Why is terrorism listed as an emerging disease

Report no. Yersinia pestis Mostly in areas of endemic plague in animals 18 investigations involving cholera Multiple 4 investigations in USA Mississippi, Maryland, Hawaii, California , 14 elsewhere Vibrio choleresis Cholera in two nursing home patients, outbreak involving imported food, outbreak involving consumption of raw fish, and outbreak involving contaminated food on international flight 12 investigations involving unknown agent on cruise ships Multiple Cruise ships Unknown Gastroenteritis outbreaks in which infectious agent was not identified by laboratory testing 26 additional investigations involving unknown agent Multiple 24 in USA, 2 elsewhere Unknown Gastroenteritis outbreaks, acute illness after surgical procedures, and other outbreaks in which no infectious agent was identified by laboratory testing.

Table 3 Epidemic Intelligence Service investigations in which bioterrorism or intentional contamination was considered a cause. Report No.

Outbreak Conclusion Salmonellosis, Oregon, A total of persons became ill with salmonella gastroenteritis. Religious group deliberately contaminated salad bars. Salmonella enterica Typhimurium strain found in laboratory at commune was indistinguishable from outbreak strain 5. Identical strains of S. Most cases caused by strain of S. Possibility that first two cases were caused by intentional contamination could not be excluded. Table 4 Number of days from beginning to notification for outbreaks in which bioterrorism or intentional contamination was considered.

Investigation Beginning of outbreak No. Discussion Investigations from to included outbreaks caused by B. References 1. Bioterrorism-related inhalational anthrax: the first 10 cases reported in the United States. Centers for Disease Control and Prevention Biological and chemical terrorism: strategic plan for preparedness and response. Am J Epidemiol. Public Health Rep. Centers for Disease Control and Prevention Bioterrorism alleging use of anthrax and interim guidelines for management—United States, A large community outbreak of salmonellosis caused by intentional contamination of restaurant salad bars.

Programs in Brief J Am Vet Med Assoc. Support Center Support Center. External link. Please review our privacy policy. Unknown infectious agent a. Vibrio choleresis. Viral hemorrhagic fever virus. Bacillus anthracis. Clostridium botulinum. Coxiella burnetii. Francisella tularensis. Rash and fever in children, no discernable cause. Botulism outbreak linked to contaminated food. Accidental infection with Sabia virus in laboratory worker. Contaminated solution used in grafting procedure; source undefined.

Exposure to live spore vaccine for anthrax. Mostly in areas of endemic plague in animals. Cholera in two nursing home patients, outbreak involving imported food, outbreak involving consumption of raw fish, and outbreak involving contaminated food on international flight. Gastroenteritis outbreaks in which infectious agent was not identified by laboratory testing. The belief that climate change is a major threat has increased steadily in the United States over the past seven years.

Views of climate change have been consistently partisan over the past decade. Americans overwhelmingly say that cooperation with other countries is important when dealing with major international threats. This is especially true on the preeminent international issue of early , the spread of infectious diseases. Indeed, an overwhelming majority of Americans think cooperation with other countries is important for dealing with all the major international issues polled.

But there is variation on whether people say cooperation is very important. However, Americans are more likely to say these major issues require cooperation than they are to say they see them as threats.

When comparing whether these issues are seen as major threats and whether cooperation to deal with them is very important, Americans tend to be more likely to say they require cooperation. There are also partisan differences on whether cooperation is important in dealing with international threats.

On each issue, Democrats are more likely than Republicans to say that cooperation with other countries is very important. The differences are especially large over 20 percentage points on global climate change, global poverty, the condition of the global economy and conflicts between other nations.

On the spread of infectious diseases, Democrats are also more likely than Republicans to say cooperation is very important, although partisan differences are not as stark as on climate change. It organizes the public into nine distinct groups, based on an analysis of their attitudes and values. Even in a polarized era, the survey reveals deep divisions in both partisan coalitions.

