Bioterrorism refers to the utilization of microorganisms such as fungi, viruses and bacteria, or toxins by extremists or terrorist groupings for producing weapons that result in diseases and death amongst humans, plants and animals. Terrorism is the illegal use of violence of force against people, property, or animals as a way of intimidating a government or the general public to attain social or political objectives ( Pal et al., 2017) . Using bioweapons or biological agents to harm people or kill is not a novel conception – nations have been involved in bioterrorism for centuries. Moreover, bioterrorism has its roots back in the fourteenth century when dead bodies were put in enemy wells for poisoning the drinking water. Also, bioterrorism took place in the Indian and French conflicts, after Native Americans were issued with blankets loaded with smallpox. This act is thought to have introduced smallpox in this formerly unexposed people and led to a mortality rate of 40%. More recently, notable events of bioterrorism have occurred ( Pal et al., 2017) . One of them is the deliberate contamination of Dalles’s of salad bars in Oregon, through the use of Salmonella. Another event is the 2001 attack through the use of anthrax-laden letters mailed to politicians and media companies.
The potential effect of bioterrorism is determined by the agent utilized, the quantity being released, the technique of dispersion, the dispersion or weather situations, the exposed population’s preexisting immunity, and how fast the attack was detected. There are various potential agents of bioterrorism such as toxins, viruses and bacteria. Common features of these agents comprise: they are dispersible in aerosols of between 1mm and 5mm particles that can penetrate the distal bronchioles, the aerosols can be delivered using simple technology, they can spread fear, panic, or disease, and they can feasibly infect masses of people. Bioterrorism can potentially lead to high mortality and morbidity since aerosolized bio-weapons could affect or kill a large number of individuals within a short period ( Pal et al., 2017) . Besides, non-aerosolized attacks like the anthrax attack could lead to mortality and mobility. The bio-weapons are hard to identify as they are odorless and tasteless, and might be dispersed through the air. Due to the potential impact bioterrorism can have on the humans and animals, there is the need to understand it better – its historical background, the different categories of biological weapons, the characteristics of an ideal bioweapon, delivery and dissemination methods of bioweapons, the exposure routes of biological weapons, and the impact of bioterrorism on humans and animals.
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Historical Background
Before the twentieth century, biological agents were mainly used in three primary forms – intentional poisoning of water and food, biological animals, plants (both dead and live) or toxins, and the use of biologically injected persons or fabrics. Today, sophisticated virological and bacteriological methods have enabled the creation of considerable stocks of biological weapons to spread and result in infections like smallpox, anthrax, Tularemia, Brucellosis, ricin poisoning viral hemorrhagic fevers, and botulinum ( Martinez & Rose, 2018) . An aerosolized spray of particles of between 1mm to 5mm is the most common dissemination of bioweapons. Other techniques of disseminating bioweapons consist of oral, deliberate poisoning of water or food supply, percutaneous, injected animal vector such as infected fleas ( Hadian & Moghasemi, 2017) . Humans-to-human spread in which an infected person with contagious infection walks amongst a group of healthy individuals has as well been identified. Based on the evidence from the 2001 anthrax attacks, physical objects like letters could be utilized to help in spreading biological agents.
Simple types of biological war have been in practice since the primeval era. During the sixth century B.C., the Assyrians employed a fungus for contaminating enemy wells to make the enemy derailed. The emergence of the germ theory of infections, as well as advancements in microbiological methods, created a new sophistication level to the theoretical usage of bioweapons in warfare. Further, glanders and anthrax were used as biological sabotage on behalf of the imperial German government in WWI, with indifferent outcomes ( Pal et al., 2017) . The utilization of bio agents as warfare weapons is not a contemporary age innovation, as proven by the fact that during the Pre-Christian period, about 300 B.C., the Greeks deployed animal corpses for poisoning the enemies’ water wells ( Sinha & Singh, 2016) . This approach was as well deployed by the Persians and Romans. During the Tortona battle, Italy, Emperor Barbarossa’s soldiers used 1155 corpses of animals and soldiers for contaminating water wells.
In the fourteenth century, when the Kaffa siege took place, there was a spread of a plague epidemic. The attackers were believed to have catapulted the cadavers of their dead soldiers within the Kaffa city walls, leading to a critical moment in the combat – the Genoese escaped from Kaffa and carried with them their disease. During the return journey to Genoa, they stopped ay different harbors in the Mediterranean Sea ( Pal et al., 2017) . Although specific sources consider a potential relationship between the plague epidemic in Kaffa and the pandemic, which decimated many people during the succeeding decades (Black Death), many researchers held that the two occasions were indeed independent.
