Bioterrorism

Bioterrorism is a form of terrorism where there is the intentional release of Biological agents (bacteria, viruses, or other germs). This is also referred to as germ warfare.

Bioterrorism is the use of bacteria, viruses, or germs to harm people. It’s used to spread fear. A bioterrorist releases these hazardous agents into the public to cause illness. Bioterrorism is rare and is used to threaten people, governments, and countries. In bioterrorist attacks, usually only a small number of people may be injured or affected. However, many more become afraid. They change their behavior because of their fear.

Terrorism is defined by the United States government as the “unlawful use of force and violence against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in furtherance of political or social objectives.” The term “terrorism” does not imply what weapon is being used.

In addition to biological agents, terrorists can also utilize traditional weapons (guns), chemical agents and nuclear bombs.

While a biological agent may injure or kill people, animals, or plants, the goal for the terrorist is to further their social and political goals by making their civilian targets feel as if their government cannot protect them.

Many biological agents are found in nature; however, they can be modified by the terrorist to make them more dangerous. Some of these agents can be transmitted from person to person, and the infection may take hours or days to become apparent.

According to the U.S. Centers for Disease Control and Prevention, bioterrorism is the deliberate release of viruses, bacteria, toxins or other harmful agents to cause illness or death in people, animals, or plants.

These agents are typically found in nature, but could be mutated or altered to increase their ability to cause disease, make them resistant to current medicines, or to increase their ability to be spread into the environment.

Biological agents can be spread through the air, water, or in food. Terrorists tend to use biological agents because they are extremely difficult to detect and do not cause illness for several hours to several days. Some bioterrorism agents, like the smallpox virus, can be spread from person to person and some, like Anthrax, cannot.

Bioterrorism is an attractive weapon because biological agents are relatively easy and inexpensive to obtain, can be easily disseminated, and can cause widespread fear and panic beyond the actual physical damage.

Military leaders, however, have learned that, as a military asset, bioterrorism has some important limitations; it is difficult to employ a bioweapon in a way that only affects the enemy and not friendly forces.

A biological weapon is useful to terrorists mainly as a method of creating mass panic and disruption to a state or a country. However, technologists such as Bill Joy have warned of the potential power which genetic engineering might place in the hands of future bio-terrorists.

The use of agents that do not cause harm to humans but disrupt the economy have been discussed.

A highly relevant pathogen in this context is the foot-and-mouth disease (FMD) virus, which is capable of causing widespread economic damage and public concern (as witnessed in the 2001 and 2007 FMD outbreaks in the UK), whilst having almost no capacity to infect humans.

What are the biological agents that can be utilized for bioterrorism?

While any germ, bacteria, or virus could potentially be utilized by terrorist, there are a number of biological agents that have been recognized as being more likely to be utilized. The reason for these agents being of concern is based on their availability to terrorists and the ease by which these agents can be disseminated.

The U.S. Centers for Disease Control and Prevention (CDC) has developed a classification system for biological terror agents, which is available on their web site (Categories). The classification is based on the likelihood of the agent being used and the risk posed by each agent.

The agents (and the diseases they cause) are listed in table 1, including hyperlinks for those wishing to learn more about a specific agent or disease. However, it is almost impossible for most people to memorize all the details about each of these agents. It is more important for the general public to understand the risk of bioterrorism and the appropriate response to a terrorist attack.

Types of Pathogenic Bacteria Used in Bioterrorism

The Centers for Disease Control and Prevention (CDC) defines bioterrorism as “deliberate release of viruses, bacteria or other germs (agents) used to cause illness or death in people, animals, or plants.” The Biological Weapons Convention (BWC), opened for signature in 1972, was the first disarmament treaty, which banned development, production, and storage of this entire category of weapons of mass destruction.

Media attention and public interest in bioterrorism, however, have intensified in the last decade. One of the main components of many target nations’ defensive strategies now focus on the development of procedures to respond to potential attacks.

A study recently published in the Journal of Forensic Sciences details how a bead-based liquid hybridization assay on the used to these four pathogenic bacteria:

• Bacillus anthracis (Anthrax)
• Clostridium botulinum (botulism)
• Francisella tularensis subsp. Tularensis (valley fever)
• Yersinia pestis (the plague)

The CDC classifies these four pathogens as category A, high-priority pathogens, because of their ease of dispersal, high mortality rates, potential to cause panic, and need for special emergency response procedures.

