Introduction:
Biological weapons were used by the Assyrians as early as the sixth century B.C. when the water was contaminated with the fungus rye ergot (Claviceps purpurea). Bioterrorism can cause widespread disease or death in the targeted population or livestock, thereby terrorizing the civilization. The identification of the event is an essential step in a bioterrorist attack. Early detection can be done by generating awareness and creating a sound surveillance system. To contain such attacks, quick detection and investigation are necessary. The public health epidemiologist determines the scope and magnitude of the attack and suggests effective interventions. It is difficult to predict a bioterrorist attack; if ignored, it can have a devastating effect. An efficient public health care system is needed to take care of the terrible consequences.
Therefore, to counter the bio attack, the public health system should include the following:
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Robust disease surveillance.
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Quick epidemiological investigation.
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Laboratory investigation.
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Sound medical management, information, education, and communication.
What Is Bioterrorism?
Bioterrorism is the purposeful release or threat of release of biological organisms like viruses, bacteria, fungi, or toxins that can cause disease or death in the human population. It is used to threaten civilizations or blackmail governments. Identifying the biological agents involved in bioterrorism is difficult, as multiple agents can be distributed to various geographical regions during incubation. However, it is difficult to distinguish between natural disease and bioterrorism attacks.
What Are the Biological Agents Used to Cause Bioterrorism?
Biological agents that can cause bioterrorism include all pathogenic microorganisms. The microorganisms that are used in bioterrorism should have the ability to cause disease or death at low concentrations and should be highly contagious with a predictable incubation period. In addition, the target population must show little or no immunity toward the biological agent for the attack to be successful. The bioterrorist agents that can be used are:
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Bacillus anthracis causing anthrax.
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Clostridium botulinum causing botulism.
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Yersinia pestis causing plague.
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Variola major causing smallpox.
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Francisella tularensis causing tularaemia.
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Filoviruses and arenaviruses causing viral hemorrhagic fever.
How Do These Biological Agents Spread?
Biological agents can spread through:
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The use of contaminated water or food.
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The infected droplets in the air.
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From person to person through contaminated objects.
What Are the Routes of Entry of Biological Agents?
The routes of entry of biological agents into the human body are:
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Inhalation.
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Contact through the skin or mucous membrane.
Various methods of delivery that are used include:
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The bomblets are delivered by aircraft.
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Use of spray tanks mounted on airplanes or buildings.
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The microorganisms that cause anthrax, plague, smallpox, and viral fevers are aerosolized and sprayed over large geographic areas.
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Infecting animals, vectors, or pests and intentionally making them cross the international border.
The BioWatch program was introduced in the United States, which uses pathogenic detectors to monitor air quality. These detectors are used to collect the microparticles on the filter, which are collected at regular intervals and analyzed using polymerase chain reaction techniques.
Every small or large disease outbreak should be investigated as a potential bioterrorist attack.
What Is Biodefense?
Biodefense is the use of medical measures to provide protection to people against bioterrorism. It includes medicines and vaccinations and focuses on medical research to prepare against bioterrorist attacks. The health departments must concentrate on preparedness activities to respond effectively to the attack. The following five phases of activities are necessary before an incident are essential for a successful response to a bioterrorist attack:
1. Preparedness Phase: During this phase, actions are taken by various authorities to understand the state of preparedness.
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It includes evaluating the laboratory setup and evaluating the hospital's preparedness in emergency response.
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Case management in case of an attack.
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Training the health professionals.
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Rapid response of the team.
2. Early Warning Phase: The warning in the surveillance system involves activities like case definitions, notifying the authorities, and interpreting the data. Immediate detection and investigation by public health agencies are essential to determine the attack's scope and magnitude and implement effective interventions.
3. Notification Phase: It is compulsory to report any unusual syndrome affecting a large number of people to the concerned authorities. The activities in this phase include rapid epidemiological investigations, prompt laboratory support for the confirmation of diagnosis, quarantine, and isolation. Health care facilities should be prepared for impending casualty management.
4. Response Phase: During this phase, the activities involve:
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Early investigation and laboratory support.
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Mass casualty management.
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Initiation of prevention.
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Curative and specific control measures for containing the further spread of the disease.
The following steps can be followed:
(i) Assess the Situation: The response is initiated by examining the problem entirely concerning the time, place, and person. For example, the transmission routes, their impact on the health facilities, the agencies involved in responding to the event, communication with the public health responders, and local, state, and national level centers for emergency management.
(ii) Contact Key Health Personnel: Coordinate with people within the health department with emergency response roles and responsibilities to record all contacts and follow-up details.
(iii) Develop Action Plan: Develop specific, measurable, achievable health response objectives. An action plan based on the assessment of the situation should be established.
(iv) Implementation of the Action Plan: Hospitals should be attentive to receiving patients and providing adequate treatment. Tented hospitals are set up, if necessary. Methods to control the disease are established. Once the infection is identified, treatment regimens are made available.
5. Recovery Phase: The shortcomings are restored, and lessons learned in this phase are used in future preparedness plans. The damage to the public health facilities and the essential items during the response phase is replenished. Public advisories for restoring normalcy are constituted. The modifications are included in the contingency plan.
Conclusion:
Bioterrorism is a great threat from both native as well as international terrorist groups. From a public health perspective, timely surveillance, awareness of syndromes resulting from bioterrorism, investigation, laboratory diagnostic capacity, and the ability to quickly transfer essential information on a need-to-know basis to handle public communication through the media are crucial. In addition, an appropriate supply of drugs, laboratory items, antitoxins, and vaccines should be ensured. Finally, drills should be formulated and practiced at all levels of public healthcare, which will help to minimize the mortality rate and reduce morbidity in case of a bioterrorist attack.
