Abstract Bioterrorism agents are highly complex and very dangerous to human beings and to the surrounding environment. Agents such as bacillus anthracis (anthrax) represent a serious threat to humans because of their high level of toxicity and their ability to cause fatal complications very quickly. It is necessary to understand how this bacteria spreads and how it is transmitted to humans to determine a course of action if a person comes into contact with its spores through the skin or through other avenues, such as inhalation. However, quick action must be taken due to the high level of toxicity of the bacteria and its impact on human health. Scientific and government experts must be prepared to address the threat of bioterrorism agents such as anthrax and develop preparedness strategies that will enable them to handle this type of threat with an aim to prevent the spread of the bacteria to many people.

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Bacillus anthracis, also known as anthrax, is classified as a bioterrorism agent which is extremely toxic and potentially fatal for humans and animals, and is typically contracted through the skin (Bologna, 2014). Bacillus anthracis forms spores under dry conditions, and these spores are highly resistant to destruction, thereby remaining viable for many years; once they come into contact with the blood or wet skin, they multiply and negatively impact human organs and systems very quickly (Bologna, 2014). It is possible to treat anthrax if a diagnosis is made quickly and antibiotic therapies are administered over a 60-day period; however, the bacteria is often fatal because it spreads quickly, leaving treatments unsuccessful (Head, Rubenstein, & Meyers, 2016). Organizations such as the Centers for Disease Control and Prevention and the Federal Bureau of Investigation are responsible for investigating all cases of anthrax because of its classification as a bioterrorism agent (Griffith et.al, 2014).

Bioterrorism agents such as anthrax require significant protections in handling and prevention in locations such as buildings where the bacteria may be prevalent (Taylor, Margaraitis, Nasir, Borrion, & Lai, 2013). For instance, if a building is under a bioterrorist attack, the vulnerabilities of the location must be identified and all areas must be secured to protect the public from further risk or harm (Taylor et.al, 2013). Risk assessments must be conducted to identify any areas of risk and to secure an area that may be affected by the agent (Taylor et.al, 2013).

A high profile case of anthrax occurred in the United States in 2001 soon after the September 11th terrorist attacks, whereby anthrax spores were delivered in correspondence via the U.S Postal Service, causing many cases of illness and several fatalities (More, 2015). This was the first case of anthrax via inhalation that took place in the United States and represented as serious challenge to the bioterrorism preparedness strategies that existed during this era (More, 2015). This case demonstrated that the clinical microbiology community was ill-equipped to handle this outbreak and that there were significant obstacles in place which limited the ability of bioterrorism organizations to be successful in their efforts against this attack (Jaton & Greub, 2014). However, the results of this case supported the belief that there were insufficient diagnostic testing tools in place and that this risk must be mitigated as best as possible through additional investigations (Hugh-Jones, Rosenberg, & Jacobsen, 2011). This demonstrates the importance of understanding the risks associated with bioterrorism threats and how laboratories can prepare for these events and manage their diagnostic strategies effectively and without delays (Jaton & Greub, 2014). Finally, the risks associated with decontamination of the sites which are affected by the agent must also be considered. It should be noted that the costs associated with the anthrax attack of 2001 was approximately $320 million to perform widespread decontamination efforts to eradicate the material in its entirety so that the public could enter into these spaces (Schmitt & Zacchia, 2011). This is an important reminder of the massive comprehensive effort that is required to address an anthrax attack and how this is best managed through a variety of sources which influence preparedness and the ability to mitigate the risk of this type of attack.

There are several types of human exposure to anthrax, including cutaneous anthrax which get into the skin and forms a black eschar; gastrointestinal anthrax which is contracted via infected meat and causes symptoms such as ulcers and abdominal pain and up to 60 percent mortality; injectional anthrax which is attributed to drug use and specifically, heroin, and has up to a 34 percent mortality rate; and inhalational anthrax, which is caused by spores which germinate in the human lung, causing flulike symptoms, respiratory distress, and up to a 45 percent mortality rate (Adalja et.al, 2015). Each of these types requires urgent diagnosis and treatment to limit the risk of fatal symptoms; however, the bacteria is categorized as a bioterrorism agent because of its toxic properties and its ability to spread to many people in a short period of time (Adalja et.al, 2015).

Organizations have developed strategies to improve preparedness in response to bioterrorism agents such as anthrax which will identify diagnostic tools, containment strategies, and treatment methods (Hendricks et.al, 2014). From a clinical perspective, it is necessary to identify the nature of the attack, the populations who are affected, and treatment strategies that will address urgent needs (Adalja, Toner, & Inglesby, 2015). In many ways, bioterrorism has emerged as a critical threat post-9/11, but the threat has been in existence for many years (D’Arcangelis, 2016). The ability of a bacteria or virus to spread through the air and cause disease and potentially massive fatalities must be continuously monitored by organizations who have established preparedness tools to address these risks (Jansen, Breeveld, Stijnis, & Grobusch, 2014). Bioterrorism is associated with an increased need to evaluate diagnostic tools and therapies that will positively impact an affected population and which will improve the ability to manage these attacks in the future (Jansen et.al, 2014). Currently, the United States has increased its efforts to improve surveillance and adopt preparedness techniques that will have a positive and lasting impact on this population (Grundmann, 2014). A variety of agencies must coordinate and develop collaborative efforts to combat anthrax and other bioterrorism agents to reduce the risk to the public and to improve the response effort (Grundmann, 2014).

In response to any threat of bioterrorism, including an anthrax attack, it is necessary for organizations to address the risk of mass casualties associated with an attack if there is insufficient preparedness in place (Wanying, Alain, & Angel, 2016). Under these conditions, it is necessary to identify models to improve decision-making and to ensure that these threats are taken seriously and all possible strategies are in place to prevent widespread bioterrorism attacks (Wanying et.al, 2016). In response to the threat of anthrax exposure, it is necessary to evaluate how this bacteria could infect large numbers of people in a short period of time and cause mass casualties; therefore, effective interventions must be in place, including vaccinations, to ensure that all precautionary measures are taken to address this risk (Fowler & Shafazand, 2011). These factors are critical in addressing the risk of this exposure and how to limit the risk of mortality that may occur if the bacteria is not eradicated quickly and if urgent treatment is not received (Fowler & Shafazand, 2011).

Bacillus anthracis is a serious and often fatal form of bacteria which is classified as a bioterrorism agent because of its ability to act upon human organs and systems very quickly. Management of anthrax is complex and requires a number of organizations with expertise in the clinical management of the disease, bioterrorism knowledge to identify the degree of risk to the affected and surrounding populations, and an overall understanding of the risk factors of this agent and why it poses a serious threat to humanity. It is important to acknowledge these concerns and to recognize that a collaborative effort from a variety of agencies is necessary to minimize risk and to contain any suspected cases of anthrax as quickly as possible to prevent its spread to the larger population. These factors will influence decision-making and bioterrorism preparedness to better manage any risks of exposure in the future and will provide additional insight regarding the importance of an environment in which there are sufficient tools in place to eradicate the agent as quickly as possible.

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