Vol. 10 No. 3 — March 2002
Bioterrorism Resources on the Internet: A Primer
by Eva Perkins • epa Research
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The bombings of the World Trade Center in New York in 1993 and the Alfred P. Murrah Federal Building in Oklahoma City in 1995 forced Americans to face the fact that terrorism is not something that happens only overseas. At that time, however, a relatively modest number of publications were devoted to this subject. September 11, 2001, changed everything. We are now witnessing a sea change in funding, support, and understanding of terrorism to enable the democratic world to prepare for and respond to future attacks.

In the wake of September 11th, many relatively obscure national and international organizations have come into the limelight for their ability to provide resources for the war on terrorism. Bioterrorism may become the next weapon in the arsenal of those who hate and seek to destroy democracy. What is bioterrorism? Which organizations and governmental agencies publish in this area? Using the power of the beloved Internet, one can easily and quickly access a wealth of information. Here's how to do it.

National and Local Organizations

National Association of County and City Health Officials

The National Association of County and City Health Officials (NACCHO) was formed in July 1994 in a merger of the National Association of County Health Officials and the U.S. Conference of Local Health Officers. The two predecessor organizations began in the 1960s. NACCHO is a nonprofit membership organization serving all of the nearly 3,000 local health departments nationwide — in cities, counties, townships, and districts. NACCHO provides education, information, research, and technical assistance to local health departments and facilitates partnerships among local, state, and federal agencies in order to promote and strengthen public health. 

NACCHO's home page features a prominent "NACCO Responds to Bioterrorism" banner that leads to this statement, "As the nation turns its eyes to the issue of bioterrorism preparedness, NACCHO is undertaking a myriad of activities to inform the public, lawmakers, and our membership about the essential role of local public health agencies in responding to an act of bioterrorism. Below are links to key information about this issue that can be found on NACCHO.ORG. We will continue to keep this Web site up-to-date with what we and others are doing and saying about this issue. Keep checking, there is more coming!" 

Links connect to NACCHO's statements on the subject, FAQs and publications, news articles, useful bioterrorism links including Centers for Disease Control and Prevention (CDC) live satellite broadcasts and publications, such as the Morbidity and Mortality Weekly Report. The satellite broadcasts have important titles like "What Every Laboratory Needs to Know About Bioterrorism Attacks," sponsored by 11 public health agencies (identified by their acronyms — AAPR, COLA, etc.) plus the CDC. One needs a certain background to appreciate the information. Suffice to say that these video and audio broadcasts are extremely important tools.

Governmental Organizations

U.S. Department of Health and Human Services

The Department of Health and Human Services (DHHS) is the U.S. government's principal agency for protecting the health of all Americans and providing essential human services, especially for those least able to help themselves. The department includes more than 300 programs, covering a wide spectrum of activities. Here are some highlights: preventing outbreak of infectious disease, including immunization services; medical and social science research; and assuring food and drug safety. The DHHS incorporates the National Institutes of Health (NIH), the Food and Drug Administration (FDA), CDC, and the Center for Medicare and Medicaid Services (formerly the Health Care Financing Administration), as well as several other agencies.

The DHHS home page announces that it has accelerated bioterrorism research. Clicking on this link leads to a press release announcing the launch of seven new initiatives to accelerate bioterrorism research and help strengthen the nation's ability to deal with the public health threat bioterrorism poses. These initiatives involve research programs at the National Institute of Allergy and Infectious Diseases (NIAID) designed to take advantage of the recent outpouring of ideas from concerned academic and industrial scientists on ways to understand and combat potential agents of bioterrorism. NIAID is the lead institute for research on bioterrorism at the NIH. Many of these programs will encourage government partnerships with business and academia in such areas as an Anthrax Vaccine Contract to develop effective vaccines, a Rapid Response Grant Program on Bioterrorism-Related Research that will evaluate and fund new applications in 5-6 months after receipt, rather than the usual 9-10 months. Research is planned on improving prevention strategies, diagnostics, and treatment of victims.

