II. Epidemiology

  1. Bioterrorism attacks number at least 37 between 1981-2018
  2. Five Category A infections had natural outbreaks in 2020 (Ebola, Lass Fever, Anthrax, Plague, Botulism)

III. Definitions

  1. Bioterrorism
    1. Deliberate release of viruses, Bacteria, toxins or fungi
    2. Intent to cause panic, mass casualties and socioeconomic disruption

IV. History

  1. Biological Weapons Convention (1975, UN)
    1. https://www.armscontrol.org/factsheets/bwc
    2. Bans development, acquisition, use or stockpiling of Biological Agents
    3. Not ratified by 10 countries: Chad, Comoros, Djibouti, Eritrea, Israel, Kiribati, Micronesia, Namibia, South Sudan, Tuvalu

V. Types: CDC Category A: High public health impact

  1. Characteristics
    1. Easily disseminated
    2. High morbidity and mortality rates
    3. Causes widespread fear and disruption
    4. Requires greatest preparation and surveillance
  2. Viral Agents
    1. Smallpox (Variola major)
    2. Filovirus hemorrhagic fever agents
      1. Ebola (Ebola Virus)
      2. Marburg (Marburg Virus)
    3. Arenavirus hemorrhagic fever agents
      1. Lassa Fever (Lassa Virus)
      2. Bolivian hemorrhagic fever (Machupo Virus)
      3. Argentine hemorrhagic fever (Junin Virus)
  3. Bacterial Agents
    1. Anthrax (Bacillus anthracis)
    2. Plague (Yersinia pestis)
    3. Tularemia (Francisella tularensis)
  4. Preformed Biological Toxins
    1. Botulism (Clostridium botulinum Toxin)

VI. Types: CDC Category B: Moderate public health impact

  1. Characteristics
    1. Moderately easy to disseminate
    2. Moerate morbidity and low mortality rates
    3. Causes widespread fear and disruption
    4. Requires specialized diagnostic testing and disease surveillance
  2. Viral Agents
    1. Alphaviruses
      1. Venezuelan Equine Encephalitis (VEE)
      2. Eastern Equine Encephalitis
      3. Western Equine Encephalitis
  3. Bacterial Agents
    1. Q Fever (Coxiella burnetti)
    2. Brucellosis (Brucella)
    3. Glanders (Burkholderia mallei)
    4. Melioidosis (Burkholderia pseudomallei)
    5. Psittacosis (Chlamydia psittaci)
    6. TyphusFever (Rickettsia powazekii)
    7. Foodborne Illness
      1. Salmonella
      2. Shigella
      3. Enterohemorrhagic E. coli (E. coli 0157)
    8. Waterborne Illness
      1. Vibrio Cholerae
      2. Cryptosporidium parvum
  4. Preformed Biological Toxins
    1. Ricin (Ricinus communis or Castor oil extract)
    2. Epsilon toxin (Clostridium perfringes)
    3. T-2 Mycotoxin
    4. Staphylococcal Enterotoxin B (SEB)

VII. Types: CDC Category C: Emerging Risks

  1. Characteristics
    1. Emerging agents with a potential for mass dissemination
    2. Potentially high morbidity and mortality rates
  2. Viral Agents
    1. Nipah Virus
    2. Hanta Virus
    3. Tickborne hemorrhagic fever viruses
    4. Tickborne Encephalitis viruses
    5. Yellow Fever (Yellow Fever virus)
  3. Bacterial Agents
    1. Multi-drug resistant Tuberculosis

VIII. Signs: Red Flags suggestive of Biological Weapon exposure

  1. Single case of an uncommon or rare disease (e.g. Smallpox)
  2. Uncommon disease presentation (season or geographic region), population (e.g. age cohort) or vector (route of exposure)
  3. Severe disease with high Infectivity
  4. Large acute patient cohort with similar symptoms or same disease
  5. Unusual clinical presentation of symptoms and signs, or atypical response to standard treatments
  6. Cluster of unexplained deaths in humans or animals

IX. Resources

  1. CDC Emergency Preparedness - Bioterrorism
    1. http://emergency.cdc.gov/bioterrorism/index.asp
  2. US Army Research Institute of Infectious Disease (USAMRIID)
    1. https://www.usamriid.army.mil/education/instruct.htm
  3. WHO Bioterrorism
    1. https://www.who.int/health-topics/biological-weapons

X. References

  1. Seeyave (2015) Crit Dec Emerg Med 29(5): 13-21
  2. Rathjen (2021) Am Fam Physician 104(4): 376-85 [PubMed]

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Ontology: Toxin (C0040549)

Definition (SCTSPA) Sustancia tóxica, nociva o venenosa producida por un organismo vivo
Definition (SNOMEDCT_US) Toxic, noxious, or poisonous substance that is produced by a living organism
Definition (NCI_NCI-GLOSS) A poison made by certain bacteria, plants, or animals, including insects.
Definition (NCI) A chemical, physical, or biological agent that causes disease or some alteration of the normal structure and function of an organism. Usually refers to poisonous substance produced during the metabolism and growth of certain microorganisms and some higher plant and animal species, or any poisonous isomer, homolog, or derivative of such a substance. It causes either permanent or reversible injury to the health of a living thing on contact or absorption, typically by interacting with biological macromolecules such as enzymes and receptors. Onset of effects may be immediate or delayed, and impairments may be slight or severe. (NCI)
Definition (CSP) poison, usually protein, produced by higher plants, animals, or microorganisms that is toxic to other living organisms.
Definition (MSH) Specific, characterizable, poisonous chemicals, often PROTEINS, with specific biological properties, including immunogenicity, produced by microbes, higher plants (PLANTS, TOXIC), or ANIMALS.
Concepts Biologically Active Substance (T123) , Hazardous or Poisonous Substance (T131)
MSH D014118
SnomedCT 80917008
English Toxin, Toxins, Biological [Chemical/Ingredient], toxins, toxin, Biological toxin, Toxin (substance), Toxin, NOS, Toxins, Biological Toxins, Toxins, Biological
German Toxine, biologische
Swedish Toxiner, biologiska
Czech toxiny biologické
Finnish Toksiinit
French Biotoxines, Toxines, Toxines biologiques
Croatian Not Translated[Toxins, Biological]
Polish Toksyny
Norwegian Not Translated[Toxins, Biological]
Spanish toxina (sustancia), toxina, Toxinas Biológicas
Portuguese Toxinas Biológicas
Italian Tossine, Tossine biologiche

Ontology: Bioterrorism (C0872021)

Definition (MSH) The use of biological agents in TERRORISM. This includes the malevolent use of BACTERIA; VIRUSES; or other BIOLOGICAL TOXINS against people, ANIMALS; or PLANTS.
Concepts Activity (T052)
MSH D023482
Swedish Bioterrorism
Czech bioterorismus, biologický terorismus
Finnish Bioterrorismi
Italian Terrorismo biologico, Bioterrorismo
English bioterrorism, biological terrorism, Biological Terrorism, Terrorism, Biological, Bioterrorism
French Terrorisme biologique, Bioterrorisme
Polish Bioterroryzm, Terroryzm biologiczny
Japanese バイオテロリズム, テロリズム-生物学的, 生物学的テロリズム
Norwegian Bioterrorisme, Biologisk terrorisme
German Biologischer Terrorismus, Bioterrorismus
Dutch Biologisch terrorisme, Bioterrorisme
Portuguese Bioterrorismo, Terrorismo Biológico
Spanish Bioterrorismo, Terrorismo Biológico