t Rare Diseases t Never Seen or Diagnosed by Today’s Clinicians t Non-traditional Routes of Infection t Emerging Patterns of Resistance t Increased Virulence Bioterrorism: Challenges of Training

The Biological Terrorist Spectrum Likelihood of Occurrence Mass Casualty Devices/Agents Devices/Agents Numbers of Casualties Hoaxes Classical AgentsClassical Agents State SponsorshipState Sponsorship Many AgentsMany Agents Individual/GroupIndividual/Group Non-Mass Casualty Devices/Agents Devices/Agents

Screensaver Intervention: Screensaver Intervention: 16.7% increase in correct responses BaselineIntervention

Web Site Usage Web Site Usage Weeks Oct Feb 2002 t 12,180 Unique Visitors t 580,300 Total Hits t 70 Countries t 883 CME certificates issued

Neisseria meningitidis Bacillus anthracis Public Health Preparation=Bioterrorism Preparation Naturally Occurring Bioterrorism “Dual-Use” “Dual-Use”

First Point of Care: Emergency Medicine Primary Care Providers: Internal Medicine Pediatrics Ob/Gyn Family Practice Hospital Infection Control Initial Diagnostics: Pathology Radiology Consultative Specialties: Infectious Disease Pulmonology and Critical Care Dermatology Nephrology Surgical Subspecialties Other Medical Subspecialties Medical Specialties

Agents of Concern Category A: Smallpox Anthrax Plague Tularemia VHF’s Botox Category B: Q fever Brucellosis Glanders VE, WEE and EEE Ricin toxin Epsilon toxin Staph enterotoxin B Category C: Nipah virus Hantavirus Tick-borne HF’s Tick-borne Encephalitis Yellow fever MDR TB

Link between anthrax, hijackers probed October 9, 2001 Posted: 4:41 PM EDT (2041 GMT) WEST PALM BEACH, Florida (CNN) -- Federal officials said Tuesday their investigation into a deadly anthrax infection in Florida included a closer look at forensic evidence gathered in the weeks since the September 11 terrorist attacks, especially items traced to the suspected hijackers, such as luggage, documents and cars. The bacteria is blamed for the death of photo editor at the supermarket tabloid The Sun. A mailroom employee also tested positive for exposure to anthrax, but is not exhibiting symptoms of the disease. Elsewhere in Florida, officials Tuesday were checking reports of a "white powdery residue" in the mail of two locations in Naples, on the west coast. Reports of possible anthrax virus in Weston and Deerfield Beach, on the east coast, proved unfounded. October 9, 2001, CNN