Introduction
Bioterrorism is the use of biological agents as weapons by an individual or as a state against the other. Bioterrorist attacks may not be easily distinguished from a natural disease infection. Therefore, the mode of transmission, the rate of transmission, the frequency with which the outbreak is witnessed as well as the geographical location of the areas of outbreak are some factors that the health researchers need to consider in determine the nature of the outbreak.
Natural disease outbreaks are generally seen in specific areas. The disease transmissions are often periodic and the possibility of the outbreak can be foretold by the researchers. On the other hand, a bioterrorist attack is characterized by unpredictable outbreak that is not endemic to a geographical region, occurs at any time, and may exhibit high rate of transmission.
However, it should be noted that this might not be the usual situations. Bioterrorism attacks often take different forms and an outbreak may not be foretold from the past outbreaks. Some of agents and diseases associated with bioterrorism are botulism, cholera (Vibrio cholera), and Escherichia coli 0157: H7, Salmonellosis, Shygella dysenteriae Type 1, and Typhi (Typhoid fever).
Epidemiology
A study on the life patterns of the biological agents used as weapons in bioterrorist attacks is vital in managing the emergency cases. The genetically manufactured organisms are “resistant to all known vaccines and drugs, highly contagious, and able to harm thousands of people” (Pavlin 1999, p1). This is also not the case always; some attacks have been characterized by less contagious strains that can be cured by antibiotics.
In this regard, we must maintain high level of diligence in “identifying and reacting to a biological attack since the attack may not follow a regular pattern” (Pavlin, 1999, p1). A mild attack may indicate a more serious case in the future and preventive precautions should be put in place. Essentially, Pavlin (1999) observes that ‘all healthcare providers and public health personnel should have basic epidemiological skills and knowledge of what to expect in such a setting” (p.1).
Bioterrorism-related Issue: Salmonella typhimurium
The bacterium Salmonella enterica serova typhimurium is a disease causing pathogen found in the genus Salmonella in the broad family of Enterobacterioceae. The genus comprises facultatively anaerobic bacteria with spore-less rods and peritrichous flagella. The pathogen causes Salmonellosis infections in humans.
It symptoms that can be seen as from 12 to 72 hours after infection include fever, diarrhea, and abdominal cramps. The infection is transmitted mainly through animal and human waste. This occurs of the contaminated substances find their way to foods and water. Its feeding adaptations and rate of multiplication makes it a suitable agent that can be used by an intentional attacker.
The use of this pathogen as a biological agent was witnessed in the summer of 1984 near Dalles, Oregon. The attack was made by a religious cult led by the Bhagwan Shri Rajneeshee. The attack was a political move aimed blocking a section of the electorate from participating in the election to influence its result. The residents of Wasco County were sickened by the biological agent to enable the Rajneeshee candidate to secure the seat (McDade & Franz, 1998).
The cult had other biological agents but, under the direction of their nurse, settled on the strain that caused food poisoning. They had obtained the medical equipments from a medical supply company on false grounds. Towards the end of August, they spread the bacteria on many common places like doorknobs, drinking glasses, produce in the local market, and on salad bars in ten restaurants (McDade & Franz, 1998). Later on, they went ahead and contaminated the Dalles water supply.
The effect of this was a series of patients reporting cases of fever, nausea, diarrhea, and headache in the nearby health centers. As McDade and Franz (1998) reported about 750 people were infected by the bacterium and within few days, the medical practitioners identified the causal agent to be Salmonella typhimurium. However, it took long before it was established that just one strain causes the different cases. This was reported by the Center for the Disease Control (CDC).
Differential diagnosis and surveillance
This is an initial consideration of a disease outbreak regardless of its seriousness. It is aimed at determining if the facts surrounding an outbreak are rare types that could indicate a bioterrorist attack.
The diagnosis of the Salmonella typhimurium infection and its subsequent treatment can be arrived at through sequencing the genomes of Salmonella typhimurium LT2 and Salmonella Typhi. The latter is a common infection and such comparison would explain why the former has unique characteristics. It is not easily noticed like typhoid and several cases can go unnoticed.
Primarily, surveillance of a disease refers to the study of the progress of the disease among a group of people. The terrorist attack witnessed in New York City and Washington D.C prompted the Center for Disease Control (CDC) to advocate for strong surveillance on the unusual disease outbreaks or multiple occurrences that can be associated by terrorism (CDC, 2001).
Currently, in the US, an initiative has been started to incorporate information technology in surveillance. In this case, the National Electronic Disease Surveillance System (NEDSS) promotes surveillance systems used at the federal, state, and local levels to collect and monitor data on trends and outbreak of diseases. The surveillance strategy was evidenced in managing the typhimurium attack since the local physicians and the hospital caretakers were on their toes to notice the abnormal reports.
In attempt to have control over the occurrences and or/progress of a bioterrorist attacks, the health care providers must be informed that certain occurrences might not be easy to notice, more so if the first cases are not many. There need not to be multiple occurrences of a disease outbreak to indicate an intentional attack. For instance, just one observed case of anthrax inhalation should be enough warning of possible attack. On the other hand, it should be noted that not only primary healthcare providers could detect an unusual outbreak.
An alarm could be raised by a laboratory technician coming across an ‘unusual strains of organisms or the county epidemiologist keeping track of hospital admission or a pharmacists distributing more antibiotics than usual’ (Pavlin 1999, p1).
Further, away from health care providers, an abnormal increase in sales of funeral services could also blow the whistle. Therefore, in order to ensure proper disease surveillance and differential diagnosis, ‘all the epidemiologic data should be tracked and aggressively followed to ensure the most rapid recognition and response’ (Pavlin, 1999, p1).
After a case has been noticed, the usual epidemiological procedures are conducted to confirm the outbreak and compare it to any previous cases. The rates of infection and transmission as well as the geographical setting and the age group attacked are also noted. The information obtained here could help in determining the cause of the outbreak and the possible remedy. The pattern exhibited by the disease will help distinguish an intentional attack from a natural disease outbreak.
Remedy
Bioterrorism has been a threat to the public at both state and international levels. Since dealing with bioterrorism attacks call for co-operation from different personnel in the public sector, creating awareness and having proper preparation should the major national and international concern.
All the health workers should be continuously provided with the basic epidemiological skills and some elementary clinical diagnosis of agents causing greater challenges. Advanced disease surveillance programs need to instituted to monitor the disease outbreaks and indeed such initiatives have been witnessed in the US CDC programs that extend it services to other countries (CDC, 2001).
References
CDC. (2001). Recognition of Illness Associated with the Intentional Release of a Biologic Agent. A Weekly Report, 2001/50(41); 893-7. Web.
McDade, J. E. and Franz, D. (1998). US Army Medical Research Institute of Infectious Diseases. Bioterrorism as a Public Health Threat, Vol. 4 No 3. Maryland. Web.
Pavlin, J. (1999). Epidemiology of Bioterrorism. Emerging Infectious Diseases, Vol.5 No 4. Washington: Walter Reed Army Institute of Research. Web.