Botulism is a neuroparalytic disease caused by a neurotoxin produced from an anaerobic spore-forming bacterium known asClostridium botulinum.1The lethal potency of this toxin has mandated intensive surveillance and control measures in the United States. Recent outbreaks of botulism have raised questions regarding the international supply and therapeutic use of botulism antitoxin, and reports that national governments2and terrorist groups3have stockpiled botulism toxin have increased levels of concern regarding global preparedness for an intentional episode of botulism poisoning. It is estimated that as little as 1 g of aerosolized botulism toxin has the potential to kill at least 1.5 million people, and modern techniques of aerosolization via tactical ballistic missiles or aeronautical spraying may be capable of disseminating up to 60% of this dosage to a target population.4 A description of the clinical features of aerosolized botulism toxin poisoning appears elsewhere in this issue.
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Roger Shapiro (1997) studied this question.