Skip to comments.Biological weapons: Preparing for the worst
Posted on 09/22/2001 8:20:51 AM PDT by Nita Nupress
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Not for commercial use. Solely to be used for the educational purposes of research and open discussion.
Inhalational anthrax: Threat, clinical presentation, and treatment
Journal of the American Academy of Nurse Practitioners
Vol. 13, Issue 4, p. 164
To provide nurse practitioners (NPs) with a basic understanding of clinical presentation, transmission, diagnosis, pharmacological treatment, and post-exposure prophylaxis of inhalational anthrax.
Selected research and clinical articles and government guidelines.
Inhalational anthrax has an incubation period of 1 to 6 days and is very difficult to diagnose early. The chest radiograph consistently reveals a widened mediastinum and pleural effusion without infiltrates. Mortality for inhalational anthrax is high, despite aggressive treatment after onset of symptoms. Delays in diagnosis contribute to the high mortality rate.
IMPLICATIONS FOR PRACTICE
The potential use of aerosolized anthrax as a biological warfare weapon has renewed interest in inhalational anthrax. Primary care providers are cornerstones in the defense against biological weapons because they may be the first to recognize and report suspicious cases.
Anthrax; bacillus anthracis; biological warfare; woolsorter's disease.
SCOPE OF THE PROBLEM
An infectious disease of antiquity, anthrax has caused outbreaks and numerous fatalities in humans and animals as far back as 1500 BC (Cieslak, & Eitzen, 1999; Pile, Malone, Eitzen, & Friedlander, 1998). Anthrax is caused by Bacillus anthracis (B. anthracis), a large gram-positive spore-forming rod. In spore form, B. anthracis can survive for decades in the environment (Cieslak, & Eitzen, 1999; Penn, & Klotz, 1997).
The potential use of aerosolized anthrax as a biological weapon has renewed interest in this infectious disease. Aerosolized anthrax is lethal in an unprotected population and remains stable and virulent during storage, making it a manageable weapon (Zilinskas, 1999). The United States (U. S.) developed anthrax in the 1950s and 1960s as an offensive biological weapon before terminating its program in 1972 (Franz et al, 1997). Iraq admitted to conducting research on anthrax as a biological weapon during the Persian Gulf war (Franz et al., 1997). In response to this threat, U.S. troops have received the anthrax vaccine; however, the military's vaccination program remains controversial due to questions regarding the safety and efficacy of the vaccine (Shafazand, Doyle, Ruoss, Weinacker, & Raffin, 1999).
An epidemic of anthrax in Sverdlovsk, part of the former Soviet Union, occurred in 1979. Autopsies performed on 42 of the 66 patients who died documented inhalational anthrax. The possible source of the exposure was an accidental release of anthrax from a nearby military facility (Ibrahim, Brown, Wright, & Rotschafer, 1999; Pile et al, 1998; Penn, & Klotz, 1997).
Several bioterrorist threats in the U. S. alleging exposure to anthrax occurred in 1998. Decontamination and prophylaxis therapy was initiated until the threats were proven to be hoaxes (Centers for Disease Control and Prevention [CDC], 1999). As a result of these threats, the CDC developed recommendations for post-exposure prophylaxis and biological warfare response guidelines.
It is important for primary care nurse practitioners (NPs) and physicians to become familiar with anthrax ("Reporting of cluster," 2000). Primary care providers are cornerstones in the defense against biological weapons because they may be the first to recognize and report potential cases (Cieslak, & Eitzen, 1999). In the event of a covert or hidden release of anthrax, health care providers will be the front-line responders in the U. S. (Dixon, Meselson, Guillemin, & Hanna, 1999; "Reporting of cluster," 2000).
This article reviews the pathophysiology, clinical presentation, diagnosis, and treatment of inhalation anthrax and discusses vaccination and post-exposure prophylaxis. The purpose is to provide NPs with a basic understanding of inhalational anthrax, the deadliest form of the disease.
Anthrax most commonly occurs in nature in animals such as cattle, goats, and sheep (Pile et al, 1998). Humans become infected after close contact with infected animals or animal products. In humans, an infection with anthrax can take three forms: cutaneous, gastrointestinal, and inhalational.