Centers for Disease Control and Prevention (CDC)

Long active as a world leader in public health, the CDC is a veritable gold mine of information as state-of-the-art as congressional funding allows. In the current climate, the CDC's budget is bound to be increased substantially, as are those of most public health agencies needing to prepare and respond to bioterrorism. The CDC issues fact sheets and advisories and, since 1952, has published the Morbidity and Mortality Weekly Report (MMWR), a scientific publication containing data and reports on specific health and safety topics. Savvy travelers have consulted its "Travelers' Health" advisories for years before setting out on a trip.

The home page of the CDC is devoted to anthrax and smallpox emergency preparedness and response plans for state and local officials to follow. Links reach the U.S. Postal Service (USPS), National Pharmaceutical Stockpile, video and satellite broadcasts, and much, much more.

Currently, the CDC is formulating the National Bioterrorism Training Plan []. This page will contain information regarding a three-phase plan to strengthen frontline public health preparedness through training. Phase I addresses the Agency's response plan, Phase II focuses on bioterrorism preparedness and response skills at the local level, and Phase III will integrate preparedness competencies into a lifelong learning system.

The National Center for Infectious Diseases (NCID) operates under the CDC. The mission of the NCID is to prevent illness, disability, and death caused by infectious diseases in the U.S. and around the world. With respect to bioterrorism, the NCID details the CDC's plan for addressing infectious disease threats and enhancing the public health information infrastructure and bioterrorism preparedness. 

To accomplish this goal, staff members work in partnership with local and state public health officials, other federal agencies, medical and public health professional associations, infectious disease experts from academic and clinical practice, and international and public service organizations. Tasks include conducting surveillance, epidemic investigations, epidemiologic and laboratory research, training, and public education programs to develop, evaluate, and promote prevention and control strategies for infectious diseases.

U. S. Food and Drug Administration (FDA)

The mission of the FDA is to promote and protect the public health by helping safe and effective products reach the market in a timely way and by monitoring products for continued safety once in use. Bringing up the FDA's Web site reveals a prominent link to bioterrorism under "Hot Topics" on the home page. Here the FDA has provided links to several consumer-oriented publications, including a fact sheet on preparing for a bioterrorism threat, congressional testimony on the safety of the American food supply, biodefense studies underway at Johns Hopkins University and St. Louis University, and toxicological research being conducted at the FDA's National Center for Toxicological Research. 

National Library of Medicine's MEDLINEplus

Searching in MEDLINEplus on biological and chemical weapons results in a wealth of information, including overviews, specific agents, organizations, and related topics. The results of one search included a paper from the National Institute of Allergy and Infectious Diseases on bioterrorism research, articles from Reuters, the Associated Press and New York Times, several papers from the Mayo Foundation for Medical Education and Research, and a handbook from the Department of Justice's Office for Victims of Crime outlining how to cope after a bioterrorist attack. This site is a definite must for any research in this area.

Chemical and Biological Defense Information Analysis Center (CBIAC)

Operated by Battelle Memorial Institute and supported by several private sector R&D companies, the CBIAC is a full-service Department of Defense (DoD) Information Analysis Center (IAC) under contract to the Office of the Secretary of Defense and administratively managed by the Defense Technical Information Center (DTIC). Established in 1986, the CBIAC serves as the DoD focal point for information related to Chemical and Biological Defense (CBD) technology.

As such, the CBIAC offers much to many. The center provides handbooks and databooks, databases, technology assessments, software, training kits, and CD-ROMs. Databases include Chemical Defense Materials Database and the DTIC databases. Other services include workshops and conferences and laboratory studies that include security work. 

CBIAC's home page links to "anthrax, mail and related topics," which leads one to information from MEDLINEPlus, Johns Hopkins Center for Civilian Biodefense Studies, CDC, New York State Health Department, and the USPS, among other agencies. Another link leads to the CBD Internet Directory, which itself links to chemical and physical properties, medical-chemical and biological defense, toxicology, and warning and identification. This last area, warning and identification, leads to the Los Alamos National Laboratory' Daily News Bulletin, which links to the Library. A search on "chemical warfare agents" yielded Chemical Warfare Agents, Satu Somani, editor, Academic Press, 1992, and Chemical Warfare Agents: Toxicology and Treatment, Timothy Marrs, John Wiley, 1996, among several other titles.