According to the study, methods for detecting biological pathogens should consist of the following criteria:

• Quantitative abilities
• Multiplexing capabilities
• High specificity
• High sensitivity

Traditional detection methods, such as microscopic identification of morphological characteristic differences of the bacteria, enzymatic tests, and staining methods can be less specific than needed, and can be time-consuming and inefficient. Single-plex assays are also impractical, as it would be necessary to screen repeatedly for every possible identity of pathogenic bacteria.

Multiplex assays are ideal, however, and techniques that rely on genetic markers work well with multiplexing.

Ribosomal RNA genes code for structural RNA molecules involved in essential biological processes, so they minimize mutations, which makes these genes good candidates for use in biological pathogen detection. Other genes related to the toxicity of the organism may also be added to a pathogen detection array as use of multiple genetic markers when screening for a pathogenic organism can help increase confidence in detection and identification.

The study also suggests the importance of finding more probes that can be used for positive identification to continue research in this field. Multiplexed assays are optimal for this type of pathogen research, as the sample can be simultaneously tested for multiple markers, “each being derived from a sequence unique to a particular genus or species.”

Multiplex assays help researchers to distinguish between toxic and genetically modified nonpathogenic strains.

Path to improved safety

There are some things you can do to prepare for a bioterrorist attack. For example, take reasonable steps to prepare, just as you would for a tornado or hurricane. It is a good idea to have enough food, water, money, and supplies (including any regular medications you may need) on hand to last you 3 or 4 days.

You should also keep emergency contact information at home, work, and school. Do not take antibiotics unless your doctor tells you to. Antibiotics prevent very few illnesses. They can have serious side effects. Overuse of antibiotics can actually make certain forms of bacteria difficult to treat. Also, antibiotics may interfere with medicines you are already taking.

While toxic gasses are used in bioterrorist attacks, you do not need to buy gas masks. They are intended only for short-term use when a deadly gas is released. They are not practical for use at all times. They are effective only if properly fitted. When not used properly, the masks can be dangerous. They can result in injury or suffocation, especially in people who have heart or lung problems.

Things to consider

Certain threats are common with bioterrorism, including:

Anthrax. Anthrax is an infection caused by bacteria. Anthrax most commonly occurs in cattle and sheep. It is rare in humans. It is usually seen only in people who have contact with infected animals or who work with animal products such as wool, or hides.

Anthrax can be a form of bioterrorism if someone deliberately spreads the bacteria in public places. Anthrax takes 3 forms in humans, all of which are caused by the same bacteria. The form of anthrax infection depends on how the bacteria enter the body:

1) Cutaneous (skin) infection is caused by touching infected animal products, contaminated soil containing anthrax bacteria or the bacteria itself. It is the most common form of anthrax.

2) Gastrointestinal (stomach and intestine) infection is caused by eating undercooked meat that is contaminated with anthrax bacteria.

3) Inhalation infection is caused by breathing in anthrax bacteria.

None of the forms can spread from person to person. It is caused only by direct exposure to the anthrax bacteria. Anthrax symptoms can be similar to other illnesses. Symptoms include:

Cutaneous anthrax starts as a red area on the skin, similar to an insect or spider bite. It may itch. Over a few days, the area becomes larger. Blisters may form, followed by a deep, black scab. The area is usually painless.

Gastrointestinal anthrax typically causes vomiting, nausea, fever, and loss of appetite. It is followed by severe stomach pain, bloody diarrhea, and vomiting with blood.Inhalation anthrax starts out like the flu, with a fever, sore throat, dry cough, and muscle aches. Inhalation anthrax does not cause a runny nose.

The symptoms are usually mild for a few days (and may even get better). The symptoms get much worse. People who have inhalation anthrax often have stomach pain. Within a few days, they will have difficulty breathing and go into shock.If you have symptoms, call your doctor.

If he or she thinks there is a possibility your symptoms are caused by anthrax, he or she will ask about your job and any travel. This information, plus an exam and possibly some lab tests or X-rays, will help your doctor decide whether you have anthrax infection.

