JHU PH 2002-19 (JAMA: hemorrhagic fever as bioweapon)

[Dennis O'Shea]

JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH
Office of Communications and Public Affairs
615 N. Wolfe Street, W1600
Baltimore, MD 21205-2179
Media Contact: Tim Parsons 410-955-6878
paffairs@jhsph.edu
May 6, 2002

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EMBARGOED FOR RELEASE ON TUESDAY, MAY 7, AT 4 P.M. EDT 
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HEMORRHAGIC FEVER VIRUSES EXAMINED AS POTENTIAL BIOWEAPONS

Ebola, Marburg, Lassa, and other viruses that cause deadly hemorrhagic 
fever illnesses could be used as biological weapons, according to a report 
from the Working Group on Civilian Biodefense, a panel of 26 experts 
convened by the Center for Civilian Biodefense Strategies at the Johns 
Hopkins Bloomberg School of Public Health. The group's consensus statement, 
which appears in the May 8, 2002, issue of the Journal of the American 
Medical Association (JAMA), is based on an analysis of published research 
and offers public health and medical guidelines for managing a potential 
attack.

Like smallpox and anthrax, the Centers for Disease Control and Prevention 
(CDC) considers hemorrhagic fever viruses "category A" biological weapons 
agents, because they have the potential to cause widespread illness and 
death, and would require special public health preparedness measures to 
contain an outbreak. The Working Group's report focuses on eight viruses: 
Ebola, Marburg, Lassa fever, New World Arenavirus, Rift Valley Fever, 
yellow fever, Ornsk hemorrhagic fever, and Kyasanur Forest Disease. Ebola 
and Marburg, which belong to the Filoviridae family of viruses, can be 
spread from person to person and are among the most deadly hemorrhagic 
fever illnesses. Ebola kills 50 to 90 percent of those infected, while 
Marburg is fatal 23 to 70 percent of the time.

"An outbreak of Ebola and Marburg would have a significant impact on our 
society, because they carry significant morbidity and mortality, and other 
than supportive medical care, there are no specific treatments," explains 
lead author Luciana Borio, MD, fellow at the Johns Hopkins Center for 
Civilian Biodefense Strategies and the Critical Care Medicine Department of 
the National Institutes of Health. "It is not possible to predict whether 
any of the hemorrhagic fever viruses are likely to be used as a bioweapon. 
However, we know that it is not impossible to weaponize these viruses and 
we, in medicine and public health, are obliged to prepare."

  If an attack were to occur in the United States, the report notes that 
diagnosing hemorrhagic fever viruses may be difficult, since most 
clinicians are unfamiliar with these diseases. Most hemorrhagic fever 
illnesses begin with a fever and rash, which is similar to other more 
common illnesses. In addition, there are no widely available diagnostic 
tests. Currently, the CDC in Atlanta, Georgia, and USAMRIID in Frederick, 
Maryland, house the only facilities in the U.S. equipped to diagnose 
hemorrhagic fever viruses.

According to the Working Group, few effective therapies or vaccines are 
available to deal with hemorrhagic fever viruses. The antiviral drug 
ribavirin is recommended only for the treatment of the Arenaviridae and the 
Bunyaviridae families of viruses. For the Filoviridae (Ebola, Marburg) and 
the Flaviviridae, the researchers recommend providing supportive care to 
treat the symptoms of infected patients. There is a vaccine to prevent 
yellow fever, but it is not widely available and it would not be useful to 
provide protection after exposure.

  The Working Group says strict infection controls must be used to prevent 
the spread of hemorrhagic fever viruses during an outbreak, many of which 
can be spread from person-to-person contact, and less commonly, via the 
airborne route. The report recommends clinicians wear special protective 
gear and that patients be isolated.

"The Working Group's consensus recommends improvements to our diagnostic 
capacity and the development of a rapid test for diagnosing hemorrhagic 
fever viruses. Research efforts should also focus on new antiviral 
medications, vaccines, and a more fundamental scientific study of the 
viruses that cause hemorrhagic fever illness," adds Dr. Borio.

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"Hemorrhagic Fever Viruses as Biological Weapons, Medical and Public Health 
Management" was written by Luciana Borio, MD; Thomas V. Inglesby, MD; C.J. 
Peters, MD; Alan L. Schmaljohn, PhD; James M. Hughes, MD; Peter B. 
Jahrling, PhD; Thomas Ksiazek, DVM, PhD; Karl M. Johnson, MD; Andrea 
Meyerhoff, MD; Tara O'Toole, MD, MPH; Michael S. Ascher, MD; John Bartlett, 
MD; Joel G. Breman, MD, DTPH; Edward M. Eitzen, Jr., MD, MPH; Margaret 
Hamburg, MD; Jerry Hauer, MPH; D.A. Henderson, MD, MPH; Richard T. Johnson, 
MD, Gigi Kwik, PhD; Marci Layton, MD; Scott Lillibridge, MD; Gary J. Nabel, 
MD, PhD; Michael T. Osterholm, PhD, MPH; Trish M. Perl, MD, MSc; Philip 
Russell, MD; and Kevin Tonat, DrPH, MPH and appears in the May 8 edition of 
JAMA.

  The participant's institution or agency provided funding for the study.

News releases from the Johns Hopkins Bloomberg School of Public Health may 
be found at <http://www.jhsph.edu>. Information on the Johns Hopkins Center 
for Civilian Biodefense Studies may be found at 
<http://www.hopkins-biodefense.org>.

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