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Epidemiologic Data on Biologic Agents of Greatest Concern

Agent	Microbiology	Incubation	Natural Routes of Transmission	Precautions	Case Fatality Rate
Anthrax/ Bacillus anthracis	Spore – forming Gram-positive bacillus	Average, 1– 7 days Range, 1– 60 days	Inhalation or ingestion of spores, cutaneous contact with infected animal byproducts, including meat, hide, hair, and bone meal. Person-to-person transmission is rare.	Standard, but use contact precautions if cutaneous or if associated with diarrhea	Cutaneous: Treated, <1% Untreated, 10 – 20%; Inhalational: Treated, >= 40%; Untreated, 97% GI: Treated, <= 40%
Plague/Yersinia pestis	Gram-negative rod	1– 7 days	Bubonic: bites from infected fleas and handling of infected tissues Pneumonic: aerosol person-to-person transmission	Standard. Use droplet precautions until patient is on appropriate therapy for 72 hours. Contact precautions if draining buboes present	Bubonic:Untreated, 50 – 60% Pneumonic: Untreated, unlikely to survive
Smallpox/ variola virus	Orthopox virus	1–1 7 days	Aerosol person-to-person transmission with 50% secondary attack rate	Standard, contact, and airborne	Among unvaccinated persons, 20 – 40%
Botulism/ Clostridium botulinum toxin	Neurotoxin produced by anaerobic Gram-positive rod	Average, 12– 36 hours Range, 1– 7 days	Ingestion of preformed toxin	Standard	Treated, 5 –10%
Tularemia / Francisella tularensis	Gram-negative rod	Average, 3 – 5 days Range, 1– 14 days	Tick bites, handling infected animal byproducts such as meat or hides, eating insufficiently cooked meats, drinking contaminated water, inhaling contaminated soil	Standard; contact precautions if lesions present	Inhalational:Untreated, 30 – 60%
Hemorrhagic Fevers/eg, Ebola and Marburg viruses	Filoviruses and Arenaviruses	Average, 5 – 10 days Range, 2 – 19 days	Contact with body fluids of infected persons	Standard and contact; airborne precautions in late stages	Untreated, 50 – 90%

For more information about biologic agents and training, visit: www.bt.cdc.gov/training/index.asp#ph

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