Smallpox and bioterrorism.
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We developed a mathematical model of a cows-to-consumers supply chain associated with a single milk-processing facility that is the victim of a deliberate release of botulinum toxin. Because centralized storage and processing lead to substantial dilution of the toxin, a minimum amount of toxin is required for the release to do damage. Irreducible uncertainties regarding the dose-response curve prevent us from quantifying the minimum effective release. However, if terrorists can obtain enough toxin, and this may well be possible, then rapid distribution and consumption result in several hundred thousand poisoned individuals if detection from early symptomatics is not timely. Timely and specific in-process testing has the potential to eliminate the threat of this scenario at a cost of <1 cent per gallon and should be pursued aggressively. Investigation of improving the toxin inactivation rate of heat pasteurization without sacrificing taste or nutrition is warranted.
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Planning for the threat of a biological weapons attack includes preparations to recognize and identify an attack and its scale. Training is the key element of any response, but it is not possible for any health service to maintain sufficient extra capacity to deal with a massive bioterrorist threat. Training must include both first- and second-line responders. Subject to issues of confidentiality, information about plans should be as widely available as possible. Planning for prevention is also important. This should include stopping the production and dispersal of weapons under international humanitarian law and establishing the ethical basis on which doctors and scientists would not become involved in the production of biological and other weapons.
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