A Modern Take on an Age-Old Biological Weapon

Reports about North Korea launching balloons filled with both fecal matter as well as propaganda into South Korean territory were intriguing. With regard to public health concerns, this raises the question as to whether fecal matter could be utilized in modern times as an effective biological weapon. 

History of Feces as a Form of Attack 

The utilization of fecal matter as a biological weapon is not exactly new ground. One of the first recorded instances of using this unique agent was during the Middle Ages, where the feces of bubonic plague victims were flung over castle walls with catapults in an effort to infect those inside. Variations of an excrement catapult were utilized by the Chinese in the 12th century and then later by others. 

Jumping forward to more modern times, during the Vietnam War, the Viet Cong made use of a simple but effective weapon known as punji sticks. The punjis were made by sharpening bamboo sticks, which would then be dipped in human fecal matter (or sometimes poison from plants or animals). The feces-encrusted spears would be placed in the ground and concealed with foliage or under a trap door and left for the enemy to fall on.  

Even more recently, in 2017, right-wing protesters in Venezuela, as part of an ongoing campaign against the government of President Nicolas Maduro, launched plastic bottles filled with human feces and water. They were quickly dubbed “poop bombs” or even “poopootov cocktails” for their likeness to the more deadly Molotov cocktail. While not common, it seems that waste has been used in political or disruption campaigns over the years and wise contingency planners should keep this in mind in the context of current events, including the upcoming election cycle.  

Public Health Realities 

Although the use of balloons as a delivery method may be new or novel, fecal matter and other bodily fluids have been spreading disease both intentionally and unintentionally for time immemorial. Many bacteria, viruses, and parasites that people may or may not be aware of can be transmitted in feces and urine, including: 

• Bacterioides spp., Salmonella, Shigella, Yersinia, Campylobacter, Aeromonas, Candida, E. coli 0157:H7, Klebsiella, Cryptosporidium, Entamoeba histolytica; 
• Viruses such as Norovirus and Hepatitis A; and 
• Intestinal parasites. 

In addition, the use of feces as a weapon has consequences because it can affect an area’s water and environmental sectors. The feces affect not only the person targeted but can spread and cause widespread diseases, such as norovirus, giardiasis, and cryptosporidiosis, over time. 

Public health professionals are consistently confronted with day-to-day situations where fecal matter is present and could potentially spread diseases – think nursing homes, cruises, Hepatitis A/B outbreaks in unhoused populations, and the list goes on. Preparedness efforts include but are not limited to public education, decontamination, various environmental measuring, and clean-up techniques. Public health professionals have the knowledge to handle said situations and work with various partners in response. 

A procession of “poop” balloons is not the same as a nursing home outbreak. However, having the mechanisms in place – whether in regard to being informed of an emergency or even responding to said emergency with other response partners – to handle common emergencies can better prepare communities for new and unusual ones. 

Preparing for Nontraditional Delivery Mechanisms 

It appears that the answer to the initial question is yes, fecal matter can be utilized as a biological weapon. Although utilizing balloons may not allow for a targeted attack on a specific person, there may be a situation where an individual or organization – whether a terror group or nation-state – could utilize fecal matter from a known (or suspected) individual with one of the aforementioned illnesses to intentionally spread disease. For example, the intentional infection of a salad bar in Oregon by salmonella is a more refined situation where an organization wanting to inflict illness did just this. 

In an attempt to gain political control over a county by influencing a 1984 election, members of the Rajneeshpuram cult contaminated the salad bars of four restaurants in The Dalles, Oregon, with Salmonella species they cultured in a laboratory on their compound. The result was 751 cases of gastroenteritis and 45 hospital admissions. 

In society today, there is a multifaceted preparedness and response climate. Both state and non-state actors have utilized – and will potentially continue to utilize – nontraditional methodology to deliver biological agents. It behooves public health preparedness practitioners to maintain an awareness of delivery mechanisms, such as this one, in order to appropriately prepare and respond. To quote the former Attorney General Alberto R. Gonzales five years after the September 11 attacks, “Since terrorists only have to succeed once and our efforts have to succeed every time, our coordination has to be even better than theirs.”