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Biologic, Chemical, and Radiologic Terrorism Attacks at a Glance
  • Potential biologic weapons are classified by the Centers for Disease Control and Prevention into Category A, B, and C levels of risk.
  • Category A comprises smallpox, anthrax, plague, tularemia, botulism, and viral hemorrhagic fevers.
  • Category B comprises a large number of pathogens ranging from Brucella and Listeria to the toxins produced by Clostridium perfringens.
  • Category C comprises a number of viruses, rickettsioses, multidrug-resistant tuberculosis, and rabies.
  • Chemical weapons are categorized into blistering agents (such as sulfur mustard), nerve agents, blood agents, urticating agents, and incapacitating agents.
  • Radiologic weapons include what is called a dirty bomb, which produces low levels of radiation contaminating an entire zone.

The bombings of the World Trade Center's twin towers on September 11, 2001, and the spate of anthrax cases that soon followed introduced new responsibilities to the medical and public health communities.13 Physicians now have a societal responsibility to know the principles of responding to outbreaks of disease caused by biologic weapons. The dermatologist's role in recognizing bioterrorism is particularly significant because many pathogens produce illnesses with prominent cutaneous findings.4,5 The dermatologic aspects of smallpox, for example, are the most obvious and dramatic aspects of the disease. Other conditions, such as anthrax, frequently—although not always—manifest in the skin. It is likely that the diagnosis of an index case of a bioterror outbreak will rest on dermatologic findings, subtle or overt.

Public health authorities recognize that terrorism may involve other sorts of unconventional weapons, including chemical and radiologic weapons. This chapter provides an overview of the manifestations of unconventional weapons that terrorists might use.

The Centers for Disease Control and Prevention (CDC) stratified potential bioweapons into three levels of risk (Tables 213-1, 213-2 and 213-3) based on ease of manufacture, ease of dissemination, subsequent person-to-person transmission, lethality, and psychosocial effects (literally, how terrified a community will be). When an organism is intentionally dispersed as part of warfare, terrorism, or criminal activity, a goal is to infect huge numbers of people. Hence, the dispersal system may be engineered to disseminate the disease widely, often as airborne spread that results in pulmonary or inhalational disease. Some—but not all—of the pathogens are then transmissible from person to person, thereby potentiating the public health effects of—and the terror associated with—biologic weapons.

Table 213-1 Biologic Agents or Diseases Most Likely to Be Used in Terrorism or Warfare (Centers for Disease Control and Prevention and National Institutes of Health Category A Agents or Diseases)a

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