Biological terrorism: Understanding the threat, preparation, and medical response
Section snippets
The genesis of today's bioterrorism threat: The cold war era
In the early 20th century, the goals of the first proliferators of biological weaponry were to select agents and delivery methods that produced the desired effect in a reasonably controlled manner without causing harm to their own troops or citizens. The first, and probably only, use of biological agents on a large scale against human beings in this century was planned and executed by the Japanese against the Chinese during World War II.2 There is also some evidence that the Soviets may have
Classic cold war agents
During the Cold War, which reached its peak in the 1980s, the Soviet Union and the United States and its allies, Great Britain and Canada, developed biological weapons. These nations' programs were developed independently as highly classified endeavors. Yet, of the thousands of bacteria, viruses, and biological toxins available in nature, the proliferators typically selected fewer than 20 agents for weaponization—and their lists were strikingly similar. (There is evidence that the Iraqi program
Individual disease agents
The sources listed below can also be found in the references at the back of this article; however, we believe these two works to be extraordinarily useful and comprehensive as ready sources of essential information on disease agents and preparation for bioterrorist attack, and as such, they deserve special attention.
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Zajtchuk R, editor. Textbook of military medicine: Medical aspects of chemicaland biological warfare. Washington (DC): Borden Institute; 1997. Available at: //www.armymedicine.army.mil/history/borden/default.htm
The attack
The likelihood of a strategic attack by Russian ICBMs carrying Y pestis or variola is much lower than it was 10 years ago. Yet, the likelihood of a biological terrorist attack on our cities is believed by most experts to be higher than it was when the Soviets were the major threat. There are numerous potential scenarios for attack, but in simplest terms, the covert and overt approach will be considered here.
Preparation for a biological attack: What can a medical facility do?
It is the physician and the medical facility, not necessarily the paramedics, police, and fire service that will take the brunt of a biological terrorist attack. The prepared physician, hospital, and medical center have the potential of making an enormous difference in outcome after an attack. Therefore, preparation at this level is critical. Fortunately, much of what should be done in anticipation of a biological terrorist attack is also applicable to any public health disaster or infectious
Conclusion
The limitation and eventual elimination of both chemical and biological weapons are two of the greatest challenges facing the international community in this century. Unfortunately, proliferation of such weapons is continuing despite the best efforts of many nations, including the United States, to prevent proliferation.62 Biological weaponry is the most worrisome issue because of the relative ease in developing and mass-producing potent agents, the continuing difficulties in identifying enemy
Acknowledgment
We acknowledge the extensive assistance provided by Joan T. Zajtchuk, MD, Spec. in HSA, during the revision of this manuscript. Her constructive and detailed editorial oversight contributed to the accuracy and clearer presentation of the subject matter.
Chemical Terrorism Defense
Chemical terrorism differs from biological terrorism in many ways (Table A1).Characteristics Toxins Chemical Agents Origin Natural Man-made Production Difficult, small-scale Large-scale industrial Volatility None volatile Many volatile Relative toxicity Many are more toxic Less toxic than many toxins Dermal activity Not dermally active* Dermally active Use Legitimate medical use No use other than as weapons Odor and taste Odorless and tasteless Noticeable odor or taste Toxic
Agricultural Terrorism and Implications for Public Health
For almost all human diseases and zoonotic disease agents that might be used against human beings, the risk of transmission from an exposed individual to another is relatively low. Exceptions, as mentioned above, are smallpox and influenza of the type encountered in the early 20th century. The relatively low transmissibility of most human agents makes production of a mass casualty event dependent on presentation of the agent to the target as a respirable aerosol cloud. A major difference
National Information Resources
National information resources include:
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Health and Human Services/Centers for Disease Control/National Centers for Infectious Diseases (domestic preparedness) http://www.bt.cdc.gov/
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Health and Human Services/Office of Emergency Preparedness (consequence management), www.ndms.dhhs.gov
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Department of Defense/US Army, Borden Institute (Textbook of Military Medicine), http://www.armymedicine.army.mil/history/borden/default.htm
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Department of Defense/US Army Medical Research Institute of Infectious
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