Author Affiliations: The Center for Civilian Biodefense Studies (Drs Inglesby, Henderson, Bartlett, O'Toole, Perl, and Russell), and the Schools of Medicine (Drs Inglesby, Bartlett, and Perl) and Public Health (Drs Henderson, O'Toole, and Russell), Johns Hopkins University, Baltimore, Md; Viral and Rickettsial Diseases, California Department of Health, Berkeley (Dr Ascher); US Army Medical Research Institute of Infectious Diseases, Frederick, Md (Drs Eitzen, Friedlander, and Parker); Office of Emergency Management, New York, NY (Mr Hauer); Centers for Disease Control and Prevention, Atlanta, Ga (Dr McDade); Acute Disease Epidemiology, Minnesota Department of Health, Minneapolis (Dr Osterholm); and the Office of Emergency Preparedness, Department of Health and Human Services, Rockville, Md (Dr Tonat).
Objective To develop consensus-based recommendations for
measures to be taken by medical and public health professionals
following the use of anthrax as a biological weapon against a civilian
Participants The working group included 21 representatives from
staff of major academic medical centers and research, government,
military, public health, and emergency management institutions and
Evidence MEDLINE databases were searched from January 1966 to
April 1998, using the Medical Subject Headings anthrax,
Bacillus anthracis, biological weapon,
biological terrorism, biological warfare, and
biowarfare. Review of references identified by this search led
to identification of relevant references published prior to 1966. In
addition, participants identified other unpublished references and
Consensus Process The first draft of the consensus statement
was a synthesis of information obtained in the formal
evidence-gathering process. Members of the working group provided
formal written comments which were incorporated into the second draft
of the statement. The working group reviewed the second draft on June
12, 1998. No significant disagreements existed and comments were
incorporated into a third draft. The fourth and final statement
incorporates all relevant evidence obtained by the literature search in
conjunction with final consensus recommendations supported by all
working group members.
Conclusions Specific consensus recommendations are made regarding
the diagnosis of anthrax, indications for vaccination, therapy for
those exposed, postexposure prophylaxis, decontamination of the
environment, and additional research needs.
Inglesby TV, Henderson DA, Bartlett JG, et al. Anthrax as a Biological Weapon: Medical and Public Health Management. JAMA. 1999;281(18):1735–1745. doi:10.1001/jama.281.18.1735
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