Cutaneous anthrax is the most frequently occurring form of anthrax in humans, but it is rare in the U. S. A cut or abrasion of the skin is the usual site of entry for anthrax spores. A painless, pruritic papule will appear in 3 to 5 days. Cutaneous anthrax is recognized by the typical black eschar on the affected areas and is easily treated with antibiotics (Cieslak, & Eitzen, 1999; Dixon et al, 1999).
Gastrointestinal anthrax is usually caused by consuming contaminated meat. Although this form has not been reported in the U. S., it can be fatal (Dixon et al, 1999). Death occurs from blood loss, intestinal perforation, and shock.
Inhalational anthrax is also known as woolsorter disease (Pile et al, 1998). Wool handlers inhale the B. anthracis spores during early processing of animal hides and become deathly ill (Franz et al., 1997). Robert Koch discovered anthrax in 1876, demonstrating for the first time the origin of a specific bacterial disease (Pile et al, 1998). John Bell recognized B. anthracis as the cause of woolsorter disease and established disinfection procedures that became the standard for the British woolen industry. In 1880, William Greenfield developed an anthrax immunization for livestock; subsequently, Louis Pasteur developed a live vaccine for anthrax. In 1881, Pasteur tested the heat-cured vaccine on sheep.
As a result of animal immunization, anthrax has been virtually eliminated as an occupational hazard of textile workers and meat packers in the U. S. (Cieslak, & Eitzen, 1999). However, anthrax remains a problem in Asia, Africa, South America, and southern Europe where animal vaccination programs are sporadic (Pile et al, 1998). The last fatal case of inhalational anthrax in the U. S.occurred in 1976 (Penn & Klotz, 1997).
Inhalational anthrax begins after spores, less than 5 microns in size, enter the body and reach the alveolar spaces (Dixon et al, 1999). The spores are transported by pulmonary macrophages, an antiphagocytic capsule is produced, and germination occurs within the macrophage (Cieslak, & Eitzen, 1999; Dixon et al, 1999; Friedlander, 1999). Macrophages transport the spores to the mediastinal and tracheobronchial lymph nodes where the bacilli cause a hemorrhagic lymphadenitis by growing in regional lymph nodes.
The bacillus produces at least three proteins, known as edema factors (EF), lethal factor (LF), and protective antigen (PA), that interfere with host defenses (Cieslak, & Eitzen, 1999; Friedlander, 1999; Ibrahim et al, 1999). The proteins form toxins called edema toxin and lethal toxin. Edema toxin is formed from EF and PA and produces excessive fluid accumulation. Lethal toxin is formed from a combination of LF and PA and releases cytokines such as interleukin -1 and tumor necrosis factor (Cieslak, & Eitzen, 1999; Dixon et al, 1999; Ibrahim, et al, 1999; Shafazand et al, 1999).
Edema toxin and lethal toxin interfere with host defenses, causing necrosis of lymphatic tissue and the release of high numbers of bacilli into the blood and lymph, which in turn leads to toxemia, septicemia, and in some cases meningitis (Cieslak, & Eitzen, 1999; Dixon et al, 1999). The hemorrhagic lymphadenitis of the mediastinal and tracheobronchial lymph nodes causes a hemorrhagic mediastinitis, which is pathognomonic for inhalational anthrax (Shafazand et al, 1999). Hemorrhagic mediastinitis results in pulmonary lymphatic blockage and pulmonary edema (Dixon et al, 1999). The overwhelming pulmonary edema and septicemia cause death in approximately 1 to 7 days after exposure.
Inhalational anthrax has a reported incubation period of one to six days and is very difficult to diagnose early (Cieslak, & Eitzen, 1999). After incubation, inhalational anthrax is biphasic in nature (Shafazand et al, 1999). The first phase, lasting an average of four days, is a non-- specific flu-like syndrome presenting with low-grade fever, non-- productive cough, myalgia, headache, malaise, and possibly mild chest pain (Cieslak, & Eitzen, 1999; Dixon et al, 1999; Franz et al., 1997; Shafazand et al, 1999). This initial phase, or prodrome, may be followed by a period of one to three days of symptomatic improvement.
