Botulism, Botulinum Toxin, and Bioterrorism: Review and Update

Janak Koirala, MD, MPH; Sangita Basnet, MD


Infect Med. 2004;21(6) 

In This Article

Potential As a Biological Weapon

Botulinum toxin has been developed and used as a biological weapon. The Japanese fed their war prisoners C botulinum cultures in the 1930s, with fatal effects.[5] Allied troops received botulinum toxoid vaccine during World War II because of concerns that Germany had weaponized botulinum toxin.[4] The United States produced botulinum toxin as a potential biological weapon during World War II. The US biological weapons program was ended after the Biological and Toxin Weapons Convention in 1972. However, the former Union of Soviet Socialist Republics conducted research on botulinum toxin as a biological weapon until the early 1990s.[19]

A Japanese cult, Aum Shinrikyo, dispersed aerosols in Tokyo and in US military installations in Japan on 3 occasions between 1990 and 1995; these efforts failed to produce illnesses or deaths.[5] A United Nations inspection team visiting Iraq after the 1991 Gulf War reported that Iraq admitted to having 19,000 L of concentrated botulinum toxin, enough to kill the entire human population 3 times by inhalation. It was believed that Iraq deployed 600-km-range missiles and 100-lb bombs filled with botulinum toxin, aflatoxin, and anthrax spores during 1990 Gulf war.[5] However, all efforts to verify this report have been unsuccessful so far.

Botulinum toxin may be used to immobilize the opponent in military action. It has been estimated that if used as a point source aerosol in a densely populated area, it could incapacitate or kill 10% of the population within 0.5 km downwind. In addition, it could be used to deliberately contaminate food.[5]

A careful dietary, activity, and travel history is of utmost importance in any suspected botulism outbreak. Patients should also be asked whether they know of anyone else with similar symptoms. An outbreak resulting in a large number of cases of acute flaccid paralysis with prominent bulbar palsies should raise suspicion of a deliberate release of the toxin.

Outbreaks consisting of cases with a common geographic factor, but without a common dietary exposure, should raise suspicion of a possible aerosol attack. Similarly, multiple simultaneous outbreaks without a common source or outbreaks with unusual botulinum toxin type (ie, type C, D, F, or G, or type E toxin not acquired from an aquatic food) would also be suggestive of bioterrorist acts.[5]


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