Plague as a Bioweapon

Yersinia pestis used in an aerosol attack could cause cases of pneumonic plague. One to six days after becoming infected with the bacteria, people would develop pneumonic plague. Once people have the disease, the bacteria can spread to others who have close contact with them. Because of the delay between being exposed to the bacteria and becoming sick, people could travel over a large area before becoming ill and possibly infecting others. Controlling the disease would then be more difficult. A bioweapon carrying Y. pestis is possible because the bacterium is available and could be isolated and grown in quantity in a laboratory. Even so, manufacturing an effective weapon using Y. pestis would require advanced knowledge and technology.

Plague has been identified by the Centers for Disease Control and Prevention (CDC) as a "Category A" agent, meaning it has been given high priority due to its potential threat to national security. The following references provide information on the use of plague as a bioweapon and associated issues to be considered during a plague outbreak.

  • Plague. Centers for Disease Control and Prevention (CDC). Contains extensive information regarding plague as a bioweapon, including fact sheets, overviews, FAQs, diagnosis and evaluation, infection control, laboratory testing, surveillance and investigation, selected publications, and education and training materials.
  • Medical Aspects of Biological Warfare. Office of the Surgeon General, Department of the Army. Addresses the weaponization of biological agents, categorizing potential agents as food, waterborne, or agricultural agents or toxins, and discusses their respective epidemiology.
    • Chapter 5: Plague. Worsham PL, McGovern TW, et al. Provides a thorough review of plague, including its history and epidemiology, as well as biological warfare and clinical issues.
  • Medical Management of Biological Casualties Handbook, Seventh Edition. U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), (September 2011). Contains specific information on a number of potential bioterrorist agents.
  • Hoffman RE, Norton JE. Lessons Learned from a Full-Scale Bioterrorism Exercise. Emerging Infectious Diseases. Nov-Dec 2000;6(6). Describes a simulated bioterrorist attack during the Topoff exercise in 2000. Participants were told that a Yersinia pestis aerosol had been covertly released, leading to more than 2,000 cases of pneumonic plague, many deaths, and hundreds of secondary cases resulting in pneumonic plague.
  • Inglesby TV, Dennis DT, et al. Plague as a Biological Weapon: Medical and Public Health Management. Journal of the American Medical Association (JAMA). May 3, 2000;283(17):2281-90. Considers the prospect of an aerosol release of Y. pestis bacteria, and provides information on epidemiology, infection signs and symptoms, diagnosis and monitoring, vaccination, medical treatment, infection control, environmental decontamination, and more.