What the acute care physician needs to know about bioterrorism

Abstract

While it seems unlikely that acts of bioterrorism would occur in Canada, bioterrorist attacks are of great concern in the United States (1–3). It is almost inconceivable that an event in the United States would not have some impact in Canada, given the frequency of international travel. Just as a resident of the greater Toronto area fell victim to West Nile Virus encephalitis following a visit to New York, New York during the 1999 summer epidemic, and hundreds of travellers returning to Canada develop malaria each year, infected travellers could return to Canada while in the incubation stage of an infection resulting from bioterrorism. Furthermore, diseases that are communicable by person-to-person contact, such as smallpox and pneumonic plague, can cause secondary cases that are in the incubation stage before the index case is recognized. While it is hoped that physicians in Canada will never face a crisis that would require the information presented in this paper, it behooves all involved in acute care to familiarize ourselves with the potential reality of bioterrorism and its management. A plan of action must be formulated and put in place before such a situation occurs – if it ever does occur. Unlike warfare, the target of the bioterrorist is the civilian population. Acute care staff needs to be able to diagnose diseases that are most likely the result of microbial bioterrorism. There must be a plan of medical management in place in the health care setting to ensure that preventive action, such as a quarantine, and the immediate and orderly distribution of vaccines and antimicrobial drugs, can be taken to minimize disease transmission. Colleagues who work in public health, laboratories, infection control and occupational health are vital partners in medical management, together with emergency services response groups (eg, police, ambulance, city authorities) and criminal investigation units.