Grunow R, Finke E-J
German Armed Forces Medical Academy, Department of Studies and Sciences, Institute of Microbiology, Munich, Germany.
Clin Microbiol Infect. 2002 Aug;8(8):510-21. doi: 10.1046/j.1469-0691.2002.00524.x.
The events of 11 September and the subsequent anthrax outbreaks in the USA have opened the world's eyes to the threat posed by terrorist groups, criminal organizations and lone operators who will stop at nothing to achieve their goals. The open or covert use of pathogens and toxins as biological warfare agents can no longer be ruled out. Against this background, the appearance of an unusual disease must be studied in order to clarify whether it is a natural or artificially caused occurrence. This issue was recently raised in discussions with local representatives and relief organizations during a tularemia epidemic in Kosovo from October 1999 to May 2000. This paper will present a procedure which attempts to use certain criteria to identify or rule out the use of biological warfare agents in the event of an unusual outbreak of disease. Data and findings gathered by routine epidemiologic and microbiological studies often provide only an indirect answer to this problem. For this reason, various criteria were formulated and points allocated to represent their importance, allowing us to deduce in a semiquantitative manner the degree of possibility of an artificial genesis of outbreaks. The significance and characterization of each criterion are discussed. An analysis of the tularemia epidemic in Kosovo based on the procedure described here indicates that a deliberate release of the causative agent of tularemia, Francisella tularensis, as a biological warfare agent is doubtful. In this paper, an approach is described to discriminate between the intentional use of biological warfare agents and natural outbreaks of infectious diseases. The developed model is flexible and considers the political, military and social analysis of the crisis-afflicted region, the specific features of the pathogen, and the epidemiologic and clinical characteristics of the epidemic.
9月11日的事件以及随后美国发生的炭疽热疫情，让全世界意识到恐怖组织、犯罪集团和孤胆作案者为达目的不择手段所带来的威胁。病原体和毒素被作为生物战剂公开或秘密使用的可能性再也无法排除。在此背景下，一旦出现不寻常的疾病，就必须展开研究，以查明其是自然发生还是人为造成。1999年10月至2000年5月科索沃发生兔热病疫情期间，与当地代表和救援组织的讨论中就曾提及这一问题。本文将介绍一种程序，该程序试图运用某些标准，在出现不寻常疾病暴发时识别或排除生物战剂的使用。常规流行病学和微生物学研究收集的数据和结果往往只能间接回答这个问题。因此，制定了各种标准并分配了分值以体现其重要性，使我们能够以半定量的方式推断疫情人为起源的可能性程度。文中讨论了每个标准的意义和特征。基于此处所述程序对科索沃兔热病疫情进行的分析表明，将兔热病病原体土拉弗朗西斯菌作为生物战剂蓄意释放的可能性存疑。本文描述了一种区分生物战剂的蓄意使用和传染病自然暴发的方法。所建立的模型具有灵活性，考虑了危机受灾地区的政治、军事和社会分析、病原体的具体特征以及疫情的流行病学和临床特征。
