OSHA Bioterrorism Resources

Bioterrorism is the intentional use of microorganisms to bring about ill effects or death to humans, livestock, and/or crops. The use of microorganisms to cause disease is a growing concern for public health officials and agricultural bodies. Since the end of the Cold War, the possibility of a bioterrorist attack has increased considerably due to the emergence of terrorists from rogue nations around the world, as well as a significant increase in violent extremist groups within the United States.


A bioterrorism incident poses a considerable health risk to those individuals and groups who are called upon to respond, due to the potential exposure to deadly microorganisms. These "first responders" may include public health officials, law enforcement, firefighters, paramedics, or the military. This web page provides information about the threat of bioterrorism and helps responders recognize, prevent, and control the health hazards that workers may face when responding to an attack.

Is bioterrorism a threat?

The terrorist attacks on September 11, 2001 and the subsequent bio-terrorist releases of anthrax brutally taught the nation that workplaces can be terrorist targets. No one can predict exactly how and where a terrorist will strike. A bioterrorist attack could result in mass deaths of humans, animals, and/or crops. Due to the time lapse between exposure and the onset of symptoms, an attack is hard to determine and control. With the rapid transit network in the U.S., people could be exposed in the area and then return home before developing symptoms and receiving a diagnosis, potentially exposing hundreds of others. The following web pages contain more in-depth discussions of the possible threat of bioterrorism, including those issues discussed above.

• Bioterrorism in the United States: Threat, Preparedness, and Response. Chemical and Biological Arms Control Institute (2000, November), 1.61 MB PDF, 339 pages. Provides a detailed analysis of the threat of bioterrorism and suggests specific measures for improving national response capabilities.
• Biological and Chemical Terrorism: Strategic Plan for Preparedness and Response Recommendations of the CDC Strategic Planning Workgroup. CDC, MMWR (2000, April 21), 20 pages. Outlines steps to improve public health and health-care response to a biological/chemical attack.
• Bioterrorism: How Prepared Are We? Shalala, D. (1999, July-August). Emerging Infectious Diseases Vol. 5, No. 4. Addresses what government organizations must do to prepare for a bioterrorist attack.
• The Prospect of Domestic Bioterrorism. Stern, J. (1999, July-August). Emerging Infectious Diseases Vol. 5, No. 4. Addresses the main factors that motivate and inhibit bioterrorist groups.
• Potential Biological Weapons Threats. Kortepeter, M. and Parker, G. (1999, July-August). Emerging Infectious Diseases Vol. 5, No. 4. Discusses various biological agents that may be used in bioterrorist attacks.
• Addressing the Potential Threat of Bioterrorism – Value Added to an Improved Public Health Infrastructure. McDade, J. (1999, July-August). Emerging Infections Disease Vol. 5, No. 4. This article addresses the benefits of preparing for a bioterrorist attack.
• CBW Terrorism and Response. Center for Nonproliferation Studies (2001, March). Contains links related to chemical and biological terrorism.

Related Safety and Health Topics

• Biological Agents
• Anthrax
• Bloodborne Pathogens
• Smallpox

Other Related Materials

• CDC Bioterrorism Page
• Bioterrorism Resources. Association for Professionals in Infection Control and Epidemiology, Inc.
• Center for the Study of Bioterrorism. Saint Louis University School of Public Health.
• Center for Civilian Biodefense Strategies. Johns Hopkins University
• All the Virology on the WWW. A biological weapons link page. The page separates government and non-government web pages.
• Center for Nonproliferation Studies. Chemical and Biological Weapons and WMD Terrorism Web Links.

Recognition 

Emergency Response to Bioterrorism

The following web pages provide federal, state and local phone numbers to contact in the case of an emergency. There are also pages detailing the development of methods to determine exposure to biological agents, as well as first response information.

• Emergency Response. CDC (2002, December 16), 2 pages. Provides links for local health departments, emergency contacts and procedures for health departments, health-care workers, and emergency responders.
• Planning Resources for Bioterrorism. CDC (2002, December 18), 3 pages. A collection of links related to preparation and planning for bioterrorist events. Includes national, state, and local-level strategies.
• Interim Bioterrorism Readiness Plan Suggestions. Association for Professionals in Infection Control and Epidemiology, Inc., Bioterrorism Working Group (2002, April), 63 pages. A summary of suggestions by APIC Bioterrorism Advisors, ICPs, members, and agency liaisons to facilitate preparation of bioterrorism readiness plans for individual and regional institutions.
• Biological Diseases/Agents Listing. CDC (2002, November 21), 3 pages. Listing of biological agents with bioterrorist potential, categorized according to the degree of threat they pose. Includes links to fact sheets for many of the agents.
• Bioterrorism Preparedness and FAQ. CDC (2001, October 25), 2 pages. Frequently asked questions and answers concerning emergency preparedness and response systems.