It is unlikely that the general public is in danger of anthrax exposure.Fortunately, anthrax can be treated with antibiotics. The treatment and its success depend on the form of anthrax.

 Cutaneous anthrax is the least serious form. People can sometimes recover even without treatment. Gastrointestinal and inhalation anthrax are more serious and may cause death if not treated.

Anthrax gets the most news attention. However, other agents used in bioterrorism include botulism, plague, and smallpox. Some other agents have also been studied for use as biological weapons, such as tularemia, brucellosis, Q fever, and viral hemorrhagic fevers. Smallpox is thought to be another more likely agent to be used in a bioterrorist attack.

Smallpox is an illness caused by the variola virus. Symptoms include fever, headache, fatigue, diarrhea, vomiting, and a specific rash. The rash starts out as flat red spots and turns into blisters. The blisters contain clear liquid and then progresses to pus. Routine vaccination for smallpox was stopped in 1972 in the U.S. The disease had been wiped out.

Smallpox can be spread from person to person, once a fever and rash have developed. If you were vaccinated before 1972, you are not still protected. It is uncertain how long the vaccine is effective. There is no specific drug to treat smallpox. However, a vaccine given even a few days after exposure may prevent death. It’s important to get prompt medical attention if you think you’ve been exposed to smallpox. Vaccines for anthrax and smallpox are not available at this time.

However, smallpox vaccines have been made so that supplies are available if needed. Because there are some risks with the smallpox vaccine, the Centers for Disease Control and Prevention (CDC) will decide if it should be given on an individual basis.

The anthrax vaccine is controlled by the U.S. Department of Defense. It is only available for military personnel at high risk of exposure in combat settings. Also, it’s available to people who work with anthrax in a laboratory setting.

How Bioterrorism Works

the purposeful release of bacteria, viruses or germs to cause injury, illness or death — became a reality in the United States. The three ways a terrorist can release biological agents is through air, water or food.

These agents are typically very difficult to detect and because the illnesses they cause are usually delayed, it makes bioterrorism a hard crime to investigate. In fact, the anthrax case of 2001 remains unsolved.Bioterrorism dates back to 1340, when diseased horse corpses were catapulted over castle walls in France.

Human bodies infected with plague were also used as ammunition in central Europe during the 14th and 15th centuries. In 1763, a British army general ordered that blankets used on smallpox patients be sent to American Indian tribes.

British Revolutionary War troops would also infect themselves with traces of smallpox, rendering themselves immune, in hopes of passing the disease along to the enemy.During World War I, Germans infected livestock headed for the Allies with anthrax.

Even though the attack proved to be unsuccessful, it led to the creation of the Geneva Protocol in 1925. This prohibited the use of biological and chemical agents during wartime, while allowing research and development of these agents to continue.

The British and German armies may have dabbled in biological warfare, but the Japanese went full steam ahead in the years that preceded World War II. Hundreds of thousands of Chinese civilians were killed by biological means at the hands of the Japanese army.

One of these attacks included dropping paper bags containing plague-infested fleas from low-flying airplanes.In 1984, the first instance of bioterrorism occurred in the United States. Cult members in rural Oregon sprinkled salmonella on salad bars all around Wasco County, hoping to affect the outcome of a judicial vote.

 In the end, 750 cases of food poisoning were reported and 45 victims had to be hospitalized. Another cult killed 12 people and injured many more in Tokyo by releasing sarin gas into a crowded subway in 1995.

What is the Problem?

The word “bioterrorism” refers to biological agents (microbes or toxins) used as weapons to further personal or political agendas. Acts of bioterrorism range from a single exposure directed at an individual by another individual to government-sponsored biological warfare resulting in mass casualties.

Bioterrorism differs from other methods of terrorism in that the materials needed to make an effective biological agent are readily available, require little specialized knowledge and are inexpensive to produce. Until the aftermath of 9/11, few instances of bioterrorism were documented in the U.S.

A bioterrorist attack could be caused by virtually any pathogenic microorganism. The agents of greatest concern are anthrax (a bacterium) and smallpox (a virus). Both can be lethal. Anthrax is not communicable while smallpox is readily transmitted from person to person. In humans, the three forms of anthrax are inhalational, cutaneous and intestinal.

