The role of bioforensics in medical bio-reconnaissance

Abstract

Since the 1990s, a broad spectrum of regional conflicts and crises have evolved that have been accompanied by a growing threat of international terrorism. How vulnerable our modern societies would be towards a covert biological attack became evident in the 2001 anthrax letters attack in the United States. Biothreats are currently associated with asymmetric warfare scenarios and non-state actors rather than with state-driven biowarfare facilities. Against this backdrop, NATO has to consider biological warfare and bioterrorism as a serious threat to its forces. In bioterroristic scenarios the deliberate release of a biological agent will most probably remain undetected until a cluster of cases will suggest an unusual outbreak of disease. In military settings it is primarily the responsibility of the Medical Services to recognize the outbreak and to launch an appropriate outbreak investigation. Major goals of a medical bio-reconnaissance mission are to rapidly identify the causative agent of the outbreak and to differentiate between natural and deliberate outbreaks. In contrast to the investigation of overt natural outbreaks, forensic aspects have to be considered and appropriate procedures have to be implemented quite from the beginning when unusual outbreaks are to be investigated. If a biothreat agent is detected, it may be necessary to enter further genetic analysis in order to differentiate between natural and intentional outbreaks and to trace back the origin of the agent. Microbial forensics is mainly concerned with taking molecular fingerprints of biothreat agents by means of molecular typing techniques enabling the investigator to identify and trace back a particular strain by comparing it with the fingerprints stored in a typing database. The bioforensic approach may well be capable of elucidating the source of an outbreak as has been evidenced in the Amerithrax case in 2001. In order to detect molecular differences of microbial strains, a number of sophisticated typing techniques are currently employed, the most recent of which is whole genome sequencing, which has even entered the field laboratories by means of portable next generation sequencing devices like the MinION™.