Survey of systems for comparative ranking of agents that pose a bioterroristic threat

Strong efforts are made to improve preparedness for the prevention and counteraction of possible deliberate release of highly pathogenic biological agents at national and international level. An objective risk assessment for highly pathogenic biological agents is urgently needed for the purpose of prioritizing measures, evaluating the vulnerabilities and supporting rapid decisions on a scientific base in case of an emergency. Hitherto, several differing ranking schemes were developed. In general, the purpose of such ranking schemes is a comparative classification of agents under consideration of different transmission paths as well as agents threatening human and/or animal health. The analysed prioritization methods differ from qualitative to (semi-)quantitative with each its benefits and disadvantages in preciseness of the result, complexity and duration of the assessment but also in comprehensibility. Mainly, risk was defined as the product of probability and impact. In this survey, factors frequently used for the assessment of the probability and impact of a deliberate agent release were identified. Main criteria for the probability of an application were the history of use, the accessibility of the agent and possible paths of introduction and contamination as well as the feasibility of agent production. For the estimation of the impact, mainly the agent's effects on human and/or veterinary public health, depending on the target population, were examined. This includes the morbidity and mortality rates as well as the severity of induced illness, possible measures for diagnosis, and treatment and prevention. Furthermore, the economic and socioeconomic consequences were considered. In this review, the authors give an overview on open-source publications dealing with risk ranking of biological agents by outlining the criteria that were applied for risk ranking.