Preventing the Use of Biological Weapons: Improving Response Should Prevention Fail

Thomas V. Inglesby, Tara O'Toole, and Donald A. Henderson

Clinical Infectious Diseases. 2000;30(6):926-929. © 2000 by the Infectious Diseases Society of America. All rights reserved.
  

Excerpt from Introduction: Biological weapons are devices intended to deliberately disseminate disease-producing organisms or toxins in food, water, by insect vector, or as an aerosol. As would be the case following exposure to any infectious disease, those infected would experience an incubation period of variable duration, depending on the pathogen, the size, and route of the inoculum, and the immune response of the affected persons. The incubation period could be days to weeks. If sufficient numbers of people were infected by the dispersal of a biological weapon, or if the agent were contagious and person-to-person transmission outran disease control measures, the result could be large-scale, possibly catastrophic epidemics. It is this outcome the prospect of a pestilence intentionally unleashed on large civilian populations that most concerns physicians, public health experts, and political leaders.

Public health, medical, military, and law enforcement experts have met in a number of settings in efforts to identify the most threatening of the biological weapons, specifically those weapons that merit priority concern in the development of public health and medical preparedness measures. The criteria for this determination have included feasibility of aerosol dissemination (thought by many to be the most likely means of exposing large populations), high case-fatality rates, the potential for secondary spread, and the availability of protective vaccines or antimicrobial agents. A limited number of agents are consistently recognized as being of greatest concern: Variola major, Bacillus anthracis, Yersinia pestis, Botulinum toxin (produced by Clostridium botulinum), Francisella tularensis, and a number of the causative agents of the syndrome termed viral hemorrhagic fever. Recommendations for the medical and public health management of these weapons are being published elsewhere in a series of consensus papers.
    

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