Veterinary toxids are widely used. These toxins are proteins with a molecular weight of 23, - 29, daltons 44, Staphylococcus aureus produces a number of exotoxins and since they normally exert their effect on the GI tract thy are called Enterotoxins. They are also called Pyrogenic toxins because they cause fever.

Staphylococcus Enterotoxin B SEB is a pyrogenic toxin that commonly causes food poisoning from improperly handled or refrigerated food. The effect of the inhaled SEB is markedly different. The diseases begins rapidly within 1 - 12 hours after ingestion with sudden onset of fever, chills, headache, myalgia and a nonproductive cough. Pulmonary edema occurs in severe cases. GI symptoms can occur concomitantly due to inadvertent swallowing of the toxin after inhalatione US Bioweapons program possessed prior to its termination in There is no specific therapy available.

Experimental immunization has been reported. No human vaccine is available. A candidate vaccine is in advanced development. Secondary aerosols are not a hazard and SEB does not pass through intact skin. Standard precautions for health care workers are recommended. Trichothecene mycotoxins are a group of more than 40 toxins produced by common molds like Fusarium, Myrotecium, Trichoderma, Stachybotrys and other filamentous fungi.

They are extremely stable in the environment and the only class of biological toxins that cause skin damage. Usual hypochlorite solution does not inactivate these toxins. They retain bioactivity even after autoclaving.

Skin exposure causes pain, pruritus, reduess, vesicles, necrosis and sloughing. Severe irritant effects are seen on the respiratory tract, GI tract and eyes on contact. Severe intoxication results in shock and death. Diagnosis should be suspected if an aerosol attack occurs in the form of "yellow rain" with contamination of the clothes and the environment by pigmented oily fluids.

Treatment is supportive only. Soap and water washing can prevent or significantly reduce dermal toxicity if done within 1 - 6 hours. Superactivated charcoal should be used for oral intoxication. No prophylactic chemotherapy or immunotherapy is available in the field.

Exposure during an attack should be prevented by mask and clothing. Secondary aerosols are not a hazard. Contact with contaminated skin and contaminated clothing can produce secondary dermal exposures. Until decontamination is accomplished, contact precautions are needed. Subsequently, standard precautions are recommended for health care workers. The agents in this group with the third highest priority include emerging pathogens that could be engineered for mass dissemination.

The characteristics that render them amenable to bioterrorism are - Availability Ease of production and dissemination Potential for high morbidity and mortality and major health impact.

The agents included in this category are: Nipah virus Hantavirus - discussed in the presentation on viral hemorrhagic fevers Tick borne hemorrhagic fever viruses Tick borne encephalitis viruses Yellow fever - discussed in the presentation on viral hemorrhagic fevers Multidrug resistant tuberculosis. The - outbreak in Malaysia caused 1 million deaths in swine and encephalitis in humans. The disease was eradicated from swine but is still likely to be present in fruit bats. Humans contracted Nipah virus by coming into direct contact with swine.

Human-to-human transmission has not been documented. No cases have been documented in the United States. Tick borne hemorrhagic fevers include Crimean-Congo hemorrhagic fever, Omsk hemorrhage fever and Kyasanur Forest disease To enhance the preparedness at local and state levels, the CDC funded co-operative agreements with states and several large cities Five areas were emphasized for the first 3 years of this program -.

The United States Food and Drug Administrations is participating in an interagency group preparing for response in a civilian emergency 55 The USAMRIID maintains an aeromedical isolation team to minimize the risk of transmission from the troops to air crews, caregivers and civilians Traditional first responders like firefighters and law enforcement officers are the most likely to respond to an announced attack, whereas physicians and other health care providers would be most likely to uncover an unannounced attack.