Private Organizations

American Psychiatric Association (APA)

The American Psychiatric Association provides professional advice for coping with fears and anxieties generated by the threat of bioterrorism. In a news release dated October 19, 2001, the APA suggested that one educate oneself about the potential danger, citing the CDC as an excellent source of timely information. On a psychological level, the APA suggests distraction with books and films, weekend getaways, conversations with friends, as well as such general healthy routines as sleep, exercise, and proper nutrition.

RAND Corporation

The RAND Corporation is the nation's first think tank. Led by Brian Jenkins, a band of researchers has worked in relative obscurity on bioterrorism, identifying and understanding organizations such as the al-Qaeda terrorist organization. "Getting the jump" on other researchers in this area, it is clear that RAND's Web site offers superior information resources. Although much of RAND's work is classified for security purposes, the site offers links to such gems as "Terrorism Panel Issues Recommendations," a report to the President and Congress that stresses the need for research, development, and production of vaccines to combat biological terrorism. Clicking on the "Publications" button brings up A Review of the Scientific Literature as It Pertains to the Gulf War Illnesses, Volume I: Infectious Diseases, which may be purchased online for $15 in either paper or PDF format. 

St. Louis University Center for the Study of Bioterrorism and Emerging Infections

The Center for the Study of Bioterrorism and Emerging Infections is a unit of the School of Public Health at St. Louis University. This Center's mission is to provide public health and healthcare facilities with the tools needed for preparedness and response to intentional use of biological agents and emerging infections. 

The Center develops training materials based on prioritized requirements to ensure that all center product development efforts are driven by three well-defined goals: to deter the use of biological agents by terrorists; to minimize the advantage of the potential effective use of any biological pathogen by terrorists through enhancing our nation's public health infrastructure to ensure prompt identification of a threat and an appropriate response; and to provide focused tools that address the highest priority biological agents and emerging threats.

Going to the Center's home page reveals a smorgasbord of resources, ranging from the re-release of Smallpox and Its Eradication, the U.S. Army Medical Command, Bio/Chemical Terrorism Satellite Broadcast, to slide presentations on anthrax and smallpox developed by the Center. 

Smallpox and Its Eradication was published by the World Health Organization (WHO) in 1988. It contains illustrative material both from WHO and from other published sources, as indicated. Stocks of Smallpox and Its Eradication were exhausted some years ago and the book is now out of print. In view of current concern about the threat of smallpox, WHO has decided with some urgency to make the book available on the World Wide Web.

The Center for the Study of Bioterrorism and Emerging Infections has put up a large bibliography characterized as follows: "The following citations are the result of a PubMed search using keywords 'Biological Warfare,' 'Biological Terrorism,' 'Biowarfare,' and 'Bioterrorism.' Current as of April 2001." Organized by publication year, one can click on 2000 in the bibliography and bring up over 100 citations in the medical literature, including "Cross JT Jr, Altemeier WA 3rd. Skin manifestations of bioterrorism. Pediatric Ann. 2000 Jan;29(1):7-9."

Following the Center's link to "Case Studies" reveals a series of papers from the MMWR, the Journal of the American Medical Association (JAMA), Science, and the Bulletin of the World Health Organization. These include studies on deliberate contamination of restaurant salad bars, deliberate anthrax exposure, and other bioterrorism-related activity.

Johns Hopkins University Center for Civilian Biodefense Studies

This important site, sponsored by a unit of the Schools of Public Health and Medicine, includes agent fact sheets, the Journal of the American Medical Association (JAMA) consensus statements, information for the general public, congressional testimony, and other materials designed to raise consciousness and build a knowledge-base for lessening the impact of potential bioterrorist attacks. The home page immediately keys one into the importance of bioterrorism and the tools available to prepare for it and wage war against aggressors. There are links to "Updated Anthrax Information," "Concise Diagnostic Criteria and Treatment Guidelines for Anthrax, Botulism, Smallpox and Plague," "How to Handle Anthrax Letters," "Bioterrorism Exercise at Andrew's Air Force Base," etc. This last link informs you that the first such exercise of its kind, DARK WINTER, was constructed as a series of mock National Security Council (NSC) meetings in reaction to a fictional, covert smallpox attack in the U.S. One is informed about exercise design, scenario highlights, and lessons learned from the exercise. 

