Arnon S S, Schechter R, Inglesby T V, Henderson D A, Bartlett J G, Ascher M S, Eitzen E, Fine A D, Hauer J, Layton M, Lillibridge S, Osterholm M T, O'Toole T, Parker G, Perl T M, Russell P K, Swerdlow D L, Tonat K
Infant Botulism Treatment and Prevention Program, California Department of Health Services, 2151 Berkeley Way, Room 506, Berkeley, CA 94704, USA.
JAMA. 2001 Feb 28;285(8):1059-70. doi: 10.1001/jama.285.8.1059.
The Working Group on Civilian Biodefense has developed consensus-based recommendations for measures to be taken by medical and public health professionals if botulinum toxin is used as a biological weapon against a civilian population.
The working group included 23 representatives from academic, government, and private institutions with expertise in public health, emergency management, and clinical medicine.
The primary authors (S.S.A. and R.S.) searched OLDMEDLINE and MEDLINE (1960-March 1999) and their professional collections for literature concerning use of botulinum toxin as a bioweapon. The literature was reviewed, and opinions were sought from the working group and other experts on diagnosis and management of botulism. Additional MEDLINE searches were conducted through April 2000 during the review and revisions of the consensus statement.
The first draft of the working group's consensus statement was a synthesis of information obtained in the formal evidence-gathering process. The working group convened to review the first draft in May 1999. Working group members reviewed subsequent drafts and suggested additional revisions. The final statement incorporates all relevant evidence obtained in the literature search in conjunction with final consensus recommendations supported by all working group members.
An aerosolized or foodborne botulinum toxin weapon would cause acute symmetric, descending flaccid paralysis with prominent bulbar palsies such as diplopia, dysarthria, dysphonia, and dysphagia that would typically present 12 to 72 hours after exposure. Effective response to a deliberate release of botulinum toxin will depend on timely clinical diagnosis, case reporting, and epidemiological investigation. Persons potentially exposed to botulinum toxin should be closely observed, and those with signs of botulism require prompt treatment with antitoxin and supportive care that may include assisted ventilation for weeks or months. Treatment with antitoxin should not be delayed for microbiological testing.
民用生物防御工作组针对肉毒杆菌毒素作为针对平民的生物武器时医学和公共卫生专业人员应采取的措施制定了基于共识的建议。
该工作组包括来自学术、政府和私立机构的23名代表，他们在公共卫生、应急管理和临床医学方面具有专业知识。
主要作者（S.S.A.和R.S.）检索了OLDMEDLINE和MEDLINE（1960年至1999年3月）以及他们的专业文献集，以查找有关将肉毒杆菌毒素用作生物武器的文献。对文献进行了综述，并就肉毒中毒的诊断和管理征求了工作组及其他专家的意见。在共识声明的审查和修订期间，于2000年4月前又进行了额外的MEDLINE检索。
工作组共识声明的初稿是在正式证据收集过程中获得的信息的综合。工作组于1999年5月召开会议审查初稿。工作组成员审查了后续草稿并提出了更多修订建议。最终声明纳入了文献检索中获得的所有相关证据以及所有工作组成员支持的最终共识建议。
雾化或经食物传播的肉毒杆菌毒素武器会导致急性对称性、下行性弛缓性麻痹，并伴有明显的延髓麻痹，如复视、构音障碍、声音嘶哑和吞咽困难，通常在接触后12至72小时出现。对故意释放肉毒杆菌毒素的有效应对将取决于及时的临床诊断、病例报告和流行病学调查。可能接触肉毒杆菌毒素的人员应密切观察，出现肉毒中毒迹象的人员需要立即用抗毒素治疗并给予支持性护理，可能包括数周或数月的辅助通气。不应因微生物检测而延迟抗毒素治疗。
