Unlike epidemics or pandemics, in bioterrorism there is a deliberate act to cause harm. It can be distinguished by a point source outbreak with exposure to many people, uncommon infectious agent, and not endemic to the area.1
Biological weapons have been used throughout history. The first documented use was of tularemia-infected rams by the Hittites.2 In the 4th century BC, Scythian archers used arrows dipped with decomposed cadavers of adders that contained Clostridium perfringens and Clostridium tetani.3 In 1348, the Mongols used plague-ridden cadavers to besiege Caffa.4 This technique was used by the Lithuanian army in 1422 and the Russian army against the Swedish army in Estonia in 1710.5–8 Although ineffective compared to respiratory transmission, transmission of small pox via fomites was used by the Europeans to wipe out American Indians.9–11 In 1797, Napoleon flooded Italian plains in hopes of spreading malaria. In 1863, Confederate soldiers sold clothes infected with small pox and yellow fever to Union soldiers.6 In 1925, 108 nations signed “The Protocol for the Prohibition of the Use in War of Asphyxiating, Poisonous or other Gases, and of Bacteriological Methods of Warfare.”9–11
During World War I, the Germans tried to infect their enemies with anthrax, Pseudomonas pseudomallei, cholera, and plague.6 A Japanese program, Unit 731, inoculated prisoners of war with Bacillus anthracis, Neisseria meningitides, Vibrio cholerae, Shigella, and Yersinia pestis.6 During World War II, the Germans experimented with Rickettsia prowazekii, Hepatitis A, and malaria on prisoners.6–11 Americans and British experimented on Anthrax.6 After World War II, the Americans experimented with Aspergillus fumigatus, Bacillus subtilis var. globigii, Serratia marcescens, Francisella tularensis, and Coxiella Burnetti in Fort Detrick, Maryland and other testing sites all over the country.6–11 In 1972, the Convention on the “Prohibition of the Development, Production, and Stockpiling of Bacteriological and Toxin Weapons and on their Destruction” or BTWC was developed although it did not provide guidelines for inspection, control of disarmament, and adherence to protocol.6–11 In the United States, research efforts continued to develop countermeasures such as vaccines and antisera and the entire arsenal of biological weapons were destroyed by February 1973.
In 1979, there was an epidemic of Anthrax in Ekaterinburg, Russia from an accidental leak in a biological research facility.6–11 During the first Persian Gulf War, there was concern for both biological and chemical warfare which prompted the United States and allied nations to prepare for such an attack during Operation Desert Shield.6–11 In 1984, the Rajneeshee cult used Salmonella typhimurium in Oregon.6–11 In 1995, the Aum Shinrikyo tried to release sarin in the Tokyo subway system and also tried Anthrax, botulinum toxin, and Ebola.6–11 In June 2018, a Tunisian extremist living in Cologne, Germany was found to have produced ricin.6–11