International Organizations

World Health Organization (WHO)

On September 24, 2001, WHO Director General Gro Harlem Brundtland, M.D., told health ministers attending a Pan American Health Organization (PAHO) meeting that countries need to strengthen their capacity to respond to the consequences of the deliberate use of biological or chemical agents as weapons. Reponses would include proper surveillance and quick, coordinated responses to incidents. Guidelines for containing disease outbreaks caused by anthrax, hemorrhagic viruses, other pathogens, biological toxins, or noxious chemicals are available through the WHO Web site.

Most infectious disease outbreaks, whether natural or deliberate, can quickly be detected through the "Global Outbreak Alert and Response Network," which is backed by WHO. This system of 72 global and regional networks of laboratories, public health experts, and Internet-based information systems continually monitors reports and rumors of disease events around the world [footnote —; accessed 12-6-01].

The home page has a prominent banner titled "Current WHO Information on Biological and Chemical Weapons" that leads one to press releases, FAQs, and links to other relevant information at WHO.

Attractively laid-out book covers announce the latest WHO books, including Public Health Response to Biological and Chemical Weapons, 2nd ed., 2001. This particular book presents national and international laws, including their potential role in mobilizing international assistance and available sources of such assistance.

Media Resources

National Academy Press

Publisher for the U.S. National Academies, National Academy Press (NAP) bills itself as the "the most powerful Web site research engine" and goes on to state "we think that the array of research options makes the NAP site unparalleled — let us know what you think?" 

Searching on "biological terrorism or chemical terrorism" yields 30 book titles, including Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response, Institute of Medicine Committee on Improving Civilian Medical Response, 1999. The table of contents is presented and chapters one through nine are conveniently hyperlinked for one to read free of charge; in this case, there are only six chapters not available full text. The executive summary alone makes this site worth visiting for its clear presentation of the subject.

Another book that directly addresses the threat from terrorists who might wield tanker-trailers on our freeways as a tool of mass destruction is Improving Surface Transportation Security: A Research and Development Strategy, National Security Council and Transportation Research Board. Washington, DC, National Academy Press, 1999. In the case of this title, one has the option of selecting HTML as a viewing option. Text can be searched via buttons that search the chapter or the entire contents of a book. The book can be purchased in paper for $18 via a shopping cart set up similar to Amazon or "read it on-line for free" as part of a special offer — such a deal! There are e-mail options and links to the National Security Council and Transportation Research Board, among others. All in all, this site is very user-friendly in a sophisticated, helpful way.

Medical NBC Online

Note the Medical References button at the top of the home page that takes one to Internet resources, online resources, briefings, software, and glossary. There are links to "What everyone needs to know about the anthrax vaccine" and "Medical issues and response to bioterrorism" — a live satellite feed from the Centers for Disease Control. Clicking on Online References leads to an incredible list of Central Intelligence Agency publications, Congressional testimony, Department of Defense news releases, National Academy Press publications, and White House documents, etc., etc.


NewsEdge has made available a publicly accessible Web site to deliver information on the latest developments on the war on terrorism, including real-time news articles. The top of the home page features a button to reach these resources that include the Associated Press' Online and WorldStream, Interfax, and ITAR-TASS news agency, and the Daily Telegraph feeds.

An Earnest Prayer
In closing, let us pray that you never need this information on an emergency basis, gentle reader. The editor joins me in hoping that this proves to be Searcher magazine's first (and only) useless article.

Bioterrorism Agents

"An infectious, usually fatal disease of warm-blooded animals, especially of cattle and sheep, caused by the bacterium Bacillus anthracis. The disease can be transmitted to humans through contact with contaminated animal substances, such as hair, feces, or hides, and is characterized by ulcerative skin lesions."

