[Microbial warfare and bioterrorism]

Infectious diseases have been used as warfares since ancient times. Since the 1920s military organizations have studied bacteria of anthrax, plague, tularemia, botulism, brucelloses, glander, Q-fever, and smallpox virus, Filo-, Arena-, Bunyaviruses causing hemorrhagic fever or Alphaviruses eliciting encephalitis. These can be dispersed by aerosol. Salmonellae, Shigellae, Vibrio cholerae, distinguished Escherichia coli strains are suitable to contaminate food, water, pharmaceutical products. Fanatical groups or terrorist individuals deploy microbe weapons. In the future, genetically engineered recombinant microbes could be used with genomes containing multiple resistance elements to antimicrobial compounds and additional virulence factors. These become resistant to all known treatment regimens, vaccination and the host immune response. Microbial terrorist attacks result in an outbrake on a restricted area with large number of casualties. The disease course is severe and unusual followed by high mortality. Identification of microbes is complicated and delayed. Most countries have neither laboratories at high biosafety level nor specially trained personnel. Physicians might misdiagnose these diseases. Health care systems with minimal elasticity face difficulties in maintaining mass quarantine. A considerable part of health care workers leave hospitals. No plan is available to stockpile medicines. Robust surveillance and laboratory systems coordinated at international level must be established. All health care personnel should be trained periodically to gain practical skills. Additional standards governing working conditions with selected microbes will be enforced by law. Related scientific data might be published with restricted access only.