Anthrax as a Biological Weapon Medical and Public Health Management

OF THE NUMEROUS BIOLOGIcal agents that may be used as weapons, the Working Group on Civilian Biodefense has identified a limited number of organisms that could cause disease and deaths in sufficient numbers to cripple a city or region. Anthrax is one of the most serious of these diseases. High hopes were once vested in the Biological Weapons and Toxins Convention, which prohibited offensive biological weapons research or production and was signed by most countries. However, Iraq and the former Soviet Union, both signatories of the convention, have subsequently acknowledged having offensive biowarfare programs; a number of other countries are believed to have such programs, as have some autonomous terrorist groups. The possibility of a terrorist attack using bioweapons would be especially difficult to predict, detect, or prevent, and thus, it is among the most feared terrorist scenarios. Biological agents have seldom been dispersed in aerosol form, the exposure mode most likely to inflict widespread disease. Therefore, historical experience provides little information about the potential impact of a biological attack or the possible efficacy of postattack measures such as vaccination, antibiotic therapy, or quarantine. Policies and strategies must therefore rely on interpretation and extrapolation from an incomplete knowledge base. The Working Group on Civilian Biodefense reviewed the available literature and expertise and developed consensus recommendations for medical and public health measures to be taken following such an attack.