Water and bioterrorism: preparing for the potential threat to U.S. water supplies and public health

Water supplies and water distribution systems represent potential targets for terrorist activity in the United States because of the critical need for water in every sector of our industrialized society. Even short-term disruption of water service can significantly impact a community, and intentional contamination of a municipal water system as part of a terrorist attack could lead to serious medical, public health, and economic consequences. Most practicing physicians and public health professionals in the United States have received limited training in the recognition and evaluation of waterborne disease from either natural or intentional contamination of water. Therefore, they are poorly prepared to detect water-related disease resulting from intentional contamination and may not be adequately trained to respond appropriately to a terrorist assault on water. The purpose of this review is to address this critical information gap and present relevant epidemiologic and clinical information for public health and medical practitioners who may be faced with addressing the recognition, management, and prevention of water terrorism in their communities.