Author Affiliations: Center for Civilian Biodefense Studies, Johns Hopkins University Schools of Medicine (Drs Inglesby, Bartlett, and Perl) and Public Health (Drs Henderson, O'Toole, Russell, and Schoch-Spana and Mr Koerner), Baltimore, Md; National Center for Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colo (Dr Dennis), and Atlanta, Ga (Dr McDade); Viral and Rickettsial Diseases Laboratory, California Department of Health Services, Berkeley (Dr Ascher); United States Army Medical Research Institute of Infectious Diseases, Frederick, Md (Drs Eitzen, Friedlander, and Parker); Science Application International Corporation, McLean, Va (Mr Hauer); Office of Communicable Disease, New York City Health Department, New York, NY (Drs Fine and Layton); Office of Emergency Preparedness, Department of Health and Human Services, Rockville, Md (Dr Tonat); and Infection Control Advisory Network Inc, Eden Prairie, Minn (Dr Osterholm).
Objective The Working Group on Civilian Biodefense has developed consensus-based
recommendations for measures to be taken by medical and public health professionals
following the use of plague as a biological weapon against a civilian population.
Participants The working group included 25 representatives from major academic medical
centers and research, government, military, public health, and emergency management
institutions and agencies.
Evidence MEDLINE databases were searched from January 1966 to June 1998 for the
Medical Subject Headings plague, Yersinia pestis, biological weapon, biological terrorism, biological warfare, and biowarfare. Review of the bibliographies
of the references identified by this search led to subsequent identification
of relevant references published prior to 1966. In addition, participants
identified other unpublished references and sources. Additional MEDLINE searches
were conducted through January 2000.
Consensus Process The first draft of the consensus statement was a synthesis of information
obtained in the formal evidence-gathering process. The working group was convened
to review drafts of the document in October 1998 and May 1999. The final statement
incorporates all relevant evidence obtained by the literature search in conjunction
with final consensus recommendations supported by all working group members.
Conclusions An aerosolized plague weapon could cause fever, cough, chest pain, and
hemoptysis with signs consistent with severe pneumonia 1 to 6 days after exposure.
Rapid evolution of disease would occur in the 2 to 4 days after symptom onset
and would lead to septic shock with high mortality without early treatment.
Early treatment and prophylaxis with streptomycin or gentamicin or the tetracycline
or fluoroquinolone classes of antimicrobials would be advised.
Inglesby TV, Dennis DT, Henderson DA, Bartlett JG, Ascher MS, Eitzen E, Fine AD, Friedlander AM, Hauer J, Koerner JF, Layton M, McDade J, Osterholm MT, O'Toole T, Parker G, Perl TM, Russell PK, Schoch-Spana M, Tonat K, for the Working Group on Civilian Biodefense . Plague as a Biological WeaponMedical and Public Health Management. JAMA. 2000;283(17):2281-2290. doi:10.1001/jama.283.17.2281