[Infectious diseases as a weapon: vigilance is needed]

The deliberate inclusion of Bacillus anthracis spores in mail has led to several cases of anthrax in the USA of which to date four have been fatal. Shortly before these incidents, the Health Council of the Netherlands had issued an advisory document which stressed the need for a well-established infrastructure and rigorous protocols so that an immediate and adequate response to cases of bioterrorism could be ensured. Physicians are expected to know the characteristics of the relevant diseases and to immediately notify the Health Inspectorate in the event of an infectious cluster which is unusual with respect to time, place or age, a cluster of a highly serious disease in healthy persons, or a cluster characterised by flaccid paralysis with bulbar signs.