Bioterrorism Lecture
To understand the concept of terrorism
To understand the rationale for the use of biological agents as terrorist weapons
To describe the characteristics of those biologic agents thought to be the choice of terrorists
Introduction
Bioterrorism is one form of terrorism. Terrorism is defined as the unlawful use of force or violence against persons or property to intimidate or coerce a government or civilian population in the furtherance of political or social objectives.
Terrorists use weapons of mass destruction. These are destructive devices that include bombs, missiles, poison chemicals, disease organisms, radiation or radioactivity at levels dangerous to human life.
The 9/11 Commission Report stated referring to the terrorist threat……
………..we are not safe
Time is not on our side…………..
Biologic agents are likely to be used by terrorists as weapons because:
They are capable of damaging populations, economies, and food supplies
Certain agents are inexpensive to make
They can be directed at a small group of people or an entire population
They can be used to attack people, economies and food supplies
They cause fear, panic and social disruption
Characteristics of biological agents that could be used as bioterrorism agents
They have a wide range of effects
They are obtained from nature
They are easily made by relatively unsophisticated methods
They are invisible to the senses
Their effects may be delayed
They can produce mass casualties
DIFFERENCES BETWEEN A BIOLOGICAL ATTACK AND A NATURAL OCCURRENCE
A biological terrorist attack may mimic a large-scale naturally occurring disease outbreak. There are differences. A biological attack:
Results from a deliberate act
Will be treated as a crime scene
May not be immediately recognized
BIOLOGICAL ATTACK VS. NATURAL OCCURRENCE
It May be preceded by verbal or written threats from a terrorist group
May find abandoned spray devices after their release
Claims by a terrorist group to have released a biologic agent
May result in contamination of critical facilities
May expand rapidly from different source cases
Will cause widespread public panic
ROUTES OF ENTRY INTO THE HUMAN BODY
Ingestion
Dermal penetration
Inhalation
AEROSOL INHALATION
The use of aerosols is an efficient way to affect the maximum number of people with a single attack.
BIOWEAPONS RECENT HISTORY
Bioweapons have a long history. Recent uses include:
U.S, Canada, Great Britain, Japan, and the U.S.S.R experiment with anthrax during World War II (W.W.II)
In 1991, Iraq threatens the use of bioweapons against U. S. troops in the Persian Gulf war
Post-W.W.II, NATO and the Warsaw Pact nations had bioweapons programs
In 1969, U. S. unilateral decision to destroy bioweapons
In 1972, Bioweapons Convention was created in which U. S. and U. S. S. R. were signatories
Possible/probable active offensive bioweapons programs in N. Korea, Iran, China, Egypt, Algeria, India, Pakistan, Syria, Israel
In 1984, the Bhagwan cult poisons Oregon salad bars with salmonella-751 people sick
In 1995, Aryan Nation orders plague bacteria from a supply house in Maryland, and Minnesota Patriots Council members convicted for planning ricin use in an assassination attempt
BIOLOGICAL AGENTS
There are several types of agents. They are classified as:
Bacteria
Rickettsia
Viruses
Biotoxins
Category A Diseases/Agents
High-priority agents include organisms that pose a risk to national security because they:
can be easily disseminated or transmitted from person to person;
result in high mortality rates and have the potential for major public health impact;
might cause public panic and social disruption; and
require special action for public health preparedness.
Category B Diseases/Agents
The second highest priority agents include those that
are moderately easy to disseminate;
result in moderate morbidity rates and low mortality rates; and • require specific enhancements of CDC's diagnostic capacity and enhanced disease surveillance.
Category C Diseases/Agents
The third highest priority agents include emerging pathogens that could be engineered for mass dissemination in the future because of :
availability
ease of production and dissemination; and
potential for high morbidity and mortality rates and major health impact.
BACTERIA
Single-celled organisms are capable of causing disease. These agents, grown on culture to produce large quantities, can be modified or “weaponized” for greater destruction
Produces inflammation in tissues and/or toxins
EXAMPLES
ANTHRAX PLAGUE TYPHOID CHOLERA TULAREMIA Salmonellosis
RICKETTSIA
Vector-borne (ticks, lice, mosquitos) parasitic form of bacteria
Diseases are difficult to treat
Variants exist worldwide
EXAMPLES
TYPHUS ROCKY MT. SPOTTED FEVER Q FEVER INDIA TICK FEVER MEDITERRANEAN TICK FEVER
VIRUSES
Smaller than bacteria
RNA or DNA in a protein coat
Use living cells to reproduce
Not affected by antibiotics
EXAMPLES
EBOLA SMALLPOX LASSA FEVER INFLUENZA VIRAL HEPATITIS VIRAL HEMORRHAGIC FEVERS
BIOTOXINS
Are poisonous byproducts of bacteria, fungi, marine animals or plants
Do not replicate in the host
Are not communicable
Highly toxic when delivered as an aerosol
EXAMPLES
BOTULINUM STAPHYLOCOCCAL ENTEROTOXIN B RICIN 1
Biological Agents most likely to be used in a terrorist attack
Bacteria - anthrax, plague, tularemia
Virus - smallpox, viral hemorrhagic fever
Biotoxin - botulism
ANTHRAX
Infectious agent: Bacillus anthracis – gram +, spore forming bacteria
May enter the body from skin (cutaneous), digestive system or by inhalation (most likely route to be used by terrorists)
Symptoms: itching, lesions, fever, fatigue, non-productive cough, respiratory failure and hemodynamic collapse
Transmission: none person to person except with cutaneous
Incubation period: 1 to 6 days
