Characterization of Biological and Chemical Agents of Terrorism

1
Characterization of Biological and Chemical
Agents of Terrorism
Medicines Role in Responding to Biological and
Chemical Terrorism Is Your Community Ready?
COL Edward M. Eitzen, MC, USA Chief, Operational
Medicine Division U.S. Army Medical Research
Institute of Infectious Diseases (USAMRIID) Fort
Detrick, MD 21702-5011
2
BW Agents Differ from CW Agents

• Biological Agents
• Natural
• Production difficult
• None volatile
• Many toxins more toxic
• Infectious agents replicate
• Not dermally active
• Legitimate medical use
• Odorless and tasteless
• Diverse pathogenic effects
• Many are effective immunogens
• Aerosol delivery

• Chemical Agents
• Man-made
• Production difficult (industrial)
• Many volatile
• Less toxic than many toxins
• Do not replicate
• Many are dermally active
• No use other than as weapons
• Odor or taste when contaminated
• Fewer types of effects
• Poor immunogens
• Mist / droplet / aerosol delivery

3
Chemical vs. Biological Agent Release

• Chemical
• Visible cloud
• Chlorine
• Odor
• Chlorine
• PhosgeneNewly mown hay
• Cyanide Almonds
• MustardMustard, garlic
• Environmental detectors
• Detection papers
• CAM
• Fox vehicle

• Biological
• No visible cloud or odor
• Environmental Detectors
• BIDS/Portal Shield
• Limited availability

4
Chemical Biological Rapid Response Team Plume
Modeling - Chemical
5
Chemical Biological Rapid Response Team Plume
Modeling - Biological
6
Onset of Action Chemical vs. Biologic

• Immediate (minutes)
• Nerve agents
• Lewisite
• Chlorine
• Cyanide
• Saxitoxin
• Delayed (hours)
• Mustard
• Phosgene
• Toxins

• Days
• Replicating biological agents
• Mustard (bone marrow toxicity)

7
Estimates of Casualties Generated by Releasing 4
Tons of Chemical or 50 Kg of Bio Agent Along
2 km Line Upwind of a City of 500,000
Ag
e
nt
C
a
s
e
s
D
e
a
t
hs
Sa
ri
n
15,000
300
VX
50,000
5000
VX ae
r
oso
l
120,000
12,000
P
l
ague
75,000
41,000
A
n
t
h
r
a
x
1
2
5
,0
0
0
9
5,
0
0
0
Health Aspects of Chemical and Biological
Weapons,WHO, 1970
8
First Responders

• Chemical
• Fire (HAZMAT)
• Police
• EMS

• Biological
• Primary care medical providers
• Emergency departments (physicians/nurses/staff)
• Health departments
• Public health surveillance systems

9
Patient Decontamination

• Chemical
• Dermal toxicity/absorption (risk to victim or
  others)
• Volatility (risk to others)
• Early Decon Minimizes risk to victim and first
  responders, SAVES LIVES
• Late Decon prior to entering healthcare
  facilities

• Biological
• Not active or absorbed through intact skin
  (except possibly T-2 mycotoxins)
• Aerosolized agent deposited on skin or clothing
  usually not a risk to victim or others
• Decon Change clothes, shower
• Heavy contamination dilute bleach

10
Environmental Contamination

• Chemical
• Vapor
• Aerosol (Mustard)
• Volatile liquids Pose continued hazard due to
  evaporation
• Persistent agents (VX) continued hazard from
  skin absorption

• Biological
• Aerosol
• Will not spontaneously re-aerosolize
• Secondary aerosolization difficult

11
Prophylaxis

• Chemical
• Pre-exposure pyridostigmine bromide (nerve
  agents)
• Vaccines N/A

• Biological
• Pre/post-exposure antibiotic
• Vaccines
• Pre-exposure
• Military Anthrax vaccine program
• Civilian Not feasible currently
• Post-exposure
• Anthrax vaccine
• Smallpox vaccine/VIG

12
Diagnosis and Therapy

• Chemical
• Detection/diagnosis
• Clinical syndrome
• Detection kits
• Toxicological analysis
• Therapy
• Supportive Care
• Specific antidotes
• Secondary exposures
• Volatile agents prior to decon

• Biological
• Diagnosis
• Clinical/epidemiologic picture
• PCR, ELISA, other assays
• Standard microbiology
• Therapy
• Supportive Care
• Specific therapies
• Secondary transmission
• Plague
• Smallpox
• VHFs

13
Comparative Analysis Chemical versus Biological
Weapons

• Anthrax, in amounts 1,000 times less that sarin,
  can affect a population 1,000 times greater in
  size
• 10 grams of anthrax may produce as many
  casualties as 100,000 grams (1 metric ton) of
  chemical nerve agent
• Botulinum toxin is 15,000 times more toxic than
  VX and 100,000 times more toxic than sarin

14
USAMRIID A Unique National Resource
Operational Medicine A Unique Resource for
USAMRIID