Public Health System (cont.)

Q: What do you think will be the next form of bioterror attack? Smallpox? Cowpox? Botulism?

Waeckerle: The CDC as well as other international authorities have classified six biologic agents as the greatest potential threat for biowarfare. First is smallpox, second is anthrax, third is the plague, fourth is tularemia, fifth is botulism toxin, and lastly are the viral hemorrhagic fevers. There are approximately 35 other infectious agents and nine other toxins which could be used as well. Keep in mind these are naturally occurring bugs and toxins, but in the future technologic developments may allow terrorists to genetically manipulate organisms to suit their needs.

Q: What about the water supply? Is that a viable means of transmission for any of these diseases, such as tularemia?

Waeckerle: This is an often-asked question and should be of concern to our country. Fortunately, with our current techniques for water purification it would be very difficult for terrorists to contaminate our water supplies in this country. The agents they might use are not the agents we have discussed but other agents that have in the past contaminated water supplies, as evidenced by cholera in past history. These should not be major concerns now.

Q: Do you think the media talk about "possible" future threats too much?

Waeckerle: The media have a very important responsibility in the implementation of our national strategy in this country. They need to educate, inform, and communicate with the American public, and they need to do so in cooperation with federal authorities so that we maintain a vigilance and security of knowledge, but we don't cause panic. I think that the media have occasionally overstated some of the concerns and caused a bit more worry in the American public than needed to be in the beginning of these incidents, but I think they are doing an excellent job for the most part now.

Q: Some countries have or are developing antibiotic resistant strains of anthrax. Would you comment on antibiotic combination therapy if Cipro wasn't available, or proved ineffective against a new strain?

Waeckerle: It is speculated that countries are engaging in such research. But that would require genetic manipulation of anthrax as well as weaponizing it, and the technology to accomplish both of these ends is very sophisticated and difficult. If, in fact, we were faced with a bio-agent that was resistant to current antibiotics used alone, laboratory studies could tell us whether we have multiple drugs available to be used in combinations to effectively treat these infections.

Q: Is there any information on anthrax virulence in immunosuppressed (organ transplant) patients?

Waeckerle: This is a question that I have not been asked before but is certainly an excellent question. We have had a great deal of experience with infections with immunocompromised patients due to the HIV outbreak. Fortunately, we have had essentially no experience with anthrax in America over the last 100 years. So to scientifically or knowledgeably discuss anthrax effects on these patients is based on our experience with other infections.

We can guess that an anthrax infection in people that are immunocompromised or on high doses of steroids or other medicines to decrease the immune response would cause them to be more challenged by anthrax, because they cannot mount a normal protective response and because they may react to the antibiotics differently than someone who is not compromised.

Q: If a person were vaccinated for smallpox as a child in the late '50s/early '60s, would they still be protected?

Waeckerle: The smallpox vaccination program was discontinued worldwide at the end of 1970s because smallpox was declared eradicated. Since then obviously no one has received any vaccinations.

Recent studies and information from the CDC have notified us that they believe the neutralizing antibodies which protect us are in the needed concentrations for about 10 years after the last vaccination you received. From this we can say that no one is adequately protected today. That is why there is such a strong movement to manufacture and supply additional vaccines in case we need them in the future.

Q: Dr. Waeckerle, do you have any final comments for us?

Waeckerle: First, let me thank WebMD and the audience for the opportunity to share information. Let me ask each of you to be concerned citizens, trust your government, and be vigilant because this is a new terrorist who does not honor the traditional rules of engagement. Obviously they now will attack civilian targets and are willing to murder women and children, which has not been something we have ever experienced. They are also willing to give up their lives in the process. I do not feel we need to panic. I do feel we need to inform our elected officials that we need to be better prepared, to be even more prepared than we currently are, to fight biologic terrorism, and we ask of them to adopt a national strategy and response plan to do so. We all need to work together because this is our country, our children, and our future. And we are very blessed. The investment may be costly, but we cannot lose this fight.

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