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11.1 Classification of Diseases Caused by
Biological Terrorism
In the light of recent concern and interest about the potential for biological terrorism
(biowarfare), there are several diseases and bacterial toxins that must be considered
in particular, like anthrax [1, 2], smallpox [3, 4], plague [5], botulinum toxin [6],
and tularemia [7]. A very detailed discussion of such diseases and other infectious
diseases with similar risks in terms of bioterrorism goes beyond the scope of this
concise chapter, but some features of these and other infectious diseases representing important threats in the biowarfare field will be mentioned. In this respect, we
may distinguish in time diseases which are:
1. old diseases which are disappearing and sometimes returning, like smallpox and
poliovirus infections (which are either extinct or close to be eradicated, thanks to
planetary vaccination programs);
2. diseases still active at present times, like carbuncle (anthrax), plague, tularemia,
tetanus, botulinum, TBC, etc.;
3. New diseases, which are appearing/spreading, like SARS (SevereAcute
Respiratory Syndrome) and its more recent variety of MERS (Middle-East
Respiratory Syndrome), infections by Ebola/Marburg viruses, hantavirus, filovirus, novel Flu virus strains and coronavirus COVID-19.
The next section is dedicated to the essential facts concerning these diseases. For
a complete medical reference to all of them, see, for instance, the Merck Manual of
Diagnosis and Therapy [8].
11.1.1 Old Infective Diseases
11.1.1.1 Smallpox (Variola)
Smallpox is a highly contagious disease (incubation 10–12 days) caused by the
smallpox virus, an orthopoxvirus. It causes death in up to 30% of infected subjects.
The indigenous infection has been eradicated (last case, Ethyopia, 1990 – WHO).
The main concern for outbreaks of smallpox is today from bioterrorism. Smallpox is
characterized by severe constitutional symptoms (fever, headache, extreme malaise)
and a characteristic pustular rash. Treatment is supportive; prevention involves vaccination, which, because of its risks (eczema, encephalitis, etc.), is done selectively.
The pathogenesis of smallpox demonstrates that the virus is transmitted from
person to person by direct contact or inhalation of droplet nuclei. Clothing and bed
linens can also spread infection. Most contagions are in the first 7–10 days after the
skin rash appears. Once crusts form, the infectivity declines. The virus invades the
oropharyngeal and respiratory mucosa, multiplies in regional lymph nodes, causing
viremia and localization in small blood vessels of the skin (rash) and rarely in CNS
(encephalitis).
M. Bologna et al.
11.1 Classification of Diseases Caused by
Biological Terrorism
In the light of recent concern and interest about the potential for biological terrorism
(biowarfare), there are several diseases and bacterial toxins that must be considered
in particular, like anthrax [1, 2], smallpox [3, 4], plague [5], botulinum toxin [6],
and tularemia [7]. A very detailed discussion of such diseases and other infectious
diseases with similar risks in terms of bioterrorism goes beyond the scope of this
concise chapter, but some features of these and other infectious diseases representing important threats in the biowarfare field will be mentioned. In this respect, we
may distinguish in time diseases which are:
1. old diseases which are disappearing and sometimes returning, like smallpox and
poliovirus infections (which are either extinct or close to be eradicated, thanks to
planetary vaccination programs);
2. diseases still active at present times, like carbuncle (anthrax), plague, tularemia,
tetanus, botulinum, TBC, etc.;
3. New diseases, which are appearing/spreading, like SARS (SevereAcute
Respiratory Syndrome) and its more recent variety of MERS (Middle-East
Respiratory Syndrome), infections by Ebola/Marburg viruses, hantavirus, filovirus, novel Flu virus strains and coronavirus COVID-19.
The next section is dedicated to the essential facts concerning these diseases. For
a complete medical reference to all of them, see, for instance, the Merck Manual of
Diagnosis and Therapy [8].
11.1.1 Old Infective Diseases
11.1.1.1 Smallpox (Variola)
Smallpox is a highly contagious disease (incubation 10–12 days) caused by the
smallpox virus, an orthopoxvirus. It causes death in up to 30% of infected subjects.
The indigenous infection has been eradicated (last case, Ethyopia, 1990 – WHO).
The main concern for outbreaks of smallpox is today from bioterrorism. Smallpox is
characterized by severe constitutional symptoms (fever, headache, extreme malaise)
and a characteristic pustular rash. Treatment is supportive; prevention involves vaccination, which, because of its risks (eczema, encephalitis, etc.), is done selectively.
The pathogenesis of smallpox demonstrates that the virus is transmitted from
person to person by direct contact or inhalation of droplet nuclei. Clothing and bed
linens can also spread infection. Most contagions are in the first 7–10 days after the
skin rash appears. Once crusts form, the infectivity declines. The virus invades the
oropharyngeal and respiratory mucosa, multiplies in regional lymph nodes, causing
viremia and localization in small blood vessels of the skin (rash) and rarely in CNS
(encephalitis).
M. Bologna et al.