NEWS FOCUS: Anthrax could be the least of our problems, according to a Royal College of Physicians seminar that sought to reassure health workers. Paul Dinsdale listened to the advice

Why make anthrax the stuff of your nightmares? If you are going to worry about biological warfare, there are at least six deadly plagues to choose from.

Delegates at a recent seminar organised by the Royal College of Physicians heard that headlinegrabbing anthrax is just one of six rated 'category A' by the US Centers for Disease Control and Prevention. The others are botulinum toxin, smallpox, plague, tularaemia (a bacterial infection), and viral haemorrhagic fevers. Of these, potentially the most deadly is botulinum toxin - it is estimated that one gram could kill 1 million people.

But the aim of the seminar, on potential health risks of biological weapons, chaired by RCP president Professor Sir George Alberti, was not intended to send the public rushing for their medical dictionaries but to reassure and inform public health workers.

Dr Robert Spencer, a microbiologist and deputy director of the public health laboratory, Bristol, told the packed audience of a number of other potential agents for so-called bio-terrorism, including salmonella, shigella, cholera and diphtheria.

'In some ways, anthrax is not a very good biological weapon, because it is a highly treatable disease and, in most cases, is self-limiting, ' says Dr Spencer.

There are two forms of possible anthrax infection: cutaneous anthrax (which is usually self-limiting) and inhalational anthrax (breathed in and potentially lethal). The disease was originally called 'woolsorter's disease' because workers in the woollen industry would breathe in hundreds of spores at a time from sheep - and seldom fell ill.

Turning to how the public health system should respond to the potential risk of bio-terrorism, a warning was sounded by Dr Nick Beeching, senior lecturer in infectious diseases at the Liverpool School of Tropical Medicine.

Dr Beeching was involved in responding to an incident a few weeks ago in which a suspect letter was identified at the Liverpool postal sorting office.Although the incident proved to be a false alarm, he told the symposium that the procedures for dealing with possible contamination had worked well.

He says that doctors should be alert for any possible contamination of a patient by a biological agent where the symptoms could be similar to those of influenza, legionnaire's disease, meningitis or related conditions.

'We need to watch out for any unusual increase in anything, especially where there is a high level of mortality or clusters of disease, ' says Dr Beeching.

Chief medical officer Professor Liam Donaldson was on hand to give reassurance in the panel discussion. He says the public health system is as well-prepared as it could be for any potential act of bio-terrorism, though, he stresses, the government sees 'no credible threat' at present: 'We are not a weak and helpless nation, we have one of the strongest public health systems in the world, ' says Professor Donaldson.

At the organisational level, London regional office deputy director of public health Dr Penny Bevan says that the guidance from the Public Health Laboratory Service, which has been updated in recent weeks, and a letter from the CMO to regional directors of public health, forms the basis of current readiness.

'We are doing things such as ensuring that adequate supplies of antibiotics are available to local ambulance crews and that health service personnel know the procedures for isolating possible contamination and potentially affected people, ' says Dr Bevan.

There have been a number of alerts in the London area since the 11 September attacks on the US.

Police have been called out but so far the incidents have proved to be false alarms.

In the event of a 'credible threat', the police would contact the consultant in communicable disease control at the relevant health authority, and procedures for isolating potentially contaminated individuals would begin.

As Dr Bevan points out, despite the publicity given to the recent cases of anthrax infection in the US, the big killers will still remain heart disease, cancer, obesity and smoking, even if they seem a lot less frightening than the current terrorist threat. l