Epidemiology

General practitioners can help fight bioterrorism

It’s the middle of February and patients are crowding waiting rooms with the same symptoms: fever, fatigue and backache. It’s flu season again, but be careful! Flu symptoms are incredibly similar to the first signs of smallpox. This devastating illness was officially wiped off the map in 1979. Only laboratories at the Centers for Disease Control in Atlanta and in Novosibirsk, Russia, are supposed to have preserved the virus, which is kept under lock and key. However, many governments believe that virus stocks still exist in other laboratories and that they could be unleashed in a deliberate act of bioterrorism.

In Canada, a bacterial attack is highly unlikely, but not impossible. According to Dr. Karl Weiss, microbiologist and infectious disease specialist at the Maisonneuve-Rosemont Hospital and Associate Clinical Professor at the Université de Montréal, general practitioners must be made aware of the disease’s potential. “Even though general practitioners would probably not treat the victims of an attack, they still have a crucial frontline role to play by quickly detecting an unsuspected act of bioterrorism. ”  

Unlike chemical weapons which act quickly on a limited number of individuals, biological weapons are much more insidious. “ During the sarin gas attacks in the Tokyo subway in 1995, 10 people were killed and 5,000 were injured virtually instantaneously. When bacteria or a virus is unleashed, it takes several days for the onset of the first symptoms. For instance, the effects of carbon (anthrax) take two or three days to manifest themselves. Smallpox takes about 10 days, ” explains Dr. Weiss.

According to the researcher, one can easily imagine a suicide attack in which a terrorist is voluntarily infected with smallpox and uses Montreal’s Métro system to spread the disease. This highly contagious virus could infect many passengers spread throughout the entire metropolitan area and beyond, before any fevers broke out. “ That’s why frontline physicians must be extremely vigilant. If a dozen patients show up with unusual symptoms, it’s wiser to assume that something is amiss than to think you’re dealing with an isolated case. ”

General practitioners must be attentive to clinical signs that are out of the ordinary. In the case of smallpox, for instance, skin eruptions appear a few days after the onset of fever. These eruptions differ from chicken pox because they first appear on the extremities, including the palm of the hands and the soles of the feet. In the case of chicken pox, eruptions first appear on the torso and always spare the palms of the hands and soles of the feet. The preliminary phase of an anthrax infection may also be mistaken for the flu. A well-informed practitioner, however, knows that nasal congestion is rare in the case of an anthrax infection, while it is common in influenza. Inversely, chest pain is a very common symptom of anthrax, but rare in influenza.