An act of biological or chemical terrorism might range from dissemination of aerosolized anthrax spores to food product contamination, and predicting when and how such an attack might occur is not possible. However, the possibility of biological or chemical terrorism should not be ignored, especially in light of events during the past 10 years (e.g., the sarin gas attack in the Tokyo subway and the discovery of military bioweapons programs in Iraq and the former Soviet Union ). Preparing the nation to address this threat is a formidable challenge, but the consequences of being unprepared could be devastating.

The public health infrastructure must be prepared to prevent illness and injury that would result from biological and chemical terrorism, especially a covert terrorist attack. As with emerging infectious diseases, early detection and control of biological or chemical attacks depends on a strong and flexible public health system at the local, state, and federal levels. In addition, primary health-care providers throughout the United States must be vigilant because they will probably be the first to observe and report unusual illnesses or injuries.

This report is a summary of the recommendations made by CDC's Strategic Planning Workgroup in Preparedness and Response to Biological and Chemical Terrorism: A Strategic Plan (CDC, unpublished report, 2000), which outlines steps for strengthening public health and health-care capacity to protect the United States against these dangers. This strategic plan marks the first time that CDC has joined with law enforcement, intelligence, and defense agencies in addition to traditional CDC partners to address a national security threat.

Terrorist incidents in the United States and elsewhere involving bacterial pathogens , nerve gas , and a lethal plant toxin (i.e., ricin) , have demonstrated that the United States is vulnerable to biological and chemical threats as well as explosives. Recipes for preparing "homemade" agents are readily available , and reports of arsenals of military bioweapons  raise the possibility that terrorists might have access to highly dangerous agents, which have been engineered for mass dissemination as small-particle aerosols. Such agents as the variola virus, the causative agent of smallpox, are highly contagious and often fatal. Responding to large-scale outbreaks caused by these agents will require the rapid mobilization of public health workers, emergency responders, and private health-care providers. Large-scale outbreaks will also require rapid procurement and distribution of large quantities of drugs and vaccines, which must be available quickly.

Preparedness and Prevention

Detection, diagnosis, and mitigation of illness and injury caused by biological and chemical terrorism is a complex process that involves numerous partners and activities. Meeting this challenge will require special emergency preparedness in all cities and states. CDC will provide public health guidelines, support, and technical assistance to local and state public health agencies as they develop coordinated preparedness plans and response protocols. CDC also will provide self-assessment tools for terrorism preparedness, including performance standards, attack simulations, and other exercises. In addition, CDC will encourage and support applied research to develop innovative tools and strategies to prevent or mitigate illness and injury caused by biological and chemical terrorism.

Should people stockpile antibiotics?

Maintain a public health preparedness and response cooperative agreement that provides support to state health agencies who are working with local agencies in developing coordinated bioterrorism plans and protocols.
Establish a national public health distance-learning system that provides biological and chemical terrorism preparedness training to health-care workers and to state and local public health workers.
Disseminate public health guidelines and performance standards on biological and chemical terrorism preparedness planning for use by state and local health agencies.

Some people are stockpiling antibiotics — a practice health officials are concerned will lead to dangerous side effects and drug-resistant germs. Still others are toting around gas masks purchased from Army surplus stores.

Recent threats and use of biological and chemical agents against civilians have exposed U.S. vulnerability and highlighted the need to enhance our capacity to detect and control terrorist acts. The U.S. must be protected from an extensive range of critical biological and chemical agents, including some that have been developed and stockpiled for military use.
 Even without threat of war, investment in national defense ensures preparedness and acts as a deterrent against hostile acts. Similarly, investment in the public health system provides the best civil defense against bioterrorism. Tools developed in response to terrorist threats serve a dual purpose. They help detect rare or unusual disease outbreaks and respond to health emergencies, including naturally occurring outbreaks or industrial injuries that might resemble terrorist events in their unpredictability and ability to cause mass casualties (e.g., a pandemic influenza outbreak or a large-scale chemical spill). 

Terrorism-preparedness activities described in CDC's plan, including the development of a public health communication infrastructure, a multilevel network of diagnostic laboratories, and an integrated disease surveillance system, will improve our ability to investigate rapidly and control public health threats that emerge in the twenty first century.

Early detection of and response to biological or chemical terrorism are crucial. Without special preparation at the local and state levels, a large-scale attack with variola virus, aerosolized anthrax spores, a nerve gas, or a foodborne biological or chemical agent could overwhelm the local and perhaps national public health infrastructure. Large numbers of patients, including both infected persons and the "worried well," would seek medical attention, with a corresponding need for medical supplies, diagnostic tests, and hospital beds. Emergency responders, health-care workers, and public health officials could be at special risk, and everyday life would be disrupted as a result of widespread fear of contagion.

First, understand how a biological or chemical agent could be delivered. By air, by water, by food… even by clothing and other materials in our environment. They can also be spread by animals (fleas, mosquitoes, rodents, livestock).
In the event of mysterious deaths suddenly taking place, it would be smart to consider that a bio-chemical attack or series of attacks was possibly being unleashed on the nation, and to immediately cease and desist all contact with major population centers… as well as other people in contact with these major population centers.

That's in the first couple days of the attack. As days progress, and potential bio-chemical agents are carried to small towns by a fleeing population, many unknowingly "infected" (in the case of a virus), or simply "carriers" in the case of a chemical, less contact with people would be a very smart move.


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