Bioterrorism In America Essays

Bioterrorism In America Essays Bioterrorism In America Paper Bioterrorism In America Paper Bioterrorism is a word that gained much attention in the United States of America and other developed countries during the recent years. Even though biological weapons were tried by different countries during World War II, the potential of these weapons in causing a mass destruction silently have made them the preferred weapon for terrorist activities. These ‘weapons of mass destruction’ can produce devastating results as they are powerful enough to eradicate people from a whole nation. Intelligence reports reporting that extremist groups are planning to attack few developed countries, have made these countries go on red alert many times. These countries have understood the need for strengthening their public health mechanisms and disease control organizations like CDC, and other defense mechanisms to avert the occurrence of a bioterrorism event. There is no universally accepted definition for bioterrorism. WHO (World Health Organization) has defined bioterrorism as the use of biological agents in terrorism which includes the malevolent use of bacteria, toxins or viruses against people, plants and animals (WHO, 2007). The looming threat of bioterrorism started haunting United States of America since 1998 (No-authors-listed, 1999). The initial biological threats were due to the spread of anthrax powder containing letters. On October 30th 1998, three letters containing anthrax were sent to health clinics in Tennessee, Kentucky and Indiana states. Similar reports of anthrax contaminated letters were obtained by the CDC (Centers for Disease Control) till December 23 1998. There were similar threats telephonically received at the public health agencies saying that ventilation systems of a few buildings were contaminated with anthrax. The Federal Bureau of Investigation (FBI) started investigating these reports and threats and they found that these were all hoaxes. But later on, CDC surveillance team identified about 22 cases of anthrax in the same year, out of which majority of cases were from New Jersey, Florida, New York city and District of Columbia. Out of these, 12 cases were having cutaneous anthrax and 10 cases were having confirmed inhalational anthrax. Majority of these patients were US postal department personnel who contracted this disease when these anthrax containing letters were sent through high-speed sorting machines, handled or when opened (No-authors-listed, 2001). Later on, five of these inhalational anthrax patients died due to the disease. Centres for Disease Control (CDC) has classified Bioterrorism agents/diseases into three categories entitled Category A, B and C, based on the priority. The highest priority is given to diseases which can result in high mortality rates, cause public panic, needs special public health preparedness and are easily transmitted from one person to another. These diseases are classified as Category A diseases. Category B includes diseases that are moderately easy to disseminate, which can produce moderate levels of mortality and morbidity, and which require specific enhancements of CDC’s diagnostic capacity. Category C includes disease that can be genetically modified in future and used for bioterrorism activities due to the ease of production, availability, and the ability to cause high mortality and morbidity rates. The diseases according to the different categories are given in Table 1. Based on these categories, the preventive strategies, planning and preparation of health and other law enforcement agencies differ. Anthrax is an acute bacterial infection caused by Bacillus anthracis. The disease occurs when human beings come into contact with the spores of the bacteria. It can infect the human being through contact, inhalation, and ingestion or by insect bites. Anthrax is a zoonotic disease and human to human spread of anthrax is not reported. It can cause cutaneous anthrax (on direct contact with spores), inhalational anthrax (by inhaling the spores), gastrointestinal anthrax or oropharyngeal anthrax (after consumption of spore contaminated material). Cutaneous anthrax is manifested as a localized cutaneous lesion that progresses through papular, vesicular and pustular stages to form an ulcer with blackened necrotic eschar surrounded by brawny edema. Inhalational anthrax is characterized by the presence of increasing fever, dyspnea, stridor, hypoxia and hypotension, with a symmetric mediastinal widening seen radiologically due to hemorrhagic mediastinitis. The symptoms of gastrointestinal anthrax are variable and include fever, nausea and vomiting, bloody diarrhea, abdominal pain and occasionally, rapidly developing ascitis. The major findings of oropharyngeal anthrax are fever, sore throat, dysphagia, painful regional lymphadenopathy and toxemia. The diagnosis of anthrax is confirmed by the identification of bacteria in body fluids and skin scrapings by staining methods, and by using polymerase chain reaction method to detect spores of B. anthracis. Anthrax is treated by using antibiotics like penicillin, ciprofloxacin, erythromycin, tetracycline or chloramphenicol. Botulism Botulism is a paralytic disease caused by the neurotoxins released by Clostridium botulinum, which begins