Biowafrare or Bioterrorism

1
Biowafrare or Bioterrorism
2

• History of biological warfare
• History of bio-terrorism
• Why biological agents as tools of terrorism?
• Potential BW agents
• Some Clinical Scenarios?

3
History of Biological Warfare
14th century Cadavers of plague victims
catapulted by Tatars
4
History of Biological Warfare
18th century Small pox-contaminated blankets
distributed by the British
5
History of Biological Warfare

• 19th century Livestock contaminated with anthrax
  and glanders Burkholderia (Pseudomonas) mallei

6
History of Biological Warfare(20th century)
1925 - Geneva Protocol

• Anthrax, smallpox, tularemia, glanders, cholera,
  hemorrhagic fever, diphtheria etc. used by the
  Japanese
• The British dropped anthrax bomb on Anthrax
  Island.
• 1972 - Biological And Toxic Weapons Convention
  (now ratified by gt140 countries)
• WWII to the end of the Cold War - USA, Canada
  and UK had BW programs

7
In 1942, Britain decided develop an effective
bioweapon using Anthrax. Sheep were taken to
Gruinard Island off the coast of NW Scotland and,
secured in wooden frames in an open field. They
were exposed to a bomb that scattered Anthrax
spores. The sheep started dying three days later.
The island is now known as Anthrax Island.
8
In 1986 an English company was paid half a
million pounds to decontaminate the 520-acre
island by soaking the ground in 280 tonnes of
formaldehyde diluted in 2000 tonnes of seawater.
9
BW in USSR

• 1973 - Biopreparat
• 55,000 staff
• 52 establishments
• Field test site on Vozrozhdeniye (Rebirth)
  island, Aral Sea
• Smallpox, anthrax, plague, tularaemia, glanders,
  VEE, Marburg (Ebola)

10
Sverdlovsk Anthrax Outbreak of 1979

• At least 96 human cases of anthrax (? gt1000)
• 68 deaths
• Official response tainted meat
• Pathology inhalation anthrax
• Plume
• Humans 4km
• Animals up to 50 km
• Incubation period up to 43 d
• Dose model suggests lt1gm released

11
Chemical Biological Terrorism

• 1984 The Dalles, Oregon, Salmonella (salad bar)
  
• 1991 Minnesota, ricin toxin (hoax)
• 1994 Tokyo, Sarin and biological attacks
• 1995 Arkansas, ricin toxin (hoax)
• 1995 Ohio, Yersinia pestis (sent in mail)
• 1997 Washington DC, Anthrax (hoax)
• 1998 Nevada , non-lethal strain of B. anthracis
• 1998 Multiple Anthrax hoaxes

12
Aum Shinrikyo and the Tokyo Subway Incident

• 1995 sarin nerve gas released on Tokyo Metro
• 12 killed 5,000 injured
• Research on anthrax, botulinum and Q fever
• 8 abortive biological attacks (anthrax)
• Attempt to obtain Ebola in Zaire
• Aircraft equipped with spray tanks

13
Aum Shinrikyo and the Tokyo Subway Incident
14
Salmonellosis Caused by Intentional Contamination

• The Dalles, Oregon in Fall of 1984
• 751 cases of Salmonella
• Eating at salad bars in 10 restaurants
• Criminal investigation identified perpetrators as
  followers of Bhagwan Shree Rajneesh

15
Salmonellosis Caused by Intentional Contamination

• The Dalles, Oregon in Fall of 1984
• 751 cases of Salmonella
• Eating at salad bars in 10 restaurants
• Criminal investigation identified perpetrators as
  followers of Bhagwan Shree Rajneesh

16
Shigellosis Caused by Intentional Contamination

• Dallas, Texas in Fall of 1996
• 12 (27) of 45 laboratory workers in a large
  medical center had severe diarrheal illness
• 8 (67) had positive stool cultures for S.
  dysenteriae type 2
• Eating muffins or donuts in staff break room
  implicated
• PFGE patterns indistinguishable for stool,
  muffin, and laboratory stock isolates