Symptoms vary depending upon how the person was exposed but generally occur within 7 days of the exposure. Initial symptoms of inhalational anthrax may resemble the flu. If untreated, symptoms will progress to breathing difficulties and eventual shock.

The incubation period for smallpox is 7 to 17 days following exposure. Symptoms include high fever, fatigue, and head and back pain. A characteristic rash follows in 2 to 3 days.

Who is at Risk?

In the U.S., the risk of contracting anthrax is extremely low. The intentional release of anthrax following the events of 9/11 resulted in only twenty-two recognized cases of cutaneous and inhalational anthrax. Any risk for inhalational anthrax due to cross-contaminated mail is also very low, even for postal workers.

The possibility does exist, however, that if anthrax was dispersed in a public place, a large number of people could be affected. Smallpox has not occurred in the U.S. since 1949. If the virus was intentionally released, the number of people affected could run to the tens of thousands.

Can It Be Prevented?

Bioterrorism differs from other methods of terrorism in that the effects are not always immediately apparent. An attack may be difficult to distinguish from a naturally occurring infectious disease outbreak.

The first evidence of an attack will be in hospital emergency rooms where the proper diagnosis will be essential in treating and preventing the spread of the disease. In the event of intentional anthrax distribution, people at risk should take a 60-day course of prophylactic antibiotics, either doxycycline or ciprofloxacin.

 Vaccination against smallpox is not recommended to prevent the disease in the general public. In people exposed to smallpox, however, the vaccine can lessen the severity of, or even prevent, illness if given within 4 days of exposure. The U.S. has a supply of vaccine for emergency use.

The Bottom Line

A story about bioterrorism carries inherent drama but also certain responsibilities. A story can raise concerns and heighten the public’s awareness of the topic or it could cause alarm and panic. And because biological materials are inexpensive and readily available, some thought should be given to whether or not the show will give ideas to potential terrorists. If a person thinks they have been exposed to a biological incident or they suspect a biological threat is planned, they should contact their local health department and/or their local police department. Either of these agencies will promptly notify the FBI, which is responsible for coordinating interagency investigation of bioterrorism.

The symptoms for early inhalational anthrax resemble those of the common cold or flu. Anthrax is diagnosed by isolating B. anthracis from the infected person or through other diagnostic tests. The fatality rate for cutaneous anthrax is about 20%; for inhalational anthrax the rate is closer to 75%. Smallpox is spread from person to person via airborne saliva droplets. The majority of people infected with smallpox do recover. There is a fatality rate of approximately 30%.

Case Examples

• A religious cult has established a base outside town. The cult has applied for a charter to start its own publicly funded school. It’s already been voted down once. The charter school is again on the ballot. On election day, hundreds of townspeople become ill and are too sick to get out to vote. In searching the cult headquarters on another matter, a vial of Salmonella typhimurium is found. After questioning by the police, one of the cult members reveals that the salmonella was used to intentionally contaminate local restaurant salad bars with the aim of limiting the number of people who would vote against the charter school.
• The E.R. is flooded with people experiencing cold and flu symptoms; some people are having difficulty breathing. Police get a phone call from someone claiming they released anthrax in a downtown office building. One of the doctors diagnoses inhalational anthrax. No one on the staff has ever seen a case before. The E.R. is thrown into a panic. Authorities are notified. At shift change, a doctor trained in the Soviet Union comes in and is informed of the case. He has experience with treating anthrax. After viewing a chest x-ray and CT, he’s convinced the problem is not anthrax. Cultures come back negative for B. anthracis, proving the doctor was correct in his diagnosis.

Summary

A bioterrorism attack is the deliberate release of viruses, bacteria, or other germs to cause illness or death. These germs are often found in nature. But they can sometimes be made more harmful by increasing their ability to cause disease, spread, or resist medical treatment.

Biological agents spread through the air, water, or in food. Some can also spread from person to person. They can be very hard to detect. They don’t cause illness for several hours or days. Scientists worry that anthrax, botulism, Ebola and other hemorrhagic fever viruses, plague, or smallpox could be used as biological agents.

Biodefense uses medical measures to protect people against bioterrorism. This includes medicines and vaccinations. It also includes medical research and preparations to defend against bioterrorist attacks.