Biological Terrorism

Historically, most planning for an emergency response to terrorism has focused on overt attacks such as bombings and attacks using chemicals. Chemical events are also likely to be overt because inhalation or skin/mucous membrane absorption of chemicals produces effects that are usually immediate and obvious. For obvious reasons, explosive and chemical attacks elicit an immediate response by law enforcement, fire and Emergency Medical Services personnel. In comparison to chemicals and explosives, the impact of biologic agents is more likely to be covert and delayed. As the recent anthrax events demonstrated, biologic agents do not have an immediate impact due to the interval between exposure and the onset of illness (the incubation period) (1). Consequently, the most likely responders to future biologic attacks will be family physicians and other primary health care providers. For example, after an intentional, covert release of Variola virus, some infected patients would arrive at their doctors' offices and local emergency rooms 1–2 weeks later. Other infected people may have traveled, and they would probably show up at emergency rooms distant from their homes. Their symptoms would appear at first to be an ordinary viral infection, including fever, back pain, headache, and nausea. As the disease progressed, many physicians would not recognize the characteristic early stage papular rash of smallpox.