Bioterrorism
Medical Author: Edmond Hooker, MD, DrPH
Medical Editor: Melissa Conrad Stöppler, MD
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Anthrax, Then and Now
Medical Author: Michael C. Fishbein, MD
Medical Editor: Leslie J. Schoenfield, MD, PhD
Revising Medical Editor: Jay W. Marks, MD
Experts have said that it is a matter of when, not if, a large scale act of bioterrorism is carried out in the U.S. Why "bio" terrorism? Biologic weapons are cheaper and more devastating than chemical weapons and maybe even nuclear weapons. Deadly quantities of infectious agents are easy to hide, transport, and spread throughout the population. Indeed, the U.S. already experienced a bioterrorism attack. In 2001, powder containing the bacterium called anthrax was distributed through the U.S. mail. All together, 22 people became infected with anthrax. These people lived in South Florida, New York City, New Jersey, Maryland, Connecticut, Pennsylvania, Virginia, and Washington, DC. Eleven people seem to have inhaled the anthrax, and 11 others were infected through the skin. The FBI and CDC (Center for Disease Control) are still investigating this outbreak.
Because of this outbreak, most Americans are now aware of the infectious disease called anthrax. Most are also aware that it is usually a disease of animals and that it is a rare cause of disease or death in humans. Prior to the outbreak in 2001, the last case of fatal anthrax in the United States was in 1976. Moreover, no fatal cases occurred in the preceding 10 years. What may not be as widely known, however, is that the 1976 case occurred in California. This was not a case of bioterrorism. The patient did die of the infection, and the autopsy was performed at UCLA Medical Center. The details of this case have been described in a medical journal called Human Pathology (Volume 9, pages 594-597, September, 1978).
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What is bioterrorism?
Bioterrorism is a form of terrorism where there is the intentional release of
biological agents (bacteria, viruses, or other germs). Terrorism is the defined
by the United States government as the "...unlawful use of force and violence
against persons or property to intimidate or coerce a government, the civilian
population, or any segment thereof, in furtherance of political or social
objectives." In addition to biological agents, terrorists can also utilize
chemical agents and nuclear bombs. While a biological agent may injure or kill
people, animals, or plants, the goal for the terrorist is to further their
social and political goals. Many biological agents are found in nature; however,
they can be modified by the terrorist to make them more dangerous. Some of these
agents can be transmitted from person to person, and the infection may take
hours or days to become apparent.
What are the biological agents that can be utilized for bioterrorism?
While any germ, bacteria, or virus could potentially be utilized by
terrorist, there are a number of biological agents that have been recognized as
being more likely to be utilized. The reason for these agents being of concern
is based on their availability to terrorists and the ease by which these agents
can be disseminated. The U.S. Centers for Disease Control and Prevention (CDC)
has developed a classification system for biological terror agents which is
available on their Web site (Categories). The classification is based on the
likelihood of the agent being used and the risk posed by each agent. The agents
(and the diseases they cause) are listed in Table 1, including hyperlinks for
those wishing to learn more about a specific agent or disease. However, it is
almost impossible for most people to memorize all the details about each of
these agents. It is more important for the general public to understand the risk
of bioterrorism and the appropriate response to a terrorist attack.
| Table 1: BIOTERRORISM AGENTS AND THE DISEASES THEY CAUSE |
| Biologic Agent |
Disease caused by the agent |
| Bacillus anthracis |
Anthrax |
| Clostridium botulinum toxin |
Botulism |
| Yersinia pestis |
Plague |
| Variola major |
Smallpox |
| Francisella tularensis |
Tularemia |
| (filoviruses [for example, Ebola, Marburg] and arenaviruses [for
example, Lassa, Machupo]) |
Viral hemorrhagic fevers |
| Brucella species |
Brucellosis |
| Epsilon toxin of Clostridium perfringens |
Food Poisoning |
| Salmonella species, Escherichia coli O157:H7, Shigella |
Food Poisoning |
| Burkholderia mallei |
Glanders |
| Burkholderia pseudomallei |
Melioidosis |
| Chlamydia psittaci |
Psittacosis |
| Coxiella burnetii |
Q fever |
| Ricinus communis (castor beans) |
Ricin toxin poisoning |
| Staphylococcal enterotoxin B |
Food Poisoning |
| Rickettsia prowazekii |
Epidemic Typhus |
| Vibrio cholerae |
Cholera |
| Cryptosporidium parvum |
Cryptosporidiosis |
| Alphaviruses (for example, Venezuelan equine encephalitis, eastern equine encephalitis, western equine encephalitis) and flaviviruses
(for example, West Nile encephalitis, Saint Louis encephalitis, Dengue) |
Viral encephalitis |
| Influenza virus |
Influenza |
| Mycobacterium tuberculosis |
MDR TB and XDR TB |
What are other sources for detailed information on bioterrorism?
There are many different government-based Web sites that have up-to-date
information on bioterrorism. These include:
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Plague »
Overview
Plague is an infectious disease caused by bacteria called Yersinia pestis. These bacteria are found mainly in rodents, particularly rats, and in the fleas
that feed on them. Other animals and humans usually contract the bacteria from
rodent or flea bites.
Historically, plague destroyed entire civilizations. In the 1300s, the "Black
Death," as it was called, killed approximately one-third (20 to 30 million) of
Europe's population. In the mid-1800s, it killed 12 million people in China.
Today, thanks to better living conditions, antibiotics, and improved sanitation,
current World Health Organization statistics show there were only 2,118 cases in
2003 worldwide.
Approximately 10 to 20 people in the United States develop plague each year
from flea or rodent bites—primarily from infected prairie dogs—in rural areas of
the southwestern United States. About 1 in 7 of those infected die from the
disease. There h...
Read the Plague article »
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