injuries poisoning
Biological Agents as Weapons
Recognition of Biological Weapon Injuries
It can be difficult to distinguish use of a biological-warfare (BW) agent from a natural outbreak of disease. Clues to the deliberate rather than a natural origin of a disease outbreak include the following: Cases of diseases not usually seen in the geographic area Unusual distribution of cases among segments of the population Significantly different attack rates between those inside and those outside buildings Separate outbreaks in geographically noncontiguous areas Multiple simultaneous or serial outbreaks of different diseases in the same population Unusual routes of exposure (eg, inhalation) Zoonotic disease occurring in humans rather than in animals Zoonotic disease occurring first in humans and then in its typical vector Zoonotic disease arising in an area with a low prevalence of the typical vector for the disease Unusual severity of disease Unusual strains of infectious agents Failure to respond to standard therapy Epidemiologic investigation of cases and cooperation with law-enforcement resources are crucial, as is risk communication to the general public. The clinical presentation, diagnosis, and treatment of patients with disease caused by high-risk BW agents are discussed elsewhere in THE MANUAL: Anthrax , Isolation (of patients) and quarantine (of contacts) may be necessary. The most communicable deliberately disseminated diseases are smallpox (for which airborne precautions are necessary) and pneumonic plague (necessitating droplet precautions). 