with cranial nerve involvement and progresses caudally to involve extremities. Botulism is of different types. Cases can be classified as food-borne botulism (from pre-formed toxin in food contaminated with the bacteria), wound botulism (from wound infected with C. botulinum), and infant botulism (by ingestion of spores and production of botulinum toxin in the intestines). Botulinum toxin is considered as one of the deadliest toxins found in nature. It is proposed that terrorists may use botulinum toxin to contaminate food material extensively leading to mass mortality. The unsuspecting nature of this disease (being a naturally occurring problem), the lethality of the toxin and the ability for easy administration to a large population within a short span of time makes this agent a deadly weapon in the hands of terrorists. Plague Plague is an acute febrile zoonotic disease caused by infection with Yersinia pestis. Although human cases are curable, plague is one of the most virulent and potentially lethal infectious diseases ever known. It can infect human beings through insect bites, respiratory droplets from infected person, or from exposure to infected tissues. Plague occurs in different clinical forms like bubonic plague (characterized by regional lymphadenitis), septicemic plague (septicemia occurs), pneumonic plague (due to hematogenous spread to lungs) and pharyngeal plague (due to pharyngitis caused by infection from droplets). The deadly potential of plague to cause epidemics is well documented. In United States, the last outbreak of urban plague occurred in Los Angeles in 1924 and 1925. Plague is treated with antibiotics like gentamicin, tetracyclines and chloramphenicol. Smallpox Even though WHO declared in 1980 that smallpox is eradicated after the last case of smallpox was reported in 1977 from Somalia, there is a possibility that this pox virus caused disease may be used by terrorists to cause panic among people. Human beings are the only reservoir of this disease. Smallpox is spread through close contact. The disease is characterized by the presence of high grade fever, macular rash, and progression to vesicular and pustular lesions. Even though the chances of reintroduction of this disease are low, if reintroduced, this disease may confuse healthcare providers with other similar respiratory infections where there will be high grade fever and rashes. The disease is diagnosed by the identification of antigens in serum and polymerase chain reaction test to detect the pox virus DNA. Tularemia Tularemia is a zoonotic disease caused by Francisella tularensis. It is spread through the bites of a tick, or through inhalation. It can cause oropharyngeal or gastrointestinal tularemia, glandular tularemia, oculoglandular tularemia, pulmonary tularemia and typhoidal tularemia. Usual symptoms include high grade fever, chills, headache, generalized myalgias and arthralgias. The disease, if untreated can cause a mortality of up to 30%. But with appropriate treatment, the mortality is less than 1%. Can we stop Bioterrorism? This is a question which many of the developing countries would be looking at now. The answer to this question may be in the negative, at least for the time being. It is very difficult to stop the bioterrorism acts presently even with a well equipped intelligence network and well established state and public administration systems. It is very difficult to detect a bioterrorism act before it gets to show up by a substantial population being affected. The usual agents used by the extremists are usually not detected rapidly, and usually spreads rapidly among the population. From a single point of source, these diseases may silently spread across the nation without being evident due to the rapid migration of people from one place to another. There were suggestions that restricting the genome data would stop bioterrorism as this would make it difficult to modify the genetic data by genetic engineering to change the virulence and resistance properties of the organism, to make it more lethal. But an article published in 2002 shows that restricting the genome data would not prevent bioterrorism (Read Parkhill, 2002). In the present situation, the best measure that can be adopted is to take preventive measures by equipping health care providers, public health departments, State and public administration departments and law and order departments to handle a situation where a bioterrorism event occurs. There should be constant surveillance on the occurrence of suspect diseases to ensure that no bioterrorist activity exists behind the occurrence of the disease. Surveillance measures CDC advocates the adoption of surveillance measures to counteract bioterrorism. The surveillance measures are divided into measures that are specific for particular diseases and other general measures. Surveillance for specific diseases include the surveillance for anthrax and smallpox, which are commonly expected diseases in bioterrorism acts. Surveillance preventive measures for anthrax The most important measure is timely recognition and detection of the disease. Health care providers should be adequately trained in detecting this disease. The easiest way of detecting the occurrence of this disease is the development of autonomous detection systems that can detect the