Detecting Bioterrorism: How to Detect the Unexpected?

Terrorism works because its actions happen when and where they are not expected. In that sense, it works like a natural disease outbreak: One cannot predict when it will come, who it will affect, or which disease will strike again. We have learned to live with this uncertainty and risk and found ways to protect ourselves against such disease outbreaks. To do so, most, if not all, countries in the world have active surveillance programs for a list of the most endemic diseases.

Bioterrorism is a term used for terrorism using biological weapons, such as infectious diseases or biological toxins. Having normal surveillance programs in place, we have the necessary tools to detect and act against many biological weapons and diseases that may be used by terrorists. However, some diseases are not included in the active surveillance programs of many countries, because they do not cause problems in the specific country, either because they never have been endemic or they have been eradicated in the past. Two important infectious diseases for which this is the case are anthrax and botulism, caused by Bacillus anthracis and Clostridium botulinum, respectively. Both are zoonotic and may live in all kinds of animals, including the animals used for consumption. In addition, these infectious diseases form spores that are difficult to kill and easily survive standard food treatments. This puts these pathogens at the top of the list of most feared diseases and biological weapons. However, these diseases have been dealt with efficiently in many countries in the past and have not caused major outbreaks in many western countries recently. This has allowed some countries to loosen the surveillance and research on these diseases. Because of the anthrax letters in the United States, the failed anthrax attack in the streets of Japan, and the increased global will to have preventive tools in place for possible terror attacks, the research into anthrax and botulism, as well as several other potential biological weapons, has been revived.

The articles in this section deal with methods to detect anthrax and botulism in settings that are relevant when used in terrorist actions. They describe several new and improved methods and discuss approaches to best look and sample for the diseases. Specifically, the use of whole-genome sequencing techniques deserves attention, as it will be an important tool in future bioterrorism and also normal surveillance research. Whole-genome sequencing can be used to detect any microorganism in a sample with 1 analysis, thus making it truly a technique to detect the unexpected. It can be foreseen that the introduction of whole-genome sequencing, not only in the field of bioterrorism, but also in the fields of public human health and animal health or as a diagnostic tool used by hospitals and general practitioners, will greatly advance treatment of infectious diseases and human health.