Editing Bioterrorism (section)

==Types of agents==
{{Globalize|section|USA|2name=the United States|date=June 2012}}
Under current [[United States law]], [[bio-agents]] which have been declared by the [[U.S. Department of Health and Human Services]] or the [[U.S. Department of Agriculture]] to have the "potential to pose a severe threat to public health and safety" are officially defined as "[[select agents]]." The CDC categorizes these agents (A, B or C) and administers the [[Select Agent Program]], which regulates the laboratories which may possess, use, or transfer select agents within the United States. As with US attempts to categorize harmful recreational drugs, designer viruses are not yet categorized and avian H5N1 has been shown to achieve high mortality and human-communication in a laboratory setting.

===Category A===
These high-priority agents pose a risk to national security, can be easily transmitted and disseminated, result in high mortality, have potential major public health impact, may cause public panic, or require special action for public health preparedness.

* [[Severe acute respiratory syndrome|SARS]] and [[COVID-19]], though not as lethal as other diseases, was concerning to scientists<ref>{{cite journal |last1=Weber |first1=Stephen G |last2=Bottei |first2=Ed |last3=Cook |first3=Richard |last4=O'Connor |first4=Michael |title=SARS, emerging infections, and bioterrorism preparedness |journal=The Lancet. Infectious Diseases |date=August 2004 |volume=4 |issue=8 |pages=483–484 |doi=10.1016/S1473-3099(04)01098-9 |pmid=15288816 |pmc=7128359 }}</ref><ref>{{cite journal |last1=Cook |first1=Alethia H. |last2=Cohen |first2=David B. |title=Pandemic Disease: A Past and Future Challenge to Governance in the United States |journal=Review of Policy Research |date=September 2008 |volume=25 |issue=5 |pages=449–471 |doi=10.1111/j.1541-1338.2008.00346.x |pmid=32327945 |pmc=7169208 }}</ref> and policymakers for its social and economic disruption potential.<ref>{{cite journal |last1=Cook |first1=Alethia H. |last2=Cohen |first2=David B. |title=Pandemic Disease: A Past and Future Challenge to Governance in the United States |journal=The Review of Policy Research |date=September 2008 |volume=25 |issue=5 |pages=449–471 |doi=10.1111/j.1541-1338.2008.00346.x |pmid=32327945 |pmc=7169208 }}</ref> After the global containment of the pandemic, the United States President [[George W. Bush]] stated "...A global influenza pandemic that infects millions and lasts from one to three years could be far worse."<ref>Office of the President. White House. (November 1, 2005). "Press release: President outlines pandemic influenza preparations and response."</ref> 
* [[Tularemia]] or "rabbit fever":<ref>{{cite web|url=http://emergency.cdc.gov/agent/tularemia/|title=CDC Tularemia - Emergency Preparedness & Response|date=February 21, 2019}}</ref> Tularemia has a very low fatality rate if treated, but can severely incapacitate. The disease is caused by the ''[[Francisella tularensis]]'' bacterium, and can be contracted through contact with [[fur]], inhalation, ingestion of contaminated water or insect bites. ''Francisella tularensis'' is very infectious. A small number of organisms (10–50 or so) can cause disease. If ''F. tularensis'' were used as a weapon, the bacteria would likely be made airborne for exposure by inhalation. People who inhale an infectious aerosol would generally experience severe respiratory illness, including life-threatening pneumonia and systemic infection, if they are not treated. The bacteria that cause tularemia occur widely in nature and could be isolated and grown in quantity in a laboratory, although manufacturing an effective aerosol weapon would require considerable sophistication.<ref>{{cite web|url=http://www.bt.cdc.gov/agent/tularemia/facts.asp|title=CDC Tularemia - Key Facts About Tularemia|url-status=dead|archive-url=https://web.archive.org/web/20100619165524/http://www.bt.cdc.gov/agent/tularemia/facts.asp|archive-date=June 19, 2010}}</ref>
* [[Anthrax disease|Anthrax]]: Anthrax is a non-contagious disease caused by the spore-forming bacterium ''Bacillus anthracis''. The ability of Anthrax to produce within small spores, or bacilli bacterium, makes it readily permeable to porous skin and can cause abrupt symptoms within 24 hours of exposure. The dispersal of this pathogen among densely populated areas is said to carry less than one percent mortality rate, for cutaneous exposure, to a ninety percent or higher mortality for untreated inhalational infections.<ref>{{Cite journal|last1=Adalja|first1=Amesh A. |author-link=Amesh Adalja |last2=Toner|first2=Eric|last3=Inglesby|first3=Thomas V.|date=March 5, 2015|title=Clinical Management of Potential Bioterrorism-Related Conditions|journal=New England Journal of Medicine|volume=372|issue=10|pages=954–962|doi=10.1056/NEJMra1409755 |pmid=25738671|doi-access=free}}</ref> An [[anthrax vaccines|anthrax vaccine]] does exist but requires many injections for stable use. When discovered early, anthrax can be cured by administering [[antibiotic]]s (such as [[ciprofloxacin]]).<ref>{{cite journal
