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Impact of Biological Disasters
Even a small-scale biological attack with a weapon grade agent on an urban center could cause massive morbidity and mortality, rapidly overwhelming the local medical capabilities. For example, an aerosolized release of little as 100kg of anthrax spores upwind of a metro city of a size of Washington D C has been estimated to have the potential to cause up to three millions of deaths.

Biological Disaster imposes heavy demands on the National health care system and it will be the public health system that will be called upon to handle the consequences. An effective public health system with component of a strong disease surveillance mechanism, facilities for rapid epidemiological and laboratory investigation, efficient medical management and information, education and communication (IEC) are essential capabilities for countering biological disasters.

Potential agents in biological warfare
The potential agents which may be used by terrorists could range from pathogens like Bacillus Anthracis (anthrax), Yerseinia Pestis (Plague) etc to organisms such as veriola (small-pox) that have been certified as globally eradicated. Biological toxins or genetically modified pathogens could also be used. Terrorists might use new agents, or use organisms such as drug resistant or genetically engineered pathogens.

Agents likely to be used for Bio-terrorism
Sl No. Disease Agent
1. Anthrax Bacillus Anthracis
2. Plague Yersenia pestis
3. Tularemia Francisella tularensis
4. Q fever Coxiella brunetii
5. Botulism Clostridium botulinum
6. Cholera Vibrio cholerae
7 Shiegellosis Shigella dysenteria (causes severe disease), flexneri, boydii, sonnei (short clinical course)
8. Small Pox Variola virus
9. Viral Haemorrhagic fever Ebola virus, Marburg virus, Lassa virus

Mode of attack
A terrorist attach is likely to focus on areas/cities to cause the maximum panic, disruption/damage and public attention. Big metropolitan cities, urban conglomerations and districts having international borders could be the likely targets. The mode of attack would depend upon the type of agents used. In order to infect or affect a large population, it is possible that the aerosol mechanism would be used in closed, confined areas where large numbers of people assemble e.g. markets, cinema halls etc. Another modality could be by contamination of food and water with toxins toxins and pathogens. Deliberate infiltration of infected animals, pests or vectors through the borders could also be another modality of attach. Pesticides/toxins/micro-organism on plans could also be used to inflict economic damage.

Distinguishing between natural and intentional disease outbreaks
With a covert biological attack, the most likely first indicator of an event would be an increased number of patients with common clinical features caused by the disseminated agent reporting to hospitals and dispensaries in the locality.

A sound epidemiological investigation of a disease outbreak will help identify the pathogen/s, institute the appropriate medical interventions and public health response. Diseases caused by genetically modified pathogens may present non-specific clinical features that could be difficult to diagnose. The disease pattern that develops will be an important factor in differentiating between a natural and a terrorist attack. Though this may give some clues, naturally occurring epidemics can have one or more of these characteristics and a biological attack may have none.

Differentiating between biological and chemical attack
In release of a chemical or biological agent, the nature and degree of hazard will depend on a multitude of factors, including, among other things, the agent and the amount released, the method by which the agent is disseminated, factors that influence its toxicity, infectivity or virulence both during and after its release, its movement and dilution in the atmosphere, and the state of protection and susceptibility of those exposed. However, a chemical agent will have immediate consequences whereas most biological agents will have an incubation period.
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