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14 : Are Hemorrhagic Fever Viruses Practical Agents for Biological Terrorism?
There is considerable controversy as to which biological agents should concern us, either for defense against military use or, for defense against terrorism. The mosquito-transmitted yellow fever virus is classified as biosafety level 3 (BSL 3), but it is aerosolinfectious and has a high case fatality, which are ameliorated by the existence of a very effective vaccine. The viral hemorrhagic fever (VHF) has appropriate properties for aerosol weapons, and this chapter concentrates on three viruses: Machupo virus, Rift Valley fever (RVF) virus, and Marburg virus. The RVF virus is the most stable of the VHF when stored in the liquid or frozen state. Intravenous ribavirin would be expected to be fairly effective against Machupo virus and perhaps helpful in RVF, but stocks are limited and not readily accessible. VHF seems to be very likely agents for lethal state-sponsored actions against large numbers of people. The severe dramatic disease they produce, with its attendant need for intensive supportive care, would increase their impact. Education of clinicians is extremely important as well and is occurring in the context of both travel medicine and bioterrorism defense.