生物毒劑炭疽桿菌,WHO提供圖片InternationalTraumaandDisasterInstitute生物毒劑細菌病毒生物體毒素InternationalTraumaandDisasterInstitute生物恐怖主義使用微生物制劑或生物毒素使人、動物、或植物羅患疾病或導致死亡。InternationalTraumaandDisasterInstitute炭疽熱 (細菌)瘟疫 (細菌)兔熱病（hareklipdas)(細菌)天花 (病毒)出血熱 (病毒)肉毒中毒Botulinum (生化毒素)恐怖主義危害最易超成的疾病:

(ClassA-CDC)InternationalTraumaandDisasterInstitute可疑生物學攻擊的跡象在特定地區的非同尋常的疾病模式

懸浮微粒（煙、霧等）形式或經口吸入傳播攻擊速度快高致病率InternationalTraumaandDisasterInstitute生物毒劑的優勢:癥狀隱密、難以捉摸且可與地方性疾病相似。使用生物試劑很難迅速檢定。(缺乏廣譜的檢定劑,潛伏期長,臨床癥狀出現晚)InternationalTraumaandDisasterInstitute生物毒素的優勢:Biologicalagentssparepropertyandphysicalsurroundings.攻擊者可使用抗生素或疫苗來自我保護。InternationalTraumaandDisasterInstitute生物武器的優勢:

人群間的傳播性

炭疽熱–無

肉毒桿菌中毒–無野兔病-無瘟疫–有(高)天花–有(高)VHF–有(中等)InternationalTraumaandDisasterInstitute傳播途徑吸入經口經皮膚和黏膜經皮的(注射)InternationalTraumaandDisasterInstitute傳播途徑:

吸入浮質點源傳播(固定的散播形式)線源傳播(移動的散播形式)InternationalTraumaandDisasterInstitute經口傳播直接:污染食物或水源間接:懸浮微粒（煙、霧）攻擊后的二次污染InternationalTraumaandDisasterInstitute經皮膚感染黏膜磨損*完整的皮膚能有效預防對大多數但不是全部生物毒劑的入侵！InternationalTraumaandDisasterInstituteInfantofMediaWorker,NEJM,11/29/01InternationalTraumaandDisasterInstitute生物攻擊的對策InternationalTraumaandDisasterInstitute物理防護是最重要的生物毒劑預防措施!LevelB個人防護措施(PPE)InternationalTraumaandDisasterInstitute預防限制某些生物制劑的作用抗生素疫苗InternationalTraumaandDisasterInstitute疫苗:炭疽熱:有瘟疫:無兔熱病:(IND)天花:有VHF:無肉毒桿菌中毒:(IND)InternationalTraumaandDisasterInstitute特定細菌毒劑的對策InternationalTraumaandDisasterInstitute炭疽熱

(炭疽桿菌)潛伏期:1-6天(平均)皮膚炭疽熱表現為典型的黑痂,公共衛生影像圖書館提供,CDCInternationalTraumaandDisasterInstitute攜帶炭疽熱孢子的煙霧攻擊可引起吸入性炭疽熱(吸入性炭疽熱是自然發病的一種罕見形式)InternationalTraumaandDisasterInstitute臨床癥狀:發熱/不適感/疲乏/咳嗽漸進性胸痛(2-3天)發病后24-72小時死亡(未經救治)InternationalTraumaandDisasterInstitute臨床特征吸入性炭疽熱傷員的胸片常顯示異常增寬的縱隔,常伴有胸腔積液,但肺部浸潤少見。InternationalTraumaandDisasterInstitute縱隔增寬,吸入性炭疽熱的特征,患者病死前22小時(公共衛生影像圖書館提供,

CDC).InternationalTraumaandDisasterInstitute炭疽熱:預防先鋒霉素(口服)強力霉素(口服)持續抗生素應用45到60天可行的情況下在感染后0,2,4周注射疫苗InternationalTraumaandDisasterInstitute瘟疫