occurrence of a biologic agent like the spores of anthrax bacilli. Such an autonomous detection system has been installed in many of the postal distribution centers across the United States (Meehan et al. , 2004). This step would help in the timely identification of the existence of a bioterrorism event, which can help in management planning, rescue and evacuation, decontamination, quarantine, and treatment of individuals exposed to the disease. Public health officials are urged to take frequent samples of air and scrapings from the surfaces of buildings for detection of the existence of anthrax bacilli. These samples should be evaluated using the polymerase chain reaction technique for the detection of genetic material of B. anthracis. These devices are very expensive, but are very sensitive and specific in detecting the organism. Once established after validation, these systems would give rapid results which would buy more time in taking preventive measures to restrict the disease occurrence. Surveillance preventive measures for Smallpox (CDC, 2006b) Smallpox is currently nonexistent in this world. This makes it difficult to be detected by the laboratories during the routine tests. National laboratories should be enabled and alerted to do the appropriate tests in case of a suspected epidemic so as to detect the disease at the right time. The positive predictive values of the tests for smallpox are low. This makes clinical detection the most important measure in case identification. Health care providers should be trained in detecting smallpox case detection and guidelines should be established to detect and take preventive measures for restricting the spread of this disease. There is an algorithm provided by the CDC to evaluate patients with smallpox which is freely available in the net at www. bt. cdc. gov/agent/smallpox/diagnosis/evalposter. asp . In suspected patients, lab testing should be done to detect the existence of this disease. If the lab tests turn out to be positive, the occurrence should be reported to state/local public health authorities. Measures should be taken to isolate and quarantine the affected persons and their relatives to prevent further spread of the disease. Contact tracing should be done thoroughly and they should be vaccinated. The remaining people in that area should be given smallpox vaccination to enable immunity in them to overcome this attack. This should be followed by a well conducted epidemiological investigation to identify the source of infection. Identification of the most likely source of infection should be supported by the identification of the population at risk, and the chain of outbreak of the disease. General surveillance measures General surveillance measures should include the detection of disease patterns b y by the health care providers. An unusual pattern of disease outbreak should point fingers to the possibility of an intentional outbreak of the disease. The disease occurrence pattern should be studied in detail using epidemiological methods to identify the disease clusters, the impact of geographical and environmental factors on the spread of the disease and the temporal association of cases with the index case. This information should be collected from different centers and should be provided to CDC to evaluate the disease pattern and take necessary actions to curtail the spread of disease. Infection-control personnel should be aware of the disease occurrence and should be able to recognize the disease as early as possible to alert the health care system. State health care departments should take necessary steps to educate and train health care professionals and other related personnel in detecting and aborting a bioterrorism event. Preparation Planning Public health emergency response system should be established that can prepare the community in facing a bioterrorist attack. CDC, National Center for Environmental Health (NCEH) and Division of Emergency and Environmental Health Services (EEHS) have formed a public health emergency response guide to counteract a bioterrorist attack. These guides are used in educating and providing guidance to health care providers, for facing an attack (CDC, 2006a). Guidelines for protecting buildings and environments from bioterrorist attacks are also available with CDC. Bioterrorism readiness plan has been formulated to incorporate health departments and other administrative and law and order departments to take the required steps in preventing an attack, and in the event of an attack, to ensure that the casualties due to the disease attack are limited. Conclusion Bioterrorist attacks are predictable to a certain extent and are preventable to a certain level. But these events are not completely preventable at present. The best measure to do in case of an attack is to take preventive measures to avoid further occurrence and to limit the spread of the attack. These should be given utmost priority in the public health system. There should be a coordinated activity from various departments to ensure that the nation remains safe in case of a bioterrorist attack. Systems have been developed and put in place to counteract biological attacks. How far these systems are effective in preventing casualties will be shown only when these systems are put to the real test.