The world is at greater risk than ever from global health threats. We may not know what the next epidemic will be, but we know that one is coming.

Bioterrorism is the intentional use of pathogen or biological product to cause harm to a human, animal, plant or other living organisms to influence the conduct of government or to intimidate or coerce a civilian population. A bioterrorism attack is the deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals or plants. These agents are typical causes of infectious diseases, but it is possible that they could be changed to increase their ability to cause disease, make them resistant to current medicine, or increase their ability to spread into the environment. The CDC named top 5 health threats in 2014 as follows:

  • The emergence and spread of new microbes
  • The globalization of travel and food supplies
  • The rise of antibiotic-resistant infections
  • Inadvertent or intentional release of pathogens
  • Bioterrorism

Infectious Disease is one of the great tragedies of living things. World-wide, naturally occurring infectious diseases remain the major causes of death. In developed world, the impact of very virulent biological agents and/or their toxins has been drastically reduced because of a very accessible health Care system and excellent public health infrastructure. Still a substantial number of people die each year from infectious diseases in these developed countries. Historically, outbreaks (wars with invincible enemies) of microbial species against the human species have killed far more people than war itself. Examples include:

  • Killing of 95% of Pre-Columbian American population by diseases like small pox, measles, plague, typhoid and influenza;
  • Death of 25 million Europeans (a quarter of the population) caused by Bubonic Plague in the 14th century;
  • The 21 million deaths due to the influenza pandemic of 1918-1919;
  • Recent ones include SARS of 2004, Influenza of 2009, Ebola of 2014 and Zika of 2016.

The biological/infectious weapons system is comprised of four components; a payload, munition, delivery system and dispersion system. The payload is the biological agent itself. The munition protects and carries the payload to maintain it’s potency during delivery. The delivery system can be a missile, vehicle or artillery shell. The dispersion system ensures dissemination of the payload at the Target site. Biological agents can be spread through the air, water or food. Some bioterrorism agents like smallpox virus can be spread from person to person while anthrax can not. Terrorists may use biological agents because they can be extremely difficult to detect and do not cause illness for several hours to several days.Why biological agents?

  • Biological agents are easy to develop as weapons
  • They are more lethal than chemical weapons
  • They are less expensive
  • They are more difficult to detect than nuclear weapons
  • Diseases caused by biological agents are not only a public health issue but also a problem of national security.

A bioterrorist attack may occur in 2 scenarios: overt and covert. In the past, emergency responses were prepared based on overt attacks like bombings and chemical agents that cause immediate and obvious effects. However, attacks with biological agents are more likely to be covert. The clues to recognize bioterrorist attack include:

  • an outbreak of rare or new disease
  • an outbreak of disease in a non-endemic area
  • a seasonal disease during an off season time
  • a known pathogen with unusual resistance or unusual epidemiologic features
  • an unusual clinical presentation or age distribution
  • a genetically identical pathogen emerging rapidly in different geographical areas.

Unfortunately, the number of countries engaged in biological weapons experimentation has grown from 4 in the 1960’s to 11 in the 1990’s. It is estimated that at least 10 nations and possibly 17 possess biological warfare agents. Of the 7 countries listed by the United States Department of State as sponsoring international terrorism, at least 5 are suspected to have biological warfare programs. Nations and dissident groups have the access to skills needed to selectively cultivate some of the most dangerous pathogens and to deploy them as agents of biological terrorism and war. The consequences of biological weapons use include:

  • They can rapidly produce Mass effect that overwhelms services and the health care system of the communities
  • They are associated with high morbidity and mortality rates
  • Most of the civilian population is susceptible to infections caused by these agents
  • The resulting illness is usually difficult to diagnose and early, particularly in areas where the disease is rarely seen
  • One kilogram of anthrax powder has the capability to kill up to 100,000 people depending on the mechanism of delivery
  • The economic impact of a biological attack has been estimated to be from 478 million/100,000 persons exposed (brucellosis scenario) to 26.2 billion/100,000 persons exposed (anthrax scenario).

Bioterrorism preparedness by the health care systems is very crucial in this present age and time

  • Be alert for illnesses that may be due to bioterrorism
  • Be aware that children, the elderly and other special needs populations may require additional considerations for the diagnosis and treatment of illnesses caused by bioterrorism
  • Learn how you can prepare for and respond to bioterrorism events
  • Familiarize yourself with online preparedness resources before disasters and emergencies
  • Based on the first wave of victims, public health officials will need to determine that an attack has occurred, identify the organism and prevent more casualties through prevention strategies (like mass vaccination, prophylaxis) and infection control procedures

Primary care providers, dermatologists, infectious disease experts, gastroenterologists, intensivists or emergency department physicians could be the first to recognize an act of bioterrorism. Once diagnoses are considered and appropriate clinical specimens are collected, the Ministry of health can facilitate rapid confirmation in it’s Public Health Laboratory and notify the WHO. The World Health Organization monitors and verifies all rumours of bioterrorist attack and ensures the availability of diagnostic capacities, vaccination, treatment and infection control.

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