Bioterrorism involves the intentional use of biological agents like viruses, bacteria, and toxins to cause illness or death in people, animals, or plants. These agents can be mutated to increase their ability to cause disease, act faster, or spread wider into the environment. They are difficult to detect and cause panic and fear among masses. The use of biological weapons for spreading terror has been practiced since ancient times, with examples from Ancient Rome, Assyrian politicians, and the 14th-century Tartars. Modern incidents of bioterrorism include the Rajneeshee cult distributing Salmonella in Oregon, terrorist organizations like Al-Qaeda exploring the use of biological agents, and the release of Sarin gas in Tokyo in 1995.

The US Centre for Disease Control (CDC) categorizes biological agents into three divisions: A, B, and C. Category A agents pose the highest risk to national security, are easily transmitted, and can cause high mortality. Examples of these agents include Anthrax, a non-contagious disease caused by the spore-forming bacterium Bacillus anthracis, which can be cured with antibiotics. Smallpox, a highly contagious virus, has a high mortality rate of 20-40% and is dangerous due to its highly contagious nature and the infrequency of vaccines administered.

Botulism, caused by Bacterium Clostridium Botulinum, is a deadly threat due to respiratory failure and acute bilateral descending flaccid paralysis. Bulbonic Plaque, caused by bacterium Yersinia Pestis, is transmitted through flea bites and aerosols, and is easily cultured and remains in circulation due to local rodents. Tulaneemia, caused by bacterium Francisellatularensis, is highly contagious and can be transmitted through contact with fur, inhalation, and ingestion of contaminated water or insect bites.

Haemorrhagic viral fever, including Marburg and Ebola, is a group of viruses with fatality rates ranging from 50-90%. Ebola fever, first discovered in Marburg, Germany, has a fatality rate of 50-90%, while Lassa and Bolivian haemorrhagic fever are found mainly in central and South America.

CATEGORY B includes diseases with low mortality rates, moderate morbidity, and easy dissemination, such as brucellosis, epsilon toxin, food safety threats by Salmonella, E. coli, Shigella, and Staphylococcus aureus, glander, melioidosis, psittacosis, Q fever, ricin toxin, abrusprecatorius, staphylococcal enterotoxin B Typhus, viral encephalitis, and threats from water supply by Vibrio cholerae and Cryptosporidium parvum.

CATEGORY C: They are the third highest priority and are considered as emerging threats for a disease. They have high mortality and morbidity rates. They can be engineered for mass dissemination in the future. These include NIPAH virus, HIV, Severe Acute Respiratory Syndrome (SARS), Hantavirus,

The planning for a bioterrorism attack involves developing a biological identification system, ensuring early detection and rapid response through cooperation between Public Health Authorities and Law Enforcements. Real-Time Outbreak Disease Surveillance (RODS) is used to collect data from various sources, including hospitals, clinics, labs, and drug sales. Researchers are also working on devices to detect bacterial toxins using tiny electronic chips. Dentists play a crucial role in preparing for and responding to bioterrorism attacks, as they can fill in the gap in hospitals and provide alternative healthcare sites. Their roles include diagnosis, monitoring, referrals, triage, vaccinations, infection control, and medical care augmentation.

Dentists trained in forensic odontology can assist in treating craniofacial injuries, administering anesthesia, starting intravenous lines, providing cardiopulmonary resuscitation, and other basic life support measures. They can also work with local Disaster Mortuary Operational Response Teams (DMORTs) and conduct local surveillance to monitor disease spread. The Dental Practice Act was modified in 2001, allowing dentists trained as Dental Emergency Responders to provide facilities in emergencies. Bioterrorism is a global threat, and medical fraternity should educate the public and policymakers about its dangers. International cooperation is needed to develop biodefense and educate target populations about precautions, responses, and protective measures in case of a bioterrorism attack. Dentists can provide support, information, and training in patient management during such catastrophes.

The World Health Organization (WHO) estimated potential casualties following the release of 50 kg of dried anthrax powder in a city of 500,000 inhabitants by aerosolisation for 2 hours, resulting in 95,000 deaths and 125,000 people being disabled. This would strain medical resources, leading to bed requirements for 12,500 people, antibiotics for 125,000 people for 60 days, and 95,000 deaths being disposed of. To defend public health against bioterrorism, improved awareness and preparedness in unexplained diseases are critical. A more sophisticated and integrated public health response is needed, requiring prompt disease surveillance, accurate laboratory diagnosis, and increased public health capacity to store adequate resources. First responders should be qualified in disease identification, techniques for biological mass casualty hospitals, methods for preventing pathogens, and decontamination. Keystones for emergency public health response should include aggressive treatment of illnesses, isolation, quarantine, enforcement of travel restrictions, safe handling of deceased victims, and public awareness of the incident. Public health systems need to be strengthened to achieve enhanced monitoring and epidemiological capacity to detect emerging diseases and provide relevant information for emergency medicine professionals to respond to a bioterrorism attack.

Role of Dentists in Strengthening the Disaster Response Capacity:

Dentistry plays a crucial role in the immediate response to a bioterrorist attack, both in staff and services. It is essential to inform the dental community about the medical and oral manifestations of diseases arising from a bioterrorist attack, create formal plans for coordinated responses, and develop educational programs on potential biological weapons. Dental offices should act as regional auxiliary hospitals if needed, and dental schools should provide information on potential biological weapons.

Dentists can educate their patients and affect public knowledge by providing data and science-based information about agents used in terrorist acts. Advanced teaching programs for threat communication may also be necessary. Dental offices, located in any community, have resources available to hospital facilities, such as sterilization equipment, air and gas lines, suction equipment, radiology capabilities, tools, and needles. Pre-designated dental offices can act as stockpile sites for materials to be distributed in the event of an attack.

During an attack, dentists and other dental workers can provide assistance, such as packaging medicines in individual doses or providing primary medical care in quarantined areas. Disease surveillance systems are critical for detecting outbreaks, monitoring their extent and spread, and determining when they are over. Dentists can also detect irregular trends in cancellations or missed appointments, which may be precursors to serious events.

Diagnosis and monitoring are essential for early identification of diseases introduced in a bioterrorist attack. Salivary swabs can provide important information on diagnosis or treatment, and dentists can refer suspicious cases for confirmation, treatment, or both to the appropriate specialists.

Bioterrorism is a pressing issue that requires a focus on public health, including in medical specialities like dentistry. Education can help combat infectious disease outbreaks and mitigate the impact of bioterrorism attacks. The government should implement proactive measures to ensure a wider range of security measures and empower the health sector in disaster management. Addressing the lack of well-equipped emergency units and expertise is crucial. India's medical profession should educate the public and policy makers on biological terrorism and build a global agreement condemning its use and encouraging preventive measures. Dental professionals can provide valuable information about potential attacks and respond effectively. Bioterrorism preparation should be included in dental curricula and Continuing Dental Education programs.

Conclusion

When it comes to responding to a major act of bioterrorism, dentistry is crucial. Dentistry's invaluable resources, including its personnel and facilities, can assist in identifying and countering bioterrorist attacks with the right planning. A disaster response plan for the profession ought to be created that can be incorporated into the plans for each community.

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