  |title = A Short Course of Antibiotic Treatment Is Effective in Preventing Death from Experimental Inhalational Anthrax after Discontinuing Antibiotics
  |last1 = Vietri
  |first1 = Nicholas J.
  |last2 = Purcell
  |first2 = Bret K.
  |last3 = Tobery
  |first3 = Steven A.
  |last4 = Rasmussen
  |first4 = Suzanne L.
  |last5 = Leffel
  |first5 = Elizabeth K.
  |last6 = Twenhafel
  |first6 = Nancy A.
  |last7 = Ivins
  |first7 = Bruce E.
  |last8 = Kellogg
  |first8 = Mark D.
  |last9 = Webster
  |first9 = Wendy M.
  |last10 = Wright
  |first10 = Mary E.
  |last11 = Friedlander
  |first11 = Arthur M.
  |journal = [[The Journal of Infectious Diseases]]
  |volume = 199
  |issue = 3
  |year = 2009
  |pages = 336–41
  |jstor = 40254424
  |doi=10.1086/596063
|pmid = 19099484
  |doi-access = free
  }}</ref> Its first modern incidence in biological warfare were when Scandinavian "freedom fighters" supplied by the German General Staff used anthrax with unknown results against the Imperial Russian Army in Finland in 1916.<ref>Bisher, Jamie, "During World War I, Terrorists Schemed to Use Anthrax in the Cause of Finnish Independence," Military History, August 2003, pp. 17–22.[https://web.archive.org/web/20091027151654/http://geocities.com/jamie_bisher/anthrax.htm Anthrax Sabotage in Finland]</ref> In 1993, the [[Aum Shinrikyo]] used anthrax in an unsuccessful attempt in Tokyo with zero fatalities.<ref name="cdc.gov"/> Anthrax was used in a [[2001 anthrax attack|series of attacks]] by a microbiologist at the US Army Medical Research Institute of Infection Disease on the offices of several United States senators in late 2001. The anthrax was in a powder form and it was delivered by the mail.<ref>{{cite web|url=https://www.cdc.gov/ncidod/eid/vol8no10/02-0330.htm|title=Emerging Infectious Diseases journal|access-date=September 8, 2017|archive-url=https://web.archive.org/web/20101015112554/http://www.cdc.gov/ncidod/eid/vol8no10/02-0330.htm|archive-date=October 15, 2010|url-status=dead}}</ref> This bioterrorist attack inevitably prompted seven cases of cutaneous anthrax and eleven cases of inhalation anthrax, with five leading to deaths. Additionally, an estimated 10 to 26 cases had prevented fatality through treatment supplied to over 30,000 individuals.<ref>{{Cite journal|last=Clarke|first=S. C.|date=2005|title=Bacteria as potential tools in bioterrorism, with an emphasis on bacterial toxins|journal=British Journal of Biomedical Science|volume=62|issue=1|pages=40–46 |pmid=15816214|doi=10.1080/09674845.2005.11732685|s2cid=19601885}}</ref> Anthrax is one of the few biological agents that federal employees have been vaccinated for. In the US an anthrax vaccine, [[Anthrax Vaccine Adsorbed]] (AVA) exists and requires five injections for stable use. Other [[anthrax vaccines]] also exist. The strain used in the [[2001 anthrax attacks]] was identical to the strain used by the [[USAMRIID]].<ref name="MacKenzie">{{cite magazine |author=Debora MacKenzie |title=Anthrax attack bug 'identical' to army strain |magazine=New Scientist |access-date=February 16, 2013 |url=https://www.newscientist.com/article/dn2265
 }}</ref>
* [[Smallpox]]:<ref>{{cite web|url=http://emergency.cdc.gov/agent/smallpox/|title=CDC Smallpox Home|date=February 19, 2019}}</ref> Smallpox is a highly contagious [[virus]]. It is transmitted easily through the atmosphere and has a high [[mortality rate]] (20–40%). Smallpox was [[smallpox#Eradication|eradicated]] in the world in the 1970s, thanks to a worldwide vaccination program.<ref>{{cite web|url=http://emergency.cdc.gov/agent/smallpox/prep/cdc-prep.asp|title=CDC Smallpox - What CDC Is Doing to Protect the Public From Smallpox|access-date=December 18, 2018|archive-url=https://web.archive.org/web/20180504090748/https://emergency.cdc.gov/agent/smallpox/prep/cdc-prep.asp|archive-date=May 4, 2018|url-status=dead}}</ref> However, some virus samples are still available in Russian and American laboratories. Some believe that after the collapse of the Soviet Union, cultures of smallpox have become available in other countries. Although people born pre-1970 will have been vaccinated for smallpox under the WHO program, the effectiveness of vaccination is limited since the vaccine provides high level of immunity for only 3 to 5 years. Revaccination's protection lasts longer.<ref>{{cite web|url=http://www.smallpox.mil/messageMap/messageMapAll.asp?cID=57|title=IHB - The DoD Immunization Information and Training Portal|access-date=May 26, 2009|archive-url=https://web.archive.org/web/20090814032533/http://smallpox.mil/messageMap/messageMapAll.asp?cID=57|archive-date=August 14, 2009|url-status=dead}}</ref> As a biological weapon smallpox is dangerous because of the highly contagious nature of both the infected and their pox. Also, the infrequency with which vaccines are administered among the general population since the eradication of the disease would leave most people unprotected in the event of an outbreak. Smallpox occurs only in humans, and has no external hosts or vectors.
