Bioterrorism

Classification of Diseases/Agents

The Centers for Disease Control and Prevention (CDC) classifies particular bioterrorism diseases/agents into one of three categories: A, B, and C.

Category A diseases/agents are considered high priority due to their ability to be transmitted easily from person to person, which can result in high mortality rates. Public panic and social disruption may ensue, so special action for public health preparedness is necessary. This category includes anthrax (Bacillus anthracis), botulism (Clostridum[Page 100]botulinum toxin), plague (Yersinia pestis), smallpox (variola major), tularemia (Francisella tularen-sis), and the viral hemorrhagic fevers (filoviruses and arena viruses). Except for botulism, these illnesses usually present initially as a flu-like illness with low-grade fever and fatigue.

Category B includes the second level of high-priority diseases/agents, with moderate dissemination and morbidity rates and relatively low mortality rates. These agents require specific CDC enhancements of diagnostic capability and disease surveillance. This category includes brucellosis (Brucella species); epsilon toxin (Clostridium per-fingens); and food and water safety threats such as Salmonella, Shigella, vitrio cholera, glanders (Burkholderia mallei), meliodosis (Burkholderia pseudomallei), Q fever (Coxiella burnettii), ricin toxin from castor beans, staphyloccal enterotoxin B (as an incapacitating agent), typhus fever (Rickettsia prowazekii), and viral encephalitis (alpha viruses).

Category C includes diseases/agents that are emerging pathogens that can be engineered for mass dissemination in the future due to availability, ease of production, and potential for high morbidity and mortality. Examples include the napah virus and hantavirus.

Responsible Agencies

The public health infrastructure is the central component to monitor exposure to bioterrorism diseases/agents, identify the specific action required to prevent primary and secondary exposure, provide containment measures, and respond with necessary medical supplies. The basic premise of the National Response Plan (NRP, Version 4.0) developed by the U.S. Department of Homeland Security is that such incidences are handled at the lowest jurisdictional level possible.

Four federal agencies will likely be involved in any response to bioterrorismin the country: (1) U.S. Department of Homeland Security (DHS), (2) U.S. Department of Health and Human Services (HHS), (3) U.S. Department of Defense (DoD), and (4) U.S. Department of Veterans Affairs (VA).

Founded in 2002, the DHS contains four important programs: (1) National Disaster Medical System, (2) Strategic National Stockpile, (3) Metropolitan Medical Response System, and (4) Federal Emergency Management Agency (FEMA).

The HHS encompasses more than 300 programs, including the following: CDC; Food and Drug Administration (FDA), Health Resources and Services Administration (HRSA), and the National Institutes of Health (NIH).

The DoD is the support agency for almost all the emergency functions of the NRP, under the Military Support to Civil Authorities (MSCA) doctrine. The MSCA is operationally directed through the U.S. Northern Command in Colorado Springs, Colorado.

...