Bioterrorism Preparedness and Response
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 typically found in nature, but it is possible that they could be changed 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, through water, or in food. Terrorists may use biological agents because they can be 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, can not
Bioterrorism agents can be separated into three categories, depending on how easily they can be spread and the severity of illness or death they cause. Category A agents are considered the highest risk and Category C agents are those that are considered emerging threats for disease.
Category A: These high-priority agents include organisms or toxins that pose the highest risk to the public and national security because:
- They can be easily spread or transmitted from person to person
- They result in high death rates and have the potential for major public health impact
- They might cause public panic and social disruption
- They require special action for public health preparedness.
Category B: These agents are the second highest priority because:
- They are moderately easy to spread
- They result in moderate illness rates and low death rates
- They require specific enhancements of CDC's laboratory capacity and enhanced disease monitoring.
Category C: These third highest priority agents include emerging pathogens that could be engineered for mass spread in the future because:
- They are easily available
- They are easily produced and spread
- They have potential for high morbidity and mortality rates and major health impact.
Federal, state, and local health authorities (the Centers for Disease Control and Prevention, the Public Health Service, etc) routinely conduct surveillance for a bioterrorist event. If an attack occurs, the local health agency (Cook County) would rapidly advise the medical community (the AMA, state medical society, individual physicians) by phone, fax, and the media with recommendations for diagnosis and treatment, as well as preventive measures for the specific biological agent involved.
Much still needs to be done and can be done to strengthen the U.S. health systems preparedness for a biological event. Federal, state, and local authorities are working with physicians, hospitals, and the pharmaceutical industry to enhance information and communication systems, ensure the availability and rapid deployment of life-saving pharmaceuticals, vaccines, and antidotes; and provide necessary medical supplies to counter the effects of chemical (eg, sarin, mustard gas) and biological agents.
Public health officials are most concerned with the following disease threats:
- Inhalational anthrax is the most serious form of anthrax and results from breathing bacterial spores into the lungs. Once in the lungs, the spores germinate into live bacteria that release potent toxins. The disease starts with flu-like symptoms, followed by severe respiratory complications. Death may occur within 2 to 3 days of symptoms. Exposure to airborne anthrax spores could cause symptoms as soon as 2 days after exposure or as late as 6 to 8 weeks after exposure. Once symptoms appear, antibiotics may have limited effectiveness for treatment of inhalational anthrax because it is too advanced.
- Cutaneous anthrax, the skin form of anthrax, can cause skin or intestinal disease. It is the most common form of anthrax and results from contamination of the skin with anthrax spores (particularly on exposed areas of the hands, arms, or face). The disease begins with a local swelling that may look like an insect bite and progresses to a fluid-filled blister. The blister dries, ulcerates, and then forms a coal-black scab (the word anthrax comes from the Greek word for coal). Without antibiotic treatment, the local infection may spread through the body and can be fatal.
- Smallpox is a serious viral disease that starts with fever, aches, fatigue, and vomiting, and progresses to a rash with blisters over much of the body. Initially, the rash may be confused with chicken pox. Smallpox spreads directly from person-to-person through airborne transmission. because it is a virus, it does not respond to antibiotics. A vaccine exists but is not available for widespread use.
- Pneumonic (new-monic) plague is caused by inhaling the bacteria associated with the "Black Death." It begins as a severe pneumonia with high fever, chills, and cough. Without prescription antibiotics, respiratory failure and death may occur within 12 to 24 hours after the initial symptoms appear. It spreads directly from person to person through the air (e.g., cough, sneeze). A vaccine exists for prevention of bubonic plague (when the lymph nodes are infected instead of the lungs) but is not considered effective against the inhaled (pneumonic) form of this disease.
- Botulism is caused by a bacterial protein that has been taken by mouth (eaten) or inhaled. It is one of the most potent toxic compounds known. Affected individuals may have difficulty speaking, seeing, and swallowing. Depending on the severity of exposure, symptoms may progress to general muscle weakness and respiratory failure. Without adequate respiratory care and treatment with antitoxin, death can occur within 24 to 72 hours. Botulism does not spread from person to person. A bioterrorist attack would likely involve airborne or foodborne release of botulinum toxin. Antibiotics are not effective.
- Tularemia (too-la-ree-mia) is one of the most infectious bacterial diseases known. A bioterrorist attack would likely involve airborne release of this organism. Fever, headache, and a pneumonia-like illness characterize the disease. Without antibiotic treatment, the disease can progress to respiratory failure, shock, and death. There is no evidence that it can be spread from person to person. A vaccine exists but is not available for widespread use.
- Viral hemorrhagic fevers are caused by a diverse group of viruses (e.g., Ebola, Marburg, Yellow Fever, Lassa, Rift Valley). Illness generally begins with flu-like symptoms such as fever, fatigue, dizziness, headache, and muscle aches. After 5 days a rash often develops, which is most prominent on the trunk of the body. Severe infection may lead to death due to complications from massive bleeding and shock due widespread damage to blood vessels. These viruses can be spread from person to person through contact with body fluids (eg, blood). A vaccine is available for prevention of Yellow Fever. Other vaccines are under investigation. No antibiotic is effective against these or any viral diseases.