Biological warfare and bioterrorism.

This article has a correction. Please see: Biological warfare and bioterrorism - March 16, 2002

Since the terrorist attack on the United States in September 2001 attention has been focused on the threat of biological warfare. The disruptive effects of deliberate release of anthrax in civilian settings have been well documented, and several other pathogens could also be used as biological weapons. We have described the key features of such pathogens, how they might be used in biological warfare, and the clinical syndromes they cause. We also discuss the medical and logistic response to their possible use.

Summary points

Appropriate dispersion of even a small volume of biological warfare agent may cause high morbidity and mortality, which may be exacerbated by public panic and social disruption

Early symptoms of disease induced by a biological warfare agent may be non-specific or difficult to recognise

Healthcare workers should be alert for unusual single cases or clusters of illness, especially in otherwise healthy adults

Unusual illness should be notified immediately to public health authorities

Strategic responses to the deliberate release of biological warfare agents must be rehearsed locally and nationally with multiple agencies

Healthcare professionals should familiarise themselves with national and local sources of advice on deliberate release

Comment in

• Immunity conferred by smallpox vaccine. How long does immunity last? [BMJ. 2002]