Biological Weapon

Aka: Biological Weapon, Biological Toxin, Bioterrorism

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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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