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Consensus Statement
May 8, 2002

Hemorrhagic Fever Viruses as Biological Weapons: Medical and Public Health Management

Author Affiliations

Author Affiliations: Johns Hopkins Center for Civilian Biodefense Strategies (Drs Borio, Inglesby, O'Toole, Henderson, and Kwik) and Departments of Microbiology and Neuroscience (Dr K. M. Johnson), Johns Hopkins Schools of Medicine and Public Health, and Division of Infectious Diseases, Johns Hopkins School of Medicine (Drs Bartlett and Perl), Baltimore, Md; Critical Care Medicine Department, Clinical Center (Dr Borio), Fogarty International Center (Dr Breman), and Vaccine Research Center (Dr Nabel), National Institutes of Health, Bethesda, Md; Center for Biodefense, University of Texas Medical Branch, Galveston (Dr Peters); US Army Medical Research Institute of Infectious Diseases, Frederick, Md (Drs Schmaljohn, Jahrling, and Eitzen); National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga (Drs Hughes and Ksiazek); Departments of Biology and Medicine, University of New Mexico, Albuquerque (Dr R. T. Johnson); Office of the Commissioner, US Food and Drug Administration (Dr Meyerhoff), and Office of Emergency Preparedness, Department of Health and Human Services (Dr Tonat), Rockville, Md; Office of Public Health Preparedness, Department of Health and Human Services (Drs Ascher, Lillibridge, and Russell and Mr Hauer), and Nuclear Threat Initiative (Dr Hamburg), Washington, DC; Bureau of Communicable Diseases, New York City Health Department, New York, NY (Dr Layton); and Center for Infectious Disease Research and Policy, University of Minnesota, Minneapolis (Dr Osterholm).

JAMA. 2002;287(18):2391-2405. doi:10.1001/jama.287.18.2391

Objective To develop consensus-based recommendations for measures to be taken by medical and public health professionals if hemorrhagic fever viruses (HFVs) are used as biological weapons against a civilian population.

Participants The Working Group on Civilian Biodefense included 26 representatives from academic medical centers, public health, military services, governmental agencies, and other emergency management institutions.

Evidence MEDLINE was searched from January 1966 to January 2002. Retrieved references, relevant material published prior to 1966, and additional sources identified by participants were reviewed.

Consensus Process Three formal drafts of the statement that synthesized information obtained in the evidence-gathering process were reviewed by the working group. Each draft incorporated comments and judgments of the members. All members approved the final draft.

Conclusions Weapons disseminating a number of HFVs could cause an outbreak of an undifferentiated febrile illness 2 to 21 days later, associated with clinical manifestations that could include rash, hemorrhagic diathesis, and shock. The mode of transmission and clinical course would vary depending on the specific pathogen. Diagnosis may be delayed given clinicians' unfamiliarity with these diseases, heterogeneous clinical presentation within an infected cohort, and lack of widely available diagnostic tests. Initiation of ribavirin therapy in the early phases of illness may be useful in treatment of some of these viruses, although extensive experience is lacking. There are no licensed vaccines to treat the diseases caused by HFVs.

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