Post to specific areas and occur seasonal and

Post September 11, 2001,
bioterrorism has become a subject of widespread concern. Significantly
bioterrorism has captured the attention of all levels of the United States
government. Unfortunately, bioterrorism is a deadly threat that is still poorly
understood. There is currently no concrete definition of bioterrorism, but society
views bioterrorism as a form of terrorism with intentional release of
biochemical agents (bacteria or viruses,) to kill or harm civilians.

            Bioterrorism
is a public health threat with a wide spectrum ranging from uses of non-mass
casualty agents to infectious agents causing mass casualties. From a public
health perspective, bioterrorism has a variety of agents that pose a concern to
our people. According to the Emerging Infectious Diseases Journal, the agents
anthrax, plague, brucellosis, smallpox, viral encephalitis and viral
hemorrhagic fevers are a high concern. These agents are said to be easy and
inexpensive to produce, therefore these agents are the concern when considering
what agents may be aerosolized or distributed over large geographic areas,
causing mass casualties.

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            A
bioterrorist attack can be difficult to distinguish from a naturally occurring
infectious disease outbreak, although if there is speculation of biochemical
agents used, the etiology and epidemiology of an outbreak must be examined. There
are clue to identify if biochemical agents were released in a bioterrorist
attack compared to a naturally occurring disease. Naturally occurring diseases
are endemic to specific areas and occur seasonal and sentinel cases are not
uncommon. Whereas a disease outbreak due to bioterrorism could occur in
non-endemic areas, occur at anytime of the year without warning, resulting in
large numbers of illnesses or deaths abruptly.

            Public
heath officials should have an understanding of bioterrorism to maintain
effective protocol to react quickly and effectively should there be a threat of
bioterrorism. Maintaining effective disease surveillance is essential in
preparing law enforcement and public officials to react accordingly should they
need to act on a potential threat using biochemical agents.  Keeping public health and law enforcement
agencies up to date on all protocol for a bioterrorist attack will only improve
the United States ability to respond to any infectious disease outbreaks and
provide added value in the event should a bioterrorist attack occur.

            Toxins
are chemical substances of biological origin and can be considered chemical or
biological warfare agents. An example of a toxin categorized to be a chemical
substance to harm is Bacillus anthracis. Although people know Bacillus
anthracis to be a biological weapon compared to a toxin weapon, Bacillus
anthracis produces a toxin that is responsible for the anthrax disease.         Bacillus anthracis is a gram-positive,
rod shaped, aerobic, encapsulated, and spore-forming bacteria. According to Toxins as Weapons: A Historical Review,
Bacillus anthracis has three different forms, cutaneous, gastrointestinal and
respiratory. When spores are inhaled, ingested or come in contact with a skin
lesion, the spores are phagocytized by macrophages and reach the lymph nodes.
With presence of nutrients, producing favorable conditions for the spores, they
then germinate and transform back into a vegetative form. The vegetative form
of Bacillus anthracis toxin then causes edema, hemorrhage and necrosis in
effected areas. In a specific case of inhalation anthrax, the most affected
lymph nodes are found in the mediastinum area. 

            Specifically,
inhalation anthrax can be caused by the dissemination of the spores through the
air and has a high mortality rate, but the other properties of this toxin make
it appropriate for use as a weapon. Explain in the Toxins as Weapons: A Historical Review it is explained how Bacillus
anthracis is used as a weapon. First off, the spores show a fitting stability
for storage and transportation in munitions or spraying tanks, and even confer
a certain level of resistance against the thermal effect produced during the
explosion of the munitions that allows opening of the compartment in which the
load of spores is carried. At the beginning of the 20th century, anthrax was
also thought to have a short and predictable incubation period, one–two days,
but it was later discovered that it could range between one and seven days. Now
it is known that it can even exceed a timespan of 60 days, which, from a
tactical point of view, is not attractive. Finally, and unlike other biological
warfare agents, no information exists indicating that anthrax is a contagious
disease that is transmitted from one person to another, something that avoids
putting American troops at risk when dealing with prisoners of war.

            Toxins as Weapons: A Historical Review
reported that on October 5, 2001, not even a month after the 9/11 terrorist
attacks, a person died in Boca Raton, FL, of inhalational anthrax. The low
incidence of this disease (only 18 occupational exposure cases were recorded in
the United States during the 20th century); the concern generated after 9/11
regarding possible Al Qaeda attacks using chemical, biological, radiological,
or nuclear (CBRN) weapons; and the fact that B. anthracis is the
biological weapon par excellence, triggered alarms when the cause of this death
was made public. Traces of the biological agent were detected a few days later
in American Media, Inc. (AMI) facilities, where the deceased worked. Two
envelopes, postmarked September 18, 2001, addressed to an NBC reporter and to
the editor of the New York Post, both with threatening messages and
indicating that they contained anthrax, were retrieved. For a series of
reasons, the logical thing to do at that time was to relate these mailings to
Al Qaeda. Among those reasons were the proximity in time of the postal mailings
with the 9/11 terrorist attacks; the messages included in the envelopes had
9/11 allusions and phrases such as “Death to America”, “Death to Israel”, and
“Allah is great”; and the suspected interest of the 9/11 suicide terrorists in
agricultural aircraft to disseminate chemical or biological agents. This is
when what is colloquially known as the Amerithrax (the name given to the
criminal investigation by the FBI) investigation began. A total of 22 anthrax
cases were recorded in different states, 11 by inhalational and 11 by cutaneous
anthrax, and five people with inhalational anthrax died. Despite this figure,
many more could have been exposed to lethal doses of anthrax but would have
suffered a subclinical infection thanks to the post exposure treatments that
health authorities recommended.

            Currently,
Bacillus anthracis is included in the Category A in the list of CDC’s (Center
for Disease and Control) bioterrorism agents. Knowing that biological attack, or bioterrorism, is the intentional release of
viruses, bacteria, or other germs that can sicken or kill people, livestock, or
crops we can understand why Bacillus anthracis, the bacteria that causes anthrax, is one of the most likely agents to
be used in a biological attack.