— The American Heritage Dictionary of the English Language, Fourth Edition
"An acute, highly infectious, often fatal disease caused by a poxvirus and characterized by high fever and aches with subsequent widespread eruption of pimples that blister, produce pus, and form pockmarks. Also called variola."
—The American Heritage Dictionary of the English Language, Fourth Edition
"Acute food poisoning caused by a toxic product produced in food by a bacterium of the genus Clostridium (C. botulinum) and characterized by muscle weakness and paralysis, disturbances of vision, swallowing, and speech, and a high mortality rate. See botulin limberneck."
—Merriam-Webster's Medical Dictionary, Network Edition 1997
"An epidemic disease causing a high rate of mortality; pestilence; a plague of cholera. A virulent contagious febrile disease that is caused by a bacterium of the genus Yersinia (Y. pestis syn. Pasteurella pestis) that occurs in bubonic, pneumonic, and septicemic forms, and that is usually transmitted from rats to humans by the bite of infected fleas (as in bubonic plague) or directly from person to person (as in pneumonic plague); called also black death."
—Merriam-Webster's Medical Dictionary, Network Edition 1997
Hemorrhagic Viruses
"Acute infection that begins with fever, myalgia, malaise and progresses to prostration; shock, encephalopathy, extensive hemorrhage; poor prognosis."
—"Biosafety and Emerging Infections: Key Issues in the Prevention and Control of Viral Hemorrhagic Fevers," 
National Center for Infectious Diseases/Centers for Disease Control and Prevention [no date] 
Biological Toxins
"Toxins are defined as any toxic substance of natural origin produced by an animal, plant, or microbe. They are different from chemical agents such as VX, cyanide, or mustard in that they are not man-made. They are non-volatile, are usually not dermally active (mycotoxins are an exception), and tend to be more toxic per weight than many chemical agents."
—"Treatment of Biological Warfare Agent Casualties," U.S. Army Field Manual FM 8-10-7
Noxious Chemicals
"The most widely encountered noxious chemicals are CO, chlorine vapor, oxides of nitrogen, hydrogen sulfide, and ammonia. Occurrence in Military Operations. 

"Carbon monoxide is formed by gun blasts, bursting shells, internal combustion engines, fires in confined spaces, and the incomplete combustion of fuels. Pathology. Asphyxiation is caused by the inactivation of blood hemoglobin through a combination with CO. The resultant anoxia may produce nervous system changes. Postmortem examinations reveal little beyond the characteristic cherry red color of the blood and hemorrhages in the brain. 

"The danger of nitrous fume poisoning is great if high explosives (such as smokeless powder or cordite) are burned or detonated in poorly ventilated areas. This may occur in gun pits, armored vehicles, ship magazines, and turrets. This may also occur in mining and tunneling operations. Pathology. Inhalation of nitric oxide causes the formation of methemoglobin and does not appear to lead to any tissue lesions. Inhalation of nitrogen dioxide results in the formation of nitrite that leads to a fall in blood pressure and to the production of methemoglobin. Inhalation of high concentrations of nitrogen dioxide (above 0.5 mg per liter) causes rapid death without the formation of pulmonary edema. Somewhat lower concentrations result in death with the production of yellow, frothy fluid in the nasal passages, mouth, and trachea and marked pulmonary edema."

—Treatment of Chemical Agent Casualties and Conventional Military Chemical Injuries: 
FM8-285: Part 2, Conventional Military Chemical Injuries

Chapter 10, "Noxious Chemicals. 
Departments of the Army, the Navy, and the Air Force, and Commandant, Marine Corps"

Johns Hopkins University Center for Civilian Biodefense Studies
This important site is designed to raise consciousness and build a knowledge-base for lessening the impact of potential bioterrorist attacks.

U. S. Food and Drug Administration
Cipro, the anti-anthrax drug, is regulated by the FDA. The FDA Web site carries links to press releases, testimony, and advisories on its use in treating anthrax inhalation. 

Chemical and Biological Defense Information Analysis Center
Established in 1986, the CBIAC serves as the DoD focal point for information related to Chemical and Biological Defense (CBD) technology.

World Health Organization
The home page has a prominent banner titled "Current WHO Information on Biological and Chemical Weapons" that leads one to press releases, FAQs, and links to other relevant information at WHO.

NewsEdge has made available a publicly accessible Web site to deliver information on the latest developments on the war 
on terrorism, including real-time news articles. 


A librarian since 1967 and information consultant since 1992, Eva Perkins launched epa Research to support medical, healthcare and legal   professionals who need information and related services.  Ms. Perkins holds an MA degree in Library Science and became a Certified Hazardous   Materials Manager in 1994, when she completed the certificate program offered by the Environmental Protection Agency through the UCLA   Department of Engineering. Her e-mail address is
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