Chapter 16.1 : General Introduction to Bioterrorism

Abstract:

Since the events of 11 September 2001 and the subsequent release of anthrax in October 2001, bioterrorism preparedness has been a major priority for the nation. As an integral member of the “first responder” team in recognizing or suspecting an act of bioterrorism, the clinical laboratory, especially the clinical microbiology laboratory, will serve as a sentinel in the detection, recovery, characterization, and identification of the targeted biological agent(s). In preparation for responding to a biological terrorism event, the clinical microbiologist is encouraged to participate in and apply the guidelines of the Laboratory Response Network (LRN). Members of the laboratory staff should be formally trained and knowledgeable in the following areas: (i) the BSL of their laboratory; (ii) principles of specimen collection, preservation, packaging, labeling, and shipment; (iii) criteria for recognizing or suspecting a potential bioterrorist activity and the institutional chain of communication; (iv) biothreat levels as designated by the LRN; (v) diagnostic testing according to consensus protocols; (vi) timely and accurate testing and reporting; and (vii) the chain of communication linking local, state, and federal agencies. Although it is not anticipated to be a major factor, members of the microbiology staff should have an understanding of the chain-of-custody guidelines being practiced in their institution. It is vital for a laboratory to be familiar with its role in response to a suspected or confirmed bioterrorism event and to develop formal standard operations procedures (SOPs), which describe how the laboratory will function in the event of a biological incident. The SOP should be part of an institution- wide SOP that is a multidisciplinary document comprised of policies from Infection Control, Public Relations, Risk Management, Pharmacy, Security, Medical Staff, and Administration. The primary role of the clinical microbiology laboratory in responding to a bioterrorism event will be no different from its present role: to detect, recover, and characterize or identify the etiological agent(s). Of utmost importance is maintaining awareness that an event may be occurring and raising suspicion that requires further investigation. Secondary roles include maintaining an active surveillance and a continuous monitoring program. The primary focus of this section and associated procedures is to provide the clinical microbiologist with guidance and information for use in preparing for and responding to a suspected or confirmed bioterrorism event. Critical issues addressed herein include the types of bioterrorism events; laboratory capacity; laboratory safety, including the packaging and shipping of biological materials, especially infectious substances; and diagnostic testing protocols for those biological agents targeted as being most likely to be released in an event because they can be easily disseminated or transmitted person to person, cause high mortality with the potential for major public health impact, cause public panic and social disruption, and require special action for public health preparedness (R. Timperi, personal communication). These agents, currently classified as category A agents, include (i) Bacillus anthracis, the agent of anthrax; (ii) botulinum toxin, produced by Clostridium botulinum; (iii) Brucella spp., the agents of brucellosis; (iv) Yersinia pestis, the agent of plague; (v) Francisella tularensis, the agent of tularemia; (vi) Burkholderia mallei and Burkholderia pseudomallei, the agents of glanders and melioidosis; (vii) staphylococcal enterotoxin B, produced by Staphylococcus aureus; and (viii) variola virus, the agent of smallpox. However, it is important to realize that any microbial agent can potentially be used in the commission of a biocrime or act of terrorism.