Post on 30-Dec-2015
transcript
The Role of Information Technologies and Science in the
Prevention of Bioterrorism
Eugene Shubnikov, MD, Institute of Internal Medicine, Russia;
Supercourse Team, Pittsburgh and the Rest of the world
Novosibirsk, Ebola Virus Laboratory, Vector
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Phillip L. Coule, M.D. 10
Biological terrorism
• Dispersal of microbes or their toxins to produce illness, death and terror
• The paths of infection can be contaminated water, food, air and packages.
• Microbes– Bacteria– Viruses– Toxins
Types of Terrorism • Domestic terrorism involves groups whose
terrorist activities are directed at elements of our government without foreign involvement. Oklahoma City is a primary example.
• International terrorism involves groups whose terrorist activities are foreign-based and/or directed by countries or groups outside the United States. Sept. 11 is an example of International Terrorism.
the Center for National Security Studies
Methods of Terrorism
• Firearms
• Explosive and Incendiary Devices
• Chemical Agents
• Biological Agents
• Nuclear Weapon
J. David Piposzar, Allegheny County Health Department
J. David Piposzar, Allegheny County Health Department
Definition of bioterrorism
• Bioterrosim is the threat or use of biological agents by individuals or groups motivated by political, religious, ecological, social or for other ideological objectives to inculcate fear or cause illness or death in order to achieve their objective. (Carus 1998*).
Fred T Muwanga MD Msc
Response and prevention of bioterrorism
• Response involves: emergency measures to save
lives active case finding through
surveillance establish diagnostic
criteria(case definition) and case management
prevention and management of secondary contamination
Accurate laboratory work
• Prevention measures Strategy formulation that stress
deterrence as well as crisis and consequence management.
Do a threat analysis so as to define the requirements
contingency planning with clear definition of roles
global surveillance of disease outbreaks to create more understanding on emerging threats
Fred T Muwanga MD Msc
Questions for reflectionWith largely theoretical knowledge on
bioterrorism, how best can we understand the problem we are faced with ?
What ability and/or capacity does the world have to respond to the challenges of bioterrorism?
What is the dividing line between bioterrorism and criminal activity ?
Fred T Muwanga MD Msc
Bioterrorism BasicsBioterrorism Basics
Definition: The unlawful use, or threatened use, of microorganisms or toxins derived from living organisms to produce death or disease in humans, animals, or plants. The act is intended to create fear and/or intimidate governments or societies in pursuit of political, religious, or ideological goals.
Bioterrorism BasicsBioterrorism BasicsWhat makes the use of biological agents so attractive to the terrorist?
– Ease of Acquisition Information readily accessible on World Wide Web American Type Culture Collection, other sources
– Ease and Economy of Production Only basic microbiology equipment necessary Small labs require no special licensing Investment to cause 50% casualty rate per sq. km:
Conventional weapon $2000, nuclear $800, anthrax $1– Lethality
50 kg aerosolized anthrax = 100,000 mortality Sverdlovsk experience, former USSR
Bioterrorism BasicsBioterrorism BasicsWhat makes the use of biological agents so attractive to the terrorist?– Stability– Infectivity
Weaponized agents may be easily spreadClinical symptoms days to weeks after
release– Low Visibility– Ease and Stealth of Delivery
Remote, delayed, undetectable releaseDifficult/impossible to trace origin of agent
Bioterrorism BasicsBioterrorism Basics
Routes of Delivery for Biological Agents
Aerosol is most likely method of dissemination
Easy, silent dispersal
Maximum number of victims exposed
Inhalation is most efficient and contagious route of infection
Food/Water-borne dispersal less likely
Less stable, ineffective for some agents
Inefficient compared to aerosol
Agents of BioterrorismAgents of Bioterrorism
Bacterial Agents
Bacillus anthracis (Anthrax)
Yersinia pestis (Plague)
Francisella tularensis (Tularemia)
Brucella spp. (Brucellosis)
Coxiella burnetii (Q Fever)
Burkholderia mallei (Glanders)
Vibrio cholerae (Cholera)
Agents of BioterrorismAgents of Bioterrorism
Viral AgentsVariola virus (Smallpox)Venezuelan Equine Encephalitis Virus (VEE)Hemorrhagic Fever Viruses: Ebola, Marburg, Lassa Fever, Argentine and Bolivian Hemorrhagic Fever Viruses, Hantavirus, Congo-Crimean Virus, Rift Valley Fever Virus, Yellow Fever Virus, Dengue Virus
Agents of BioterrorismAgents of Bioterrorism
Biological ToxinsBotulinum Toxins
Staphylococcal Enterotoxin B
Ricin
Mycotoxins (T2)
Agent TypeMinimum Dose
Incubation period
Initial Symptoms
Duration of illness Lethality
Animal Indicator
Anthrax Bacteria8,000 (spores) 1-6 days Flu-like 3-5 days High 90% Yes
Plague Bacteria100 organisms 2-3 days
Pneumonia / Flu-like 1-6 days High 90-100% Yes
Tuleramia Bacteria 10 organisms2-10 days (avg. 3-5) Flu-like >=2 w eeks
Moderate 5-30% Yes
Brucellosis Bacteria 10 organisms 5-60 days Flu-likeWeeks to months Low 2-10% Yes
Q Fever Rickettsia 1 organisms 10-40 days Flu-like 2-14 days Low 4% Yes
Smallpox Virus 10 organisms7-17 days (avg. 12) Flu-like 4 w eeks High 30%
