Botulinum Toxin as a Biological Weapon

Botulinum toxin is on the A list of potential bioterrorist weapons because of its toxicity, its lethality, its ease of production, ease of transport, ease of use, and the need for prolonged, intensive care of affected victims (36). The colorless, odorless, and probably tasteless toxin is the most poisonous substance known (36). The most efficient route of exposure through a terrorist attack would be inhalational, causing a distribution of illness distinctly different from naturally occurring human botulism. One gram of crystalline toxin dispersed through an airborne route, could kill up to 1 million people, although technical limitations on dispersal could reduce the number of casualties (36). 

Development of botulinum as a bioweapon began nearly 70 years ago, when a Japanese biological warfare group fed cultures of C. botulinum to prisoners during 

In spite of potential technical difficulties, terrorists are most likely to use an aerosolized form of botulinum toxin to inflict the greatest number of casualties most efficiently. A successful point source aerosol release could incapacitate or kill 10% of people within 0.5 km downwind of the release (36). Terrorists could also use food as a vehicle for the toxin. Although food contamination would cause fewer casualties compared to an aerosol release, it would be more difficult to distinguish a food-borne attack from naturally occurring food-borne botulism. Contamination of public water supplies is unlikely for three reasons  

Terrorists are unlikely to use therapeutic, cosmetic botulinum toxin (FDA approved in 2002) because the commercial preparation contains only 0.3% of the injectable lethal dose and 0.005% of the lethal oral dose (37). 

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David L. Swerdlow, and Kevin Tonat. "Botulinum Toxin as a Biological Weapon Medical and Public Health Management." Journal of the American Medical Association 285 (2001) 1059-70. 

Arnon, S.S., Schechter, R., Inglesby, T.V., et al. Botulinum toxin as a biological weapon medical and public health management. JAMA 2001, 285, 1059-70. 

Arnon, S. S., Schechter, R., Inglesby, T. V., Henderson, D. A., Bartlett, J. G., Ascher, M. S., et al. for the Working Group on Civilian Biodefense. (2001). Botulinum toxin as a biological weapon Medical and public health management. Journal of the American Medical Association, 285, 1059-1070. 

Arnon SS, Schechter R, Inglesby TV, Henderson DA, Bartlett JG, Ascher MS, Eitzen E, Fine AD, Hauer J, Layton M, Lillibridge S, Osterholm MT, O Toole T, Parker G, Perl TM, Russell PK, Swerdlow DL, Tonat K Working Group on Civilian Biodefense. Botulinum toxin as a biological weapon medical and public health management. JAMA 2001 285(8) 1059-70. 

Arnon SS, Schechter R, Inglesby TV, et al. (2001) Botulinum toxin as a biological weapon Medical and public health management. Journal of the American Medical Association 285(8) 1059-1070. 

Working Group on Civilian Biodefense, Consensus Statement Botulinum Toxin as a Biological Weapon. Medical and Public Health Management, JAMA, 285 (2001) 1068. 

The seven serotypes of botulinum toxin produced by Clostridium botulinum are the most toxic substances known. They are associated with lethal food poisoning after the consumption of canned foods. This family of toxins was evaluated by the United States as a potential biological weapon in the 1960s and is believed to be an agent that could be used against our troops. Unlike other threat toxins, botulinum neurotoxin appears to cause the same disease after inhalation, oral ingestion, or injection. Death results from skeletal muscle paralysis and resultant ventilatory failure. Because of its extreme toxicity, the toxin typically cannot be identified in body fluids, other than nasal... 

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