II. Epidemiology
III. Definitions
- Bioterrorism
- Deliberate release of viruses, Bacteria, toxins or fungi
- Intent to cause panic, mass casualties and socioeconomic disruption
IV. Background
- Biological Weapons Convention (1975, UN)
- https://www.armscontrol.org/factsheets/bwc
- Bans development, acquisition, use or stockpiling of Biological Agents
- Not ratified by 10 countries: Chad, Comoros, Djibouti, Eritrea, Israel, Kiribati, Micronesia, Namibia, South Sudan, Tuvalu
- Historical Examples
- Diseased Livestock (14th century B.C.E., ancient Egypt)
- Hittites drove diseased cattle into their enemies camps
- Decomposed human bodies (1155, Italy)
- Water wells were poisoned by throwing dead bodies into the well
- Plague (1346, Crimean Peninsula)
- Mongols catapulted bodies of Plague victims over the city walls of Caffa
- Leprosy (1495, Italy)
- Spanish mixed blood from Leprosy patients with wine and sold the wine to their french enemies
- Smallpox (1754 to 1763, North America)
- Transmitted to native americans via infected blankets during the French and Indian War
- Smallpox and Yellow Fever (1863, U.S.)
- Confederates sold to union forces the clothing from patients with Yellow Fever and Smallpox
- Anthrax (2001, U.S.)
- Anthrax spores sent via U.S. postal service to congressional offices
- References
- Diseased Livestock (14th century B.C.E., ancient Egypt)
V. Types: CDC Category A: High public health impact
- Characteristics
- Easily disseminated
- High morbidity and mortality rates
- Causes widespread fear and disruption
- Requires greatest preparation and surveillance
- Viral Agents
- Smallpox (Variola major)
- Filovirus hemorrhagic fever agents
- Ebola (Ebola Virus)
- Marburg (Marburg Virus)
- Arenavirus hemorrhagic fever agents
- Lassa Fever (Lassa Virus)
- Bolivian hemorrhagic fever (Machupo Virus)
- Argentine hemorrhagic fever (Junin Virus)
- Bacterial Agents
- Preformed Biological Toxins
- Botulism (Clostridium botulinum Toxin)
VI. Types: CDC Category B: Moderate public health impact
- Characteristics
- Moderately easy to disseminate
- Moerate morbidity and low mortality rates
- Causes widespread fear and disruption
- Requires specialized diagnostic testing and disease surveillance
- Viral Agents
- Alphaviruses
- Venezuelan Equine Encephalitis (VEE)
- Eastern Equine Encephalitis
- Western Equine Encephalitis
- Alphaviruses
-
Bacterial Agents
- Q Fever (Coxiella burnetti)
- Brucellosis (Brucella)
- Glanders (Burkholderia mallei)
- Melioidosis (Burkholderia pseudomallei)
- Psittacosis (Chlamydia psittaci)
- TyphusFever (Rickettsia powazekii)
- Foodborne Illness
- Waterborne Illness
- Preformed Biological Toxins
- Ricin (Ricinus communis or Castor Oil extract)
- Epsilon toxin (Clostridium perfringes)
- T-2 Mycotoxin
- Staphylococcal Enterotoxin B (SEB)
VII. Types: CDC Category C: Emerging Risks
- Characteristics
- Emerging agents with a potential for mass dissemination
- Potentially high morbidity and mortality rates
- Viral Agents
- Nipah Virus
- Hanta Virus
- Tickborne hemorrhagic fever viruses
- Tickborne Encephalitis viruses
- Yellow Fever (Yellow Fever virus)
-
Bacterial Agents
- Multi-drug resistant Tuberculosis
VIII. Signs: Red Flags suggestive of Biological Weapon exposure
- Single case of an uncommon or rare disease (e.g. Smallpox)
- Uncommon disease presentation (season or geographic region), population (e.g. age cohort) or vector (route of exposure)
- Severe disease with high Infectivity
- Large acute patient cohort with similar symptoms or same disease
- Unusual clinical presentation of symptoms and signs, or atypical response to standard treatments
- Cluster of unexplained deaths in humans or animals
IX. Resources
- CDC Emergency Preparedness - Bioterrorism
- US Army Research Institute of Infectious Disease (USAMRIID)
- WHO Bioterrorism
X. References
- Seeyave (2015) Crit Dec Emerg Med 29(5): 13-21
- Rathjen (2021) Am Fam Physician 104(4): 376-85 [PubMed]