NOVA Online | Bioterror | Frequently Asked Questions

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Bioterror FAQ
Frequently asked questions about the risks of bioterrorism and possible defenses against it

Note: In light of the recent anthrax cases in the United States, some of this FAQ is geared toward Americans. Audiences worldwide, however, should find the information relevant.

How difficult is it for terrorists to acquire and use disease agents for bioterrorism?
Can we, as a nation, defend ourselves against bioterrorism?
What is the National Pharmaceutical Stockpile (NPS)?
What should doctors and hospitals do to be prepared? Are they well-prepared now?
What can I do to be prepared?
Should I buy a gas mask or surgical masks?
Should I have my own supply of Cipro or other antibiotics?
Should I get vaccinated against anthrax?
Should I get vaccinated against smallpox?
If I was vaccinated against smallpox before 1980, am I still protected?
Is it safe for me to drink water from the tap?
Can I protect myself against an attack through the mail?
What should I do if I receive an anthrax threat by mail?
If I suspect an attack, what should I do?
Besides anthrax, what are other potential diseases of bioterrorism?
What if my fear about bioterrorism is having a serious impact on my family and work life?

The Centers for Disease Control and Prevention (CDC) and the Johns Hopkins Center for Civilian Biodefense Studies provided information and guidance in the development of NOVA's Bioterror FAQ.

1. How difficult is it for terrorists to acquire and use disease agents for bioterrorism?

We have witnessed that terrorists can obtain anthrax and other agents. Years before the current wave of anthrax-tainted letters, the wealthy and well-organized Japanese cult Aum Shinrikyo secured anthrax, botulinum toxin, and Q fever. They tried to release deadly clouds over Tokyo as many as a dozen times, but without success. They turned instead to sarin gas, which they sprayed in the Tokyo subway, killing roughly a dozen people and injuring thousands.

It is not easy to acquire, handle, and disperse deadly biologic agents in quantities that would cause disease epidemics. However, 12 countries considered potential enemies of the U.S. have biological weapons programs. And there are individuals worldwide, including in Iraq and the former Soviet Republics, who have expertise.

Law-enforcement and intelligence agencies of the federal government are working to control the flow of expertise and equipment necessary for large-scale bioterrorism acts. In addition, public-health experts have identified the most likely disease agents, such as anthrax and smallpox, and are working to improve our nation's disease-detection system to respond quickly.

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2. Can we, as a nation, defend ourselves against bioterrorism?

Yes. Collectively, we can defend ourselves. Some of the keys are:

Control unwarranted fears that tax the public health system and help terrorists attain their goal of spreading panic.
Understand the most likely disease agents and control their availability.
Improve our national disease surveillance system, enabling rapid response, containment, and treatment.
Develop stockpiles of needed pharmaceuticals to be used in the event of a bioterror incident, so that if a huge number of people are affected, supplies will be adequate to provide treatment.
Improve emergency response capabilities, locally and nationally, to effectively manage and contain a bioterror attack and provide treatment.
Increase research into treatments and vaccines.
Improve technology to identify diseases quickly and to detect an aerosol release of biological agent into the atmosphere.
Improve and strengthen international treaties to prevent development of state biological weapons programs and the spread of technology to terrorists.

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3. What is the National Pharmaceutical Stockpile (NPS)?

The NPS is a large reserve of antibiotics, chemical antidotes, and other medical supplies set aside for emergencies. The Centers for Disease Control and Prevention reports that it has the capacity to move these stockpiled materials to affected areas in the U.S. within 12 hours of notification. There are eight different stockpiles, strategically located around the country. In addition to the medical supplies already set aside, the federal government has made agreements with drug manufacturers to make large amounts of additional emergency medicine available quickly. For more information on the NPS, go to http://www.bt.cdc.gov/stockpile/index.asp

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4. What should doctors and hospitals do to be prepared? Are they well-prepared now?

