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Bioterrorism literally means using microorganisms or infected samples to cause terror and panic in populations. Bioterrorism had already started 14 centuries before Christ, when the Hittites sent infected rams to their enemies. However, apart from some rare well-documented events, it is often very difficult for historians and microbiologists to differentiate natural epidemics from alleged biological attacks, because: (i) little information is available for times before the advent of modern microbiology; (ii) truth may be manipulated for political reasons, especially for a hot topic such as a biological attack; and (iii) the passage of time may also have distorted the reality of the past. Nevertheless, we have tried to provide to clinical microbiologists an overview of some likely biological warfare that occurred before the 18th century and that included the intentional spread of epidemic diseases such as tularaemia, plague, malaria, smallpox, yellow fever, and leprosy. We also summarize the main events that occurred during the modern microbiology era, from World War I to the recent 'anthrax letters' that followed the World Trade Center attack of September 2001. Again, the political polemic surrounding the use of infectious agents as a weapon may distort the truth. This is nicely exemplified by the Sverdlovsk accident, which was initially attributed by the authorities to a natural foodborne outbreak, and was officially recognized as having a military cause only 13 years later. [ABSTRACT FROM AUTHOR]

Objective: To develop a model for quick and accurate evaluation of unusual epidemic events (UEE), based on the original model of bioterrorism risk assessment. Methods: A new scoring system was developed for quick differentiation between a biological attack and other epidemics, using eight qualitative and six quantitative indicators. Results: A new scoring system was applied to three UEEs: (1) a spontaneous outbreak of a new or re-emerging disease ('swine flu'); (2) a spontaneous outbreak following accidental release of a pathogen (Sverdlovsk anthrax); and (3) a spontaneous natural outbreak of a known endemic disease that may mimic bioterrorism or biowarfare (Kosovo tularaemia). The disease agent was found to be the most important and the most informative UEE component of the scoring system. Conclusions: This new scoring system may be useful for public health institutions and federal civil and military officials responsible for bio-attack investigations. [ABSTRACT FROM AUTHOR]