* [[Botulinum toxin]]:<ref>{{cite web|url=http://emergency.cdc.gov/agent/botulism/|title=CDC Botulism - Emergency Preparedness & Response|date=August 19, 2019}}</ref> The [[neurotoxin]]<ref>{{cite journal|title=BOTULINUM TOXIN | pmc=2856357 | pmid=20418969|doi=10.4103/0019-5154.60343|volume=55| issue=1 |year=2010|pages=8–14 | last1 = Nigam | first1 = PK | last2 = Nigam | first2 = A | journal=Indian Journal of Dermatology | doi-access=free }}</ref> Botulinum is the deadliest toxin known to man, and is produced by the bacterium ''[[Clostridium botulinum]]''. Botulism causes death by [[respiratory failure]] and [[paralysis]].<ref>{{cite web|url=http://emergency.cdc.gov/agent/botulism/factsheet.asp|title=CDC - Facts About Botulism|access-date=December 18, 2018|archive-url=https://web.archive.org/web/20170703054124/https://emergency.cdc.gov/agent/botulism/factsheet.asp|archive-date=July 3, 2017|url-status=dead}}</ref> Furthermore, the toxin is readily available worldwide due to its cosmetic applications in injections.
*[[Bubonic plague]]:<ref>{{cite web|url=http://emergency.cdc.gov/agent/plague/|title=CDC Plague Information - Emergency Preparedness & Response|date=February 21, 2019}}</ref> Plague is a disease caused by the ''[[Yersinia pestis]]'' bacterium. Rodents are the normal host of plague, and the disease is transmitted to humans by [[flea]] bites and occasionally by [[Bioaerosol|aerosol]] in the form of [[pneumonic plague]].<ref>{{cite web|url=https://www.cdc.gov/ncidod/dvbid/plague/index.htm|title=CDC - 01 This Page Has Moved - CDC Plague Home Page - CDC Division of Vector-Borne Infectious Diseases (DVBID)|url-status=dead|archive-url=https://web.archive.org/web/20090519183229/http://www.cdc.gov/ncidod/dvbid/plague/index.htm|archive-date=May 19, 2009}}</ref> The disease has a history of use in biological warfare dating back many centuries, and is considered a threat due to its ease of culture and ability to remain in circulation among local rodents for a long period of time. The weaponized threat comes mainly in the form of pneumonic plague (infection by inhalation)<ref>{{cite web|url=http://www.bt.cdc.gov/agent/plague/faq.asp|title=CDC Plague - Frequently Asked Questions (FAQ) About Plague|url-status=dead|archive-url=https://web.archive.org/web/20090528004421/http://www.bt.cdc.gov/agent/plague/faq.asp|archive-date=May 28, 2009}}</ref> It was the disease that caused the [[Black Death]] in medieval Europe.
* [[Viral hemorrhagic fever]]s:<ref>{{cite web|url=http://emergency.cdc.gov/agent/vhf/|title=CDC Viral Hemorrhagic Fevers - Emergency Preparedness & Response|date=May 16, 2019}}</ref> This includes hemorrhagic fevers caused by members of the family ''[[Filoviridae]]'' ([[Marburg virus]] and [[Ebola virus]]), and by the family ''[[Arenaviridae]]'' (for example [[Lassa virus]] and [[Machupo virus]]). [[Ebola virus disease]], in particular, has caused high [[fatality rate]]s ranging from 25 to 90% with a 50% average. No cure currently exists, although vaccines are in development. The Soviet Union investigated the use of filoviruses for biological warfare, and the [[Aum Shinrikyo]] group unsuccessfully attempted to obtain cultures of Ebola virus.<ref>{{cite journal |url=https://wwwnc.cdc.gov/eid/article/5/4/99-0409_article |title=Aum Shinrikyo: Once and Future Threat? |date=August 4, 1999 |doi=10.3201/eid0504.990409 |last1=Olson |first1=Kyle B. |journal=Emerging Infectious Diseases |volume=5 |issue=4 |pages=413–416 |pmid=10458955 |pmc=2627754 |access-date=February 8, 2020 |archive-date=March 20, 2020 |archive-url=https://web.archive.org/web/20200320070116/https://wwwnc.cdc.gov/eid/article/5/4/99-0409_article |url-status=dead }}</ref> Death from Ebola virus disease is commonly due to [[multiple organ failure]] and [[hypovolemic shock]]. Marburg virus was first discovered in [[Marburg]], Germany. No treatments currently exist aside from supportive care. The arenaviruses have a somewhat reduced case-fatality rate compared to disease caused by filoviruses, but are more widely distributed, chiefly in central [[Africa]] and [[South America]].

