WORLD OF MICROBIOLOGY AND IMMUNOLOGY Bioterrorism, protective measures79•
ity. The CDC plan also calls for an increased emphasis on epi-
demiological detection and surveillance, along with the devel-
opment of a public heath infrastructure capable of providing
accurate information and treatment guidance to both medical
professionals and the general public.
Because an informed and watchful public is key ele-
ment in early detection of biological pathogens, the CDC
openly identifies potential biological threats and publishes a
list of those biological agents most likely to be used on its web
pages. As of July 2002, the CDC identified approximately 36
microbes including Ebola virusvariants and plague bacterium,
that might be potentially used in a bioterrorist attack
Other protective and emergency response measures
include the development of the CDC Rapid Response and
Advanced Technology Laboratory, a Health Alert Network
(HAN), National Electronic Data Surveillance System
(NEDSS), and Epidemic Information Exchange (Epi-X)
designed to coordinate information exchange in efforts to
enhance early detection and identification of biological
weapons.
Following the September 11, 2001 terrorist attacks on
the United States, additional funds were quickly allocated to
enhance the United States Department of Health and Human
Services 1999 Bioterrorism Initiative. One of the key elements
of the Bioterrorism Preparedness and Response Program
(BPRP) increases the number and capacity of laboratory test
facilities designed to identify pathogens and find effective
countermeasures. In response to a call from the Bush adminis-
tration, in December 2001, Congress more than doubled the
previous funding for bioterrorism research.
Advances in effective therapeutic treatments are funda-
mentally dependent upon advances in the basic biology and
pathological mechanisms of microorganisms. In response to
terrorist attacks, in February 2002, the US National Institute of
Allergy and Infectious Diseases (NIAID) established a group
of experts to evaluate changes in research in order to effec-
tively anticipate and counter potential terrorist threats. As a
result, research into smallpox, anthrax, botulism, plague,
tularemia, and viral hemorrhagic feversis now given greater
emphasis.
In addition to medical protective measures, a terrorist
biological weapon attack could overburden medical infra-
structure (e.g., cause an acute shortage of medical personnel
and supplies) and cause economic havoc. It is also possible
that an effective biological weapon could have no immediate
effect upon humans, but could induce famine in livestock or
ruin agricultural production. A number of former agreements
between federal and state governments involving response
planning will be subsumed by those of the Department of
Homeland Security.
On a local level, cities and communities are encour-
aged to develop specific response procedures in the event of
bioterrorism. Most hospitals are now required to have
response plans in place as part of their accreditation require-
ments.
In addition to airborne and surface exposure, biologic
agents may be disseminated in water supplies. Many commu-
nities have placed extra security on water supply and treat-ment facilities. The U.S. Environmental Protection Agency
(EPA) has increased monitoring and working with local water
suppliers to develop emergency response plans.
Although it is beyond the scope of this article to discuss
specific personal protective measures—nor given the com-
plexities and ever-changing threat would it be prudent to offer
such specific medical advice—there are a number of general
issues and measures that can be discussed. For example, the
public has been specifically discouraged from buying often
antiquated military surplus gas masks, because they can pro-
vide a false sense of protection. In addition to issues of
potency decay, the hoarding of antibiotics has is also discour-
aged because inappropriate use can lead to the development of
bacterial resistance and a consequential lowering of antibiotic
effectiveness.
Generally, the public is urged to make provisions for a
few days of food and water and to establish a safe room in
homes and offices that can be temporarily sealed with duct
tape to reduce outside air infiltration.
More specific response plans and protective measures
are often based upon existing assessments of the danger posed
by specific diseases and the organisms that produce the dis-
ease. For example, anthrax (Bacillus anthracis), botulism
(Clostridium botulinumtoxin), plague (Yersinia pestis), small-
pox (Variola major), tularemia (Francisella tularensis), and
viral hemorrhagic fevers (e.g., Ebola, Marburg), and are-
naviruses (e.g., Lassa) are considered high-risk and high-
priority. Although these biogenic agents share the common
attributes of being easily disseminated or transmitted and all
can result in high mortality rates, the disease and their under-
lying microorganisms are fundamentally different and require
different response procedures.
Two specific protective measures, smallpox and
anthrax vaccines, remain highly controversial. CDC has
adopted a position that, in the absence of a confirmed case of
smallpox, the risks of resuming general smallpox vaccina-
tionfar outweigh the potential benefits. In addition, vaccine
is still maintained and could be used in the event of a bioter-
rorist emergency. CDC has also accelerated production of a
smallpox vaccine. Moreover, vaccines delivered and injected
during the incubation period for smallpox (approximately 12
days) convey at least some protection from the ravages of the
disease.
Also controversial remains the safety and effectiveness
of an anthrax vaccine used primarily by military personnel.See alsoAnthrax, terrorist use of as a biological weapon;
Bacteria and bacterial infection; Biological warfare;
Epidemics and pandemics; VaccineBLACK DEATH•seeBUBONIC PLAGUE
BLACK LIPID BILAYER MEMBRANE •see
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