Animal Varients
Encephalitides VEE, EEE, WEE Virus 10 organisms 2-6 days Flu-like
days to w eeks low Yes
Hemorrhagic Fevers Ebola, Marburg Virus 1 organism 4-21days Flu-like 7-16 days
High Marburg 25% Ebola 50-90% Yes
Botulinum Toxin 100 ng 1-5 daysmuscle w eakness 24-72 hours High 30% Yes
Characteristics of BT AgentsCharacteristics of BT Agents
Chotani, 2003Chotani, 2003
Bioterrorism BasicsBioterrorism BasicsEvents Suggesting the Release of a Bioweapon
Multiple people ill at the same time (epidemic) Previously healthy persons affected High morbidity and mortality among affected
individuals Identification of diseases and pathogens
unusual to a particular region Recent terrorist claims or activity Unexplained epizootic of sick or dead animals
Bioterrorism BasicsBioterrorism Basics
Events Suggesting the Release of a Bioweapon Severe respiratory disease in a healthy host An epidemic curve rising and falling rapidly Increase in fever, respiratory, and GI symptoms Lower attacks rates in people working indoors
vs. outdoors Seasonal disease during a different time of year Known pathogen with unusual antimicrobial
resistance pattern Genetically-identical pathogen in different areas
Bioterrorism BasicsBioterrorism BasicsWhat Can We Do As Medical Professionals? Maintain a high index of suspicion by including
biological agents in differential diagnoses Learn to recognize historical and physical examination
findings suggestive of bioweapon exposure Stay informed of local, regional and national
epidemiologic trends Be knowledgeable about treatment and prophylaxis of
patients exposed to biological agents Know whom to report suspected biological agent
exposures and illnesses to (Police, State Intelligence agency, Infectious Disease Specialists, Local and State Health Officials)
Phillip L. Coule, M.D. 29
Is this something new?
• 14th Century – Kaffa– City on Crimean
Peninsula• Hurled plague infested
corpses over walls of city to infest it
• 1346 – Tatar army hurls its plague ridden dead over the walls of the city
Phillip L. Coule, M.D. 30
Is this something new?• 18th Century French and
Indian War– British Officers gave
blankets from smallpox victims to Indians aligned with French
– Caused an epidemic in tribes
– Effective means of incapacitating group
Reported Cases of Bioterrorism• World war II - Polish resistance
organizations used biological agents against German forces
• 1952 - Mau Mau, an independence movement in Kenya , used a plant toxin to poison livestock.
• 1966 - Dr.Mitsuru Suzuki a Japanese physician, infected healthcare providers and patients with Salmonella typhi
• 1981 - Dark harvest group got anthrax contaminated soil from Gruinard Island and damped it on Porton Down.
• 1984 - Rajneeshees in Portland, Oregon(USA)used Salmonella typhimurium to contaminate restaurant salad bars.
• 1995 - AUM Shinrikyo used sarin nerve gas in the Tokyo subway in Japan
• 2001 - Anthrax contaminated s mail sent to various people in USA.
Fred T Muwanga MD Msc
Biological Terrorism - A New Trend?
• 1978: Bulgarian exile injected with ricin in London• 1979: Sverdlovosk, USSR – accidental anthrax released –
40 fatalities • 1984: Oregon, Salmonella – Rajneeshee cult• 1991: Minnesota, ricin toxin• 1994: Tokyo, Sarin and biological attacks• 1995: Arkansas, ricin toxin• 1995: Indiana, Y. pestis purchase• 1997: Washington DC, ‘Anthrax/plague’ hoax• 1998: Nevada , nonlethal strain of B. anthracis• 1998-9: Multiple ‘Anthrax’ hoaxes • 2001: Anthrax Outbreak USA
CasualtiesIncident Number of Cases Number of deaths
Polish Resistance Not reported 200 Germans
Mau Mau Not reported 33 head of cattle
Dark Harvest None None
Rajneeshes 751(45 hospitalised)
no deaths
AUM Shrinkyo 5500 ( 641 seen atSLIH* on day 1 &349 following week)
106 hospitalised atSLIH. 12 deaths (2at SLIH)
Dr.Suzuki 200 4 deaths
Anthrax(USA) 22 4 deaths
Fred T Muwanga MD Msc
Motive for bioterrorismIncident Motive
Polish resistance Resistance against foreign occupation
Mau Mau Resistance against colonialism
Dark Harvest Send a political message
Rajneeshes Win a local election by incapacitating thenon-Rajneeshee voters
AUM Shrinkyo Seize control of Japan through massmurder, causing fear and apprehension
Dr.Suzuki Revenge for unfair treatment he receivedat the medical training
Anthrax (USA) Inculcate fear
Fred T Muwanga MD Msc
Lessons learnt• Motives for bioterrorism vary and
could include: - murder(Aum Shrinkyo) - gaining political mileage (Mau Mau and
Dark harvest) - desire for revenge (Dr.Suzuki) - Cause fear (Anthrax cases) - Incapacitation (Rajneeshes) - anti-agriculture (Mau Mau)• Terrorists do not usually announce their
intent• secondary contamination can occur
(SLIH workers)
• There are various methods of dissemination:
Direct application (Dr.Suzuki) Food or water contamination
(Rajneeshes) Aerosol contamination (Aum
Shrinkyo and anthrax cases)• The effects of bioterrorism can
be immediate(illness and death) or long term (Post-stress disorder)
Fred T Muwanga MD Msc
Responses to Bioterrorism
• Early detection of active and potential cases
• Emergency measures to save lives
• Prevention and management of secondary contamination
Anatomy of a Bioterrorist Attack
Preparation5 years
Execution 1 day
Diagnosed case 3 days
First Death
Multiple deaths
Terrorism takes much Time and planning