U.S. Army Medical Research Institute of Infectious

Pathophysiology Division, U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21701-5011... 

Tohoku University, 120,232 U.S. Army Medical Research Institute of Infectious Diseases, 176 U.S. Food and Drug Administration, 29,241 University of Alaska, 29 University of British Columbia, 312 University of California—Berkeley, 107,290 University of Chicago, 204 University of Florida, 279 University of Hawaii, 232 University of Maryland, 78,107333 University of Miami, 166 University of Rhode Island, 21 University of Utah, 256 University of Virginia, 347 University of Zurich, 347 University of the Philippines, 256 Varian Associates, Inc., 66 Wright State University, 87 Yale University, 29... 

Isolation Procedures Once a victim of chemical or biological agents or weapons gets to the hospital or another healthcare facility, that person may have to abide by patient isolation procedures. These include Standard Precautions, Airborne Precautions, Droplet Precautions, and Contact Precautions. These precautions are spelled out in the third edition of Medical Management Of Biological Casualties Handbook published by the U.S. Army Medical Research Institute of Infectious Disease located at Fort Detrick in Frederick, Maryland. 

Drugs There is an antitoxin stored at the CDC. To arrange to use this antitoxin, call your state health department (or CDC at 404-639-2206 or 404-639-3753 workdays, or call weekends or evenings at 404-639-2888). This chemotherapy (antitoxin) available from CDC is a licensed trivalent equine antitoxin for serotypes A, B, and E. There is no reversal of botulism disease with this drug, but the antitoxin does usually prevent further nerve damage. The U.S. Department of Defense (DOD) has a heptavalent equine despeciated antitoxin for serotypes A - G (IND). DOD also has pentavalent toxoid (vaccine) for serotypes A - E (IND). The currently recommended schedule is for use at zero, two, and twelve weeks with a one year booster. This vaccine is supposed to induce solidly protective antitoxin levels in greater that 90 percent of those vaccinated after one year. Contact USAMRIID, (U.S. Army Medical Research Institute of Infectious Diseases), Fort Detrick, Maryland. Tel. 301-619-2833. 

Information about clinical diagnosis and management can be found elsewhere.1-9 Additional information about responding to bioterrorism is available from CDC at http // www.bt.cdc.gov the U.S. Army Medical Research Institute of Infectious Diseases at http // www.usamriid.army.mil/education/bluebook.html the Association for Infection Control Practitioners at http //www.apic.org and the Johns Hopkins Center for Civilian Biodefense at http //www.hopkins-biodefense.org. 

U.S. Army Medical Research Institute of Infectious Diseases... 

Our initial expectations were that we would interview far more FDA officials than we did. However, we ended up interviewing more DoD officials, at all levels of policy and operations. Officials were interviewed in the following DoD offices Anthrax Vaccine Immunization Program (AVIP) J-4 Eogistics Directorate Office of the ASD(HA) JPO-BD the Defense Supply Center in Philadelphia Office of the Assistant to the Secretary of Defense for Nuclear, Chemical, and Biological Defense Programs U.S. Army Soldier Biological and Chemical Command U.S. Army Medical Materiel Development Activity and U.S. Army Medical Research Institute of Infectious Diseases... 

Epidemiological Clues to a Biological Event. With awareness of the baseline data for their practice setting, nurses should be alert for unusual patterns of disease or health-related indicators. Representative examples of unusual patterns of diseases that might suggest a deliberate bioterrorist act are presented in Table 22.1 (U.S. Army Medical Research Institute of Infectious Diseases [USAMRIID], 2005 U.S. Department of Health and Human Services [USDHHS], 2001). 

Aerobiologists at the U.S. Army Medical Research Institute of Infectious Diseases (Fort Detrick, MD) have developed a reproducible, head-only ricin aerosol exposure model for laboratory nonhuman primates (NHP) that yielded acute LCtso values for African green monkeys or rhesus monkeys corresponding to approximately 6-10 or 15 pg/kg, respectively (Wilhelmsen and Pitt, 1996). Exposure of NHP to aerosolized ricin (particle size 1-2 pm) caused a dose-dependent toxicity that is delayed from 8 to 24 h early anorexia and lethargy were frequently observed, followed by gastric distress, hypothermia, hypotension, acute respiratory distress, and death. Rhesus monkeys exposed to the equivalent of approximately 20-40 pg/kg ricin by aerosol died from acute respiratory distress about 36-48 h after exposure necropsy revealed fibrinopurulent pneumonia, acute inflammation of the trachea and airways, and massive pulmonary alveolar flooding (Wilhelmsen and Pitt, 1996). 

More on anthrax, the Ebola virus, and especially the smallpox virus, are presented in firsthand accounts in Richard Preston s The Demon in the Freezer A True Story, published in 2002. Following the format of his previous book The Hot Zone A Terrifying True Story, Preston interviewed many of the principals involved in the CDC and, in particular, in the U.S. Army Medical Research Institute of Infectious Diseases at Fort Dedrick, Maryland. He gives particulars about the highly successful program to eradicate smallpox, and about still-remaining sources of the stored virus. Included is the fact that genetic modification has produced a new strain that is not affected by conventional vaccinations. 

Ground was broken in 1967 for construction of a new, modern laboratory building at Fort Detrick. The building would open in phases during 1971 and 1972. With the disestablishment of the biological warfare laboratories, the name of the U.S. Army Medical Unit, which was to have been housed in the new laboratories, was formally changed to U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) in 1969. The institute s new mission was stated in General Order 137, 10 November 1971 (since superseded) ... 

Fig. 19 3. Members of the Aeromedical Isolation Team (AIT) prepare to transfer a patient from a stretcher isolator into the Biosafety Level 4 (BL-4) isolation suite at the U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland. The interior of the isolator is maintained at a pressure negative to the external environment by a high-efficiency particulate air (HEPA) filtered blower. The isolator can be attached directly to a transfer port, visible on the external wall of the building, to allow movement of the patient into the suite without exposing the environment to the patient. Team members are seen wearing protective suits and positive-pressure, HEPA-filtered Racal hoods (manufactured by Racal Health Safety, Inc, Frederick, Md). Photograph Public Affairs Office, Fort Detrick, Frederick, Md.

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