Bioterrorism is teremed as "the intentional or threatened use of viruses, bacteria, fungi, or toxins from living organisms to produce death or disease in humans, animals, and plants." The use of biological agents to effect personal or political outcomes is not new, and the modern use of biological agents is a reality. The most notable intentional uses of biological agents for criminal or terror intent are (1) the use of Salmonella enterica serovar Typhimurium in 10 restaurant salad bars (by the Rajneeshee religious cult in The Dalles, Oregon, 1984); (2) the intentional release of Shigella dysenteriae in a hospital laboratory break room (perpetrator[s] unknown; Texas, 1996); and (3) the use of Bacillus anthracis spores delivered through the U.S. postal system (perpetrator[s] unknown, although the FBI named Bruce Ivins, now deceased, as the likely suspect; five eastern U.S. states, 2001). The S. enterica-contaminated salads resulted in 751 documented cases and 45 hospitalizations due to salmonellosis. The S. dysenteriae release resulted in eight confirmed cases and four hospitalizations for shigellosis. The B. anthracis spores infected 22 people (11 cases of inhalation anthrax and 11 cases of cutaneous anthrax) and caused five deaths. The list of biological agents that could pose the greatest public health risk in the event of a bioterrorism attack is relatively short and includes viruses, bacteria, parasites, and toxins that, if acquired and properly disseminated, could become a difficult public health challenge in terms of limiting the numbers of casualties and controlling panic.
Among weapons of mass destruction, biological weapons can be as destructive as chemical weapons, including nerve gas. In certain circumstances, biological weapons can be as devastating as a nuclear explosion: a few kilograms of anthrax spores could kill as many people as a Hiroshima-size nuclear bomb. Biological agents are likely to be chosen as a means of localized attack ( biocrime) or mass casualty (bioterrorism) for several reasons. They are mostly invisible, odorless, tasteless, and difficult to detect. Furthermore, perpetrators may escape undetected as it may take hours to days before signs and symptoms of their use become evident. Additionally, the general public is not likely to be protected immunologically against agents that might be used in bioterrorism. Ultimately the use of biological agents in terrorism results in fear, panic, and chaos.

  In 1998 the U.S. government launched the first national effort to create a biological weapons defense. The initiatives included (1) the first-ever procurement of specialized vaccines and medicines for a national civilian protection stockpile; (2) invigoration of research and development in the science of biodefense; (3) investment of more time and money in genome sequencing, new vaccine research, and new therapeutic research; ( 4) development of improved detection and diagnostic systems; and (5) preparation of clinical microbiologists and clinical microbiology laboratories as members of first-responder teams to respond in a timely manner to acts of bioterrorism. In 2002 the Congress enacted the Public Health Security and Bioterrorism Preparedness and Response Act, which identified "select" agents whose use is now tightly regulated (table 37.8). The agents are categorized (A, B, or C) based on (1) ease of dissemination, (2) communicability, and (3) morbidity and mortality. A final rule implementing the provisions of the act that govern the possession, use, and transport of select agents was issued in 2005.
Effect of bioterrorism
In 2003 Congress established the Department of Homeland Security to coordinate the defense of the United States against terrorist attacks. As one of many duties, the secretary of Homeland Security is responsible for maintaining the National Incident Management System to monitor large-scale hazardous events. Bioterrorism and other public health incidents are managed within this system. The Department of Health and Human Services will respond and deploy assets as needed within the areas of its statutory responsibility (e.g., the Public Health Service Act and the Federal Food, Drug, and Cosmetic Act), while appraising the secretary of Homeland Security of the nature of the response. The secretary of Health and Human Services directs the CDC to effect the necessary integration of public health activities.

The events of September and October 2001 in the United States changed the world. Global efforts to prevent terrorism, especially using biological agents, are evolving from cautious planning to proactive preparedness. In the United States, the CDC has partnered with academic institutions across the country to educate, train, and drill public health employees, first responders, and numerous environmental and health-care providers. Centers for Public Health Preparedness were established to bolster the overall response capability to bioterrorism. Another CDC-managed program that began in 1999, the Laboratory Response Network (LRN), serves to ensure an effective laboratory response to bioterrorism by helping to improve the nation's public health laboratory infrastructure through its partnership with the FBI and the Association of Public Health Laboratories (APHL). The LRN maintains an integrated network that links state and local public health, federal, military, and international laboratories so that a rapid and coordinated response to bioterrorism or other public health emergencies (including veterinary, agriculture, military, and water- and food-related) can occur.

In the absence of overt terrorist threats and without the ability to rapidly detect bioterrorism agents, it is likely that a bioterrorism act will be defined by a sudden spike in an unusual (nonendemic) disease reported to the public health system. Also, suddenly increased numbers of zoonoses, diseased animals, or vehicle-borne illnesses may indicate bioterrorism. Important guidelines and standardized protocols prepared for all sentinel (local hospital, contract, clinic, etc.)  laboratories to assist in the management of clinical specimens containing select agents have been established by the American Society for Microbiology in coordination with the CDC and the APHL.


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