During the Carolstein siege in 1422, the Lithuanian army catapulted corpses of lifeless comrades and feces into the town to frighten the inhabitants and spread deadly fevers in different regions. Another reported usage of bio agents as a warfare weapon took place over 300 years later. In the French-Indian War that occurred between 1754 and 1767, the British commandant commanded the spread of blankets that were injected with smallpox for countering the Indian tribes, which were British enemies ( Pal et al., 2017) . The spread of the infected blankets took place in 1763, and the reappearance of the infection amongst the native people continued for over 200 years. Post-WWI and WWI, many countries have researched the use of biological weapons.
Categories of Bioweapon Agents
As previously mentioned, bioterrorism involves the deliberate discharge of virus, bacteria, or other agents used for causing diseases or death in human beings, plants, or animals. The biological agents are categorized into three groups. The first group consists of the agents that are easily transmitted or spread from an individual to another. They lead to high mortality rates and can potentially trigger significant public health consequences. Also, they may create social interruption and public panic and need special measures for public readiness. The second class of agents comprises those which are relatively easy to spread, and they cause moderate rates of morbidity and low mortality ( Tournier et al., 2019) . They also need specific superior diagnostic ability as well as illness surveillance. The last category encompasses the emerging agents, which might be engineered for mass transmission in the future due to their availability. They can be produced and disseminated quickly, and they are likely associated with high mortality and morbidity rates, and considerable health effect ( Sinha & Singh, 2016) . Bioweapons can be produced at a relatively lower cost, and they are easy to produce. They result in deaths, disabling sicknesses, and could be distributed or aerosolized over a wider geographical region. There are various potential pathogens that terrorists can use, but only a few of them can be easily prepared and dispersed. Some of the biological agents include Q fever, glanders, botulism, tularemia, plague, and anthrax.
The Characteristics of a Perfect Bioweapon
A bioweapon could be more effective in smaller quantities compared to the hydrogen bomb. The design of biological attacks is to destroy a population by either causing disease or more frequently, killing huge populations of individuals via mass destruction. The features of bioweapons are: they are highly toxic and infectious, they are stable in dispersal and storage, leads to difficulty in health response, they are easy to create and generate impacts which can be manipulated ( Rossodivita, Visconti, Saporito & Rizzardini, 2019) . Although various pathogens trigger illnesses in people, plants, and animals, only a minimal number of these pathogens qualify to be a bioweapon. In essence, t bioweapons have distinct characteristics ( Martinez & Rose, 2018) . Bioweapons must be easy to get or create. In developing biological attacks towards a targeted population, huge quantities of biological agents are needed. Besides, an ideal bioweapon should be highly capable of incapacitating the affected, or in other words, be highly fatal. Other crucial features of bioweapons are the transmission route, and thus, the ease of spreading, with a suitable delivery method. Lastly, the agent’s suitability should be evaluated, mainly when massive amounts should be kept for an unknown period.
Overall, bioweapons can also be grouped as per specific features that define the risk to health. The first category is infectivity, in which bioweapons are classified based on the agent’s ability to penetrate as well as reproduce in the host. The second classification is pathogenicity, which is the agent’s ability to cause illness once it penetrates the body ( Thongyuan et al., 2019) . Another category is transmissibility, which is the agent’s ability to be disseminated from an infected person to a healthy individual. Lastly, bioweapons are classified by their neutralization ability that is, having therapeutic goals or preventive tools.
Delivery Mode and Dissemination Method of Bioweapons
Biological agents are deliverable in either dry or wet state. Dry powders made of extremely tiny particles are likely to have greater features of dissemination and have storage benefits. Dried agents need a higher technological sophistication for production, although spray driers or freeze-drying has been in existence in the industry for decades. An aerosolized agent is the most common method of delivery. The agent might be disseminated through connecting a spray device to a mobile transmission ( Pal et al., 2017) . An example is an industrial pesticide sprayer designed for mounting on an aircraft. A release line then occurs as the sprayer operates. This is referred to as a line source and is disseminated vertical to the wind direction, windward of the planned target place. Up to a particular range, any person downwind of the line source is hypothetically at danger.
The range which the toxic or infectious agent reaches is determined by several factors such as the direction and speed of the wind, atmospheric pressure, and the availability of inversion conditions, and the agent’s characteristics. Biological agents may be disseminated through scattering them in the air, the infection of animals which transmit the infection to people, and poisoning water and food ( Pal et al., 2017) . Potentially, different human pathogens might be utilized as weapons, but public medical agencies have recognized only a limited which have the potential of causing mass fatalities resulting in public disturbances.
