McKenzie Piper

Annotated Bibliography
(2017). Bioterrorism. Centers for Disease Control and Prevention. Retrieved from

https://www.cdc.gov/healthcommunication/toolstemplates/entertainmented/tips/

Bioterrorism.html.

The main reasons bioterrorism poses such a threat is because the materials to produce a
deadly attack are readily available, requiring very little expertise or money. Two of the
most common pathogenic microorganisms used are anthrax and smallpox. Anthrax,
though it is not contagious from person to person, comes in three (all potentially lethal)
forms: inhalational, cutaneous, and intestinal. One of the most dangerous things about
anthrax exposure is that symptoms of sickness can take as long as seven days to arise
while the bacterium is brewing in the victim’s system. And even when the victim starts to
feel sick, it usually mimics the flu, warranting a person to wait it out to see if their
sickness clears up before seeing a doctor. This added time allows for further development
of the anthrax bacterium. The other most common pathogenic microorganism, smallpox,
prompts “high fever, fatigue, and head and back pain,” which, although more alarming,
are common enough to ignore for a few days. The giveaway for small pox is the rash
which usually takes up to three days to form, all the while the virus is festering.
Bioterrorism attacks are especially frightening because of their lack of detectability.
Because the symptoms of both of the aforementioned pathogenic microorganisms are
similar at first similar to common sickness, it is difficult to distinguish a flu outbreak
from an anthrax-employed bioterrorist attack, for example. The realization that there has
been an attack relies almost completely on elements such as emergency room visitation
increase which is subject to fluctuate anyway. The treatment for anthrax and smallpox is
a 60-day antibiotic course and the smallpox vaccine, respectively. However, both of these
“treatments” rely on the victim seeking medical attention within days of exposure. For
instance, the small pox vaccine has only been shown to “lessen the severity of… illness if
given within 4 days of exposure.” Though the obvious response is to increase public
awareness, the fear is that this may “give ideas to potential terrorists.” This is why it is
important to find a way to help people distinguish a cold or flu from an intentional
pathogen exposure event.

(2018). Biological weapons, bioterrorism, and vaccines. History of Vaccines. Retrieved from

https://www.historyofvaccines.org/content/articles/biological-weapons-bioterrorism-and-

vaccines.
 In the 20th century, the United States military developed and tested biological weapons
from 1949 to 1969 in Biological Warfare Laboratories based in Camp Detrick, Maryland.
Here, they “weaponized several biological agents” among these were anthrax and
botulinum toxin. The Biological and Toxin Weapons Convention was a national treaty,
ratified in 1975 by over 100 nations, including the U.S. However, the Soviet Union is
said to have mass produced the smallpox virus among other biological weapons even
after signing this treaty. U.S.S.R. officials claimed that they destroyed these materials in
the late 1980s, yet they kept production capabilities in tact until at least the 1990s.
Daschle, T. & Myers, R. B. (2016). A threat to the food system: We need to do a better job of

protecting U.S. agriculture against bioterrorism. U.S. News. Retrieved

fromhttps://www.usnews.com/opinion/articles/2016-10-17/americas-food-supply-and-

national-security-are-at-risk-to-bioterrorism

Beyond just the people affected by bioterrorism today, the agriculture of the United
States has the potential to be permanently altered by the effects of bioterrorism.
Pathogens linked to al-Qaida were found to have included not only human-targeting
toxins, but toxins that would destroy food, livestock, and crops. This specific kind of
bioterrorism is known as agroterrorism, and was deemed “more likely than a nuclear
attack” by the Commission on the Prevention of WMD Proliferation and Terrorism and
subsequently gave the United States a failing grade for bioterrorism readiness. In
response, the Blue Ribbon Study Panel on Biodefense recommended that congress act
quickly on increasing oversight on efforts to counter agroterrorism. The main reason
agroterrorism in particular is such an important threat to address is because an attack
would likely completely devastate the economy. Agriculture is a $1 trillion business in
United States, employing nearly 10% of America’s workers. $60 billion worth of
American household income stems from jobs in animal agriculture alone. Though direct
exposure to biological pathogens or toxic chemicals sparks rightful fear in the hearts of
Americans, an agroterrorist attack has the potential to cause even more widespread
casualty, as two-thirds of animal pathogens can be transmitted to humans, making an
agroterrorism event a human one, too.