The second phase presents with an abrupt onset of acute respiratory distress. Fever, severe dyspnea, cyanosis, and shock mark the rapid deterioration (Cieslak, & Eitzen, 1999; Penn & Klotz, 1997). The enlarged mediastinal lymph nodes may partially compress the trachea and cause stridor (Shafazand et al, 1999). Auscultation of lung sounds may be remarkable for crackles and signs of pleural effusion. Diaphoresis is often present, resulting in hypotension and chills ("U.S.Army," 1996). A decreased level of consciousness and possible coma may be symptoms of meningitis, which occurs when an overwhelming bacterial load is present (Shafazand et al, 1999; Penn & Klotz, 1997; "U.S.Army," 1996). After onset of respiratory distress, shock followed by death occurs within 24 to 36 hours (Franz et al., 1997; "U.S.Army," 1996).
The chest radiograph consistently reveals a widened mediastinum and pleural effusion without infiltrates, which is a hallmark of inhalational anthrax (a typical chest radiograph can be viewed on-line at http://phil.cdc.gov/public/1118.htm). This widened mediastinum is a result of mediastinitis and pleural effusion and may be present as early as the second day following exposure (Dixon, et al, 1999; Cieslak, & Eitzen, 1999; Franz et al., 1997; Ibrahim, et al, 1999; Penn & Klotz, 1997; Pile et al, 1998; Shafazand et al, 1999; "U.S.Army", 1996).
Blood cultures and a Gram stain should be obtained. Grampositive bacilli can be detected during the illness in blood smears; spores are not found in blood samples. Bacillus anthracis cultured from blood confirms the diagnosis (Cieslak, & Eitzen, 1999; "U.S.Army", 1996). A nasal swab, or environmental sample, containing gram-positive B. anthracis supports a diagnosis of anthrax due to intentional release as in war or terrorist activity (Cieslak, & Eitzen, 1999). Detecting circulating antibodies against the toxins with the enzyme-linked immunosorbent assay (ELISA) can help to confirm the diagnosis (Franz et al., 1997; Ibrahim, et al, 1999).
A confirmed or suspected case of anthrax must be reported to the CDC and local health and law enforcement authorities immediately (CDC, 1999). "Although inhalation anthrax in man is usually fatal, prompt recognition of disease may improve outcome and allow for immunization/prophylaxis for other individuals who may have been exposed" (Penn, & Klotz, 1997, p. 29). Immediate reporting may also deter further terrorist activity.
Management Mortality for inhalational anthrax is high, despite aggressive treatment after onset of symptoms. Delays in diagnosis contribute to the high mortality rate. The Sverdlovsk outbreak reported 11 survivors of inhalation anthrax, suggesting that aggressive management and early diagnosis may optimize survival (Shafazand et al, 1999). Support in an intensive care unit is necessary due to severe respiratory distress in the second phase. Standard universal precautions are adequate since human-to-human transmission of anthrax has not been reported (Cieslak, & Eitzen, 1999; CDC, 2000).
Pharmacological therapy. Penicillin G has historically been the drug of choice for treating inhalational anthrax (Cieslak, & Eitzen, 1999; Franz et al., 1997; "U.S. Army", 1996). The recommended dose is 2 million units of penicillin G intravenously (IV) every 2 hours. Penicillin is still recommended in cases where the susceptibility of the organism is known. Adding streptomycin 30 mg/kg intramuscularly (IM) every day has demonstrated a synergistic effect in animal studies (Franz et al., 1997; Ibrahim, et al, 1999).