Doctors and hospitals should continue to report clusters of illness that may occur to their local public health officials. Doctors and hospital staff should be aware of the first signs or symptoms of illness that could be related to a bioterrorism incident and be prepared to report possible cases immediately through their local public health officials. In the last few years, a number of efforts, including satellite training, hospital grand rounds, published articles in physician journals, and access to Web-based training have helped improve doctors' ability to detect and treat unusual illnesses.

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5. What can I do to be prepared?

Some of the "preparations" that have been suggested for acts of bioterrorism, such as purchasing gas masks and stockpiling antibiotics, are at best of little value, and at worst risky to your health and the public-health system.

On the other hand, it's wise to take some of the same basic precautions you would take to prepare for a natural disaster, such as an earthquake. Unless you are evacuated by local law enforcement during a disease outbreak, you should "shelter in place." You should have on hand a large enough stock of emergency necessities to keep your family supplied for a three- to four-day period so that you do not need to leave your home. An important step is to meet with your family and discuss why you need to prepare.

The American Red Cross provides a checklist to help family disaster planning, at the following Web site:

http://www.redcross.org/services/disaster/beprepared.

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6. Should I buy a gas mask or surgical masks?

You should not buy a gas mask. A gas mask would only protect you if you were wearing it at the exact moment a bioterrorist attack occurred. Unfortunately, a release of a biological agent is most likely to be done covertly. You would not know ahead of time to put on your mask. To wear a mask continuously or "just in case" a bioterrorist attack occurs is impractical, if not impossible.

Also, to work effectively, gas masks must be specially fitted to the wearer, and wearers must be trained in their use. Gas masks purchased at an Army surplus store or off the Internet carry no guarantees that they will work.

More serious is the fact that gas masks can be dangerous. There are reports of accidental suffocation when people have worn masks incorrectly, as happened to some Israeli civilians during the Persian Gulf War.

Surgical masks don't carry the risk of suffocation and are inexpensive. They may offer some protection against biological agents, but like gas masks they need to be worn at the time of exposure.

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7. Should I have my own supply of Cipro or other antibiotics?

It is not necessary to have a personal stockpile of antibiotics, and panic-buying and the misuse of antibiotics poses serious health threats for individuals and dangers to the public-health system.

The most likely cases of bioterrorism will affect only tens or hundreds of people and require only small supplies of readily available drugs. In the case of a significant bioterrorist attack affecting thousands of people, the government has an emergency supply of antibiotics and other drugs that can be sent anywhere in the U.S. within 12 hours. Public health officials are working to increase these supplies to be ready for even the remote likelihood of a large-scale bioterrorist attack affecting millions of people.

Reasons not to stockpile antibiotics:

Hoarding may create shortages in areas where drugs are needed to treat patients with chronic diseases and immediate needs.
Antibiotics have a limited "shelf life" before they lose their strength.
There are a number of different germs a bioterrorist might use to carry out an attack. No single pill can protect against all types of attacks.

Critically, antibiotics should only be taken when needed and with medical supervision. They can have serious side effects and drug interactions. Misuse of antibiotics leads to the evolution of drug-resistant germs. Such misuse could render currently effective drugs useless in the future—for you as an individual and for the public at large.

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8. Should I get vaccinated against anthrax?

No. Except for military personnel who may enter a war zone, vaccination is currently not recommended and the vaccine is not available to healthcare providers or the public.

The current anthrax vaccine requires six shots over an 18-month period, and an annual booster is recommended. Only limited supplies of the vaccine are available even to the military. The CDC is increasing stockpiles of this vaccine because it might be useful, in conjunction with antibiotics, in treating people exposed to anthrax. And a new vaccine is being developed under a Defense Department contract that might eventually be widely available.

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9. Should I get vaccinated against smallpox?

No. Vaccination is currently not recommended, and the vaccine is not available to healthcare providers or the public. In the unlikely chance a case of smallpox is detected, the Centers for Disease Control and Prevention has an emergency supply of vaccine to treat 15 million people. Unlike many vaccines, which take weeks or months to be effective, the vaccine for smallpox is effective if given 2-3 days after exposure and can prevent a fatal outcome even when given 4-5 days after exposure.

