Bioterrorism

Abstract

Although bioterrorist attacks have taken place over the last two decades, it is still an area of ignorance amongst UK medical staff, including pathologists. This is paradoxical since it is pathologists and anatomical pathology technologists (APTs) in the mortuary who are more likely to be involved closely than many other medical and paramedical staff. The purpose of this chapter is to outline some of the history of bioterrorism (BT), the responses of government, what the likely agents are and their clinical pathologies, medico-legal aspects and what everyone in mortuary work should be prepared for. By definition, much is uncertainty, although the expert consensus is that all industrialised countries could experience a BT attack sooner or later. Following the initiative of the USA, many countries (including the UK) have drawn up plans and produced guidance documents. These have been freely adopted here, accompanied by personal observations where there is no agreed evidence base. Biowarfare and, to a lesser extent, bioterrorism have been with us for hundreds of years, but the modern industrialised world has only woken up to the actuality in the last decade (1)-see Box 1 and Box 2. Although the potential was beginning to be addressed in the 1990s (and really only in the USA) at government and institutional levels (2), it was the 2001 episode of anthraxcontaminated letters in the mail (in the USA) that truly focused minds. The civil and criminal investigation responses to that event are well documented (3), but the critical role of pathology in that investigation needs to be emphasised (4-6). Bioterrorism is defined as "the use or threatened use of biologic agents against a person, group, or larger population to create fear or illnesses for purposes of intimidation, gaining an advantage, interruption of normal activities, or ideologic activities. The resultant reaction is dependent upon the actual event and the population involved and can vary from a minimal effect to disruption of ongoing activities and emotional reaction, illness, or death" (7). Bioterrorism should be distinguished from state-initiated biowarfare research projects and applications. The governments of the UK, USA, Germany, USSR, Japan and Iraq, to list only the most publicised examples, have all supported research into the potential use of biological agents in order to harm enemy military and/or civilian personnel in the twentieth century. They have officially ceased such activities now, but much important information has been gleaned from accidents and other events during this phase of activity. It was the 1990s events in Japan and Iraq that forced everyone to think of BT as a serious possibility that could affect any country, no matter how well prepared militarily for conventional or nuclear attack. In 1997, the Journal of the AmericanMedical Association devoted a whole issue to BT, which reached a wide audience (8, 9). © 2008 Springer-Verlag London Limited.