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Apart from the natural transnational movement of the pathogenic organisms, their potential use as weapons of biological warfare and bio-terrorism has become far more important now than ever before. Utilization of organisms causing smallpox and anthrax by such terrorist groups can cause greater harm and panic.

Biological Agents are living organisms or their toxic products that can kill or incapacitate people, livestock, and plants.

Bio-terrorism can be defined as the use of biological agents to cause death, disability or damage mainly to human beings. Thus, bio-terrorism is a method of terrorist activity to prevail mass panic and slow mass casualties.

The three basic groups of biological agents, which could be used as weapons, are bacteria, viruses, and toxins. Most biological agents are difficult to grow and maintain. Many break down quickly when exposed to sunlight and other environmental factors, while others, such as anthrax spores, are very long lived. Biological agents can be dispersed by spraying them into the air, by infecting animals that carry the disease to humans, and by contaminating food and water. Potentially, hundreds of human pathogens could be used as weapons; however, public health authorities have identified only a few as having the potential to cause mass casualties leading to civil disruptions.

There are three categories of biological agents potential enough to cause mass casualties. However, those in category A have the greatest potential for fear and disruption and most significant public health impacts. The list of these biological agents with a very brief description about them is given below.
  • The disease anthrax is caused by the gram-positive, non-motile Bacillus anthracis. Anthrax has been a scourge of cattle and other herbivores for centuries. During the industrial revolution, the inhalation form was first recognized as an occupational pulmonary disease in workers in the wool industries of Europe. Anthrax makes an ideal biological weapon. The inhalation form of disease is highly lethal. The spores can maintain virulence for decades and they can be milled to the ideal particle size for optimum infection of the human respiratory tract. Different clinical forms of the disease are observed, depending on the route of exposure. Inhalational anthrax presents with non-specific symptoms that cannot be distinguished from many more common diseases based on early clinical manifestations or routine laboratory tests. Therefore, despite aggressive medical care sometimes develop rapidly progressive disease and dye.
  • If used as a biological weapon, smallpox represents a serious threat to civilian population because of its case fatality rate of 30% or more among unvaccinated persons and the absence of specific therapy. Smallpox has long been considered as the most devastating of all infectious diseases and today its potential for devastation is far greater than at any previous time. Smallpox virus is a member of genus Orthopoxvirus, and it is closely related to the viruses causing cowpox, vaccinia and monkey pox. It is one of the largest DNA viruses known, and it has a bricklike appearance on electron microscopy. Transmission of this virus can occur in several different ways: generally by droplets, occasionally by aerosol, by direct contact with secretions or lesions from a patient, and rarely by formites contacted with the infection virus from a patient. Transmission risk increases if the index patient is coughing or sneezing or if he or she has hemorrhagic disease. Typically, the virus enters the respiratory mucosa and then travels to regional lymph nodes where it replicates. The incubation period from infection to onset of rash ranges from 7 to 17 days, averaging 12 to 14 days. Smallpox scabs remain infectious until they fall off, whereas chickenpox is no longer infectious once the lesions are crusted.

  • The mere mention of the word plague conjures up many images because has already demonstrated a historical potential to kill millions of people across the globe. It is a disease that results from infection by non-motile, gram-negative coccobacillus Yersinia pestis. When stained, its bipolar appearance is often described as resembling a safety pin. Pestis has two important properties that differentiate it from B. anthracis- person-to-person transmissibility and a lack of spore production. Following the bite of an infected flea, plague bacilli are carried via the lymphatic to the regional lymph nodes where they multiply exponentially.This is only weapon besides smallpox, which can cause devastation beyond those persons who are initially infected. With modern air travel, containing an out break of plague could be challenging. A vaccine for plague does exist; however, it is no longer being produced, and it does not demonstrate efficacy against infection by aerosol.

  • Botulism or Botulinum toxins are deadly. A toxin is any toxic substance that can be produced in an animal, plant, or microbe. The toxins produce serious disease in human beings. Many natural toxins can be produced by chemical synthesis or can be expressed artificially. Toxins are natural and non-volatile and generally do not penetrate intact skin, which happens in case of chemical weapons. There are different types of toxins and they are immunologically distinct, meaning that antibodies developed against one do not cross-react against others. Those that most commonly cause human disease are types A, B, and E. Humans can be intoxicated either by oral means, inhalation, or wound infection. Mass casualties can be produced through contamination of food source or by aerosol dissemination. The incubation period of botulism can range from as short as 24 to 36 hours to several days from the time of inhalation.

