Update on bioterrorism preparedness.

Knowledge and preparation are the best defense against a biological attack. By understanding the epidemiology of biological warfare agents and diseases, strategies can be planned to decrease the morbidity and mortality associated with them. There is an urgent need for developing rapid diagnostic tests, effective vaccines, and drug therapy to defend against biological weapon attacks. The CDC, along with other agencies and partners, are defining how the public health system is to prepare for and respond to public health threats posed by terrorism.

Other biologic toxin bioweapons: ricin, staphylococcal enterotoxin B, and trichothecene mycotoxins.

The ideal biologic warfare agent is lethal, easy, and inexpensive to produce in large quantities, stable in aerosol for/with the ability to be dispersed over wide areas, has no effective treatment or vaccine, and is communicable from person to person. With the exception of the last characteristic, the biologic toxins (ricin, staphylococcal enterotoxin B, T-2 mycotoxin, and botulinum) possess all the properties mentioned. This article will discuss the first three biologic toxins, with an emphasis on particular points of interest to the dermatologist. Botulinum toxin will be covered in another article.

Other viral bioweapons: Ebola and Marburg hemorrhagic fever.

The term viral hemorrhagic fever refers to a clinical syndrome characterized by acute onset of fever accompanied by nonspecific findings of malaise, prostration, diarrhea,and headache. Patients frequently show signs of increased vascular permeability, and many develop bleeding diatheses. The hemorrhagic fever viruses represent potential agents for biologic warfare because of capability of aerosol transmission, high morbidity,and mortality associated with infection, and ability to replicate in cell culture in high concentrations. Herein we discuss the Filoviridae, the agents of Ebola and Marburg hemorrhagic fevers.

Tularemia: the disease and the weapon.

Tularemia is a bacterial infection usually transmitted via arthropod vectors or direct contact with infected animals. Naturally occurring cases are relatively rare, and can result in six different clinical syndromes. Tularemia is also a potential agent of bioterrorism or biowarfare, and is categorized as a high-level threat. Effective antibiotic treatment is available, including potential use of oral antibiotics in a mass casualty situation. An awareness of potential clinical presentations of tularemia will facilitate timely intervention,appropriate diagnostic testing, and decreased morbidity in the event of a biologic attack with Francisella tularensis.

Precautions against biological and chemical terrorism directed at food and water supplies.

Deliberate food and water contamination remains the easiest way to distribute biological or chemical agents for the purpose of terrorism, despite the national focus on dissemination of these agents as small-particle aerosols or volatile liquids. Moreover, biological terrorism as a result of sabotage of our food supply has already occurred in the United States. A review of naturally occurring food- and waterborne outbreaks exposes this vulnerability and reaffirms that, depending on the site of contamination, a significant number of people could be infected or injured over a wide geographic area. Major knowledge gaps exist with regard to the feasibility of current disinfection and inspection methods to protect our food and water against contamination by a number of biological and chemical agents. However, a global increase in food and water safety initiatives combined with enhanced disease surveillance and response activities are our best hope to prevent and respond quickly to food- and waterborne bioterrorism.

Bioterrorism: an overview.

How real is the threat of bioterrorism? Experts may disagree on the likelihood of use, but the possibility cannot be totally dismissed. Complacent ignorance of a low-probability, high-cost risk is dangerous and can result in devastating global consequences.

The next target of bioterrorism: your food.

One of the many forms that biological warfare may take is the targeting of major food crops. In a poor country where millions of citizens depend on staple crops such as rice, an act of bioterrorism that destroys the crop would create a famine, resulting not only in malnutrition and starvation but also in reduced immune resistance to a range of common illnesses. To reduce the potential of deliberate introductions of crop pathogens as acts of terrorism, researchers must be able to "fingerprint" pathogens at the molecular level and discriminate between naturally occurring and deliberately introduced outbreaks. Several domestic and international surveillance, tracking, and reporting efforts are under way.