Introduction

The global biological threat of bioterrorism is serious, and the potential for devastating casualties is high, particularly for certain biological agents. There are at least ten countries around the world currently that have offensive biological weapons programs.  However, with appropriate use of public health and medical countermeasures many casualties may be prevented or minimized. Public health has a significant part to play because of its surveillance role, which if properly deployed can detect organisms in time to enable there to be an effective response.  Public health’s main functions are to provide the community with a plan to maintain good health, to prevent its citizens from getting ill, and to control the spread of disease.  Thus the response of public health, once a bioterrorism threat is suspected or identified, is to coordinate the overall health response by conducting an epidemiological investigation to determine the source, informing medical providers of the status of the situation, providing prophylactic antibiotics or vaccines as appropriate, and informing the general public how to respond to protect themselves.  The Butler County Health Department through coordination with the Director of Poplar Bluff/Butler County Emergency Management, & Homeland Security Agency and the operation of the county’s Emergency Operations Center (EOC) will implement it.

Background

There have been many historical accounts of the use of biological weapons in warfare.  Two of the earliest reports date to the 6th century BC, with the Assyrians poisoning enemy wells with rye ergot, and in 1346 when the Tartar army during the siege of Kaffa hurled the corpses of plague victims over the city walls. Evidence suggests this may have started the Black Death epidemic. The United States started an active research program in 1943 to produce biological agents for offensive use.  That was stopped in 1969 when President Nixon issued an Executive Order.  The USSR had an extensive program that employed over 55,000 people who helped produce tons of pernicious biological agents into the late 1990’s.  Iraq conducted research and development on at least six agents and did extensive research on various short and long-range delivery systems.  Countries identified by the ex-Secretary of Defense William Cohen as those “aggressively seeking” nuclear, biological, and chemical weapons include Libya, Iraq, Iran, and Syria. A biological agent is commonly portrayed as a genetically engineered organism resistant to all known vaccines and drugs, highly contagious, and able to harm thousands of people.  Our level of suspicion and diligence in identifying and reacting to a biological attack must remain high, since the attack may not follow an expected pattern. Further more, a small outbreak of illness could be an early warning of a more serious attack, and recognition and prompt institution of preventive measures (such as effective vaccines and antibiotics) could save thousands of lives. There is increasing concern over the possibility of the terrorist use of biological agents to threaten either military or civilian populations. Appropriate public health response can blunt the threat of bioterrorism with a strong public heath infrastructure. Health care providers and public health personnel should have basic epidemiological skills and knowledge to facilitate the rapid identification of a bioterrorist attack. A presentation made in February 2001 by the Centers for Disease Control and Prevention to the National Emergency Management Association, listed the biological and chemical agents of greatest concern.

The three categories in order of greatest concern:

Category A – these agents: 1) can be easily transmitted person to person, 2) cause high Mortality, with potential for major public health impact, 3) might cause public panic and social disruption, and 4) require special action for public health preparedness.

• Anthrax (B. anthracis)
• Smallpox (Variola virus)
• Plague (Y. pestis)
• Tularemia (F. tularensis)
• Botulism (Botulinum toxin)
• Viral Hemorrhagic fever viruses Ebola, Marburg, Lassa

Category B – these agents: 1) are moderately easy to disseminate, 2) cause moderate morbidity and low mortality, and 3) require specific enhancements of CDC’s diagnostic capacity and enhanced disease surveillance.

• Q fever (Coxiella burnetti)
• Brucellosis (Brucella species)
• Glanders (Burkholderia mallie)
• VEE, EEE, WEE (alpha viruses)
• Ricin toxin (from castor beans)
• Epsilon toxin of Clostridium perfringens
• Staphylococcus enterotoxin B

Some food/waterborne pathogens

Category C – these agents include emerging pathogens that could be engineered for mass dissemination because of: 1) availability, 2) ease of production and distribution, and 3) potential for high morbidity and mortality and major public health impact.

• Nipah virus
• Hantavirus
• Tickborne hemorrhagic fever viruses
• Tickborne encephalitis viruses
• Yellow fever
• Multi-drug resistant tuberculosis