If you enjoy watching crime dramas as much as I do, you may have noticed that many episodes focus on bioterrorism. These shows captivate the audience and evoke fear by highlighting the reality of bioterrorism as a genuine threat. In the end, it's the brave first responders and law enforcement who save the day.
Bioterrorism, however, is a real fear for many people as tensions around the world continue. Whether on a small or large scale, the idea has loomed in our minds for as long as we can remember.
Bioterrorism in History and Media
You may already be familiar with biological agents such as anthrax, ricin, and the bubonic plague. Between 1981 and 2018, there were reportedly 37 global bioterrorist attacks. Bioterrorism has had a rich history in the past 100 years.
For example, during World War I, Germany attacked Romania, Russia, France, and the United States by infecting horses. In World War II, Japan used biological weapons such as anthrax, botulism, and the plague against China. In 1972, two college students were caught planning to infect the Chicago water supply with typhoid fever. In 2001, bioterrorists mailed anthrax to news media offices and the United States Congress. The COVID-19 pandemic has recently pushed bioterrorism into public discussion.
The pandemic has highlighted possible vulnerabilities in the healthcare system to bioterrorist attacks. Simply put, the public's fears about extremist groups and bioterrorism mean that healthcare workers should take measures to address these concerns.
Overview of Bioterrorism Agents
Biological weapons are the agents or devices used in bioterrorist attacks. These weapons are used to disseminate toxins or pathogenic organisms to the target. The result of these attacks is disease or death in humans, animals, or plants.
Nurses need to be familiar with all types of biological weapons to act in the event of an attack. Biological weapons can be devastating to individuals. Quick recognition, thorough training, and decision-making skills may save lives.
Different agents have unique presentation and treatment modalities for which nurses should be prepared. The Centers for Disease Control and Prevention (CDC) classify biological weapons in categories based on morbidity and mortality in humans.
- Category A: This category encompasses diseases posing the highest threat to national security. They are highly contagious and cause severe illness or death. These diseases would significantly impact public health, potentially leading to widespread panic and necessitating the implementation of specialized public health preparedness measures.
- Category B: This category includes diseases considered to be a secondary threat. While causing less severe illness and death compared to Category A, they are still a concern. Additionally, these diseases are less easily spread from person to person.
- Category C: This category focuses on emerging pathogens. This category is considered the third highest threat. These diseases have the potential to cause significant illness and death, but they are not currently widespread. However, they could be engineered for mass transmission, making them a potential future threat.
Biological agents can also be divided into five categories: bacterial, viral, fungal, protozoal, and toxins. Some of the most common agents in the media and news are bacterial, such as anthrax and typhoid fever. Many people are also familiar with viral agents such as smallpox but not the link to bioterrorism. Fungal, protozoal, and toxin biological weapons are not as represented in public discussion. It is necessary, however, for nurses to familiarize themselves with all categories of biological weapons.
Bacterial Bioweapons
One of the most well-known biological weapons is Bacillus anthracis or anthrax. The name for anthrax is derived from "anthracis," which means black in Greek. This name is due to the black necrotic lesions with cutaneous anthrax infection. It can be contracted through skin contact, inhalation, or ingestion.
- Cutaneous anthrax: Causes black, necrotic lesions on the skin
- Inhalation anthrax: Leads to respiratory symptoms and can progress to systemic illness
- Gastrointestinal anthrax: Results from consuming contaminated food and causes digestive problems
Anthrax is a Category A bioterrorism agent, highlighting its high risk to public health.
Early diagnosis and treatment are crucial for survival.
Viral Bioweapons
Viral hemorrhagic fevers (VHFs) are a group of viruses that can cause severe illness and bleeding. They are spread through contact with infected animals or other humans.
- Four families of VHFs:Flaviviridae, Filoviridae, Bunyaviridae, Arenaviridae
- Examples: Ebola, dengue, yellow fever, Crimean-Congo hemorrhagic fever
- Symptoms: Fever, headache, malaise, bleeding, and organ damage
It is also important to note that the CDC considers VHFs a category A bioweapon. This categorization is because these viruses are stable in aerosol form, are difficult to treat, and have severe symptoms. Early diagnosis and isolation are crucial for preventing outbreaks.
Fungal Bioweapons
Histoplasma capsulatum and Coccidioides are fungal agents with potential for bioterrorism. These airborne spores can cause severe illnesses like pneumonia and meningitis.
While many people with histoplasmosis and coccidioidomycosis experience mild or no symptoms, severe cases can lead to life-threatening complications. Diagnosis involves testing for fungal antigens and other markers. Preventing the spread of these fungal agents is crucial for public health.
Protozoan Bioweapons
Protozoan bioweapons are not common, but one known agent is Cryptosporidium parvum. This organism is part of 15 Cryptosporidium species known to cause human infections. Infection with Cryptosporidium presents with watery diarrhea, fever, nausea, vomiting, and abdominal pain.
Some patients may even suffer from these symptoms for months to years. Diagnosis is typically made by identifying the organism in stool samples using polymerase chain reaction (PCR) tests, special stains, or antigen detection assays. The CDC identifies this agent as a category B threat because of the potential to affect water safety.
Toxins
Ricin, a deadly toxin found in castor beans, is a potential bioweapon. It can be inhaled, ingested, or injected, causing severe illness and death.
Symptoms:
- Inhalation: Cough, fever, respiratory distress
- Ingestion: Abdominal pain, vomiting, diarrhea, organ failure
- Injection: Blisters, erythema, tissue damage
Treatment: There's no antidote for ricin poisoning. Treatment focuses on supportive care and managing symptoms.
Bioterrorism Threat: The CDC classifies ricin as a Category B bioterrorism agent due to its high toxicity and potential for widespread harm.
The Bottom Line
Many bioweapons exhibit similar symptoms, particularly during the initial stages of exposure, which can also resemble those of less severe or more common illnesses. If a patient is suspected of being exposed to any of these agents, it is crucial to isolate them immediately. Adhere strictly to the recommended isolation protocols and ensure thorough contact tracing. Diagnosis may require specific testing in some instances, so nurses need to follow established protocols diligently and stay updated on any new information from the CDC.
About the Author:
Golda Ntali, DNP, BSN, RN, received her doctorate in nursing practice at Capella University. She has experience in home health, rehabilitation, dementia care, academic support, and utilization management. She is also skilled in writing and researching medical and health topics and integrating this information into informative medical content. She is passionate about translating evidence into accessible information for all populations. Her special interests are quality improvement, disease prevention, patient education, wellness, and healthcare systems.
Golda is an independent contributor to CEUfast's Nursing Blog Program. Please note that the views, thoughts, and opinions expressed in this blog post are solely of the independent contributor and do not necessarily represent those of CEUfast. This blog post is not medical advice. Always consult with your personal healthcare provider for any health-related questions or concerns.
If you want to learn more about CEUfasts Nursing Blog Program or would like to submit a blog post for consideration, please visit https://ceufast.com/blog/submissions.
