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MICROBIAL BIOTERRORISM

Microbial bioterrorism refers to the use of microbial pathogens as weapons of terror that target civilian populations. A primary goal of bioterrorism is not necessarily to produce mass casualties but to destroy the morale of a society through creating fear and uncertainty. The events of September 11, 2001, followed by the anthrax attacks through the U.S. Postal Service, illustrate the vulnerability of the American public to terrorist attacks, including those that use microbes. The key to combating bioterrorist attacks is a highly functioning system of public health surveillance and education that rapidly identifies and effectively contains the attack.

Agents of microbial bioterrorism may be used in their natural form or may be deliberately modified to maximize their deleterious effect. Modifications that increase the deleterious effect of a biologic agent include genetic alteration of microbes to produce antimicrobial resistance, creation of fine-particle aerosols, chemical treatment to stabilize and prolong infectivity, and alteration of the host range through changes in surface protein receptors. Certain of these approaches fall under the category of weaponization, a term that describes the processing of microbes or toxins in a manner that enhances their deleterious effect after release. The key features that characterize an effective biologic weapon are summarized in Table 33-1.

The U.S. Centers for Disease Control and Prevention (CDC) has classified microbial agents that could potentially be used in bioterrorism attacks into three categories: A, B, and C (Table 33-2). Category A agents are the highest-priority pathogens. They pose the greatest risk to national security because they (1) can be easily disseminated or transmitted from person to person, (2) are associated with high case-fatality rates, (3) have potential to cause significant public panic and social disruption, and (4) require special action and public health preparedness.

TABLE 33-1KEY FEATURES OF BIOLOGIC AGENTS USED AS BIOWEAPONS
TABLE 33-2CDC CATEGORY A, B, AND C AGENTS

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