It can’t happen here’: You better think again

If you live and work far from one of the nation’s financial or governmental centers, a bioterrorism attack may seem about as likely as an asteroid strike. Not zero chance, but close to it.

But if you think you don’t have to worry about bioterrorism because of your location, think again. After all, notes Michael Bell, MD, lead author of a guidance paper on bioterrorism, "I wouldn’t have expected Oklahoma City to be targeted for bombing. . . . It’s impossible to say any particular site is going to be absolutely safe." Bell is a bioepidemiologist for the Hospital Infections Program with the Centers for Disease Control and Prevention in Atlanta.

Past events already have proven that point. In 1984, a religious cult in the rural community of The Dalles, OR, intentionally contaminated restaurant salad bars with S. Typhimurium, sparking a communitywide outbreak of salmonellosis that afflicted more than 750 people. The county previously had an average of five salmonellosis cases a year. When a vial of the bacteria was found in a laboratory on the cult’s compound, cult members admitted putting the organism on the salad bars and in the city’s water supply tank. They reportedly hoped to influence local elections by sickening potential voters.1

More recently, the group Aum Shinrykyo released nerve gas in the Tokyo subway system. Authorities later discovered that the group had experimented with botulism and anthrax.

Planning for bioterrorism can be integrated into a broader effort to detect emerging infectious diseases, which also can evolve suddenly.

"We must always be prepared for the unexpected, whether it be a naturally occurring influenza pandemic, multiple antibiotic-resistant infections, or the deliberate release of anthrax by a terrorist," said James M. Hughes, MD, director of the National Center for Infectious Diseases at the Centers for Disease Control and Prevention in Atlanta, as he testified before a U.S. Senate subcommittee.2

In fact, it may be difficult to tell in the first days of an outbreak whether it was intentional or naturally occurring. Before Legionnaire’s disease was identified in a 1976 outbreak, some suspected that the veterans in Philadelphia had been intentionally targeted with a pneumonia-like disease. Likewise, before rodent-borne hantavirus was identified in the Southwest in 1993, rumors spread that the Navajo tribe had been targeted with a biological agent.

Trying to define the probability of a bioterrorism act is impossible because they are so unpredictable, says Bell. "We can lull ourselves into a false sense of security, but I don’t think we should," he says. "Even though we seem to think it’s a small probability, we don’t know what that means. All we can say is it’s a nonzero probability. The probability does exist. Then we have to decide if it’s important enough to prepare for."

Nationally, bioterrorism planning includes the Office of Emergency Preparedness, the National Security Council, the Federal Bureau of Investigation, the Department of Defense, local and state health departments, and other federal agencies.

Different communities will set their own priorities for preparedness, says Bell. "Each state is taking a tailored approach to what it needs to do," he says.

References

1. McDade JE, Franz D. Bioterrorism as a public health threat. Emerging Infectious Diseases 1998; July-Sept 4(3).

2. Hughes JM. Testimony before the Subcommittee on Labor, Health and Human Services, and Education of the Committee on Appropriations, U.S. Senate. June 2, 1998.