The purpose of this manual is to provide basic information onbiological toxins to military leaders and health-care providersat all levels to help them make informed decisions on protectingtheir troops from toxins. Much of the information contained hereinwill also be of interest to individuals charged with counteringdomestic and international terrorism. We typically fear what wedo not understand. Although understanding toxin poisoning is lessuseful in a toxin attack than knowledge of cold injury on an Arcticbattlefield, information on any threat reduces its potential toharm. I hope that by providing information about the physicalcharacteristics and biological activities of toxins, the threatof toxins will actually be reduced. I did not intend to providedetailed information on individual threat toxins or on medicalprevention or treatment. This primer puts toxins in context, attemptsto remove the elements of mystery and fear that surround them,and provides general information that will ultimately help leadersmake rational decisions, protect their soldiers and win battles.

The mission of the U.S. Army Medical Research and DevelopmentCommand's Medical Biological Defense Research Program is to studyand develop means of medically defending the U.S. Armed Forcesfrom toxins and infectious threats posed by adversaries. It isour responsibility to develop medical countermeasures to toxinsof plant, animal and microbial origin. We believe that there isa biological toxin threat and we know of countries that are notin compliance with the Biological Weapons Convention of 1972.Therefore, prudence mandates a strong defensive program. The toxinsdescribed herein are all nonreplicating agents; some have beenidentified by the intelligence community as biological warfarethreats.

Physical measures, such as the protective mask and decontaminationsystems, developed for the chemical threat are, for the most part,effective against toxin threats. Research to develop individualmedical countermeasures to toxins is complicated by several factors.A number of toxins could be selected by an adversary for use inlow-tech, relatively inexpensive weapons. Many more are potentiallyavailable through genetic engineering or chemical synthesis. Biologicalweapons are far more easily obtained and used than nuclear weapons.They actually may be more easily produced and used than conventionalexplosive weapons. Colorless, tasteless, odorless, small-scaleaerosols may be generated relatively easily with a cheap plasticnebulizer attached to a pump or pressurized air bottle. However,production and use of toxins as true mass casualty weapons isnot a trivial undertaking.

The likely route of intoxication for soldiers or victims of terroristattack is through the lung by respirable aerosols; another possibilityis through the gastrointestinal tract by contamination of foodor water supplies, although the latter would be difficult in chlorinatedwater, or in rivers, lakes or reservoirs because of dilution effects.The effects of most toxins are more severe when inhaled than whenthey are consumed in food or injected by bites or stings. Sometoxins can elicit a significantly different clinical picture whenthe route of exposure is changed, a phenomenon that may confounddiagnosis and delay treatment. Finally, because the primary populationat risk is relatively small (military troops, not the generalpublic, as with childhood infectious diseases), there is littlecommercial incentive to produce vaccines, antisera or therapeuticdrugs to counter toxin threats.

There are still many unknowns regarding toxins and their weaponization.Statements in this document on the nature of a "typical toxinattack" are based on my understanding of the physical characteristicsof toxins, recent studies of aerosolized toxins in small laboratorychambers to test protective drugs and vaccines, and historicaldata from larger-scale studies with toxin or simulant aerosols. The following three descriptions, Toxin, Mass Casualty Biological(toxin) Weapon and Militarily Significant Weapon, define theseterms for the purposes of this primer.

1. A Toxin is any toxic substance that can be produced by an animal,plant or microbe. Some toxins can also be produced by molecularbiologic techniques (protein toxins) or by chemical synthesis(low molecular weight toxins). Chemical agents, such as soman,sarin, VX, cyanide and mustard agents, typically man-made forweaponization, are not included in this discussion except forcomparison.

2. A Mass Casualty Biological (toxin) Weapon (MCBW) is any toxinweapon capable of causing death or disease on a large scale, suchthat the military orcivilian infrastructure of the state or organization being attacked is overwhelmed. (Note: The commonly accepted term for this categoryof weapons is "Weapons of Mass Destruction," althoughthat term brings to mind destroyed cities, bomb craters and greatloss of life; MCBWs might cause loss of life only. I do not anticipatethat "MCBW" will replace the term "Weapon of MassDestruction" in common usage, but it is technically moredescriptive of toxin weapons).

3. A Militarily Significant (or Terrorist) Weapon is any weaponcapable of affecting-directly or indirectly, physically or throughpsychological impact-the outcome of a military operation.

[ Introduction ][ Table of Contents ][ Understanding the Threat ][ Countermeasures ][ Answers to Often-Asked Questions ]
[ The Future ][ About the Author ]

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