In either case, the medical community at large will be responsible for diagnosis and management of diseases caused by biological and chemical weapons. The Association for Professionals in Infection Control and Epidemiology APIC in cooperation with the CDC has prepared a Bioterrorism Readiness Plan to serve as a reference document and a template to facilitate preparation of bioterrorism readiness plans for individual institutions National Association of Counties conducted a survey of county Public Health directors A significant number of responding counties counties in 36 states reported less than optimal levels of preparedness for biological and chemical warfare and for policies and procedures to enforce a quarantine.

Among the reasons cited for unpreparedness were insufficient funding, insufficient work force and insufficient communications networks.

In most cities, large health care institutions have disaster plans and various types of task forces with "experts" in different areas in place. However, they need to be updated and modified to include new information on biological and chemical weapons.

In addition to being able to recognize and manage diseases associated with bioterrorism events, health care providers will need to stay abreast of new developments.

The same issue of Emerging Infectious Diseases August, has a review on the activity of humoral immunity against several biological agents and discusses the use of passive antibody administration Immediate Immunity as a specific defense against biological weapons Various models and estimates of the economic impact of bioterrorism attacks have been published.

Rapid implementation of a post-attack prophylaxis program is the single most important means of reducing the huge economic impact The model proposed by Kaufamnn et al. In the field of Infectious Diseases, reality is stranger than anything a writer could dream up. The most menacing bioterroist is Mother Nature herself. Their assistance in collecting the most recent literature and helping convert thoughts and rough drafts into a presentable review was invaluable.

Skip to main content. Overview of Potential Agents of Biological Terrorism. Nancy Khardori's Presentation on Bioterrorism Adobe Acrobat Reader required Infectious Agents as Tools of Mass Casualties Historically, outbreaks wars of microbial species against the human species have killed far more people than war itself. Bioterrorism , National Security and Law Bioterrorism has now been defined as the intentional use of a 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 4.

Historical Perspective and Trends Related to Bioterrorism The intentional use of living organisms or infected materials derived from them has occurred over centuries during war and "peace" time by armies, states, groups and individuals 14,15, Some of the more recent events of biological warfare are chronicled below - The Tartars catapulted bodies infected with plague into Caffa now Ukraine in at the end of a 3 day siege. The inhabitants of Central and South America were decimated by small pox and measles that accompanied the Spanish conquistadors.

British forces used blankets contaminated with small pox to infect North American Indians in the 18th century. The modern era of biological weapons development began immediately before and during World War II. The Japanese released fleas infected with plague in Chinese cities in the 's and 's. Between and Japanese unit dropped bombs containing up to 15 million plague infected fleas on two Chinese cities - Quxian and Ning-hsien, resulting in at least deaths.

Water supplies and food items were contaminated with B. Cholera, Shigella spp. Weather Underground , a United States revolutionary group intended to obtain agents at Ft. Detrick by blackmail and to temporarily incapacitate United States cities to demonstrate the impotence of the federal government. Report originated with a US Customs informant. College students influenced by ecoterrorist idealogy and 's drug culture planned on using agents of typhoid fever, diphtheria, dysentery and meningitis to target the entire world population initially and later narrowed the plan to five cities near Chicago.

The attack was aborted when cultures were discarded. Bulgarian defector Georgi Markov was assassinated in Lauda using ricin-filled pellet infected with a spring-loaded device disguised in an umbrella. Similar device used against a second defector in the same area was unsuccessful. Sverdlovsk, Russia Accidental release of anthrax from Soviet bioweapons facility caused an epidemic of inhalational anthrax with at least 77 cases and 60 deaths.

Red Army Faction Members of a Marxist revolutionary ideology group allegedly cultivated botulinum toxin in a Paris safe-house and planned attacks against at least 9 German officials and civilian leaders.

This probably was an erroneous report, later repudiated by the German government. Rajneeshee Cult Indian religious cult headed by Rajneeshee plotted to contaminate restaurant salad bars with Salmonella typhimanice in Dallas, Oregon.

The motivation was to incapacitate voters to win local elections and seize political control of the county. The incident resulted in a large community outbreak of salmonellosis involving patients and at least 45 hospitalizations. The plot was revealed when the cult collapsed and members turned informants.

