A plausible worst-case scenario of increasing multidrug resistance as a tool for assessing societal risks and capabilities in Sweden.

A "plausible worst-case scenario" of a gradually increasing level of multidrug-resistant bacteria (carbapenem-resistant E. coli) in the human population was developed and used to study how Swedish authorities would manage this situation and to identify preventive measures that could be taken. Key findings include: (1) a scenario in which 5% of the population in southern Sweden become carriers of carbapenem-resistant E. coli is possible or even likely in 10 to 15 years; (2) it is not clear when and how the increase of E. coli resistant to carbapenems as in the scenario would be detected in the general human population; (3) identified negative consequences of the scenario on society were primarily due to increased demands on the healthcare system and potential consequences for food-producing animals, food safety, and environmental health; and (4) a number of preventive and mitigation measures were suggested, including initiating long-term screening programs for public and animal health as well as for food and water production to monitor increasing levels of carbapenem resistance. Strategies and plans to prevent and handle future increasing prevalence of multidrug-resistant bacteria need to be developed.

Historical perspective on agroterrorism: lessons learned from 1945 to 2012.

This article presents a historical perspective on agroterrorism cases from 1945 until 2012. The threat groups and perpetrators associated with bio- and agroterrorism are clustered into several groups: apocalyptic sects, lone wolves, political groups, and religious groups. We used open-source information, and 4 biological agroterrorism cases are described: (1) in 1952, Mau Mau poisoned cattle in Kenya by using a plant toxin from the African milk bush plant; (2) in 1985, the USDA claimed that Mexican contract workers were involved in deliberately spreading screwworm (Cochliomyia hominivorax) among livestock; (3) in 2000, Palestinian media reported that Israeli settlers released sewer water into Palestinian agricultural fields; and (4) in 2011, a person was sentenced to prison after threatening US and UK livestock with the deliberate spread of foot-and-mouth disease virus. All 4 cases can be assigned to political groups. These cases have not attracted much attention in literature nor in the public media, and the credibility of the sources of information varies. We concluded that agroterrorism has not been a problem during the period studied. Lessons learned from the few cases have generated awareness about the fact that nontypical biological weapons and non-high-risk agents, such as African milk bush, screwworm, and sewer water, have been used by attackers to influence local decision makers. This review will be useful in improving future preparedness planning and developing countermeasures.