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Biological weapons can be used in bioterrorism, biowarfare, or biocrime and include bacteria, viruses, fungi, and toxins; some agents are lethal, and others cause illness or incapacitation. Directing biological weapons at the human population, crops, and livestock often involves dispersing them as aerosols for easier spread. People or vectors can spread agents through ingestion, direct contact, or other methods. This activity reviews the most common agents and the evaluation and treatment of their resulting illnesses. Objectives: Identify clinical syndromes that can be caused by biological agents, including bacteria, viruses, fungi, and toxins. Differentiate between naturally occurring diseases and those caused by biological weapons by using standard diagnostic clues and epidemiological patterns. Select appropriate therapies and antimicrobial agents for specific biological weapon agent-related illnesses. Collaborate with other healthcare providers, first responders, and public health agencies to enhance preparedness and response to biological weapon-related incidents. Access free multiple choice questions on this topic.

Biological weapons are agents, including bacteria, viruses, fungi, and toxins, used for malicious purposes: in war (biowarfare), to cause terror (bioterrorism), or for criminal acts (biocrime). [Suspected Intentional Use Of Biologic And Toxic Agents. 2018] Some agents are lethal, and others cause illness or incapacitation. Entities direct biological agents at the human population, crops, and livestock. More than 180 pathogens and biotoxins have been researched or employed as biological weapons, including those that cause anthrax, tularemia, brucellosis, plague, Legionnaire disease, Q fever, glanders, melioidosis, smallpox, viral hemorrhagic fevers, influenza, coccidiosis, rice blast, and wheat rust. Biotoxins include ricin, botulinum toxin, and staphylococcal enterotoxin B. Designers create biological weapons to disperse as aerosols, facilitating rapid spread across large populations. However, agents may also spread from person to person or by vectors, ingestion, direct contact, or other methods. Agents used for biological weapons have distinct advantages over conventional agents (eg, chemical weapons): Microbial agents are often more easily mass-produced Large quantities are easy to conceal and transport Agents are more easily able to become airborne or waterborne, increasing the area of dissemination Some agents pass from person to person Classification Biological agents are classified into different categories depending on their ability to cause illness and their impact on public health. The United States Centers for Disease Control and Prevention (CDC) categorizes agents into 3 groups:[1] Category A Highest priority Easily disseminated or transmitted High mortality rates and potential for major public health impact Can cause public panic and social disruption Require specific actions for public health preparedness Category B Second highest priority Moderately easy to disseminate Moderate morbidity and low mortality Require specific enhancements to the CDC's diagnostic and disease surveillance capacities Category C Third highest priority Potentially engineered for mass dissemination Potential for high morbidity and mortality and significant health impact

Category B Second highest priority Moderately easy to disseminate Moderate morbidity and low mortality Require specific enhancements to the CDC's diagnostic and disease surveillance capacities Category C Third highest priority Potentially engineered for mass dissemination Potential for high morbidity and mortality and significant health impact Category A agents include Bacillus anthracis (anthrax), Clostridium botulinum toxin (botulism), Yersinia pestis (plague), Variola major (smallpox), Francisella tularensis (tularemia), and viruses that cause hemorrhagic fevers (eg, Ebola virus, Marburg virus, Lassa virus). Category B agents include Brucella species (Brucellosis), Chlamydia psittaci (Psittacosis), Coxiella burnetii (Q fever), ricin toxin (from Ricinus communis), enteric pathogens (Salmonella, Escherichia coli O157:H7, Shigella), Staphylococcal enterotoxin B, and viruses that cause encephalitis. Category C agents are emerging pathogens such as Nipah virus and hantavirus.[1]

Once a patient has been diagnosed with an illness potentially due to a biological weapon, communication with the interprofessional healthcare team, including clinicians, nurses, pharmacists, and public health officials, should occur. Adequate decontamination of the patient and appropriate precautions for first responders and hospital staff to avoid additional casualties or the spread of contagious diseases are priorities. In attacks involving many people, communication with hospital leadership and government officials is required to access medical supply stockpiles and mobilize human and other resources to treat large numbers of patients. Training and education before biological warfare events, when emotions are calm and resources adequate, are more effective than just-in-time training after an event. Healthcare staff must clearly understand the available resources and anticipated demands on those resources in large-scale events. The relatively recent use of ricin and anthrax as bioterrorism agents demonstrates how even small-scale attacks quickly become international news. Healthcare providers may need to communicate with law enforcement agencies, members of the media, and elected officials.