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An Update on Bioterrorism-Related Conditions

Amesh A. Adalja, MD, FACP, FACEP, March 6, 2015

It has been nearly 14 years since the anthrax attacks took place. In the months and early years following these attacks, the US embarked on the important task of readying the nation for another biological attack. This preparation was multifaceted, and an important component of it was ensuring that healthcare providers—the front-line responders—were able to accurately diagnose and treat these infections.

However, as time has passed, many healthcare providers may have not kept up with new developments in treating these infections, and many may have been too early in their training to be fully exposed to the education effort that occurred a decade ago.

To this end, my colleagues and I wrote a clinical review article, now published in the New England Journal of Medicine, updating the knowledge base for these important infections.


Several Microbes Discussed

There are many microorganisms that could potentially be used as bioweapons, but we focused our review on those with the most significance: anthrax, smallpox, plague, botulism, and tularemia—all high-consequence conditions caused by category A agents.

Our aim was to highlight the evolution in treatment of these infections that has occurred since 2001, as medicine and science have advanced considerably since that time. For example, a monoclonal antibody is now available for the treatment of anthrax, experimental antivirals for smallpox, and a heptavalent antitoxin for botulism.


Bioterrorism Risk Remains

Despite the fact that no major bioattack has occurred since the events of 2001, the threat persists and preparing to combat it should remain a national security priority. Though improvements in our ability to care for patients who may be infected—naturally or otherwise—with these often deadly microbes have occurred, there are still tasks that lie ahead, including the development of new treatments, rapid diagnostics, and vaccines, coupled with healthcare providers keeping abreast of the latest developments in clinical management.



Adalja AA, Toner ES, Inglesby TV. Clinical management of potential bioterrorism-related conditions. N Engl J Med 2015;372:954-962.