The possibility of an antibiotic-resistant strain of B.anthracis has prompted experts to recommend ciprofloxacin as the drug of choice until drug sensitivity reports confirm the sensitivity of the organism to penicillin (Cieslak, & Eitzen, 1999; Ibrahim, et al, 1999). Ciprofloxacin was recently approved to reduce the incidence and progression of inhalational anthrax following exposure to aerosolized B.anthracis (Food and Drug Administration [FDA], 2000). Ciprofloxacin also provides the convenience of twice-daily dosing. It is recommended to initiate treatment at the earliest signs of disease with ciprofloxacin 400 mg, IV every 12 hours (Cieslak, & Eitzen, 1999; Franz et al., 1997). An alternative regimen starts with a 200mg dose of doxycycline IV, followed by 100 mg IV every 12 hours (Franz, et al., 1997; Dixon et al, 1999; "U.S.Army", 1996). A 30-day or longer course of antibiotics may help to maintain long-term protection (Ibrahim, et al, 1999). The FDA (2000) recommends ciprofloxacin be administered for a total of 60 days. Cieslak and Eitzen note that these recommendations are based on animal studies and in vitro data: "...no human clinical experience with these regimens exists" (p. 4, 1999).
In children, penicillin G 100,000-150,000 U/kg/day in divided doses every 4-6 hours is preferred (Dixon et al, 1999). The FDA has approved the use of ciprofloxacin in pediatric patients for inhalational anthrax. The recommended pediatric dose of ciprofloxacin for post-exposure inhalational anthrax is 15mg/kg orally twice a day or 10mg/kg IV twice a day (FDA, 2000). Penicillin may also be the drug of choice during pregnancy, although the life-threatening nature of a biologically altered strain of B. anthracis may warrant the use of ciprofloxacin, despite adverse indication, until drug sensitivity is confirmed (Shafazand et al, 1999; "U.S. Army," 1996).
Corticosteroid therapy should be started in cases of meningitis, massive edema, and toxemia. Possible choices include dexamethasone, prednisone, and hydrocortisone (Dixon et al, 1999; Ibrahim, et al, 1999).
Post-exposure prophylaxis. Individuals exposed to anthrax who do not display symptoms will not require support with intensive care or IV antibiotic regimens (Ibrahim, et al, 1999). Post-exposure prophylaxis should be started at the earliest opportunity with ciprofloxacin 500 mg orally every 12 hours or doxycycline 100 mg orally every 12 hours (Cieslak, & Eitzen, 1999; Ibrahim, et al, 1999; FDA, 2000). In the event of an anthrax threat, drug therapy can be delayed 24-48 hours until evidence of release is verified (Cieslak, & Eitzen, 1999). Post-exposure chemoprophylaxis should continue for 4 to 6 weeks until anthrax vaccination provides antibodies or exposure can be excluded (Dixon et al, 1999; CDC, 1999). According to recent recommendations (FDA, 2000), ciprofloxacin prophylaxis should be administered for a total of 60 days.
Fluoroquinolones are not usually recommended for children or during pregnancy due to the risk of arthropathy (Shafazand et al, 1999). However, the CDC (1999) recommends weighing the adverse effects of ciprofloxacin against the potential life-threatening effects of inhalational anthrax. The FDA (2000) has approved the use of ciprofloxacin for prophylaxis in children who have been exposed as a result of an intentional release of inhalational anthrax. The prophylactic pediatric dose of ciprofloxacin is 15 mg/kg orally twice a day or 10 mg/kg twice a day IV (FDA, 2000). The CDC recommends ciprofloxacin in children and pregnant women until sensitivity to penicillin is known. Amoxicillin 40 mg/kg/day orally in divided doses every 8 hours is the recommended prophylactic dose in children once susceptibily to penicillin is determined (CDC, 1999).
Vaccination. Vaccination after a biological incident is recommended, in conjunction with post-exposure chemoprophylaxis (CDC, 1999). The anthrax vaccine can be obtained from the CDC and should be administered in a series of three doses. The first 0.5ml subcutaneous injection should be given as soon as possible after confirmed exposure and repeated at 2 weeks and 4 weeks (CDC, 1999; Ibrahim, et al, 1999). This vaccine has not been evaluated for efficacy and safety in the elderly or children. The anthrax vaccines developed for animals should not be administered to humans (CDC, 2000). Patients should be closely monitored for early symptoms of anthrax during prophylaxis and after antibiotic therapy is discontinued. In animal studies, relapse after antibiotics are discontinued occurred in unvaccinated subjects (Penn, & Klotz, 1997).
