November 29, 2001

Planning for Bioterrorism

A preview of selected text from the upcoming book: “Physical and Biological Hazards of the Workplace, Second Edition”

By Peter H. Wald, MD and Gregg M. Stave, MD

Concerns about biological warfare and bioterrorism have existed for several decades, and have been heightened by the horrific events of September 11, 2001 , and their aftermath.

Several countries are known to have had biological warfare programs and stocks of agents are known to exist. At least 35 agents and organisms have been classified as possible bioterrorism concerns. The most widely discussed are anthrax, botulism, plague, tularemia, and smallpox (Table 20-5.). An epidemic of anthrax occurred in the former Soviet Union following an accidental release from a military facility in Sverdlovsk in 1979. As of this writing, in October 2001, there had been more than a dozen exposures to anthrax sent through the mail in the US , resulting in several cases of cutaneous anthrax and one fatality due to inhalation anthrax. These episodes have led to heightened fears about the possibility of further small and also large-scale bioterroism activities.

While publicized incidents of bioterrorism lead to significant fears, it should be kept in mind that the actual risk of being involved in an event is extremely small. The dissemination of large quantities of bioterroism agents and organisms fortunately has many significant technical challenges.

A prudent response to concerns involves different actions for individuals, professionals, and organizations. In general, people should be reassured that their personal risk is very low, and that they should take reasonable precautions in everyday life. This includes not handling suspicious looking mail and packages, and accessing their local emergency response system as needed. The practices of hoarding antibiotics or using antibiotics without a medical diagnosis should be discouraged.

For the medical and emergency response community, there is a need to learn to recognize the signs and symptoms of bioterrorism agents and organisms (Table 20-5.). This is of special concern because many of these diseases are otherwise uncommon, or, as in the case of smallpox, have not been seen for decades.

Significant improvements in the public health infrastructure are needed to enhance readiness for bioterrorism. Increased funding of these activities is likely in light of the events of 2001.

The animal care community also plays a role in surveillance, since some of the organisms involved are animal pathogens. Veterinarians, farmers, and others who work with and care for animals need to recognize potential public health implications of certain problems seen in animals.

Organizations and companies that handle mail and packages need to develop prudent handling procedures to recognize and isolate suspicious items. Medical, maintenance, safety, and security staffs, and emergency response personnel should receive appropriate training.

Finally, concerns about bioterrorism should be kept in perspective in the context of the everyday risks to life and health. Most preventable morbidity and mortality is due to addictions (especially tobacco) and modifiable lifestyle factors, and treatable diseases and risk factors. Individuals, healthcare personnel and health systems should maintain and increase the focus on these more mundane issues, as they will ultimately have the greatest impact on life and health.

Table 20-5. Potential Biological Warfare Agents

Courtesy of Michael Hodgson, M.D., http://occenvmed.net/biocard16.doc , accessed 10/16/01

Bioterrorism Websites

            http://www.bt.cdc.gov

http://www.hopkins-biodefense.org

http://biotech.law.umkc.edu/blaw/govdocs.htm

http://biotech.law.umkc.edu/blaw/Bioterror.htm

http://www.ama-assn.org/ama/pub/category/6206.html

http://www.usamriid.army.mil/education/bluebook.html

http://miemss.umaryland.edu/WMDSupplement.pdf

http://www.nbc-med.org

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“Physical and Biological Hazards of the Workplace, Second Edition”
by Peter H. Wald, MD and Gregg M. Stave, MD

NEW! Now extensively updated and expanded, this practical "how-to" reference provides an overview including basic information on either the physical type or underlying biology of workplace hazards. The new edition includes updated references and latest research. Biological agents are covered in equal depth, from the fundamentals of microbiology and infectious disease, to the specific details of organic hazards like wood dust and endotoxins. Release date, December 2001. Hardcover, 600 pages.