Jonathan B. Tucker, PhD
Monterey Institute of International Studies

The threat of biological and chemical warfare continues to frighten many Americans. Some people have even taken matters into their own hands by purchasing antibiotics and/or gas masks.

How grave is the risk? Will any of these measures really protect us? To find out, Bottom Line/Health spoke with chemical and biological weapons expert Jonathan B. Tucker, PhD.

What are the health risks of a bioterrorist attack? As everyone knows, a number of cases of anthrax exposure and infection have already occurred.

Inhalation anthrax occurs if enough spores of the bacterium Bacillus anthracis are inhaled. It’s not contagious. Flulike symptoms typically start within one to seven days of exposure. Inhalation anthrax should be treated before symptoms begin with an antibiotic, such as ciprofloxacin (Cipro), penicillin, tetracycline or doxycycline. Once symptoms develop, the condition is fatal in more than 80% of cases.

Skin (cutaneous) anthrax infection results when the bacterium enters cuts or abrasions in the skin. Although fatal in up to 20% of cases if left untreated, cutaneous anthrax generally responds well to antibiotics.

The other agents most likely to be used cause three illnesses.

The first is botulism. This disease is a type of poisoning caused by a toxin produced by the bacterium Clostridium botulinum. About 50% of victims die unless treated with an antitoxin.

The second is pneumonic plague. Caused by the bacterium Yersinia pestis, the disease causes flulike symptoms and is highly contagious. It’s deadly in more than 50% of cases unless victims are treated with antibiotics, such as streptomycin, tetracycline or gentamicin.

The third is smallpox. Caused by the variola virus, this disease, which was eradicated worldwide in 1979, is marked by fever and a rash that first looks like chicken pox and later turns into pus-filled lesions. It’s highly contagious if one comes in close proximity to someone with symptoms, which develop about two weeks after exposure to the virus. About 30% of patients die unless they are vaccinated within three to five days after exposure. No drug treatment is available.

Is the US government prepared to cope with these types of attacks? There are adequate stocks of antibiotics to treat anthrax and plague and antitoxin to treat botulism.

The Centers for Disease Control and Prevention (CDC) is procuring more smallpox vaccine to supplement the 15.4 million doses that are currently available. Fifty-four million additional doses should be available by next year. In addition, government officials have said they are negotiating to buy 300 million doses of the vaccine -- enough for every American.

Still, large gaps exist in the public and private health systems, which are the first line of defense against a bioterrorist attack. Doctors and nurses must be trained how to recognize symptoms and how to treat them. City, county and state health departments need more staff and resources. Diagnostic laboratories also need to be outfitted with the technology to identify infections like anthrax in time to treat them.

What can individuals do to protect themselves? If you develop an unusual illness or skin rash, notify your physician and local health department at once.

It’s also a good idea to ask your doctor to take continuing education classes about the symptoms and treatment of anthrax, smallpox and other infections.

To educate physicians, The Journal of the American Medical Association (JAMA) recently began publishing a series of review articles on bioterrorism agents. For more information, go to the JAMA Web site at http://jama.ama-assn.org.

Law-enforcement agencies have urged Americans to be alert. What exactly does this mean? It is important for individuals to report any suspicious behavior to the authorities. This means calling 911 if you see someone leaving a package unattended or spraying something in a subway, a crowded shopping mall or near the air-intake system of a building.

The antibiotic Cipro is FDA-approved for use as an anthrax antidote. Should I ask my doctor for a prescription just in case? Individuals should not stockpile antibiotics. Self-administering these drugs in the absence of anthrax exposure can cause harmful side effects.

The overuse of antibiotics increases the resistance of pathogenic bacteria to these life-saving drugs, making them less effective when they are really needed.

If a person understands the importance of not taking an antibiotic, such as Cipro, unnecessarily, what’s wrong with getting the drug? If thousands of people stock up on Cipro, they could deplete the national supply that would be needed in an actual emergency.

In the event an outbreak of anthrax occurs, the federal government will distribute Cipro to the affected population within 12 hours. That’s what happened in the recent cases involving anthrax exposure.

Will a gas mask protect me in case of an attack? Probably not. A poison gas, such as sarin, or a biological agent, such as the bacterium that causes anthrax, is usually odorless and colorless -- and it’s unlikely that you would have warning that it had been released. That means to really protect yourself you’d have to wear the mask all the time, which is impractical.

What about vaccines for anthrax and/or smallpox? These vaccines are currently in very limited supply and are only available to military personnel, who are at far greater risk than civilians. What’s more, there is concern over possible complications of these vaccines.

Back in the 1960s, the smallpox vaccine caused serious complications, such as brain damage and even death, in roughly one of every million people vaccinated.

It would make sense to begin vaccinating the US population as a preventive only if the threat of a terrorist attack with smallpox were so high that it outweighed the risk of complications from the vaccine. Currently, that is not the case. But government officials are increasing supplies of the vaccine in case the situation changes. If a smallpox outbreak ever occurs, the federal government will provide smallpox vaccine to individuals exposed to the disease or at immediate risk.

Fortunately, the smallpox vaccine works extremely fast, producing full immunity within 10 days. It is even effective at preventing the disease or rendering it less severe when administered up to three to five days after infection.

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Jonathan B. Tucker, PhD, director of the Chemical & Biological Weapons Nonproliferation Program at the Monterey Institute of International Studies in Washington, DC. He is the author of Scourge: The Once and Future Threat of Smallpox (Atlantic Monthly Press) and Toxic Terror: Assessing Terrorist Use of Chemical and Biological Weapons (MIT Press).