Goodsell, D. (2002). Anthrax toxin. Protein Data Bank. Retrieved from http://pdb101.rcsb.org/

motm/28.

When evaluating the probability of an anthrax epidemic, it is important to note that the
bacteria cannot be transferred from person to person – it is most commonly contracted
from contact with infected products or animals. However, no direct contact is needed for
 the most fatal form: inhalation. Once a victim encounters the bacterium, its toxin is a
deadly trio of exotoxins – toxins released by living bacteria – which are released after the
spores are lodged in the skin or lungs. The first part of the toxin is the protective antigen.
This is the delivery mechanism that finds cells and delivers the next two parts of the trio:
the edema factor and the lethal factor. These components are the fatal ones that attack
whichever cells the protective antigen seeks out for them. The protective antigen, like in
most other bacterium such as ones that cause cholera and whooping cough, does not
scour for the healthiest cells. Rather, it determines the weakest cells to which the other
factors of the bacteria will be the most effective and therefore damaging, making it even
more effective than cyanide. Whereas a single anthrax molecule can be the cause of
death, one cyanide molecule matches one protein molecule of its host.

Greenfield, R. A., & Bronze, M. S. (2003). Prevention and treatment of bacterial diseases caused

by bacterial bioterrorism threat agents. Drug Discovery Today, 8(19). Retrieved from

https://www.sciencedirect.com/science/article/pii/S1359644603028472.

The most prevalent destructive bacterial agents are “Bacillus anthracis, Yersinia pestis,
Francisella tularensis, and the neurotoxin of Clostridium botulinum.” Better prevention
strategies are needed because though the threat may seem low, the mortality rate of
inhalational anthrax is a grim 45%, suggesting mass casualties if an attack were to occur.
Because of this, further research needs to be dedicated to determining the most effective
and efficient prevention and treatment for anthrax. Yersina pestis refers to the plague,
which is “highly contagious, difficult to recognize, and is frequently fatal.” Studies
suggest the ability to develop a safe and effective vaccine against the pneumonic plague
which would diminish the threat as a detrimental pathogen. Vaccine development would
also help the threat of tularemia, a highly infectious condition which is commonly
aerosolized in bioterrorism events.
Hall, M. J., Norwood, A. E., Ursano, R. J., Fullerton, C. S., & Levinson, C. J. (2002).

Psychological and behavioral impacts of bioterrorism. PTSD Research Quarterly, 13(4).

Retrieved from https://www.ptsd.va.gov/professional/newsletters/research-

quarterly/v13n4.pdf.

Sufferers of biological or chemical attacks tend to struggle severely with PTSD,

especially as a result of the limited medical treatment for the plethora of illnesses they
may develop as results of the toxin they came in contact with. Psychological factors are
 rarely accounted for in instances of bioterrorism, however psychological consequences
prove present in case studies, including one of the 1995 Oklahoma City bombing. In this
study, analysts revealed that there are mainly two categories of people affected: direct
exposure and vulnerable to exposure. For those directly impacted, many develop “PTSD,
depression, and alcohol use” to cope with the trauma. As for those were vulnerable to
exposure, only those who previously suffer from mental illness tend to show the same
severity of illness. Those who were vulnerable, but without preexisting mental instability,
even still report “an altered sense of safety and hypervigilance.” Going back to the
Oklahoma City bombing anecdote, 34% of direct survivors had PTSD and 22% had
major depression four years after the actual bombing. The study also reported that nearly
40% of those affected by PTSD and/or depression “had no previous psychiatric illness.”

Riedel, S. (2004). Biological warfare and bioterrorism: a historical review. Proceedings (Baylor

University. Medical Center), 17(4), 400–406. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200679/pdf/bumc0017-0400.pdf.

