEE DOD C-84 (formalin inactivated TC-83) (IND): 0.5 mL SC for up to 3 doses				C-84 vaccine used for non-responders to TC-83
	EEE inactivated (IND): 0.5 mL SC at 0 & 28 d				EEE and WEE inactivated vaccines are poorly
	WEE inactivated (IND): 0.5 mL SC at 0, 7, and 28 d				Immunogenic. Multiple immunizations are required

DISEASE	VACCINE	CHEMOTHERAPY (Rx)	CHEMOPROPHYLAXIS (Px)	COMMENTS
Viral Hemorrhagic Fevers	AHF Candid #1 vaccine (x-protection for BHF) (IND)	Ribavirin (CCHF/arenaviruses) 30 mg/kg IV initial dose 15 mg/kg IV q 6 h x 4 d 7.5 mg/kg IV q 8 h x 6 d	NA	Aggresive supportive care and management of hypotension very important
	RVF inactivated vaccine (IND)	Passive antibody for AHF, BHF, Lassa fever, and CCHF

Smallpox	Wyeth calf lymph vaccinia vaccine (licensed): 1 dose by scarification	Cidofovir (effective in vitro)	Vaccinia immune globulin 0.6 mL/kg IM (within 3 d of exposure, best within 24 h)	Pre and post exposure vaccination recommended if > 3 years since last vaccine

Botulism	DOD pentavalent toxoid for serotypes A - E (IND): 0.5 ml deep SC @ 0, 2 & 12 wk, then yearly boosters	DOD heptavalent equine despeciated antitoxin for serotypes A-G (IND): 1 vial (10 mL) IV		Skin test for hypersensitivity before equine antitoxin administration
		CDC trivalent equine antitoxin for serotypes A, B, E (licensed)

Staphylococcus Enterotoxin B	No vaccine available	Ventilatory support for inhalation exposure

Ricin	No vaccine available	Inhalation: supportive therapy G-I : gastric lavage, superactivated charcoal, cathartics

T-2 Mycotoxins	No vaccine available		Decontamination of clothing and skin

Nuclear

Biological

Chemical

Chemical

North Anna Power Station

Surry Power Station

UVA Nuclear Reactor Facility
Decommissioned in 1998

FEMA Fact Sheet:
Nuclear Power Plant Emergency

Introduction

Medical Management

History of Biological Warfare and Current Threat

Medical Aspects of the Biological Threat

Bacterial Agents
Anthrax
   Brucellosis
   Cholera
   Glanders
   Plague
   Tularemia
   Q Fever

Viruses
    Smallpox
    Venezuelan Equine Encephalitis
    Viral Hemorrhagic Fevers

Biological Toxins
Botulinum
   Staphylococcal Enterotoxin B
   Ricin
   T-2 Mycotoxins

Personal Protection

Decontamination

Appendix A:
Glossary of Medical Terms

Appendix B:
Patient and Precaution Levels

Appendix C:
Comparative Lethality: Toxins/Chemicals

Appendix D:
Aerosol Toxicity: Toxins

Appendix E:
Differential Diagnosis: Toxins/Nerve Agent

Appendix F:
Specimens for Lab Diagnosis

Appendix G:
BW Agents: Lab Identification

Appendix H:
BW Agents: Characteristics

Appendix I:
BW Agents: Vaccines, Therapeutics and Prophylactics

Appendix J:
Medical Sample Collection for Biological Threat Agents

Introduction

Nerve Agents

Mustard Agents

Hydrogen Cyanide

Psychotomimetic Agents

Potential CW Agents