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    Antidote to Terrorism: Preparedness

    Public Health Experts Plan for the Unthinkable

    Where's There's Ill Will, There's a Way

    As the attacks of September 11, 2001 made starkly evident, terrorists may try to strike at civilian targets such as high-rise buildings, transportation hubs, sporting events, and public spaces such as malls.

    Terrorists might choose to spread an infectious disease by facilitating person-to-person contact, or by deploying agents that have been "weaponized." For example, an infectious disease that normally infects the skin could be turned into an aerosol or powder form that could then be sprayed over a wider area, said an emergency response expert from the U.S. Department of Health and Human Services, who spoke with WebMD on background.

    There are several notorious examples of small-scale biological and or chemical attacks in recent memory. In 1984, followers of the Indian guru Bhagwan Shree Rajneesh deliberately contaminated salad bars in 10 restaurants in Western Oregon; more than 700 people were poisoned. The group supposedly carried out the act, said to be the first documented case of bioterrorism in modern U.S. history, as a test of a plan to contaminate the local water supply. Their alleged motive was to prevent people from voting against cult-backed candidates in a county election.

    In 1995, the fringe Japanese group Aum Shinrikyo spread the deadly nerve gas sarin in the Tokyo subway system, causing 12 deaths and more than 5,500 injuries.

    "The scenarios are numerous. That is the problem," notes Jennifer Leaning, MD, professor of international health at the Harvard School of Public Health in Boston, one of 19 academic institutions funded by the CDC to develop public health strategies for coping with bioterrorism.

    In a written reply to questions from WebMD, Leaning noted, "there are many pathways [for terrorist acts] -- think air and water. Then think of all the networked systems we live in -- the mail system was just one. The possible ingenuity a terrorist might employ, of relying on a system that already disseminates things, is what troubles many of us."

    Leaning contends that it is "virtually impossible" to fully protect food and water supplies in a country as large and complex as the United States.

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