Epidemiology of Pathogens Listed as Potential Bioterrorism Agents, the Netherlands, 2009-2019

We provide incidences (cases/10 million persons) in the Netherlands during 2009-2019 for pathogens listed as potential bioterrorism agents. We included pathogens from the highest categories of the Euro-pean Medicines Agency or the US Centers for Disease Control and Prevention. Notifiable diseases and re-cently published data were used to calculate the aver-age annual incidence. Coxiella burnetii had the high-est incidence because of a Q fever epidemic during 2007-2010. Incidence then decreased to 10.8 cases/. Pathogens with an incidence >1 were Brucella spp. (2.5 cases), Francisella tularensis (1.3 cases), and Burkholderia pseudomallei (1.1 cases). Pathogens with an incidence <1 were hemorrhagic fever viruses (0.3 cases), Clostridium botulinum (0.2 cases), and Bacillus anthracis (0.1 cases). Variola major and Yer-sinia pestis were absent. The generally low incidences make it unlikely that ill-meaning persons can isolate these pathogens from natural sources in the Nether-lands. However, the pathogens are stored in laborato-ries, underscoring the need for biosecurity measures.