Consensus Process Three formal drafts of the statement that synthesized infor- mation obtained in the formal evidence-gathering process were reviewed by mem- bers of the working group. Consensus was achieved on the final draft.
Conclusions A weapon using airborne tularemia would likely result 3 to 5 days later in an outbreak of acute, undifferentiated febrile illness with incipient pneumonia, pleu- ritis, and hilar lymphadenopathy. Specific epidemiological, clinical, and microbiologi- cal findings should lead to early suspicion of intentional tularemia in an alert health system; laboratory confirmation of agent could be delayed. Without treatment, the clinical course could progress to respiratory failure, shock, and death. Prompt treat- ment with streptomycin, gentamicin, doxycycline, or ciprofloxacin is recommended. Prophylactic use of doxycycline or ciprofloxacin may be useful in the early postexpo- sure period.