The most effective way of delivering a biological war agent is through an aerosol. The systems of aerosol delivery are designed for generating invisible clouds with droplets or particles of o.5mm to 10mm in diameter that can stay floating on the air for a long time. The aerosol discharge of particles that are inhalable in that size range leads to a significant inhalation risk because the particles may move deep into the lungs ( Martinez & Rose, 2018) . Biological war agents can be utilized for contaminating water systems or food. Heat can destroy most toxins and agents; therefore, to ensure effectiveness, many agents are used on raw foods or added to the prepared food ready to eat. Standard methods of purifying water, such as filtration and chlorination, can well inactivate most pathogens and certain toxins ( Hadian & Moghasemi, 2017) . Nonetheless, chlorination cannot inactivate multiple spores, and large-scale filtration is mainly unsuccessful against most bacteria, viruses, cysts, and pores. Also, biological war agents can be delivered through covert injection. Certain agents are fatal once injected. The likely methods of bioweapon attack in any functioning environment differ considerably with the region, subject to the type of delivery method used, the time of day, weather situations, as well as the local topography.
Exposure Routes of Bioweapons
Biological weapons are transmittable in various ways. First, there is the parenteral mode, whereby agents are transmitted via blood or body fluids. Also, they can be transmitted through the airway through the emission by infected people and inhalation by surrounding individuals. Similarly, they can be transmitted through contact, in which the agents an agent present on an infected organism’s surface could infect another organism ( Thongyuan et al., 2019) . Finally, they can be transmitted via oral-fecal route mode via foods, objects, or other items poisoned with infected patients’ feces or via sexual contact. Generally, bioweapons can be transmitted through the respiratory system via inhalation, mucous and skin membranes, and digestive system through ingestion.
Effects of Bioterrorism on Humans and Animals
Bioweapons have the potential of producing a life-threatening disease. Bio-toxins are fundamentally poisons that could be lethal at high enough dosages. Even when released in small amounts in the air, bioweapons could lead to substantial loss of life, depending on various factors such as the agent’s infectivity, lethality, and the time taken to identify and treat the people exposed to the agent or those who are sick ( Radosavljevic, 2019) . Also, bioterrorism leads to the psychological impact. For instance, psychological responses after a bioterrorism event can include social isolation, fear, and anger. After the anthrax attack of 2001, many people believed they were infected and looked for treatment. Attempting to identify the uninfected ones might complicate the ability of health centers to treat the infected and exposed ones, particularly during unclear diagnoses.
Conclusion
Today, with technological advancements, bioweapon infections are known to spread more rapidly and have proven much harder to control and get rid of compared to the historical bioweapons. Nevertheless, bioterrorism readiness aids in mitigating possible negative consequences, and is needed by public health and healthcare agencies to be part of the extensive emergency management plan. In establishing substantial public health, healthcare, as well as emergency management response, is necessary now.
References
Hadian, B., & Moghasemi, A. (2017). Bioterrorism, a threat to general health. Yafteh , 19 (3), 33- 40.
Martinez, M., & Rose, E. (2018). Potential Bioterrorism Agents with Mucocutaneous Findings (Anthrax, Plague, Tularemia, Smallpox). In Life-Threatening Rashes (pp. 301-318). Springer, Cham.
Pal, M., Tsegaye, M., Girzaw, F., Bedada, H., Godishala, V., & Kandi, V. (2017). An overview on biological weapons and bioterrorism. Am J Biomed Res , 5 (2), 24-34.
Radosavljevic, V. (2019). Environmental health and bioterrorism. Encyclopedia of environmental health , 450.
Rossodivita, A., Visconti, A., Saporito, T., & Rizzardini, G. (2019). Bioterrorism: toxins as potential biological weapons-an emerging global health threat. International Journal of Infectious Diseases , 79 , 55.
Sinha, S., & Singh, J. (2016). Classification, causes, control measures and acts of bioterrorism. Int J Appl Biol Pharm Technol , 7 (2), 342-354.
Thongyuan, S., Tulayakul, P., Ruenghiran, C., Khuntamoon, T., Viriyarumpa, S., & Binot, A. (2019). Bioterrorism: toxins as potential biological weapons-an emerging global health threat. Abstracts/International Journal of Infectious Diseases , 79 (S1), 1-150.
Tournier, J. N., Peyrefitte, C. N., Biot, F., Merens, A., & Simon, F. (2019). The threat of bioterrorism. The Lancet Infectious Diseases , 19 (1), 18-19.