(鼠疫耶爾森菌)潛伏期:2-3天InternationalTraumaandDisasterInstitute瘟疫的臨床分型:在自然條件下，瘟疫通過跳蚤叮咬而傳播3型腹股溝腺炎原發性敗血癥肺炎

InternationalTraumaandDisasterInstitute臨床表現:

(肺炎型瘟疫)高熱/寒戰/頭痛/肌痛血性痰漸進性呼吸衰竭InternationalTraumaandDisasterInstitute瘟疫的預防

強力霉素(口服)目前無可用疫苗InternationalTraumaandDisasterInstitute兔熱病一般形式下由于鹿虻、蚊子或扁虱的叮咬而感染三種主要臨床類型:潰瘍淋巴結型傷寒型肺炎型(最常見于煙霧毒劑生物攻擊后)InternationalTraumaandDisasterInstitute兔熱病的預防以下途徑之一:先鋒霉素(口服)強力霉素疫苗(研究性新藥)-Pre-ExposureInternationalTraumaandDisasterInstituteResponseto

ViralAgentsInternationalTraumaandDisasterInstituteSmallPox

(Variola)Incubationperiod:7-19daysInternationalTraumaandDisasterInstituteFieldObservation…EarlystagesofSmallpoxcanbemistakenforVaricella(ChickenPox,Monkeypox,orCowpox).InternationalTraumaandDisasterInstituteInternationalTraumaandDisasterInstituteSmallpoxDiagnosis:Fullydevelopedcutaneouseruptionsofsmallpox,mostabundantontheextremitiesandface(centrifugaldistribution)AlllesionssamestageofdevelopmentInternationalTraumaandDisasterInstituteAdvancedsmallpox,courtesyofWHOInternationalTraumaandDisasterInstituteProphylaxis:SmallpoxVaccination/Revaccinationforallexposedindividualswithin3-5daysInternationalTraumaandDisasterInstituteQuarantineDropletandairborneprecautionsIsolationmustbemaintainedforaminimumof17daysfollowingexposureforallcontactsRingvaccinationofclosecontactsInternationalTraumaandDisasterInstituteViralHemorrhagicFevers

(VHF)Adiversegroupofillnessesassociatedwithfeverandableedingdiathesis.InternationalTraumaandDisasterInstituteVHFcausedby4viralfamilies:Filoviridae:e.g.,EbolaandMarburgviruses*Arenaviridae:e.g.,Lassavirus,newworldArenavirusesBunyaviradae:e.g.,Hantaviruses,CCHFFlaviviridae:e.g.,YellowFever*MostimportantVHFfamilywhenconsideringpotentialusebyterroristsInternationalTraumaandDisasterInstituteDiagnosisTravelhistoryHighindexofsuspicionSpecificvirologicdiagnosisInternationalTraumaandDisasterInstituteResponseto

BiologicalToxinsInternationalTraumaandDisasterInstituteBotulinumToxinInternationalTraumaandDisasterInstituteNaturalfood-borneoutbreakstendtooccurinsmallclusters.Highernumbersofcasesshouldraisethepossibilityofabiologicalattack.AerosolizedbotulinumtoxinIntentionalcontaminationofawidelydistributedfoodordrinkitemInternationalTraumaandDisasterInstituteFieldObservation…

BotulinumIntoxicationAfebrileProgressivesymmetrical descendingflaccidparalysisbeginning withbulbar(cranialnerve)palsiesInternationalTraumaandDisasterInstituteClinicalEffects:Symptomsusuallybeginwithcranialnervepalsies:

Ptosis(droopinguppereyelids)Diplopia(doublevision)Dysphagia(difficultyswallowing)Dysphonia(difficultyspeaking)InternationalTraumaandDisasterInstituteProphylaxis:BotulinumToxinVaccine(InvestigationalNewDrug)InternationalTraumaandDisas