Minnesota Patriots Council Right wing "Patriot" movement obtained Ricin extracted from castor beans by mail order. Aum Shinrikyo New Age Doomsday cult seeking to establish a theocratic state in Japan attempted at least 10 times to use anthrax, botulinum toxin, Q fever agent and Ebola virus in aerosol form.

All attempts with biological weapons failed. Multiple chemical weapon attacks with Sarin, Vx, hydrogen cyanide in Matsumato, Tokyo and an assassination campaign were conducted.

Nerve gas Sarin killed 12 and injured in Tokyo subway. Texas Intentional contamination of muffins and donuts with laboratory cultures of Shigella dysenteriae. The event caused gastroenteritis in 45 laboratory workers and 4 were hospitalized.

Larry Wayne Harris Allegedly threatened to release "military grade anthrax" in Las Vegas, Nevada. Obtained plague and anthrax vaccine strains , repeatedly isolated several other bacteria. Made vague threats against US federal officials on behalf of right wing "patriot" groups.

Arrested when he talked openly about biological weapons terrorism. Intentional dissemination of anthrax spores through the US Postal System leading to the death of five people, infection of 22 others and contamination of several government buildings. Investigation into the attacks so far has not led to any conclusions.

Chronology of Anti-Bioterrorism Biosafety Actions The United States signs but fails to ratify the treaty. The treaty contained no provision for verifications and inspection. International pressures mount to draw up new treaties to curb such weapons. November 25, President Richard M. Nixon unilaterally renounces the use of biological weapons in war by the United States and restricts research to immunization and safety efforts. Three months later, he extends the ban to include toxins.

The Biological and Toxin weapons Convention entered into force March 26, There are now states parties to the convention and an additional 18 signatories Article VI of the Convention that provides for actions against noncompliance has proved to be an inadequate mechanism. May 13, Shortly after the Allied victory against Iraq, President George Bush announced that the United States will renounce the use of chemical weapons for any reason.

April, Russian President Boris N. Yeltsin declares that Russia's biological weapons program is being discontinued.. January, President George Bush signs the Chemical Weapons treaty at the convention banning the production and use of chemical weapons. January 7, The Presidential Advisory Committee on Gulf War Veterans' illnesses, finds no conclusive evidence linking Gulf War Syndrome to exposure to chemical or biological weapons. April 15, New regulations aimed at limiting access to chemicals and pathogens that could be made into weapons go into effect under the Antiterrorism and Effective Death Penalty Act.

April 29, The Chemical Weapons Convention went into effect. It has more than signatories and 65 ratifications. July 25, The United States rejected a protocol to strengthen the Biological Weapons Convention as well as the whole approach to it Like the Chemical Weapons Conventions CWC , a strong bioweapons protocol could add to the deterrence of bioweapons which are a much greater threat.

The Threat of Biological Weapons The Biological weapons system is comprised of four components; a payload, munition, delivery system and dispersion system. Types of Bioterrorism Attacks A bioterrorist attack may occur in 2 scenarios - overt and covert. Agents of Bioterrorism Attacks Based on the ease of transmission, severity of morbidity, mortality, and likelihood of use, biological agents can be classified into 3 categories Table 1 Table 1 Table 2 Category A Agents Category A includes the highest priority agents that pose a risk to national security because of the following features - i.

Plague Microbiology and Epidemiology Plague is caused by Yersinia pestis , previously called Pasturella pestis. Clinical Features Y. Laboratory Diagnosis A high index of clinical suspicion and a careful clinical and epidemiologic history and physical examination are required to allow timely diagnosis of plague.

Antimicrobial Therapy. Post Exposure Prophylaxis Close contact for purposes of initiating antimicrobial prophylaxis is defined as contact with a patient at less than 2 meters. Vaccination A licensed killed whole cell vaccine was available in the United States from to late Infection Control Procedures Standard precautions should be used for bubonic plague patients.

