Experience in the medical management of potential laboratory exposures to agents of bioterrorism on the basis of risk assessment at the United States Army Medical Research Institute of Infectious Diseases (USAMRIID)

Experience in managing laboratory exposures to potential agents of bioterrorism is limited. The United States Army Medical Research Institute of Infectious Diseases reviewed laboratory exposures involving these agents (1989 to 2002) to assess the effectiveness of medical management. The evaluation o...

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Bibliographic Details
Published inJournal of occupational and environmental medicine Vol. 46; no. 8; p. 801
Main Authors Rusnak, Janice M, Kortepeter, Mark G, Aldis, John, Boudreau, Ellen
Format Journal Article
LanguageEnglish
Published United States 01.08.2004
Subjects
Alphavirus Infections - diagnosis
Alphavirus Infections - therapy
Anthrax - therapy
Antibiotic Prophylaxis
Bacillus anthracis
Bioterrorism
Chikungunya virus
Humans
Laboratory Infection - prevention & control
Laboratory Infection - therapy
Military Medicine
Occupational Exposure
Plague - therapy
Retrospective Studies
Risk Assessment
United States
Vaccines - administration & dosage
Yersinia pestis
United States
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Summary:Experience in managing laboratory exposures to potential agents of bioterrorism is limited. The United States Army Medical Research Institute of Infectious Diseases reviewed laboratory exposures involving these agents (1989 to 2002) to assess the effectiveness of medical management. The evaluation of 234 persons (78% vaccinated) for exposure to 289 infectious agents revealed 5 confirmed infections (glanders, Q fever, vaccinia, chikungunya, and Venezuelan equine encephalitis). Postexposure antibiotic prophylaxis was given for most moderate- or high-risk bacterial exposures (41/46; 89%); most unvaccinated minimal-risk (7/10; 70%), and subsets of vaccinated minimal-risk exposures (18/53; 34%) but generally not negligible-risk exposures (6/38; 16%). Vaccine "breakthroughs" were not unexpected (enzootic Venezuelan equine encephalitis, localized vaccinia) or presented with mild symptoms (Q fever). A multifaceted policy of personal protective measures, vaccination, early assessment, and postexposure antibiotic prophylaxis was effective in minimizing morbidity and mortality in at-risk laboratory workers.
ISSN:1076-2752
DOI:10.1097/01.jom.0000135539.99691.4e