Decontamination. Decontamination of people potentially exposed to a biological release of anthrax may be appropriate (CDC, 1999; Cieslak, & Eitzen, 1999). Clothing and personal effects should be removed and sealed in plastic bags; a shower with soap and water is necessary to complete decontamination procedures (CDC, 1999; Cieslak, & Eitzen, 1999). Environmental surfaces can be cleaned with a hypochlorite solution of one part bleach to 10 parts water after an investigation of the release has been completed.
Active immunization by vaccination is the key to prevention of inhalational anthrax in high-risk populations (Friedlander, 1997; Ibrahim, et al, 1999). The FDA approved an anthrax vaccine in 1970 for human use in the U. S. The vaccine has been referred to as MDPH-PA or Michigan Department of Public Health Protective Antigen (Pile et al, 1998; Ibrahim, et al, 1999).
The vaccine should be stored at 2 to 8 degrees Celsius. The schedule for vaccination is 0.5 ml subcutaneously at 0, 2, and 4 weeks, followed by boosters of the same dose given at 6, 12 and 18 months. An annual booster is recommended in the event of continued exposure (Friedlander, 1997). High-risk populations, such as workers who could be exposed to animal products from countries that lack adequate anthrax control or individuals working with anthrax in a laboratory setting, should be vaccinated. United States military at risk for exposure to biological weapons in the Persian Gulf region received the vaccine (Friedlander, 1997).
Reported side effects of the vaccine are local reactions and rare systemic reactions. Local reactions occur in about 30% of vaccine recipients and include edema, warmth, erythema, pruritis, and tenderness with a small painless nodule at the injection site (Ibrahim, et al, 1999; Pile et al, 1998). The most severe local reaction noted is edema from the injection site to the elbow or forearm (Friedlander, 1997). Local reactions have been noted after the first injection which increase with subsequent injections and subside by the 6th and 7th injections, suggesting an allergic reaction (Ibrahim, et al, 1999). Systemic reactions are reported in less than 0.2% of vaccine recipients. Symptoms include mild myalgia, malaise, and headache, which may last from 1 to 2 days (Friedlander, 1997).
New vaccines are being researched and developed that would provide a less frequent dosing schedule. A cost-effective vaccine available for public protection may be developed in the near future (Ibrahim, et al, 1999).
The potential use of anthrax as a biological weapon has renewed interest in the clinical presentation and treatment of this infectious disease. Recognizing the clinical presentation, diagnosing, reporting, and treating casualties of biological warfare are developing responsibilities for the NP It is important for NPs to stay informed of developing technology aimed at prevention and protection against anthrax, and the potential of terrorist activity in metropolitan areas, port cities, military installations, and rural communities. Knowledge of local emergency and disaster plans is important for prompt and efficient response to an intentional or unintentional release of B. anthracis. Methods for procurement of antibiotics and vaccines in case of mass casualties must be part of the disaster plan. Disease reporting protocols for suspected and diagnosed infectious disease should be readily available. Despite the best efforts of NPs and other health care providers, the consequences of an intentional release of anthrax could result in a public health disaster. The knowledgeable and immediate response of NPs in the event of an intentional release of aerosolized anthrax will control public panic and minimize morbidity and mortality.
Centers for Disease Control and Prevention (CDC). (1999). Bioterrorism alleging use of anthrax and interim guidelines for management-United States, 1998. MMWR Morbidity and Mortality Weekly Report, 48(4), 69-74.
Centers for Disease Control and Prevention. (2000). Anthrax - General informaton. Division of Bacterial and Mycotic Diseases, April 5. Retrieved October 10, 2000 from World Wide Web: http://www.cdc.gov/incidod/dbmd/diseaseinfo/anthrax-g.htm
Cieslak, T. J., & Eitzen, E. M. (1999). Clinical and epidemiologic principles of anthrax. Emerging Infectious Diseases, 5(4). Retrieved March 24, 2000 from World Wide Web: http://www.cdc.gov/ncidod/EID/vol5no4/cieslak.htm
Dixon, T. C., Meselson, M., Guillemin, J., & Hanna, R C. (1999). Anthrax. The New England Journal of Medicine, 341(11), 815-826.
