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The Threat of Biological Warfare and Possible Preventative Measures
     The events of September 11,2001, have made the threat of terrorism on our mainland very real. The twin towers were made into rubble that day, along with the lives of the many people touched by the overwhelming loss of life that occurred that day. Now, if that isn’t enough to cope with, in creeps the specter of bio-terrorism. Biological weapons are devices intended to deliberately disseminate disease producing organisms or toxins in food, water, by insect, or as an aerosol. Bacillus anthracis, the organism that causes anthrax, has been bandied about the media and the American public has been saturated by stories of possible cases and fatalities. One agent not often discussed but every bit as horrifying as anthrax is smallpox. Smallpox is an acute, highly contagious virus disease characterized by prolonged fever, vomiting, and pustular eruptions that often leave pitted scars, or pockmarks, when healed as defined by Webster’s New World College Dictionary. Smallpox, commands respect and the concern of the American public along with that terrorism, of the biological variety, however improbable, is very possible.
     Smallpox was once large in scope before vaccinations. At one point or another, everyone was going to contract it. A release of smallpox in aerosol form would scatter readily, and because of its stability in aerosol form would prove very formidable even in a small dose. Even mention of a group of smallpox cases can cause national panic and a possible public outcry for national emergency control measures to be taken. Several
factors cause the concern: smallpox has historically been feared as one of the most serious of all pestilential diseases, it physically disfigures, it bears a thirty percent fatality rate, it can be spread person to person, primarily by droplet nuclei expelled from the oropharynx of the infected person or by aerosol . Items most often thought as harmless, such as clothing or bed linen, could also spread the virus. After an incubation of about ten to twelve days, the patient experiences high fever and pain. Then a rash begins which forms into scabs by the seventh of eighth day. Between twenty-five and thirty percent of all unvaccinated patients die of the disease (1).
     Smallpox, anthrax and plague head the list of agents that can be used for bio-warfare. None of these agents has so far effectively been deployed as a biological weapon, and thus no real world events exist to provide likely scenarios (1).

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Still, the prospects are frightening. Recipes for making biological weapons are now available on the internet, and even groups with modest finances and basic training in biology and engineering could develop, should they wish, an effective weapon (2) at little cost. The 1972 Biological Weapons and Toxin Convention (BWTC), calls for banning the development, storage and usage of biological weapons. It had been signed by 162 states (3), including most of the 17 states suspected of having offensive biological weapons in a recent report (4). Seven of the 17 are named sponsors of international terrorism (5). Information such as that, coupled with the terrorism our country witnessed first hand on September 11th, American citizens have the right to worry.
     It is difficult to gauge the extent of biological weapons development in other nations since production facilities require little space and are not easy to identify (6).
With that said, and the state of affairs in America being what they are, an occurrence of bio-terrorism is becoming increasingly probable. What can the U.S. do to prepare? While there is no simple answer to that question, America can try to seek a logical response to that question. A national awareness and education program can help quell some hysteria. Professionals that deal with infectious diseases can receive enhanced information and training in detecting and treating these diseases that are most likely to be used for terror such as smallpox, anthrax or plague. A delayed diagnosis of any one of these diseases can prove very dangerous to any community involved. Infectious disease professionals can work closely with community leaders and medical staffs at all hospitals to educate them in the area of detection. After all, the symptoms of anthrax are very similar to the flu. A properly informed person might think about the existence of anthrax as opposed to just writing it off as the flu.
     In the case of a large or small outbreak, hospitals will be thrust into dealing with high numbers of sick and dying people almost instantly. Few hospitals can handle even a slight increase in the number of ill patients walking through their doors. Contingency plans can be developed by the Federal government for all hospitals nationwide. Hospitals can possibly seek Federal financial assistance to maybe build a wing for infectious diseases, keep stocked levels of vaccines and therapeutics, educating all employees within a hospital about the detection and dangers of these horrible diseases and maybe every hospital can have I.D. professionals on staff. A by product of all this can be that more medical students may lean towards careers as I.D. professionals.
     Finally, the threat of smallpox and any other biological weapon being used to eradicate Americans, attempting to ward the attacks off, or trying to control the further spread of infectious disease if an attempt is successful, is almost too much too handle. Even with all that America can do to avoid such scenarios, the harsh reality is that maybe only “luck” can keep the danger of an attack from affecting our lives. Still, hoping for “luck” is, on its own, unacceptable. America must remain sharp and poised to deal with the threat of bio-terrorism.

2.     Danzig R, Berkowsky PB. Why should we be concerned about biological warfare? JAMA 1997;285:431-2
3.     Zanders JP. The Biological and Toxin Weapons Convention. Stockholm International Peace Institute.
4.     Cole LA. The specter of biological weapons. Scientific American 196:60-5.
5.     USIS Washington File. Albright: US pursuing full-fledged effort against terrorism. 30 April 1999.
6.     Zilinskas RA. Iraq’s biological weapons: the past as future? JAMA 1997; 278:418-24.
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