Supplies of smallpox vaccine are being increased. Public health officials are considering whether routine vaccination should be re-instated. The threat of potential biological weapons use must be weighed against the risks of routine vaccination: The vaccine can cause serious side effects.

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10. If I was vaccinated against smallpox before 1980, am I still protected?

Probably not. Vaccination has been shown to wear off in most people after 10 years but may last longer if a person has been vaccinated on multiple occasions. If health authorities determine that you have been exposed to smallpox or are at risk of infection, they would recommend that you be re-vaccinated immediately.

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11. Is it safe for me to drink water from the tap?

Yes. It would be extremely difficult for a bioterrorist to contaminate our drinking water supplies to cause widespread illness.

Huge amounts of water are pumped daily from our reservoirs, most of which is used for industrial and other purposes. Anything deliberately put into the water supply would be greatly diluted. Poisoning water supplies would require truckloads of biological or chemical agents that are difficult to produce and relatively easy to detect.

In addition, water treatment facilities routinely filter the water supply and add chlorine to kill harmful germs.

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12. Can I protect myself against an attack through the mail?

The U.S. Postal Service delivers roughly 208 billion pieces of mail each year. Even with increased security measures, it may be impossible to ensure that all mail is free of biological agents. However, there are simple, commonsense precautions you can take.

Traits of a suspicious letter or parcel:

no return address
excessive postage
handwritten or poorly typed address, incorrect titles or titles with no name, or misspellings of common words
addressed to someone no longer with your organization or otherwise outdated
unusual weight, lopsided or oddly shaped
marked with restrictive endorsements such as "Confidential"
strange odors, stains, or powders
unexpected or from someone unfamiliar to you

If you handle large quantities of mail from strangers and/or believe you or your workplace may be targeted for bioterrorism, you may want to take the extra precaution of wearing plastic gloves and a surgical mask.

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13. What should I do if I receive an anthrax threat by mail?

Do not handle the mail piece or package suspected of contamination.
Make sure that damaged or suspicious packages are isolated and the immediate area cordoned off.
Ensure that all persons who have touched the mail piece wash their hands with soap and water.
Call 911 to notify your local law-enforcement authorities.
List all persons who have touched the letter and/or envelope. Include contact information and have this information available for the authorities.
Place all items worn when in contact with the suspected mail piece in plastic bags and have them available for law-enforcement agents.
As soon as practical, shower with soap and water.

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14. If I suspect an attack, what should I do?

You should call 911. Your local law-enforcement agencies will notify other local, state, and federal agencies.

If you believe you have come in contact with a contaminated object, wash with soap and water. You should wait for medical assistance and diagnosis before taking any drugs you may have on hand.

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15. Besides anthrax, what are other potential diseases of bioterrorism?

A number of different bacteria, viruses, and toxins could be used as weapons of bioterrorism. Salmonella was used as a food poisoning by a religious cult in Oregon in the early 1980s to sicken hundreds of people. Biological weapons programs in the Soviet Union explored the use of smallpox, cholera, and plague. Among the 28 agents developed by the U.S. biological weapons program of the 1950s and 1960s were the agents that cause tularemia, Q-fever, and Venezuelan equine encephalitis.

Most disease agents, however, are difficult to process and disseminate effectively as weapons of mass destruction. See Agents of Bioterror for a more thorough guide, with information about diseases and treatments.

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16. What if my fear about bioterrorism is having a serious impact on my family and work life?

Given the attacks upon civilians that took place on September 11, it is reasonable to feel anxious. However, bioterrorism experts emphasize that the risks of a wide-scale and successful attack are extremely low. Much greater are the dangers of letting your fears escalate: Stress weakens your immune system and can have a spiraling effect as it disrupts your family and work life.

Should your fear get to the point that it stops you from doing the things you would normally do in a day, it might be helpful to talk with a counselor. Your health care provider can make a referral if you do not already have someone in mind. In the wake of the attack on New York City, we have learned how helpful it has been to many New Yorkers to speak with a counselor or to go to a mental health center.

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