The Threat of Bioterrorism

As the 21st century begins, the threat of bioterrorist attacks on the United States (U.S.) has increased. The September 11, 2001 terrorist attacks on the World Trade Center in New York, and the Pentagon in Washington, D.C., increased awareness of the vulnerability of the U.S. to outside attack, including the risk of biological and chemical weapons. Of all the weapons of mass destruction, including nuclear, chemical, and biological weapons, biological agents are the most greatly feared. Unfortunately, the U.S. is least prepared to deal with them. Governmental anti-terrorist activities have primarily been directed toward managing a chemical release or explosion. Training for crisis management after spills of hazardous materials, explosions, fires, and other civil emergencies occur frequently in many communities. The expected scenario after release of an aerosol cloud of a biological agent would be quite different. An aerosol release would likely be undetected. It may not be known until days or weeks later that an infectious agent or toxin had been released into an unsuspecting civilian population. Depending on the incubation period or time needed for an agent to enter the circulation, patients would begin appearing in emergency rooms and doctors’ offices with symptoms of diseases that few healthcare professionals have ever seen. Special measures would be needed for patient care, obtaining laboratory confirmation regarding microorganisms unfamiliar to most laboratories, providing vaccines or antibiotics to large segments of the population, and potentially implementing local quarantine measures.

From World War II and continuing through the cold war era with the Soviet Union, the U.S., and several other countries maintained stores of agents that could potentially be used as biological weapons. The U.S. terminated its biological weapons development program by executive order in 1970 and by 1973 had destroyed its entire biological arsenal. The U.S., together with 162 other countries, signed the Biological and Toxin Weapons Convention in 1972. This agreement prohibited offensive research and production of biological weapons. Since then, the U.S. Army Medical Research Institute on Infectious Diseases has been responsible for defensive medical research. This research focuses on potential biological warfare agents to better protect the U.S. military, including protocols regarding decontamination, prophylaxis, clinical recognition, laboratory diagnosis, and medical management. Alarmingly, several countries that signed the 1972 Biological and Toxin Weapons Convention are thought to have developed or are in the process of developing biological agents that could be used as weapons of mass destruction. Of further concern is the potential that agents would be "weaponized" by being produced into an aerosolized form that could be distributed over a large population by plane and carried by wind currents.

The U.S. Centers for Disease Control and Prevention (CDC) operates a national program for bioterrorism preparedness and response that incorporates a broad range of public health partnerships. The CDC classifies biological diseases and agents into three categories. Category A agents include anthrax, botulism, plague, smallpox, tularemia, and viral hemorrhagic fever. The focus of this course is Category A diseases/agents. Category A diseases or agents posessing at least one of the following characterisitcs:

1. They can be easily disseminated or transmitted from person to person.
2. They have the potential to cause many deaths.
3. They can cause public panic and social disruption.
4. They require sophisticated public health preparation and action.

Category B agents include: Q fever, brucellosis, glanders, ricin toxin, epsilon toxin, melioidosis, psittacosis, Staphylococcus enterotoxin B, typhus fever, viral encephalitis, and other agents that pose food and water safety threats. Category B agents are moderately easy to disseminate, but cause less illness and death than Category A agents.

Category C diseases and agents include emerging pathogenic organisms that could be engineered in the future with the capability of mass dissemination, potential for high death and illness rates, and would have a major impact on the public health system. Examples of potential Category C agents include Nipah virus, Hantavirus, tick-borne encephalitis, yellow fever, and multiple drug resistant tuberculosis.


The 1972 Biological and Toxin Weapons Convention prohibits offensive research and development of potential biological weapons.

In addition to learning general information about bioterrorism, such as the content of this course, it is vital that nurses and other healthcare professionals know the disaster plan in their specific places of employment. They should be familiar with specific patient isolation procedures, personal protection, and decontamination procedures. Health professionals must be able to recognize the potential for major impact from a bioterrorism event. Although an effective attack could produce as many casualties as a nuclear attack, an unannounced bioterrorist attack would be unlikely to be recognized immediately. Healthcare professionals must work closely with public health authorities to help detect a bioterrorist threat as early as possible, to provide effective treatment for patients, and to help control public panic by providing accurate information.

The most current definitive information about bioterrorist threats and how to respond to them can be obtained by viewing the website of the Centers for Disease Control and Prevention (CDC).

Click here to access the "Bioterrorism Readiness Plan: A Template for Healthcare Facilities"

Be prepared to answer the following question.

According to "Bioterrorism Readiness Plan: A Template for Healthcare Facilities" Section I, A. ; who should be notified immediately if you suspect that your facility is receiving victims of a bioterror event?

Additional websites that provide information about bioterrorism are listed at the end of this course.