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• W2324822034 abstract "Microbial infections have long been accepted as an unavoidable risk to the human species. Over the millennia, humans have adapted to this risk by developing complex host defense mechanisms. In the modern era we have studied the natural history of microorganisms, discovered and refined the use of antibiotics, and delineated the bacterial genome and bacterial virulence machinery, advances which have promoted strategies to reduce the morbidity and mortality of microbial infections. Recent progress has also been made, which has resulted in effective interventions for reducing environmental risks and preventing human-to-human transmission of infectious agents. These approaches have had a huge positive impact on childhood mortality. Both the events of September 11, 2001, and the subsequent highly publicized use of the United States Postal Service to spread anthrax infection have drastically changed our sense of confidence toward the prevention and treatment of infectious diseases. It has become clear that our present disease control strategies are ineffective and possibly obsolete in dealing with bioterrorism. The standard goals of public health organizations—confinement of specific pathogens to endemic areas, eradication of microorganisms, and vaccination campaigns to eliminate specific pathogens—are now undergoing a process of reprioritization in light of the new realities that we face with bioterrorism and biological warfare. We live in a world in which the chasm between rich and poor is becoming wider and wider, in which religious, political and economic tensions are increasingly defeating diplomatic attempts to resolve regional conflicts. The frustration of chronically unresolved conflicts is a force that may be making bioterrorism and biological warfare seem a legitimate recourse, one of the few ways to gain attention for one's point of view. Although considered the tool of small radical groups, a biological approach to warfare is still an integral part of the national defense systems of several countries. Despite the approval of the Biological Weapons convention by 140 nations in 1972, a number of nations (including some of the signatories) have continued to develop biological weapons. Bioterrorism seemed a fairly theoretical problem until the outbreak of anthrax in the United States, which followed close on the heels of the terrorist attacks in New York City. In light of these events, both of which have been widely considered to be acts of terrorism, developed countries are now demanding that their biomedical research communities restructure their research priorities to provide protection against such unconventional threats. Despite the fact that hundreds of potential agents could be used in biological warfare or bioterrorism, attention has been focused on microorganinsms, including anthrax and smallpox, which have the potential for aerosol dissemination (1). These agents belong to the category A group (Table 1) identified by the Centers for Disease Control and Prevention (http://www.bt.cdc.gov/agent/agentlist.asp) as organisms posing the highest risk to national security. They can be disseminated or transmitted from person to person, they carry a high mortality rate, and they have the potential for major public health impact. Their dissemination might cause public panic and social disruption, and an outbreak would demand a high degree of public health preparedness. Furthermore, the recent anthrax experience in the United States has taught us that public panic, the disruption of key services, and the contamination of federal buildings forced to close for extended time periods for decontamination procedures, have devastating consequences on the sense of homeland security, despite the limited number of fatalities. It is important to note that the handling of these two specific agents requires a level of scientific sophistication and facilities that only complex organizations within well-developed national programs can afford. Indeed, both anthrax and smallpox have been proposed for bioweapons projects specifically engineered by military programs to be used in battlefield scenarios targeting combat units. However, these biological warfare tools likely are impractical for small groups targeting civilians in acts of bioterrorism.TABLE 1: Agents identified by the Center for Disease Control and prevention as possible bioweaponsIt is surprising, therefore, that so little attention has been paid so far to the category B agents (Table 1) listed by the Centers for Disease Control and Prevention. Despite the fact that these microorganisms and their toxins typically cause moderate morbidity and low mortality, they pose a significant risk because they are easy to produce and disseminate, they do not require complex production and stocking facilities, and they can be handled by non-professional personnel. The threats to food and water safety represented by the Category B agents make them an obvious choice for bioterrorism initiatives executed by terrorist groups whose level of scientific expertise may be relatively primitive. Food and water contamination is a simple strategy to spread biological agents in acts of bioterrorism, an approach that has already been exploited in the United States (2). Naturally occurring food- and water-borne outbreaks such as enterohemorrhagic Escherichia coli and Shigellae outbreaks in North America or cholera outbreaks both in endemic areas and in refugee camps confirm that a large number of individuals can be affected over a wide geographic area in a relatively short time period (3). Currently, we are poorly prepared to face this kind of bioterrorism. Guidelines for increasing food and water safety, implementing disinfection and inspection policies, and establishing disease surveillance and crisis response teams need to be developed and implemented to properly manage this potential threat. Furthermore, to be better prepared to face this hypothetical, yet plausible scenario, it is necessary to develop and support research programs specifically focused on the rapid identification, prevention, and response to the application of food- and water-borne agents. These initiatives should be considered a wise investment of our economic and intellectual resources, irrespective of a possible biological attack. Although smallpox has been eradicated and naturally occurring anthrax is rare, water- and food-borne infections still cause 6 to 60 billion cases of diarrhea every year and claim the life of a child every 15 seconds. Given that the major burden of either naturally occurring or bioterrorism-associated gastrointestinal diseases would be on the pediatric population, it is appropriate for the pediatric GI community to address this new reality." @default.
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• W2324822034 date "2003-03-01" @default.
• W2324822034 modified "2023-10-18" @default.
• W2324822034 title "Bioterrorism and Biological Warfare: Not Only A Respiratory Affair" @default.
• W2324822034 cites W2023858815 @default.
• W2324822034 cites W4241018885 @default.
• W2324822034 doi "https://doi.org/10.1097/00005176-200303000-00001" @default.
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