Evaluation

Potential Biological Agents for Bioterrorism  

There are an unlimited number of potential biological agents that could be used in bioterrorism attacks, although some are more deadly and likely to be used than others. Biological agents include bacterial agents, toxins, and viruses.

• Recognition of Illness Associated with the Intentional Release of a Biologic Agent. CDC, MMWR (2001, October 19), 5 pages. Provides guidance to healthcare and laboratory workers for identifying a bioterrorism-related disease outbreak.
• Biological Warfare and Its Cutaneous Manifestations. The Electronic Textbook of Dermatology (1995-2000), 50 pages. This article was written by Thomas W. McGovern, MAJ, MC and George W. Christopher, LTC, USAF, MC. It gives an overview of bacterial, toxin, and viral diseases potentially used in biological warfare. 
• Medical Management of Biological Casualties. U.S. Army Medical Research Institute of Infectious Diseases (2001, February). This is a section of a military handbook that provides information and recommendations regarding medical response to a biological warfare attack on a civilian or military population. Contains specific information on a number of potential bioterrorist agents. 
• Symposium on Medical and Public Health Response to Bioterrorism. CDC (1999, July-August), 2 pages. Special issue of Emerging Infectious Diseases covering the first national symposium on this topic. Vol. 5, No. 4. Contains articles on a wide range of issues related to bioterrorism.
• Medical Aspects of Chemical and Biological Warfare. U.S. Army Medical NBC Online Information Server (1997). Broad coverage of chemical and biological warfare including history, threat, medical treatment, decontamination and chapters addressing specific agents. 
• Knowledge Key to Combating Chemical/Biological Warfare. US Department of Defense (1999, February 23), 3 pages. Article by Linda D. Kozaryn advising service members to be aware of and educate themselves about the growing chemical-biological threat.
• Level A Protocols - Laboratory Response Network (LRN). American Society for Microbiology (2001, November 14), 9 pages. Describes the role that level A laboratories play in combating bioterrorism within the LRN.

Control

What Needs to Be Done to Counteract Future Bioterrorist Attacks?

Here are links to sites that provide some ideas on preparing for responding to a bioterrorist attack. Some of the ideas include: better state and federal disease surveillance and epidemiology, stockpiling vaccine for emergency use, mass vaccination of first responders, and training for medical personnel.

• Guidance for Protecting Building Environments from Airborne Chemical, Biological, or Radiological Attacks. CDC, NIOSH (2002, May), 23 pages. This document identifies actions that a building owner or manager can implement without undue delay to enhance occupant protection from an airborne chemical, biological, or radiological attack.
• Public health response to biological and chemical weapons: WHO guidance. WHO (2001, November), 444 KB PDF, 97 pages. Addresses public health issues surrounding a chemical/biological attack. Provides risk management principles for planning a response to such an attack. Also describes international sources of assistance.
• CBW Terrorism and Response: Center for Nonproliferation Studies (2001, March). Contains sections devoted to chemical/biological terrorist threat assessment, response, and counterterrorism. Includes information from presidential initiatives, major legislation, State Department, Federal Bureau of Investigation, and Government Accounting Office Reports.
• Improving Local and State Agency Response to Terrorist Incidents Involving Biological Weapons. DOD (2000, September 12), 182 KB PDF, 32 pages. This document gives a thorough set of recommendations for local response to bioterrorism. A biological weapons response plan is set forth in a 13-component response template.
• Addressing Bioterrorist Threats: Where Do We go from Here? Hamburg, M. (1999, July-August). Emerging Infectious Diseases Vol. 5, No. 4. Describes what needs to be done at local, state, and federal levels to prepare for a bioterrorist attack.
• Biological Warfare: A Nation at Risk – A Time to Act. National Defense University (1996, January), 10 pages. This article provides insights on the prospect of biological warfare. It examines the issue from the perspective of U.S. enemies. It also suggests what needs to be done in the future with relation to preparation for bioterrorism.
• Vaccines in Civilian Defense Against Bioterrorism. Russell, P. (1999, July-August). Emerging Infectious Diseases Vol. 5, No. 4. Discusses the feasibility of using immunizations as a defense against bioterrorism, both at the military and general public level. Calls special attention to the feasibility of administering smallpox and anthrax vaccines to the general public.
• Bioterrorism Readiness Plan: A Template for Healthcare Facilities. CDC, APIC (1999, April 13), 1.5 MB PDF, 34 pages. This document aids individual healthcare institutions in the preparation of bioterrorism readiness plans.
• Bioterrorism: Implications for the Clinical Microbiologist. Klietmann, W. and Ruoff, K. (2001, April). Clinical Microbiology Reviews 14(2):364-381. This review focuses on the role envisioned for clinical laboratories in response to a bioterrorist event. 

