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bioterrorism

The intentional release of pathogen(s) for the purpose of harming of killing civilians. [1] Classification: 1) class A* a) Anthrax (Bacillus anthracis) - anthrax spores are easily dispersed by aerosolization - infective spores may be sent through the mail [1] - aerosolized release of Bacillus anthracis spores over densely populated areas could result in mass-casualty [15] b) plague (Yersinia pestis) - intentional aerosol release or pathogen - untreated plaque is nearly 100% fatal c) smallpox (Variola virus) - effectively eradicated worldwide - Variola virus exists only in a few laboratory respositories - aerosol dissemination of virus obtained from laboratory respository d) botulism (Clostridium botulinum) - aerosol dissemination - food-borne botulism - contamination of water supply unlikely e) tularemia (Francisella tularensis) - aerosol dissemination - serologic diagnosis cannot be made in timely manner - Francisella tularensis DNA on tissue specimens f) viral hemorrhagic fever [1] - Flaviviridae - yellow fever - dengue - tick-borne flavivirus - Filoviridae - Ebola virus - Marburg virus - Arenaviridae - Lassa fever - South American hemorrhagic fevers - Bunyaviridae - Rift Valley fever - Hantavirus - Crimean Congo hemorrhagic fever - hemorrhagic fever with renal syndrome - intensive supportive care is the primary treatment 2) class B* - Q fever - brucellosis - glanders - melioidosis - viral encephalitis - typhus fever - ricin - Staphylococcal enterotoxin B - psittacosis - foodborne illness - waterborne illness 3) class C - Nipah virus - hantavirus * class A: greatest potential danger, easily disseminated or person to person spread, high mortality * class B: less easily spread, fewer deaths * class C: future ability to engineer for mass dissemination with substantial mortality

Related

biodefense biological warfare

General

terrorism

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18. American College of Physicians, Philadelphia 2012, 2015, 2018.
  2. Arnon SS, Schechter R, Inglesby TV Botulinum toxin as a biological weapon: medical and public health management. JAMA. 2001 Feb 28;285(8):1059-70. PMID: 11209178
  3. Borchardt SM, Ritger KA, Dworkin MS. Categorization, prioritization, and surveillance of potential bioterrorism agents. Infect Dis Clin North Am. 2006 Jun;20(2):213-25 PMID: 16762736
  4. Borio L, Inglesby T, Peters CJ, Schmaljohn AL et al Hemorrhagic fever viruses as biological weapons: medical and public health management. JAMA. 2002 May 8;287(18):2391-405. PMID: 11988060
  5. Breman JG, Henderson DA. Diagnosis and management of smallpox. N Engl J Med. 2002 Apr 25;346(17):1300-8. PMID: 11923491
  6. Bush LM, Abrams BH, Beall A, Johnson CC. Index case of fatal inhalational anthrax due to bioterrorism in the United States. N Engl J Med. 2001 Nov 29;345(22):1607-10 PMID: 11704685
  7. Dennis DT, Inglesby TV, Henderson DA Tularemia as a biological weapon: medical and public health management. JAMA. 2001 Jun 6;285(21):2763-73 PMID: 11386933
  8. Inglesby TV, Dennis DT, Henderson DA Plague as a biological weapon: medical and public health management. Working Group on Civilian Biodefense. JAMA. 2000 May 3;283(17):2281-90. PMID: 10807389
  9. Inglesby TV, O'Toole T, Henderson DA et al Anthrax as a biological weapon, 2002: updated recommendations for management. JAMA. 2002 May 1;287(17):2236-52. PMID: 11980524
  10. Adalja AA, Toner E, Inglesby TV. Clinical Management of Potential Bioterrorism-Related Conditions. N Engl J Med. 2015 Mar 5;372(10):954-962. PMID: 25738671
  11. Bower WA et al Clinical Framework and Medical Countermeasure Use During an Anthrax Mass-Casualty Incident. MMWR. Recommendations and Reports Dec 4, 2015 / 64(RR04);1-28 http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6404a1.htm
  12. Christian MD. Biowarfare and bioterrorism. Crit Care Clin. 2013 Jul;29(3):717-56. Review. PMID: 23830660
  13. Chung S, Baum CR, Nyquist AC DISASTER PREPAREDNESS ADVISORY COUNCIL, COUNCIL ON ENVIRONMENTAL HEALTH, COMMITTEE ON INFECTIOUS DISEASES. Chemical-Biological Terrorism and Its Impact on Children. Pediatrics. Jan 20, 2020 PMID: 31988169 PMID: 31988168 https://pediatrics.aappublications.org/content/early/2020/01/23/peds.2019-3749 - Technical report https://pediatrics.aappublications.org/content/early/2020/01/23/peds.2019-3750
  14. http://www.bt.cdc.gov
  15. Bioterrorism and Complementary Alternative Medicine (CAM): What the Public Needs To Know http://nccam.nih.gov/health/alerts/bioterrorism/