Food and Drug Administration (2000, August 31). Approval of Cipro for use after exposure to inhalational anthrax. FDA Talk Paper. Rockville, MD: Author. Retrieved September 5, 2000 from the World Wide Web: http://www.fda.gov/bbs/topics/ANSWERS/ANS01030.html
Franz, D. R., Jahrling, R B., Friedlander, A. M., McClain D. J., Hoover, D. L., Bryne, W. R., Pavin, J. A., Christopher, G. W., & Eitzen, E. M. (1997). Clinical recognition and management of patients exposed to biological warfare agents. Journal of the American Medical Association, 278(5), 399-411.
Friedlander, A. M. (1997). Anthrax. In F. R. Sidell, E. T. Takafuji & D. R. Franz (Eds.), Medical aspect of chemical and biological warfare (467-478). Washington, DC; TMM publications. Retrieved May 7, 2000 from the World Wide Web: http://www.nbc-med.org
Friedlander, A. M. (1999). Clinical aspects, diagnosis and treatment of anthrax. Journal of Applied Microbiology, 87, 303.
Ibrahim, K. H., Brown, G., Wright, D. H., & Rotschafer, J. C. (1999). Bacillus anthracis: Medical issues of biologic warfare. Pharmacotherapy, 19(6), 690-701.
Penn, C. C., & Klotz, S. A. (1997). Anthrax pneumonia. Seminars in Respiratory Infections, 12(1), 28-30.
Pile, J. C., Malone, J. D., Eitzen, E. M., & Friedlander, A. M. (1998). Anthrax as a potential biological warfare agent. Archives of Internal Medicine, 158, 429434.
Reporting of cluster of cases with possible public health significance including those that suggest a possible chemical bioterrorist incident (2000). Maine Epi-Gram, March 2000, 2-3.
Shafazand, S., Doyle, R., Ruoss, S., Weinacker, A., & Raffin, T. A. (1999). Inhalational anthrax: Epidemiology, diagnosis and management. Chest, 116 (5), 1369-1376.
U. S. Army Medical Research Institute of Infectious Diseases. (1996). Medical management of biological casualties handbook, August 1996 (Second edition). Frederick, MD: Author. Retrieved April 27, 1998 from the World Wide Web: http://www.nbc-med.org/FMs/medman/index.htm
Zilinskas, R. A. (1999). Iraq's biological warfare program: The past as future? In J. Lederberg (Ed.), Biological weapons (137-158). Cambridge, MA: MIT.
I'd still stay away from any night games for a while. Especially cool windless ones.
Maybe we should start an on going symptom thread for early detection...(kidding-sort of)
Has anyone ever heard of it?
Unless it was a rerun, an hour ago CNN said that the FBI (FAA?) is prohibiting cropdusters from flying again tomorrow. The newsperson said at least two times it was an "update," so I'm assuming that wasn't old news. They said that so far it's only for tomorrow. What kind of sense is that? Either there's a problem or there's not!
This next one is probably the best article so far. The target audience is emergency room physicians and it was published in a peer-reviewed journal in Feb, 2000. The author, G. Moran, has appeared before Congress, if I'm remembering correctly. (I'll double-check and come back to correct that if I'm wrong.)
It's a done deal that the crop dusters were grounded because of football.
To be honest I think the threat may start to diminish but I'll be on the lookout. I'm downwind from Ft. Dietrick.
If they are going to do a laydown it will probably be chemical (high probability/low risk) and it will need to be a wide spread (non-communicable) and it will need to be airborn.
I think we're over the hump. But I could be wrong.
You can go to www.agaviation.org. Sorry I don't know how to link. Latest is until 12:05 Monday. Go there and click on message.
When I see replies like yours, my first inclination is to stop posting this kind of information and let everyone "fend for themselves," so to speak. After all, as nunya bidness states, the relative chances of a bioterrorist attack happening to any one given person is remote. Even if the terrorists succeeded in committing such an atrocious act, the chances it would "happen to me" are probably low, especially if I don't live in New York or DC. My intent is not to scare anyone or cause anyone to lose even one minute of sleep over this and it bothers me if someone does.
