CDC Alerts Doctors to Diseases Worse Than Anthrax

Thursday’s unprecedented alert from the Centers for Disease Control and Prevention asking doctors to watch out for cases of smallpox, plague and other uncommon diseases marked a milestone in the nation’s fast-changing reaction to biological terror.

Suddenly, suggestions that were once considered the domain of alarmists have become the daily stuff of government.

The CDC said there is no evidence of an attack in the United States involving any disease but anthrax. But the agency said the Sept. 11 terrorist assaults, combined with the appearance of anthrax-causing bacteria at U.S. media outlets and Congress, warranted the notice.

The alert, however, surprised even many public health experts, especially because it raised the prospect of several deadly African viruses, including Ebola and Marburg, appearing in the United States. Several of the diseases on the CDC list could be far more lethal than anthrax, although they also would be far harder for a terrorist to employ.

“I must say, I was floored when I saw Ebola and Marburg,” said Barry Bloom, dean of the Harvard University School of Public Health. “But if you ask what’s the list of organisms that nations have tried to grow and stockpile, they’re out there.”

Dr. Eric Rakow, chief medical officer of New York University Medical Center, said the CDC bioterrorism warning was unprecedented. “We are in a new age,” he said. “We have never seen this before.”

After the Sept. 11 attacks, the CDC recommended a “heightened surveillance” for unusual diseases associated with bioterrorism. But the alert Thursday marked an escalation of concern.

Moreover, the warning was only the latest of several sharp shifts in government policy in the last few days related to bioterrorism.

On Wednesday, Health and Human Services Secretary Tommy G. Thompson said he was negotiating to buy 300 million doses of the smallpox vaccine, enough for every American. The national stockpile now has 15 million doses.

Thompson also has asked Congress for money to boost the amount of antibiotics held in reserve for emergencies. The government now has antibiotics to treat 2 million people for 60 days. Thompson wants enough to cover 12 million people.

And the CDC has begun conducting live satellite and Internet conferences to teach doctors, nurses and others the basics of diagnosing anthrax, a disease that most American doctors have never encountered.

Thursday’s alert came in a weekly CDC newsletter issued to the nation’s physicians and public health authorities.

In addition to anthrax, the CDC told physicians that “agents of highest concern” included plague, botulism, smallpox, tularemia and hemorrhagic fevers, such as Ebola and Marburg. The agency said these were the easiest to use with the greatest potential for public panic and social disruption.

Normally, the agency’s Morbidity and Mortality Weekly Report documents measles outbreaks, food poisoning and other public health developments. But it also serves as a critical early warning system for serious public health emergencies. It was the vehicle, for example, by which federal health authorities first brought AIDS to the attention of physicians across the country.

“There’s no evidence of any threat from agents other than anthrax at this time,” said Dr. Julie Gerberding, acting deputy director of the CDC’s National Center for Infectious Disease. “But it’s a great time to remind people that we do live in an era when other threats can become a reality.”

Many potential biological warfare agents are odorless and colorless, and public health officials have long said that a biological attack might not be detected until patients began appearing at doctors’ offices and emergency rooms. The federal government has sponsored a modest number of programs that teach health care workers the symptoms of illnesses associated with bioterrorism.

The anthrax-causing bacteria that has been used so far respond to antibiotics. While one man in Florida has died of the disease, five other people who have contracted it are expected to recover. Anthrax is not contagious. And by sending it through the mail, the perpetrator of the anthrax attacks has exposed only a relatively small pool of people.

Other biological agents could be far more dangerous, even though some are treatable with antibiotics or other pharmaceuticals.

Smallpox, for example, is highly contagious and fatal in about 30% of cases. A single infected person could spread the disease to many others.

On the other hand, smallpox has been eradicated as a natural phenomenon, and the few laboratory stocks of the disease are thought to be closely guarded. And the spread of smallpox would be hard to control, meaning that the disease could eventually reach whatever group launched an attack.

Diseases such as the plague and tularemia would also be hard to spread through a letter or airborne spray. Anthrax-causing bacteria can be made to form spores, which are hardy and can pass easily through the mail. Plague and tularemia bacteria, by contrast, are fragile and can be destroyed even by the ultraviolet rays in sunlight.

It took years for scientists with the former Soviet biological weapons program to turn plague and tularemia into weapons, said Raymond Zilinskas, a bioweapons expert and senior scientist with California’s Monterey Institute of International Studies.

Some weapons experts have worried about the migration of Soviet stockpiles or scientists to weapons programs in other nations.

Also, the former Soviet program is believed to have experimented with the Ebola virus, several weapons experts said.

The CDC said that it wanted to explain to doctors the symptoms of diseases such as Ebola, which few U.S. doctors have ever seen, and of plague and anthrax, which show symptoms similar to those of common illnesses, like the flu.