  • Tularemia is caused by Francisella tularensis, which is a gram-negative, non-motile coccobacillus. Tularemia is a zoonotic disease acquired in a natural setting by humans through skin or mucous membrane contact with the body fluids or tissues of infected animals or from being beaten by infected deerflies, mosquitoes, or ticks. It can remain viable for weeks in the environment or in animal carcasses and for years if frozen. Unlike anthrax, which requires thousands of spores to infect someone, tularemia can cause illness with as few as 10 to 50 organisms. After an incubation period of 2 to 10 days, pneumonia symptoms develop associated with weight loss and nonproductive cough. The drug of choice for treatment is streptomycin with other aminoglycosides.

Causes of Biological Disaster
There are number of causes why biological weapons are potentially more powerful agents to mass casualties leading to civil disruptions. To attract widespread attention and to harm a selected target, these outfits can utilize possibly any biological material, which fulfils some of the criteria of bio-weapons.
  • Biological agents can be disseminated with readily available technology. Common agricultural spray devices can be adopted to disseminate biological pathogens of the proper particle size to cause infection in human population over great distances.
  • he perpetrators can use natural weather conditions, such as wind and temperature inversions as well as existing building infrastructures (e.g. ventilation system) or air movement related to transportation (e.g. subway cars passing through tunnels) to disseminate these agents and thus to infect or intoxicate a large number of people.
  • The expense of producing biological weapons is far less than that of other weapon systems.

The methods of bio-logical agent dissemination and delivery techniques include:
  • Aerosols - biological agents are dispersed into the air, forming a fine mist that may drift for miles. Inhaling the agent may cause epidemic diseases in human beings or animals.
  • Animals – some diseases are spread by insects and animals, such as fleas, mice, flies, mosquitoes, and livestock.
  • Ood and water contamination - some pathogenic organisms and toxins may persist in food and water supplies. Most microbes can be killed, and toxins deactivated, by cooking food and boiling water. Most microbes are killed by boiling water for one minute, but some require longer.
  • Person-to-person - spread of a few infectious agents is also possible. Humans have been the source of infection for smallpox, plague, and the Lassa viruses.

Past History of Biological Disasters
Biological warfare has a long history of mass destruction through epidemic and pandemic diseases. Limited biological warfare is reported to have been carried out by Japan during World War-II. Recently, mycotoxins have been reported to be used in Afghanistan. Even before that it has also been documented that the Red Indians in North America were given the smallpox infected blankets. Nevertheless, the recent Anthrax attack in 2001 through letters caused worldwide concerns regarding the threats of bio-terrorism. Beginning in mid-September 2001, the USA experienced unprecedented biological attacks involving the intentional distribution of bacillus anthracis spores through the postal system. The full impact of this bio-terrorist activity has not been assessed, but already the toll is large. Hundreds of people were affected. In the 20th-century series of cases, the mortality rate of occupationally acquired Inhalational anthrax was 89%, but majority of these cases occurred before the development of critical care units and in most cases before the advent of antibiotics. Prior to 2001 attacks, at Sverdlovsk, it had been reported that 68 of the 79 patients with Inhalational anthrax dies. However, a separate report from a hospital physician recorded 358 ill with 45 dead. A recent analysis of available Sverdlovsk data suggests that there may have been as many as 250 cases with 100 deaths.

Japan used plague bacilli in China during 1932-1945 causing 260,000 deaths
Dispersal of anthrax spores due to accident in production unit in USSR caused 68 deaths in 1979
In 1984, Osho followers used Salmonella typhimurium in salad in a restaurant in Oregaon, USA leading to 751 cases
Shigella dysenteriae Type 2 employed in Texas, USA in 1996
Anthrax through postal envelopes in USA in Oct-Nov 2001 leading to 22 cases and 5 deaths

Impact & Prevention
Even a small-scale biological attack with a weapon grade agent on an urban center could cause massive morbidity and mortality, rapidly overwhelming the local medical capabilities. For example, an aerosolized release of little as 100kg of anthrax spores upwind of a metro city of a size of Washington D C has been estimated to have the potential to cause up to three millions of deaths.
1. The general population should be educated and the made aware of the threats and risks associated with it.

1. Only cooked food and boiled/chlorinated/filtered water should be consumed
2. Insects and rodents control measures must be initiated immediately.
3. Clinical isolation of suspected and confirmed cases is essential.

2. An early accurate diagnosis is the key to manage casualties of biological warfare. Therefore, a network of specialised laboratories should be established for a confirmatory laboratory diagnosis.
3. Existing disease surveillance system as well as vector control measures have be pursued more rigorously.
4. Mass immunization programme in the suspected area has be more vigorously followed up.
5. Enhancing the knowledge and skills of clinicians plays a vital role in controlling the adverse impact of the attack. As bio-terrorism related infections will remain rare events, creative ongoing strategies will be required to sustain attention to potential new cases.
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