The reason I posted the articles is because of my philosophy about this kind of stuff: Knowledge is a good thing and allows one to have at least a small measure of control over his fate (although God has the ultimate control). This "sense of control" over your environment can go a long way in relieving the anxiety that comes from watching FoxNews & MSNBC all weekend tell us about new arrests, cropdusting manuals and hidden boxcutter knives.
Basic knowledge allows one to make basic preparations, and basic preparations in turn tend to put one more at ease. Somehow, the idea of a respiratory biological agent turned loose on the public is not quite so frightening if you know you can reach in your closet for your gas mask. The Israelis have lived this way for years. I think we'd better start getting used to the changes brought about by the collapse of the WTC towers and start making some small adjustments to our lives to adapt to these changes.
It stands to reason that once someone acquires knowledge about bioterrorism, he has the option of taking positive, proactive steps to prepare for contingencies. And that's the tricky part: If he doesn't, he may experience even more anxiety. And of course, the part that's out of my control here is what the reader does once he's read the information and acquired the knowledge. ;-)
Many people (perhaps most) would rather not even know about these types of things because it just causes too much anxiety. I can respect that approach to life and don't want to intrude on anyone's method of coping. But what these people don't realize is that this allows the terrorists to "win" without even doing anything. With something as serious as bioterrorism, the words "out of sight" are probably not equivalent to "out of mind." The suppressed anxiety is still there, it just manifests itself in some other way!
With all that in mind, I've decided to post some information so people won't be so anxious about this...
Maybe this will help: For gas masks (don't forget replacement filters)
cheaperthandirt.com 1-800-421-8047 (they're sold out, but this is the only company I can vouch for. Call for update.)
More here: http://www.google.com/search?hl=en&q=%22gas+mask%22+order++&btnG=Google+Search
For antibiotics, you can:
-Get them from an aware, friendly doctor (highly recommended but sometimes hard to find unless you know one who trusts you. They can't just go around dispensing antibiotics to everyone because there's the potential for abuse.)
-Order them online from an overseas pharmacy (you may get ripped off unless you ask around for references first. I don't have any.)
-Take a trip across the border to Mexico (no prescription required; they're cheap & made by the same US manufacturers)
-Go to your local pet supply shop and get the fish antibiotics (I'm not recommending this--proceed with extreme caution!)
Remember, the odds are that you won't even need any of this stuff. ;-)
So true...I just loaned my friend my copy of Nuclear War Survival Skills yesterday as he was interested in building a shelter for his family. I printed out the book for Y2K and three-ring bound it with dividers. Lots of good info there.
I remember wondering at the time if it was some sort of abortive bioterror attack. Now I'm really wondering.
I am not an epidemiologist by any means, but it seems rather a strange disease to suddenly appear on the East Coast- several times, IIRC. Is there any repository online of weird disease outbreak data nationwide over say, the last 10 years that we might have a gander at?
I would have thought you would know that.
This type of warfare is so easy and inexpensive to do. Even a regular vehicle can easily be converted into a chemical/biological generator, but I won't give specifics.
About the gas mask issue. For OUR family that's pretty hopeless. EVEN cheaper than dirt makes it financially impossible with 9 in the family. I'm SURE there are others in the same boat. Maybe this is wrong thinking, but shouldn't the govt be doing something along those lines of protecting us little people?
I believe there is two strains of another deadly biological that needs to be included on the list.....HRC2004 and HRC2008
It's "for your information."
But what is IIRC?
IIRC = "if I recall correctly"
They are flying again... Unless of course, someone changes there mind tomorrow :) You can go to the FOX site to read the whole thing, if you'd like.
VIA FOX NEWS CHANNEL 12:05 a.m. local time. 9/25/01
Shortly after midnight Monday, the duty officer at the FAA in Washington confirmed the ban was being lifted, first with the Eastern Time Zone.
"At five minutes after, the ban is being lifted in each time zone," said the officer, who did not give his name.
Will hotlink to this muy doomer thread.
Too bad this unimaginable nightmare has become a reality watch :_(
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