Bioterrorism

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.

Bioterrorism agents are classified as categories A, B, and C

Category A

Category B

Category C

High-priority agents include organisms that pose a risk to national security because they can be easily disseminated or transmitted from person to person, result in high mortality rates, and have the potential for major public health impact. They might cause public panic and social disruption, and require special action for public health preparedness.

The second highest priority agents include those that are moderately easy to disseminate, result in moderate morbidity rates and low mortality rates, and require specific enhancements of CDC’s diagnostic capacity and enhanced disease surveillance.

The third highest priority agents include emerging pathogens that could be engineered for mass dissemination in the future because of availability, ease of production and dissemination, and potential for high morbidity and mortality rates and major health impact.

Agents/diseases include anthrax (Bacillus anthracis), botulism (Clostridium botulinum toxin), plague (Yersinia pestis), smallpox (Variola major), tularemia (Francisella tularensis), and viral hemorrhagic fevers [filoviruses (e.g. Ebola, Marburg) and arenaviruses (e.g. Lassa, Machupo)].

Agents/diseases include brucellosis (Brucella species), epsilon toxin of Clostridium perfringens, food safety threats (e.g., Salmonella species, Escherichia coli O157:H7, Shigella), glanders (Burkholderia mallei), melioidosis (Burkholderia pseudomallei), psittacosis (Chlamydia psittaci), Q fever (Coxiella burnetii), ricin toxin from Ricinus communis (castor beans), Staphylococcal enterotoxin B, typhus fever (Rickettsia prowazekii), viral encephalitis [alphaviruses (e.g. Venezuelan equine encephalitis, eastern equine encephalitis, western equine encephalitis)], and water safety threats (e.g. Vibrio cholerae, Cryptosporidium parvum).

Agents include emerging infectious diseases such as Nipah virus and Hanta virus, and Mycobacterium tuberculosis (multidrug-resistant strains).

Newer trends are products of microbes that can kill or incapacitate targeted hosts, e.g. hormones, neuropeptides, cytokines called as “designer substances” to target a particular organ or type of enemy. Others are “ethnic bombs” and parasite biological weapons under trial to affect cash crops.

Countermeasures For Bioterrorism

Deterrence (certainty of being punished for the act perpetrated: To strengthen the area of biodefense, the US senate passed the “Bioterrorism Act of 2002.” According to this law, there is an essential element of national preparedness against bioterrorism and the focus is on safety of drugs, food, and water from biological agents and toxins. However, we in India are still waiting for a law on bioterrorism.

Prevention (reducing the opportunity, enhanced intelligence): Currently, there is a lacuna in international legislations and treaties to curb or prevent biological weapons’ attacks. Launched in 2004 under the aegis of a $1 million grant from the US-based Alfred P. Sloan Foundation, Interpol held its first “Interpol Global Conference on Preventing Bioterrorism” at its headquarters on 1-2 March 2005.

The March conference sought to “examine the risk of bioterror attacks, case studies, prevention of attacks, preparation and training of law enforcement personnel, and the related legal and political framework.”

Surveillance and assessment (early detection or awareness) by epidemiological methods: public health authorities must implement surveillance systems so that they can recognize patterns of non-specific syndromes that could indicate the early manifestations of a biological warfare attack.

1.Harnessing information, which are considered to be epidemiologic clues of a possible biological warfare Epidemiologic clues of a biologic warfare or terrorist attack.

2.Verification, immunization, and confirmation

3.Initiation of appropriate prevention and control measures

Laboratory investigation for diagnosis and characterization/sensitivity of the biological organism: The main role of the hospital-based clinical microbiology laboratory in support of a biothreat, biocrime, or act of bioterrorism is to “raise suspicion” when a targeted agent is suspected in a human specimen.

It should be prepared to recognize and respond to a covert event involving the collection, preservation, transport, and testing of human specimens.

Medical management (preventive, promotive, and curative services): Medicines and vaccine to be provided; the category of population to be given chemoprophylaxis/immunoprophylaxis identified; availability of the requisite quantity of drugs or vaccine; and outline of the mechanism of administration with health infrastructure.

Dissemination (public safety and law enforcing agencies):

Warning network such as hospitals and public health agencies
Individual clinical expertise of medical personnel

Way forward:

To create awareness among the public and doctors;
To stock pile drugs and vaccines; allocation of separate funds;
Preparedness: this is not a cause for panic–it is a cause for serious,
Deliberate long-term concern;
International collaboration
Microbiologists are the main focal points of action because the biological weapons are the products of their specialty

To meet the challenge of bioterrorism, coordinated and concerted efforts of different agencies, viz. the intelligence agency, the army, the BSF, SSB, law enforcement machinery, health departments most importantly (surveillance, laboratory response network, alertness of medical and paramedical faculties), civil administration, etc. are required.