Handling public concerns regarding bioterrorism

Public concern and fears of a bioterrorist attack may remain heightened in the coming days.

The likelihood of a large-scale bioterrorist event is currently thought to be low, given the technical sophistication required to develop and effectively disperse most biological weapons. Current media reports of widespread prescribing of antibiotics and purchasing of gas masks for respiratory protection highlight the need for public education to put the risk of bioterrorism in perspective.

The Health Unit strongly recommends against prescribing prophylactic antibiotics and/or purchasing gas masks in the absence of any surveillance or laboratory evidence of a bioterrorist event in Ontario.

If an attack were detected, the Health Unit would rapidly notify the medical community with detailed recommendations on diagnosis, treatment, and preventive measures for the specific biologic agent involved, via FAX and our Website. At the provincial level, appropriate ministries and agencies are coordinating the development and implementation of response planning for chemical, biological, radiological and nuclear counterterrorism. The Centre for Emergency Preparedness holds the national stockpile System which contains the following medication that could be used in response to a biological or chemical terrorist event:

i)Atropine 0.6 mg vial

ii)Diazepam 10 mg. Vial

iii)Ciprofloxacin 500 mg (oral)

iv)Tetracycline 250 mg (oral)

v)Amoxicillin 500 mg (oral)

Use of prophylactic antibiotics is not without risk: Inappropriate use of antibiotics will lead to increased antibiotic resistance among microorganisms causing common bacterial infections (e.g., otitis media, pneumonia) and may result in serious adverse effects (e.g., Clostridium difficile colitis, allergic reactions, interactions with other medications).

The Health Unit also strongly recommends that physicians not prescribe antibiotics for their patients to stockpile for future use: stockpiling of antibiotics could lead to inappropriate patient decisions to self-medicate, incomplete courses of antibiotics that might select for resistant organisms, the eventual use of expired medications, and to the depletion of national supplies for medically indicated uses.

Purchasing of gas masks for protection against biologic agents is likewise discouraged. Gas masks would only be protective if worn at the exact moment a bioterrorist attack occurred, and it is impractical to wear masks continuously as a protective measure against the possibility of a covert release of a biologic agent. Moreover, masks need to be fitted properly; improper use of gas masks can cause serious injury and death, especially among persons with underlying heart or lung disease.