Mortality: 5 to 20% percutaneous, 80 to 90% inhalation
Treatment: antibiotics
Prevention: vaccine
PLAGUE
In nature, fleas living on rodents spread the infection to humans. As a bioterrorist weapon – inhalation of aerosol leads to pneumonia, sepsis, and infections of bodily organs
Infectious agent: Yersinia pestis – a gram neg., non-motile bacillus
Maybe bubonic ( infection of lymph nodes) or pneumonic (infection of lungs)or septicemic
Symptoms: cough with bloody sputum, fever, chill, shortness of breath
Transmission: may occur person to person by respiratory droplet inhalation
Incubation period: 2 to 3 days
Mortality: 50 to 60%
Treatment: antibiotics
Prevention: vaccine ineffective against aerosol exposure
TULAREMIA
A zoonotic, bacterial infection caused by Francisella tularensis, a gram negative coccobacillus
In nature, bacteria is commonly found in ticks living on rabbits and transmitted by handling the animal or by a tick bite. Inhalation of aerosol leads to pneumonia and sepsis
Symptoms: sudden and influenza-like with fever, chills, headache, and nausea
Transmission: not usually person to person
Incubation period:3 to 5 days(range 1 to 14)
Mortality: low unless untreated
Treatment: antibiotics if early, vaccine available
Prevention: in nature, avoid tick bites and using gloves when handling infected animals
BOTULISM
Infectious agent: Clostridium botulinum – a spore-forming, anaerobic bacillus
In nature, maybe foodborne, wound, or intestinal. As a bioterrorist weapon, ingestion or inhalation leads to the production of the neurotoxin and resulting flaccid paralysis
Symptom: fatigue, weakness, blurred vision, difficulty in swallowing and speaking, descending muscle paralysis and respiratory failure
Transmission: none person to person
Incubation period: 12 to 72 hours
Mortality: most lethal compound per weight
Treatment: antitoxins, respiratory support
Prevention: vaccine available for types A and B
SMALLPOX
Infectious agent: Variola virus - Orthopoxvirus
Declared eradicated in 1980, but stockpiles may exist
Not naturally acquired. It can be disseminated as an inhaled as an aerosol
Symptoms: Fever, muscular rigidity, headaches, and vomiting. Severe cases experience prostration and hemorrhage into the skin and mucous membranes
The rash appears after about three weeks; progresses from macules (initial skin lesions) to papules to pustular vesicles, to scabs
Transmission: may occur person to person by respiratory droplets or skin inoculation. Highly contagious when the rash appears
Incubation period: 10 to 12 days
Mortality: less than 1% in the minor form and 20 to50 % in the major form
Treatment: supportive
Prevention: vaccine
VIRAL HEMORRHAGIC FEVERS (VHFs)
These are highly infectious viral illnesses caused by the Filoviruses (Ebola and Marburg), Arenaviruses (Lassa fever), Bunyaviruses (Congo hemorrhagic fever and Hantaviral disease), and Flaviviruses
Symptoms: vary from one type to the next. They include: sudden onset of fever, muscle aches, headache, followed by vomiting, diarrhea, and rash, and internal bleeding
Complications: In severe forms, multiorgan failure occurs, primarily due to hemorrhagic and pulmonary complications
Mode of transmission: handling infected wild animals, but may be used as an aerosol bioterrorist weapon
Incubation period: 2 to 21 days
Reservoir: gorillas and chimpanzees
Transmission: some may be spread person to person by contact with body secretions
Mortality: Ebola rates have reached 90% but vary
Treatment: supportive
Prevention: Avoid contact with infected monkeys or other animal hosts
PREPAREDNESS FOR BIOTERRORISM
- Build an Emergency Supply Kit.
- Make a Family Emergency Plan.
- Check with your doctor to make sure everyone in your family has up-to-date immunizations.
- Consider installing a High-Efficiency Particulate Air (HEPA) filter in your furnace return duct, which will filter out most biological agents that may enter your house.
During a Biological Threat
The first evidence of an attack may be when you notice symptoms of the disease caused by exposure to an agent.
In the event of a biological attack, public health officials may not immediately be able to provide information on what you should do. It will take time to figure out exactly what the illness is, how it should be treated and who is in danger.
During a threat:
Watch TV, listen to the radio or check the Internet for official news and information including:
- Signs and symptoms of the disease
- Areas in danger
- If medications or vaccinations are being distributed
- Where to seek medical attention if you become ill
- If you become aware of a suspicious substance, quickly get away.
- Cover your mouth and nose with layers of fabric that can filter the air but still allow breathing. Examples include two to three layers of cotton such as a t-shirt, handkerchief or towel.
- Depending on the situation, wear a face mask to reduce inhaling or spreading germs.
- If you have been exposed to a biological agent, remove and bag your clothes and personal items. Follow official instructions for disposal of contaminated items.
- Wash yourself with soap and water and put on clean clothes.
- Contact authorities and seek medical assistance. You may be advised to stay away from others or even to quarantine.
- If your symptoms match those described and you are in the group considered at risk, immediately seek emergency medical attention.
- Follow the instructions of doctors and other public health officials.
- Avoid crowds.
- Wash your hands with soap and water frequently.
- Do not share food or utensils.
- https://www.ready.gov/Bioterrorism
- http://www.dhs.gov/xlibrary/assets/prep_biological_fact_sheet.pdf
- Centers for Disease Control and Prevention Bioterrorism (Link)
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