Since initial symptoms resulting from a biological warfare agent may often be indistinguishable from those produced by endemic infections, a biological weapon may be capable of overcoming a military force before the presence of the agent is even suspected. When one member of a unit falls victim, others may still be incubating the disease. Troops deployed to foreign lands are at greater risk for exotic endemic disease agents, since they may lack natural immunity. Therefore, a biological warfare attack may not even be suspected after the first casualties have presented to medical personnel. Finally, the psychological and demoralizing impact of the sinister use of a lethal infection or toxin cannot be underestimated. Many biological agents, including bacteria, viruses, and toxins, can be used as biological weapons. The respective chapters in this textbook contain detailed discussions of these pathogens and toxins as biological weapons. Biological warfare could be used against the United States in a theater of operations or against our civilian populations in any number of realistic scenarios. The medical consequences of such use are potentially catastrophic unless measures are taken to minimize the potential impact of biological warfare agents on our people. Proper planning for terrorist as well as military scenarios, better and more realistic training under NBC conditions, adequate environmental detection and monitoring, improved vaccines and prophylactic drugs for our military, and sensitive and specific medical diagnostics are all pathways toward defending against the possible nightmare of biological attack.
Textbook of Military Medicine: Medical Aspects of Chemical and Biological Warfare, p. 636-658