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The fears and predictions of bioterrorist attacks at the close of the 20th century were transformed into reality when anthrax laden letters were posted to several people through the United States postal system following the September 11 terrorist attacks. From then henceforth, bioterrorism ceased to be a theoretic concern. In essence, the attack was a challenge to medical preparedness, disaster management strategies and the scientific understanding of the epidemiologies of various biothreat agents. This possibility of future bioterrorists attacks on the civilian population has precipitated a high level of attentiveness that was nothing but dormant before the September 11, 2001 attacks on the World Trade Center and subsequent anthrax mailings that claimed the lives of five people. To terrorists, biological weapons possess great desirability because they are inexpensive to produce; are easy to obtain; have high mortality and morbidity rates; can be used to create panic and fear; the effects are extremely difficult to diagnose and treat; is transmissible from person to person and lastly, it offers the perpetrators an easy escape after launching the attacks(Monica 2001). It is upon these potentialities of biological weapons that models are created in preparation of a possible covert biological attack.
Botulism toxin is the most poisonous substance known to man. In context, a single gram of crystalline botulism toxin has the capacity to kill in excess of one million people. Even at low doses as 0.05-0.1 g, the toxin can still cause death in humans. Botulism naturally occurs in three forms; food borne, infant or intestinal toxemia, and wound, but these naturally occurring forms are extremely rare. Others are inhalational and iatrogenic botulism. However, due to its high toxicity and lethality, it is currently characterized as a major bioweapon threat. Coupled to its toxicity and lethality are its ease of production, transportation and the health effects on survivors which necessitate prolonged intensive care(Glik et al 2004).
Botulism Bioterrorist Attack: A Hypothetical Scenario
The Vice President of the United States of America is expected to visit Chandler in Arizona, a city of a quarter million residents. His itinerary includes an appearance at a local school where he will speak with the students, make a speech at Western International University before a crowd of 3000 people inclusive of the students before wrapping up the program with a press conference. The Federal Bureau of Investigation have information to the extent that due to the Vice President’s tough stance on the fight against terrorism, a terrorist group linked to a rogue state possessing botulinum toxin, is planning to attack the Vice President. Preliminary investigations of the terrorist group reveal that they have succeeded in acquiring some biological weapons as well as an aerosolization equipment. However, for some reason the FBI classifies these information as vague and desists from informing the Department of Health and Human Services, the state health department and the local law enforcement authorities.
Later on after the Vice President has completed his tour program and is back in Washington, the FBI informants on the ground at the time of the Vice President’s speech in Western International University report an unusual incidence. In a span of three days the university hospital report at least twenty cases of identical illness characterized by difficulties in swallowing, mild to severe muscle weakness, dizziness, mouth breathing, excess mucus in the throat and nose, having a feeling of having a cold but without the usual fever, difficulty in moving eyes, slurred or disturbed speech, and severe generalized weakness. However, no causative microorganism was isolated and confirmed toxicity cases were immediately taken through anti toxin treatment.
At the end of the first week fifty students had been put in intensive care as they required a breathing machine. At the end of the second week, the University had lost five students and a health alert was issued as more and more students continued to stream in for diagnosis and commencement of treatment. Coincidentally, the Vice President and a host of the dignitaries who accompanied him had also been diagnosed with similar symptoms. Based on the increasing health impacts, the local law agencies together with the FBI verified the initial vague predictions of a terrorist attack on the Vice President hence launching investigations on the perpetrators. Meanwhile, casualties and deaths continued to skyrocket as the Laboratory Response Network worked against the lethality of botulinum to save lives.
Differences between natural and intentional botulism outbreaks
These characteristics and the transcendence of events typifies a bioterrorist attack as opposed to a natural outbreak. For a natural outbreak, the causative(vegetative) microorganisms must be isolated as opposed to the latter where isolation may not be achieved(Mayhall 2004). The major routes of transmission such as drinks and food may be attributed to increasing patient numbers only if such an increase could be linked to a possible source of contamination, otherwise intentional botulism is definitive of the sporadic and catastrophic spread of botulism in the absence of person to person transmission. The incubation of botulism in intentional cases is comparatively shorter than in natural cases.
Response to the hypothetical terrorist attack
The most effective tool of combating a biological attack is education. Public education promotes the early detection of the disease hence allowing for a rapid institution of appropriate therapeutic interventions and control measures. These help to potentially blunt botulinum spread to catastrophic levels apart from primarily saving lives. The medical providers remain the first defense against a bioterrorist attack. Through the Laboratory Response Network(LRN) for bioterrorism created by the Centers for Disease Control and Prevention, the multilevel system becomes very instrumental in conclusive early detection of the pathogen used in the attack: Clostridium botulinum toxin.
Since this bioterrorist agent is classified in category A owing to their great potential for large scale dissemination, public panic and mass causality, the interlinkage between clinical laboratories and public health laboratories can be used to reduce the impact of the bioterrorist attack(Grace 2003). Since person to person transmission is absent in botulism cases, transmissibility and infection control should be focused on decontaminating the surfaces suspected of having the toxin through the use of Sodium hypoclorite or sodium hydroxide to inactivate the toxin.