17
Recent Cases of Anthrax in the U.S (N 409)

• Two postings of contaminated letters 4 found
• 22 cases (plus 1 lab-acquired case)
• 11 inhalational/ 11 skin cases
• 5 deaths
• 32,000 given prophylactic antibiotics
• Extensive contamination of postal system
• Thousands of false alarms and hoaxes

18
Why Bioterrorism?

• Cheap (low cost/kill ratio)
• Simple to produce (but not to deliver)
• Defense is difficult
• Expertise available
• PUBLIC PANIC
• Devastating effect

19
Effectiveness of Bioterrorism
Cyanide 50 Mustard gas 100 Sarin 5,000 Botu
linum toxin 1,000,000 Anthrax 50,000,000, Tular
aemia 50,000 x 106
20
Cost of coping with Bioterrorism
21
Federal Agencies Involved in Bioterrorism

• PHS
• CDC
• Secret Service
• USDA
• FDA
• SBCCOM
• USAMRIID
• OEP

• NSC
• DOD
• FEMA
• DOJ
• DHHS
• Treasury
• EPA
• FBI

22
Potential BW Agents CDC Category A
Features
Organisms

• Easily disseminated or transmitted person to
  person
• High mortality major public health impact
• Public panic and social disruption
• Special action for public health preparedness

• Anthrax
• Plague
• Smallpox
• Tularaemia
• Viral haemorrhagic fevers
• Botulinum toxin

23
Potential BW Agents CDC Category B
Features
Organisms

• Moderately easy to disseminate
• Moderate morbidity, low mortality
• Require enhancement of diagnostic capacity and
  surveillance

• Q fever
• Brucellosis
• Glanders melioidosis
• VEE, EEE and WEE
• Enteric pathogens
• Other toxins

24
Potential BW Agents CDC Category C
Organisms
Features

• Nipah virus
• Hantaviruses
• Tickborne Hemorrhagic Fever
• Tickborne encephalitis
• Yellow fever
• Multi Drug Resistant Tuberculosis

• Emerging agents
• Availability
• Easy to produce and disseminate
• Potential for high mortality and morbidity

25
BioterrorismWhat Can Be Done?

• Awareness
• Laboratory Preparedness
• Plan in place
• Individual collective protection
• Detection characterization

26
American Academy of Family Physician Suggestions

• Know how to contact local and state health
  departments
• Maintain contacts with local health officials
• Maintain reference materials on the diagnosis and
  treatment of agents of bioterrorism
• Develop a bioterrorism response plan for your
  office. Be prepared to use infection control
  practices
• Know the requirements for laboratory support
• Be aware of proper post-exposure management for
  patients and health care staff.
• Develop skills in and resources for counseling
  patients to minimize the psychologic consequences

27

28
Clinical Scenario 1

• City of 1.2 million
• Several military establishments
• A 28 yr old woman, with 2 days fever, malaise,
  fatigue
• Improved in 2-3 days
• Then presented to hospital with severe
  respiratory distress, dyspnea, stridor, shocked
  and cyanosed

29
Clinical Scenario 1

• IV amp erythro
• within 18 hr
• Respiratory distress
• Hypotensive
• Rapid deterioration and death

30
Clinical Scenario 1Laboratory Results

• Encapsulated Gram positive rod seen on blood film
• Tacky, granular, bees-eye, non-haemolytic
  colonies on blood agar from blood and CSF

• 20 similar cases over next week

31
Clinical Scenario 1
At post mortem

• Haemorrhagic thoracic lymphadenitis
• Haemorrhagic meningitis

? Diagnosis
32
Clinical Scenario 2

• 5-year old female presents a 3-day history of
  malaise, headache and fever.
• No previous history of illness and all
  immunization on schedule
• Maculo-papular lesions on palate, and skin
• Skin lesions continue to increase and become
  raised and filled with fluid over the next 2 days

Diagnosis?
33
If faced by suspect case(s)
What to do
Seek expert advice as soon as possible!