Category B Agents This category 47 contains the second highest priority agents because they a. Diagnosis - The incubation period is 2 - 14 days, varies according to number of organisms inhaled.

Management - All suspected cases of Q fever should be treated to reduce the risk of complications. Brucellosis Also called undulant fever, Mediterranean Fever, Malta Fever Epidemiology and Microbiology Brucellosis is a zoonotic disease caused by infection with one of the six species of Brucellae, a group of facultative intracellular gram negative coccobacilli 36,44, Diagnosis The usual incubation period is 8 - 14 days but may be longer.

Management The United States military recommends doxycycline mg Q12 hr plus rifampin mg a day for six weeks. Glanders and Melioidosis Epidemiology and Microbiology Caused by Burkholderia mallei and Burkholderia pseudomallei respectively Diagnosis The incubation period is 10 - 14 days. Epsilon Alpha Toxin Clostridium perfringens produces 12 toxins Enterotoxin B These toxins are proteins with a molecular weight of 23, - 29, daltons 44, T-2 Mycotoxins Trichothecene mycotoxins are a group of more than 40 toxins produced by common molds like Fusarium, Myrotecium, Trichoderma, Stachybotrys and other filamentous fungi.

The characteristics that render them amenable to bioterrorism are - Availability Ease of production and dissemination Potential for high morbidity and mortality and major health impact The agents included in this category are: Nipah virus Hantavirus - discussed in the presentation on viral hemorrhagic fevers Tick borne hemorrhagic fever viruses Tick borne encephalitis viruses Yellow fever - discussed in the presentation on viral hemorrhagic fevers Multidrug resistant tuberculosis Nipah virus The - outbreak in Malaysia caused 1 million deaths in swine and encephalitis in humans.

Five areas were emphasized for the first 3 years of this program - Preparedness, planning and readiness assessment Surveillance and epidemiology capacity Biological laboratory capacity Chemical laboratory capacity Health alert network and training The United States Food and Drug Administrations is participating in an interagency group preparing for response in a civilian emergency 55 The USAMRIID maintains an aeromedical isolation team to minimize the risk of transmission from the troops to air crews, caregivers and civilians We would like to conclude this discussion with a quote "Modern adventurers like to up the ante, but even the most extreme sports wouldn't produce the adrenaline of a race against pandemic influenza or a cloud of anthrax at the Super Bowl.

References Diamond J. Guns, Germs and Steel. Publication NIE Heymann, DL. Hearing on the Threat of bioterrorism and the Spread of Infectious Diseases. It is also possible that the relative level of threat could change. For example, if an effective vaccine is developed against a particular agent, its level of threat would decrease, whereas if an agent becomes resistant to current therapies, its level of threat could increase. Researchers in the Department of Molecular Virology and Microbiology have studied and continue to investigate a number of pathogens that present a potential risk for use in bioterrorism.

Included among them are the Category A agents - anthrax , dengue , Ebola, smallpox , and tularemia - as well as Category B and C agents such as chikungunya , influenza , and Zika.

The research encompasses investigations into the basic biology of these agents, their interactions with the immune system, as well as the development of vaccines and tools to study and combat these agents. Department of Molecular Virology and Microbiology. Media Component. The classification into Categories A, B, and C is based on: The ability of the agent to be disseminated The mortality rate of the agent The actions required for public health preparedness The capability of causing public panic.

Definition of Potential Bioterrorism Agent Categories Category A Category B Category C Pose the highest risk to national security Pose the second highest risk to national security Emerging pathogens that could be engineered for mass dissemination Can be easily disseminated or transmitted from person to person Are moderately easy to disseminate Are easily produced and disseminated Have potential for high morbidity and mortality rates and major health impact Require special public health preparedness actions Require enhanced diagnostic capacity and disease surveillance Are available Have potential to cause public panic and social disruption.