Military Preparedness for Bioterrorism

• CB Warfare and Defenses. Center for Nonproliferation Studies (2001, October 24). This page contains links related to the armed forces and how they are preparing for bioterrorism. Topics include the anthrax vaccination program, biological weapons defense, decontamination, detection, warning mechanisms, and identification.
• Defending Against Invisible Killers - Biological Agents. U.S. Department of Defense (2000, September), 4 pages. Describes military concerns with biological agents, including methods of deployment, detection systems, vaccination, and physical protective equipment.

Compliance

The following compliance information includes regulations, interpretations, and related material applicable to emergency response activities as a result of a bioterrorist attack. Refer to the Emergency Response Safety and Health Topics page for additional information.

• OSHA Standards
• 1910.120, Hazardous waste operations and emergency response. This is the entire HAZWOPER standard. Paragraph "q" of the standard is emergency response.
• Preambles to OSHA Standards
• Hazardous waste operations and emergency response (1989).
• Section 0, Intro to 29 CFR Part 1910, Hazardous Waste Operations and Emergency Response.
• Section 1, I. Background.
• Section 2, II. Summary and Explanation of the Standard.
• Section 3, III. Summary of the Final Regulatory Impact. and Regulatory Flexibility Analysis and Environmental Impact Assessment.
• Section 4, IV. International Trade.
• Section 5, V. OMB Approval Under the Paperwork Reduction Act.
• Section 6, VI. Public Reporting Burden.
• Section 7, VII. State Plan States.
• Section 8, VIII. Federal and State Coverage of the Public Sector and Volunteers.
• Section 9, IX. Federalism.
• Section 10, X. Authority.
• OSHA Directives
• OSHA CPL 2-2.59A, Inspection Procedures for the Hazardous Waste Operations and Emergency Response Standard, 29 CFR 1910.120 and 1926.65, Paragraph (q): Emergency Response to Hazardous Substance Releases (1998, April 24), 77 pages. This instruction establishes policies and provides clarification to ensure uniform enforcement of paragraph (q) of the HAZWOPER standard, 29 CFR 1910.120 and 1926.65.
• CPL 2-1.037. Compliance policy for emergency action plans and fire prevention plans (July 9, 2002), 296 KB PDF, 20 pages.

Other

• Bioterrorism, Public Health, and Civil Liberties. Annas, G. (2002, April 25). New England Journal of Medicine 364:1337-1342. Discusses possible government responses to bioterrorism and how they would affect public health policy/practice and civil liberties. 
• Biological Weapons - A Primer for Microbiologists. Hawley, R. and Eitzen, E. (2001). Applied Biosafety 6(3):101-116. Provides background on bioterrorism and discusses decontamination, protective measures and other key response issues.
• Hospitals and Community Emergency Response – What You Need to Know. OSHA Publication 3152 (1997), 45 pages. This document is intended to assist hospitals in preparing for response to an emergency. It presents legal requirements, preplanning and training recommendations, relevant standards and some additional resources.
• The Chemical and Biological Weapons Nonproliferation Project. The Henry L. Stimson Center (2002). This website provides information on a variety of issues associated with chemical and biological weapons. Internal publications are included.

Question and Answer

• Bioterrorism: Implications for Public Health. Public Health Grand Rounds, University of North Carolina.  (1999, June 11).

Economic Analysis of a Bioterrorist Attack

• The Economic Impact of a Bioterrorist Attack: Are Prevention and Postattack Intervention Programs Justifiable? Kaufmann, A.; Meltzer, M.; and Schmid, G. (1997, April-June). Emerging Infectious Diseases Vol. 3, No. 2. Presents cost analyses of bioterrorist attacks with Bacillus anthracis, Brucella melitensis, and Francisella tularensis.

Testimonies

• Secretary Thompson Testifies on Bioterrorism Preparedness. US Department of Health and Human Services (2001, October 3), 3 pages. This page includes statements made by HHS Secretary Tommy G. Thompson before the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies concerning bioterrorism preparedness.
• HHS Accelerates Bioterrorism Research. US Department of Health and Human Services (2001, December 6), 3 pages. HHS Secretary Tommy G. Thompson announces seven new initiatives to accelerate bioterrorism research and help strengthen the nation's ability to deal with the public health threat posed by bioterrorism.
  
  

  Revised: 14 July 2003