The first account of bioterrorism, though not originally labeled as such, as early as 600
BC. Though they didn’t know why exactly it worked, it was common to use “filth and
cadavers, animal carcasses, and contagion” which yielded “devastating effects and
weakened the enemy.” Strategies such as these, along with polluting wells and other
water sources, continued into the 20th century, encompassing even the American Civil
War. Though the Black Death began from uncertain causes, the Tartars used it to their
advantage in the siege of Caffa by throwing the bodies of plague victims into the city,
spreading the epidemic and forcing Genoese forces to retreat. In turn, the Italians who
fled Caffa brought the plague to Mediterranean seaports which led infected persons to
various other seaports, directly contributing to the second plague pandemic. Though
vulgar and crude, this biological warfare attack is consistent with the technology present
at that time, and it serves as one of the earliest accounts of how deadly disease was used
as a weapon. The Tartars may have been the first to utilize the plague as a weapon,
however there are many other accounts of similar activity beyond the 1346 siege of
Caffa: Karolstein in 1422 and Reval in 1710 to name a couple. In the “New World,”
smallpox was utilized in a similar way in the 15th century, Pizzaro was said to have
“presented South American native with variola-contaminated clothing.” Similarly, the
commander of British forces during the French-Indian war, Sir Jeffrey Amherst,
deliberately infected the hostile native population to diminish resistance in Fort Pitt by
 ordering subordinate officer, Captain Ecuyer, to gather blankets from the smallpox
hospital and gift them to the Native Americans.
Schoenfelder, S. (2011). Anthrax. Austin Community College. Retrieved from

http://www.austincc.edu/ microbio/2993s/ba.htm.

From a biological standpoint, what makes anthrax in particular so powerful is the

Bacillus anthracis bacterium’s ability to form endospores, allowing it to manifest in non-
living conditions and withstand extreme climate. Though during this time, the bacteria is
not reproducing, once it reaches “friendly climate or conditions,” Bacillus anthracis is
ready to re-germinate into its active state, thus restoring its power to infect. Additionally,
this endosporic ability has virtually no time limit; the anthrax bacterium can survive
thirty-six years in its dormant state and will still be just as viable.
Spencer, J., & Scardaville, M. (2001). Understanding the bioterrorist threat: Facts & figures. The

Heritage Foundation Backgrounder, 1488. Retrieved from https://www.heritage.org/

homeland-security/report/understanding-the-bioterrorist-threat-facts-and-figures.

Another fear factor regarding bioterrorist attacks stems from how unpredictable the
method of contamination can be. As evident in Chart 1, there exists a myriad of different
methods of exposure across known possible chemicals and biological pathogens,
including injection/direct contact, food or drink, water, and pharmaceutical
contaminations, as well as airborne and unknown disseminations. None of these methods
is the dominant one, but the most common conclusion is “dissemination unknown” which
is the result of 28% of chemical or biological terrorist incidents. The rest of the methods
are nearly even, ranging from 11-17%. Within each of these contamination methods,
there are even more specifics that are to be pondered. For example, depending on the
intended size and effect of the attack, individual victims could be subject to direct
inhalation via aerosol sprays, or many victims could be targeted by an explosive
containing the toxic chemical or biological agent.

Stein, B. D., Tanielian, T. L., Eisenman, D. P., Keyser, D. J., Burnam, A., & Pincus, H. A.

(2004). Emotional and behavioral consequences of bioterrorism: Planning a public health

response. The Milbank Quarterly, 82(3). Retrieved from

http://www.jstor.org.proxy.library.vcu.edu/stable/pdf/4150506.pdf?refreqid=excelsior%3

A932b2b2c7684c864bee05747409d6ae3.

Terrorist groups like al-Qaeda have publicly asserted their attempts to obtain “chemical,
biological, radiological, or nuclear weapons (CBRN)… to be a religious duty” (Lumpkin
2001). Since the September 11, 2001 attacks, it is clear that the United States needs to
prepare for similar events in the future concerning terrorist attacks involving CBRN. As
displayed in Table 1, bioterrorist attacks often feature delayed and/or longer lasting
results than other forms of terrorism. Additionally, this table explains that there is a lot
more to be left to interpretation, as evident by the “size of attack” and “knowledge of
attack boundaries or scope” are “unknown.” Factors such as these make way for more
traumatic emotional responses because of the uncertainty associated with bioterrorism
events. Studies on direct victims of bioterrorism attacks show that the majority suffer
from post-traumatic stress disorder, ranging in severity. For example, a study on the
mental effects of biological terrorism analyzed the aftermath of a suspected anthrax
package in South Wales wherein 13 people were exposed in 2002. The Hospital Anxiety
and Depression scale was used to determine that 45% of the victims were suffering from
anxiety.