Infectious Diseases in Critical Care Medicine

Table 1 Classification of Bioterrorism Agents

Category and agents Characteristics

Category A “High-priority agents include organisms that pose
a risk to national security because they:
Anthrax (B. anthracis)
Botulism (Clostridium botulinumtoxin) can be easily disseminated or transmitted from
person to person;
Plague (Yersinia pestis)
Smallpox (V. major) result in high mortality rates and have the potential
for major public health impact;
Tularemia (Francisella tularensis)
Viral hemorrhagic fevers [filoviruses (e.g., Ebola,
Marburg) and arenaviruses (e.g., Lassa, Machupo)]

might cause public panic and social disruption;
and require special action for public health
preparedness.”
Rabies (see discussion in “Selected Pathogens” section)

Category B “Second highest priority agents include those that:
Brucellosis (Brucellaspp.) are moderately easy to disseminate;
Epsilon toxin ofC. perfringens result in moderate morbidity rates and low
mortality rates; and
Food safety threats (e.g.,Salmonellaspecies,
Escherichia coliO157:H7,Shigella, Vibriospp.,
Listeria monocytogenes, C. jejuni, Y. enterocolitica)

require specific enhancements of CDC’s

diagnostic capacity and enhanced disease

surveillance.”

Glanders (Burkholderia mallei)

Melioidosis (Bk. pseudomallei)

Psittacosis (Chlamydophila psittaci)

Q fever (Coxiella burnetii)

Ricin toxin fromRicinus communis(castor beans)

Staphylococcal enterotoxin B

Typhus fever (Rickettsia prowazekii)

Viral encephalitis (alphaviruses [e.g., Venezuelan

equine encephalitis, eastern equine encephalitis,

western equine encephalitis])

Viruses (noroviruses, hepatitis A virus)

Water safety threats (e.g.,Vibrio cholerae,

Cryptosporidium parvum)

Protozoa (Cyclospora cayatanensis, Giardia lamblia,

Enamoeba. histolytica, Toxoplasmaspp.,

Microsporidia)

Category C “Third highest priority agents include emerging
pathogens that could be engineered for mass
dissemination in the future because of:
Emerging infectious diseases such as Nipah virus and
hantavirus, yellow fever virus, tick-borne
encephalitis complex (Flaviviridae). Other viruses
within the same group are louping ill virus, Langat
virus, and Powassan virus.

availability;

Tick-borne hemorrhagic fever viruses [Crimean-Congo

hemorrhagic fever (Nairovirus-a Bunyaviridae),

Omsk hemorrhagic fever, Kyasanur forest disease

and Alkhurma viruses].

ease of production and dissemination; and

Multidrug-resistantM. tuberculosis potential for high morbidity and mortality rates and

major health impact.”

SARS virus (SARS-associated coronavirus)

West Nile virus (a Flaviviridae)

Pandemic and avian influenza (H5N1 influenza)

Monkeypox virus (Orthopoxvirusof the Poxviridae

family)

Genetically engineered biological weapons

Source: From Refs. 1, 4–8.

434 Cleri et al.