The last epidemic: selective decontamination in the control of mortality among radiation victims

Observations made in Hiroshima and Nagasaki have learned that at some distance from the hypocenter of an A-bomb explosion, individuals--in densely populated areas many thousands--may receive a radiation dose which could be survived practically all exposed persons provided bacterial infections by potentially pathogenic microorganisms could effectively be prevented. As a result deteriorating hygienic circumstances may soon promote the occurrence of epidemics by pathogenic bacteria in a zone surrounding the bombed area. This may be promoted by the presence of persons with a suppressed defence capacity due to (low dose) irradiation obtained during the explosion or later on by fall out. Both infections by potentially pathogenic microbes--most of endogenous origin--as well as infections by a number of different pathogenic bacterial species could effectively be prevented by selective decontamination (SD). SD is a method of infection prophylaxis in use in neutropenic patients such as patients with acute leukaemia during remission induction therapy. SD is performed by oral treatment with colonization resistance saving antimicrobial drugs and should start within two or three days after a nuclear explosion. Suggestions are made for the organisation of large scale treatment of many thousands of persons with SD-pills while implications of the latter for the control of epidemic spread of infections among persons living in the first aid zone who have not been exposed to radiation during or after the explosion, are also mentioned.