Signs and Symptoms: Sudden onset of illness with generalized malaise, spiking fevers, rigors, severe headache, photophobia, and myalgias. Nausea, vomiting, cough, sore throat, and diarrhea may follow. Full recovery takes 1-2 weeks.

Venezuelan equine encephalitis (VEE) virus is an arthropod-borne alphavirus that is endemic in northern South America, Trinidad, Central America, Mexico, and Florida. Eight serologically distinct viruses belonging to the VEE complex have been associated with human disease; the two most important of these pathogens are designated subtype I, variants A/B, and C. These agents also cause severe disease in horses, mules, burros and donkeys (Equidae). Natural infections are acquired by the bites of a wide variety of mosquitoes. Equidae serve as amplifying hosts and source of mosquito infection. In natural human epidemics, severe and often fatal encephalitis in Equidae always precedes disease in humans. The virus is rather easily killed by heat and disinfectants.

VEE was weaponized by the United States in the 1950's and 1960's before the U.S. offensive biowarfare program was terminated, and other countries have been or are suspected to have weaponized this agent. This virus could theoretically be produced in either a wet or dried form and potentially stabilized for weaponization. This agent could then theoretically be delivered against friendly forces in a manner similar to the other agents already discussed.

VEE is characterized by inflammation of the meninges of the brain and of the brain itself, thus accounting for the predominance of CNS symptoms in the small percentage of infections that develop encephalitis. The disease is usually acute, prostrating and of short duration. The case fatality rate is less than 1 percent, although is somewhat higher in the very young or aged. Nearly 100 percent of those infected suffer an overt illness. Recovery from an infection results in excellent short-term and long-term immunity.

After an incubation period varying from 1 to 5 days, onset is usually sudden. It is manifested by generalized malaise, spiking fever, rigors, severe headache, photophobia, and myalgias in the legs and lumbosacral area. Nausea, vomiting, cough, sore throat, and diarrhea may follow. This acute phase lasts 24-72 hours. A prolonged period of asthenia and lethargy may follow, with full health and activity regained after 1-2 weeks. Approximately 4 percent of children during natural epidemics develop signs of central nervous system infection, with meningismus, convulsions, coma, and paralysis. Adults rarely develop neurologic complications. In children manifesting severe encephalitis, the fatality rate may reach 20 percent. Permanent neurologic sequelae are reported in survivors. Experimental aerosol challenges in animals suggest that the incidence of CNS disease and associated morbidity and mortality would be high after a BW attack, as the VEE virus would infect the olfactory nerve and spread directly to the CNS. A VEE infection during pregnancy may cause encephalitis in the fetus, placental damage, abortion, or severe congenital neuroanatomical anomalies.

Standard Precautions are recommended for healthcare workers. Person-to-person transmission may theoretically occur by means of respiratory droplet infection. There is no specific therapy. Patients with uncomplicated VEE infection may be treated with analgesics to relieve headache and myalgia. Patients who develop encephalitis may require anticonvulsants and intensive supportive care to maintain fluid and electrolyte balance, ensure adequate ventilation, and avoid complicating secondary bacterial infections. Patients should be treated in a screened room or in quarters treated with a residual insecticide for at least 5 days after onset, or until afebrile, as human cases may be infectious for mosquitoes for at least 72 hours. The virus can be destroyed by heat and disinfectants.

PROPHYLAXIS

Vaccine: An investigational vaccine, designated TC-83, is a live, attenuated cell-culture-propagated vaccine which has been used in several thousand persons to prevent laboratory infections. The vaccine is given as a single 0.5 ml subcutaneous dose. Febrile reactions occur in up to 18 percent of persons vaccinated, and may be moderate to severe in 5 percent, with fever, myalgias, headache, and prostration. Approximately 18 percent of vaccinees fail to develop detectable neutralizing antibodies, but it is unknown whether they are susceptible to clinical infection if challenged. Contraindications for use include an intercurrent viral infection or pregnancy. TC-83 is a licensed vaccine for Equidae.

Nuclear	Biological	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 Tear Gases Arsines Psychotomimetic Agents Toxins Potential CW Agents