===Category B===
Category B agents are moderately easy to disseminate and have low mortality rates.

* [[Brucellosis]] ([[Brucella|''Brucella'' species]])<ref>{{cite web|url=http://emergency.cdc.gov/agent/brucellosis/|title=CDC Brucellosis - Emergency Preparedness & Response|date=May 16, 2019}}</ref>
* Epsilon toxin of ''[[Clostridium perfringens]]''
* Food safety threats (for example, ''[[Salmonella]] species'', [[Escherichia coli O157:H7|''E coli'' O157:H7]], ''[[Shigella]]'', ''[[Staphylococcus aureus]]'')
* [[Glanders]]<ref>{{Cite web |url=https://www.cdc.gov/nczved/dfbmd/disease_listing/glanders_gi.html |title=CDC Glanders |access-date=September 8, 2017 |archive-url=https://web.archive.org/web/20100209041042/http://www.cdc.gov/nczved/dfbmd/disease_listing/glanders_gi.html |archive-date=February 9, 2010 |url-status=dead }}</ref> (''[[Burkholderia mallei]]'')
* [[Melioidosis]] (''[[Burkholderia pseudomallei]]'')<ref>{{Cite web |url=https://www.cdc.gov/nczved/dfbmd/disease_listing/melioidosis_gi.html |title=CDC Melioidosis |access-date=September 8, 2017 |archive-url=https://web.archive.org/web/20100211092041/http://www.cdc.gov/nczved/dfbmd/disease_listing/melioidosis_gi.html |archive-date=February 11, 2010 |url-status=dead }}</ref><ref>{{Cite web |url=https://www.cdc.gov/nczved/dfbmd/disease_listing/melioidosis_gi.html#2 |title=CDC Why has melioidosis become a current issue? |access-date=September 8, 2017 |archive-url=https://web.archive.org/web/20100211092041/http://www.cdc.gov/nczved/dfbmd/disease_listing/melioidosis_gi.html#2 |archive-date=February 11, 2010 |url-status=dead }}</ref>
* [[Psittacosis]] (''[[Chlamydia psittaci]]'')
* [[Q fever]] (''[[Coxiella burnetii]]'')<ref>{{cite web|url=http://emergency.cdc.gov/agent/qfever/|title=CDC Q Fever - Emergency Preparedness and Response|date=January 15, 2019}}</ref>
* [[Ricin]]<ref>{{cite web|url=http://emergency.cdc.gov/agent/ricin/|title=CDC Ricin - Emergency Preparedness & Response|date=May 16, 2019}}</ref> toxin from ''[[Castor oil plant|Ricinus communis]]'' ([[castor bean]]s)
* [[Abrin]] toxin from ''[[Abrus precatorius]]'' ([[Rosary pea]]s)
* [[Staphylococcus|Staphylococcal]] enterotoxin B
* [[Typhus]] (''[[Rickettsia prowazekii]]'')
* Viral [[encephalitis]] ([[alphavirus]]es, for example,: [[Venezuelan equine encephalitis virus|Venezuelan equine encephalitis]], [[Eastern equine encephalitis virus|eastern equine encephalitis]], [[Western equine encephalitis virus|western equine encephalitis]])
* Water supply threats (for example, ''[[Vibrio cholerae]]'',<ref>{{cite web|url=http://www.webmd.com/a-to-z-guides/cholera-11156|title=Cholera|work=WebMD}}</ref> ''[[Cryptosporidium parvum]]'')

===Category C===
Category C agents are emerging [[pathogen]]s that might be [[genetic engineering|engineered]] for mass dissemination because of their availability, ease of production and dissemination, high mortality rate, or ability to cause a major health impact.

* [[Nipah virus]]
* [[Hantavirus]]