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. Background

  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
  2. Historical Examples
    1. Diseased Livestock (14th century B.C.E., ancient Egypt)
      1. Hittites drove diseased cattle into their enemies camps
    2. Decomposed human bodies (1155, Italy)
      1. Water wells were poisoned by throwing dead bodies into the well
    3. Plague (1346, Crimean Peninsula)
      1. Mongols catapulted bodies of Plague victims over the city walls of Caffa
    4. Leprosy (1495, Italy)
      1. Spanish mixed blood from Leprosy patients with wine and sold the wine to their french enemies
    5. Smallpox (1754 to 1763, North America)
      1. Transmitted to native americans via infected blankets during the French and Indian War
    6. Smallpox and Yellow Fever (1863, U.S.)
      1. Confederates sold to union forces the clothing from patients with Yellow Fever and Smallpox
    7. Anthrax (2001, U.S.)
      1. Anthrax spores sent via U.S. postal service to congressional offices
    8. References
      1. Frischknecht (2003) EMBO Rep (Suppl 1):S47-52 +PMID: 12789407 [PubMed]

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]

Images: Related links to external sites (from Bing)

Related Studies