In the December 2002 issue of Clinical Pediatric Emergency Medicine, Andrew Kienstra and the author addressed the evaluation and management of children exposed to or infected with biological agents of terrorism. This topic had become particularly relevant to pediatricians, emergency physicians, and other front-line health care workers in the United States the previous year, when a child contracted cutaneous anthrax as part of the distribution of anthrax spores to prominent political and media figures via the US Postal Service. The ensuing 11 years have seen an enormous increase in bioterrorism research. This article reviews updates in the detection, diagnosis, and management of the organisms and toxins considered to be at highest risk for bioterrorist use.