Mass Casualty Education - Bioterrorism
From the “Academy Update” of the American Academy of Nurse Practitioners, Vol.
17 (6), October 17, 2001.
“With the heightened risk of biological terrorism arising in the aftermath of the
events of September 11, 2001, nurse practitioners need to increase their
awareness of the signs and symptoms of potential disease entities that can be
spread in this manner. As early as September 11 th , the Centers for Disease Control
(CDC) sent a directive to all state and local heal th departments asking for the
immediate reporting of outbreaks of any syndromes that seem unusual or out of
the ordinary for that population and time of year. Of prime concern are the six
Category A diseases: Anthrax, Botulism, Plague, Tularemia, Smallpo x and
Hemorrhagic Fever.”
Read: “Recognition of Illness Associated with the Intentional Release of a Biologic Agent” at
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5041a2.htm
Bioterrorism Agents by Category
(Source: http://www.bt.cdc.gov/agent/agentlist -category.asp)
Category A
Definition
The U.S. public health system and primary healthcare providers must be prepared to address
various biological agents, including pathogens that are rarely seen in the United States. Highpriority agents include organisms that pose a risk to national security because they
 can be easily disseminated or transmitted from person to person;
 result in high mortality rates and have the potential for major public health impact;
 might cause public panic and social disruption; and
 require special action for public health preparedness.
Agents/Diseases
 Anthrax (Bacillus anthracis)
 http://www.bt.cdc.gov/agent/anthrax/anthrax-hcp-factsheet.asp
 Botulism (Clostridium botulinum toxin)
 http://www.bt.cdc.gov/agent/botulism/hcpfacts.asp
 Plague (Yersinia pestis)
 http://www.cdc.gov/plague/healthcare/clinicians.html
 Smallpox (variola major)
 http://www.bt.cdc.gov/agent/smallpox/diagnosis/casedefinition.asp
 http://www.bt.cdc.gov/agent/smallpox/diagnosis/
 Tularemia (Francisella tularensis)
 http://www.bt.cdc.gov/agent/tularemia/tularemia-biological-weaponabstract.asp#2
 Viral hemorrhagic fevers (filoviruses [e.g., Ebola, Marburg] and arenaviruses [e.g., Lassa,
Machupo])
 http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/Fact_Sheets/Viral_He
morrhagic_Fevers_Fact_Sheet.pdf
Category B
Definition
Second highest priority agents include those that
 are moderately easy to disseminate;
 result in moderate morbidity rates and low mortality rates; and
 require specific enhancements of CDC's diagnostic capacity and enhanced disease
surveillance.
Agents/Diseases
 Brucellosis (Brucella species)
 Epsilon toxin of Clostridium perfringens
 Food safety threats (e.g., Salmonella species, Escherichia coli O157:H7, Shigella)
 Glanders (Burkholderia mallei)
 Melioidosis (Burkholderia pseudomallei)
 Psittacosis (Chlamydia psittaci)
 Q fever (Coxiella burnetii)
 Ricin toxin from Ricinus communis (castor beans)
 Staphylococcal enterotoxin B
 Typhus fever (Rickettsia prowazekii)
 Viral encephalitis (alphaviruses [e.g., Venezuelan equine encephalitis, eastern equine
encephalitis, western equine encephalitis])
 Water safety threats (e.g., Vibrio cholerae, Cryptosporidium parvum)
Category C
Definition
Third highest priority agents include emerging pathogens that could be engineered for mass
dissemination in the future because of
 availability;
 ease of production and dissemination; and
 potential for high morbidity and mortality rates and major health impact.
Agents
 Emerging infectious diseases such as Nipah virus and hantavirus
See Illinois Department of Public Health Fact Sheet for Emergency Evaluation and Treatment
for treatment of all Category A and selected Category B agents/diseases and radiation
exposure; available at: http://www.idph.state.il.us/Bioterrorism/pdf/BTFullGuidelines.pdf
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