Deadly anthrax attacks in the United States, explosions in London subways and trains, and Japanese sarin gas attacks have kept the threat of bioterrorism at the forefront of public consciousness for the past decade.
In January, the US Department of Homeland Security announced its new national bioterrorism response plan, stating it "establishes a comprehensive, all-hazards approach to enhance the ability of the United States to manage domestic incidents." Administered by the Federal Emergency Management Agency, the National Response Plan describes a close working relationship between the US Departments of Health and Human Services and Homeland Security that will bring about a unified response to bioterrorism and other public health emergencies while supporting state and local efforts.
Neurologists would most certainly be at the forefront of treating injuries brought on by a bioterrorist attack. But are neurologists and others who will be drawn into disaster management prepared to respond locally and nationally should a large-scale bioterror attack occur?
"I think not," remarked Leon D. Prockup, MD, one of the country's leading experts on the health care arena's bioterrorism preparedness efforts and an international expert in neurotoxicology and occupational and environmental neurology. Dr. Prockup, Professor of Neurology and Director of the Neurotoxicology Program at the University of South Florida in Tampa, believes that America is far from prepared for an almost inevitable bioterror attack. "Physicians aren't geared toward treating victims" of nerve- and brain-damaging agents that would come with a bioterror attack, he said. Dr. Prockup refers to the NBCEs-nuclear, biological, chemical, and explosive agents-as a broader term for describing terrorism involving nuclear, chemical, and biological weapons.
National leaders and policymakers have heightened the public's awareness and fear over the possibility of attacks by terrorists using large-scale chemical or biological agents. But a public health response plan continues to lag, according to Trust for America's Health (TFAH), a national nonprofit organization. The group recently gave the federal government a grade of D+ in public health emergency preparedness in a report funded by the Robert Wood Johnson Foundation.
"Accelerated, immediate action must be taken to bridge the gap in our nation's preparedness, no matter the threat," said Shelley A. Hearne, DrPH, Executive Director of TFAH. "The health community has worked tirelessly since 9/11 to make improvements, but serious vulnerabilities still remain. While there is no way to be 100% prepared, there are still basic achievable levels of preparedness we have yet to meet. Americans deserve-and must demand-better."
Citizens and physicians cannot realistically counteract the effect of a nuclear attack, according to Dr. Prockup. "Nuclear attack is so catastrophic, it's a matter of prayer," he said. Still, Hollis-Eden Pharmaceuticals Inc, a San Diego-based company, has thus far been awarded about $2.5 million from the US Department of Defense and the NIH to continue to develop an experimental antiradiation drug. The steroid 5-androstenediol, to be marketed as Neumune and packaged as a self-administered injectable, has been under experimentation at the Armed Forces Radiobiology Research Institute since 1997. Neumune is said to restore infection-fighting white blood cells and platelets, which would prevent hemorrhage. The drug has been tested on monkeys but has not yet undergone a large study to test whether it can improve survival after a lethal dose of radiation. The company hopes to win FDA approval under a federal rule that allows animal data to be used in lieu of dangerous or unethical human testing.
Treatment for anthrax, polio, plague, botulism, viruses and bacteria, and smallpox will require more sophisticated plans and better vaccines than are currently available, said Dr. Prockup.
The September 2001 anthrax attacks that occurred through use of the postal service resulted in five deaths. Anthrax is an acute infectious disease caused by the spore-forming bacterium Bacillus anthracis. Anthrax is diagnosed through isolation of B anthracis from the blood, skin lesions, or respiratory secretions or by measuring specific antibodies in the blood of people with suspected exposure. Treatment with antibiotics must be initiated early to be effective. "Most physicians have never seen anthrax, so we're not trained in that," said Dr. Prockup. "Most physicians practicing today have not seen polio or smallpox. We're not generally trained in these things either."
According to the CDC, the anthrax vaccine, manufactured and distributed by BioPort Corporation, is reported to be highly effective in protecting against anthrax. The vaccine is a cell-free filtrate vaccine, containing no dead or live bacteria.
The standard immunization against anthrax consists of three subcutaneous injections administered two weeks apart, followed by three additional subcutaneous injections given at six, 12, and 18 months. Annual booster injections of the vaccine are recommended thereafter.
The US Department of Defense has been testing the anthrax vaccine on military personnel since 1998, injecting 1.3 million troops per a mandatory program. The Defense Department program was temporarily halted by a federal ruling in December 2003, brought about by a lawsuit filed by military personnel and civilian contractors who had concerns about side effects. The Defense Department resumed immunizations last spring, but on a voluntary basis.