Bioterrorism Threat Lives on, as Do Vaccine-Related Events

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SCOTTSDALE, ARIZ. -- Despite the grateful lull that has followed Sept. 11 and the anthrax scare in 2001, bioterrorism remains a very real threat, a Food and Drug Administration counterterrorism official says.

Dr. Boris Lushniak, the FDA's assistant commissioner for counterterrorism policy and assistant U.S. surgeon general, hopes that vigilance remains active in medical offices and emergency departments across the United States--but frankly, he has his doubts. "I daresay we are going to be caught off guard," Dr. Lushniak said during the Alfred L. Weiner Lecture at the annual meeting of the Noah Worcester Dermatological Society.

A disturbing number of organisms meet all or some of the criteria for an ideal agent of biological terrorism: easy to obtain and work with; inexpensive to produce; able to be widely disseminated; fairly stable in the environment; capable of producing high morbidity and mortality; transmissible person to person; and difficult to diagnose and treat, which would allow an attack to quickly overwhelm the health care system.

On a positive note, the U.S. government has now stockpiled enough vaccine against smallpox to inoculate every man, woman, and child in the country, Dr. Lushniak reported.

Yet, when U.S. public health authorities were notified recently about an individual with suspicious skin lesions on an inbound flight from China, they were unable to find any hospital in a major metropolitan area willing to admit and quarantine the 200 people aboard until danger to the public was ruled out.

Fortunately, in that case, the threat was nullified during 4 hours of frantic planning as the airliner approached U.S. shores, but it stands as a wake-up call about preparedness. "If this is ever to occur, we'd really have to change the way we do our business," he said.

The potential agents of greatest concern--labeled category A by the Centers for Disease Control and Prevention--remain the same as ever: anthrax, smallpox, plague, tularemia, viral hemorrhagic fevers, and botulinum toxin.

The timing could be critical.

Anthrax, for example, can be controlled with antibiotics if it is recognized and treated with postexposure prophylaxis before protein-rich toxins are produced by the organism. "If you can nip it in the spore bud, so to speak, then you really have solved the problem," he said. …