SECTION 1
BASIC BIOTERRORISM
What Is Bioterrorism?
Bioterrorism can be defined as the intentional release, or threatened release, of disease-producing living organisms or biologically active substances derived from living organisms, for the purpose of causing death, illness, incapacity, economic damage, or fear. These organisms are considered weapons of mass destruction, or mass casualty weapons.
There are hundreds of potential biological weapons, including bacteria, viruses, genetically altered or enhanced infectious agents, vaccine and/or multidrug-resistant organisms, and toxins produced by organisms, some of which behave more like chemical than biological weapons. These weapons can be used for inciting panic and fear, paralyzing a nation, overwhelming medical services, causing severe economic damage, causing illness and death, and gaining a military advantage.
Many biological weapons are relatively inexpensive and easy to produce. Although the most sophisticated and effective versions require considerable equipment and specialized scientific expertise, primitive versions can be produced in a small, unobtrusive area, with minimal equipment and limited training. The former Soviet Union’s Germ Warfare Program developed many such highly specialized biological weapons. One such weapon consists of a Yersinia pseudotuberculosis bacterium that produces an initial, seemingly ordinary febrile illness, followed shortly by a severe progressive demyelinating neuropathy that leaves its victims completely paralyzed. Other unusual and dangerous weapons developed by the Russian program include hybrid (chimera) viruses that might simultaneously produce both smallpox and Ebola; bacterial proviruses that produce an initial case of plague, then release Venezuelan equine encephalitis virus when exposed to antibiotics; a prion weapon that produces a mad cow disease-like illness; stealth viruses that lay dormant within the victim until activated at a later time; and the previously mentioned bioregulator weapons.
Bioregulator weapons provoke the production of excessive amounts of normally occurring biological substances, producing a hugely exaggerated and detrimental physiologic response. Such weapons presently known to exist include a bacterium that produces large quantities of endorphins, which can cause extreme lethargy or even catatonia in addition to whatever usual pathological effects that organism produces, and an organism that produces excessive neurokinin P (substance P), which can cause sudden vasodilation with severe hypotension or shock, and bronchoconstriction with severe shortness of breath.
The Soviet biological weapons research program lasted for over 50 years, until its official dissolution by Boris Yeltsin in 1992. In that time, the Soviet program not only caught up with the U.S. program, behind which it had lagged by about 5 years, but it became, by far, the most sophisticated biological weapons program in the world. The present status of these weapons in the former Soviet arsenal is not entirely known.
The use of biological weapons in wartime is not a new concept. The first recorded instances date back to the sixth century B.C., when the Assyrians poisoned enemy wells with rye ergot to disable them with ergotism, or St. Anthony’s fire, as it was known in the Middle Ages. At about the same time, the Greeks were employing the purgative herb hellebore to “occupy” their enemies during the siege of Krissa. Many such instances involving the military use of living organisms or toxins exist throughout history.
In the twentieth century, the development of biological weapons reached a fever pitch with well-organized and well-funded biological warfare programs in Germany and Japan during World War II, and in the United States and the Soviet Union during the cold war. The United States dismantled its biowarfare program in the 1960s, but the Russians, who at the time denied having such a program, produced tons of traditional disease weapons and many innovative and extremely dangerous new weapons. After the breakup of the Soviet Union and the subsequent prolonged economic crisis that occurred there, many of the scientists who helped develop and refine the Russian biological weapons found themselves without jobs or, if still employed, without paychecks. A number of them left Russia and found their way to oil-rich third world countries, such as Iraq, which actively support terrorism, and where their knowledge and skills were highly prized. Some of the scientists are believed to have left Russia with samples and seed cultures in their pockets with which they could easily begin developing new biological weapons programs. From these countries, some of the most dangerous weapons are known to have found their way into the hands of international terrorist organizations that undoubtedly would use them against their perceived enemies at the first opportunity.
Although this book deals only with human diseases, it is important to remember that not all biological weapons directly target human beings. There is a great potential for disrupting food supplies and producing huge economic damage with weapons aimed at farm animals and crops. Foot and mouth disease would be just such a potential weapon even though it does not produce any significant human illness.
Categorizing Biological Weapons
The Centers for Disease Control and Prevention (CDC) prioritizes biological weapons as categories A, B, and C, according to such qualities as their accessibility, ease of use, potential for social disruption, morbidity, mortality, and contagiousness.
CATEGORY A
• Can be easily disseminated and/or transmitted from person to person
• Cause high mortality and have the potential for major public health impact
• Might cause public panic and social disruption
• Require special action for public health preparedness
Included in this category are such diseases as plague, smallpox, viral hemorrhagic fevers, botulism, tularemia, and anthrax.
CATEGORY B
• Are moderately easy to disseminate
• Cause moderate morbidity and low mortality
• Require specific enhancements of the CDC’s diagnostic capacity and enhanced disease surveillance
This category includes the toxins or agents of diseases such as brucellosis, glanders, Q fever, ricin, abrin, trichothecene (T-2) mycotoxins, and staphylococcus enterotoxin B.
CATEGORY C
• These 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 and major health impact.
This category includes diseases such as the Hantaviruses, multidrug-resistant tuberculosis, tick-borne encephalitis and hemorrhagic fever viruses, and yellow fever.
Agents may also be separated into groups according to type, such as bacteria, virus, fungus, or toxin. The illnesses they produce can be divided according to their most prominent symptoms or the syndromes they produce, such as pneumonia or acute respiratory distress with and without fever, flulike illness with rash, neurologic syndromes with and without fever, and acute gastrointestinal (GI) syndromes with and without fever. A more complete listing of such syndromes can be found in Section 2 of this book. However they are classified or categorized, the most important factor is to consider them when confronted with an ill patient, especially if an attack with one or more biological weapons has already been announced or identified.
Flulike Illness
Many biological weapons have an initial presentation similar to that of influenza. This presentation has come to be known as a flulike illness (FLI) or influenza-like illness (ILI). The CDC lists the symptoms of influenza as the rapid onset of fever, malaise or fatigue, myalgias, headache, cough, sore throat, and nasal congestion. Any syndrome that presents with most or all of these symptoms fits the category of flulike illness. A large number of currently recognized biological weapons present in just that way and must be differentiated from common influenza as quickly as possible. One way to make this differentiation is to look at some of the other symptoms associated with these biological weapons, such as chest pain, rash, hemoptysis, and prominent gastrointestinal symptoms, which are not common with influenza. Additionally, sore throat and nasal congestion are common presenting symptoms of influenza, but sore throat occurs in only a handful of biological weapons, and nasal congestion is common only after exposure to trichothecene mycotoxins. A comparison of influenza to the presenting symptoms of most of the likely biological weapons can be found in Table 1.
What Makes an Effective Weapon?
There are a number of qualities and factors that make a particular agent appealing to a terrorist (or the military) for use as a biological weapon. The type of attack planned, the resources of the terrorist or group, and the goals of the attack (i.e., kill, incapacitate, frighten, or disrupt) will dictate the weapon of choice.
INEXPENSIVE AND EASY TO PRODUCE
Anthrax is a good example of a weapon that can be acquired or produced in large quantities for under $100. It can be found in soil in most parts of the world and is easily and rapidly grown in culture with minimal equipment and little expertise. Even though smallpox would make a much more devastating weapon, it would be extremely expensive or even impossible to acquire for the majority of terrorist organizations, and it requires expensive equipment and special skills to adequately maintain it.
EASY TO WEAPONIZE
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