2Hour Bioreadiness Training

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2-Hour Bioreadiness Training

• USF Center for Biological Defense
• www.bt.usf.edu

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(No Transcript)
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Bioterrorism

• The application of biologic agents or their
  toxins as a weapon against people, animals or
  crops.
• Most confirmed cases have involved biocrimes
  rather than bioterrorism or biowarfare.
• Prior to 9/11, there were over 1,000 biological
  supply houses, endemic sources and various
  governments that had stockpiles of biological
  agents.

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Use of Biological Agents in the 20th Century
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Japans BW Program

• Conducted biological chemical warfare in
  Manchuria from 1932-1945
• Unit 731 -Epidemic Prevention Water
  Purification Department of the Kuantung Army- to
  prepare for BW
• Unit 100 - Dept. of Veterinary Disease
  Prevention of the Kuantung Army- to ready BW for
  use

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US BW Program

• Investigated anthrax, botulism, tularemia,
  plague, Q fever, Venezuelan Equine encephalitis,
  brucellosis Staphylococcus enterotoxin B with
• animal human studies
• Tested aerosolization dispersal methods in US
  cities

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End of Offensive Program

• 1969 - President Nixon stopped all offensive
  biological toxin weapon research production
• 1972 - Prohibits stockpiling of biological agents
  for offensive military purposes research
• Stockpiles of biological agents munitions from
  US program destroyed between 1971-1973
• US continues a bioweapons medical defensive
  program

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Soviet BW Program

• Chief Directorate for Biological Preparations
  or Biopreparat .
• 6 research laboratories, 5 production facilities,
  up to 55,000 scientists.
• Intended to carry out offensive biological
  weapons R D.
• Concealed behind the legal civilian
  biotechnology research.
• Defectors have detailed the VAST quantities of
  biological agents made by the Soviets.

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Biopreparat Products and Accidents

• Voz Island 1971
• Possible Smallpox outbreak with 9-10 cases and
  2-3 fatalities
• Sverdlovsk 1979 Accidental release of anthrax
  from the Soviet Institute of Microbiology

• Products
• anthrax
• Marburg
• smallpox
• plague
• tularemia
• VEE

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The Umbrella Gun Ricin Pellet Assassination
with a Biological Agent
Ricin pellet
Wax seal
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Bagwhan Shree Rashneesh

• First known
• intentional
• attack in the US by cult followers

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Rajneeshee Cult Biocrime

• Oregon 1984
• Political Motivation
• Contaminated 10 salad bars with Salmonella
  typhimurium
• Result 751 cases

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Disturbing Facts.

• Origin of epidemic not confirmed until a cult
  member confessed.
• Ma Anand Puja - 38 y.o. American nurse of
  Phillipine origin obsessed with poisons, germs
  and disease.
• Obtained cultures from The American Type Culture
  Company for Salmonella, tularemia, Enterobacter
  cloacae, Neisseria gonorrhoeae, Shigella
  dysenteriae.

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1995 Tokyo Subway Attack12 deaths and 5500
injuries
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Aum Shinrikyo Biological Agent Activity

• Laboratories with BW capabilities
• Research on anthrax, botulism Q-fever
• Allegedly tried to spray anthrax botulism 3X in
  Japan
• Seized arsenal - botulinum toxin drone aircraft
  with spray tanks
• Looked in Africa for Ebola

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Some Recent Headlines !!!!

• Sweep of AMI building found Anthrax in nearly 90
  spots.
• Toxic Ricin found at South Carolina postal
  facility."
• Senator Frist reports that Ricin found in
  Dirksen Building.

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October 2001 Anthrax Mailings
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The Florida Experience

• Approximately 7,000 items tested in Florida (Many
  related to the AMI building)
• No item tested positive on confirmatory testing
  outside of the AMI building
• Most items were simply everyday items

• Cream Filled Cookies
• Keyboards
• Catalogs with Absorbent Powder
• Collection Notices
• Rolls of Money
• Airliner Seat Trays
• Sets of Luggage
• Car bumpers
• Clothing Items

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The REAL effect of Bioterrorism

• In 2001, there were 11 cases of inhalation
  Anthrax and 12 cases of cutaneous anthrax.
• 32,000 people took Ciprofloxacin for 60 days.
• There were gt7,000 hoaxes and false alarms in the
  months following the attacks.
• Billions of have been spent to protect our
  citizens.
• One postal facility re-opened recently after a
  180 million renovation.
• Is this the most efficient way of protecting
  Americans?

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Where are the Weapons??
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Why Use Biological Agents?

• Cheap, Relatively Simple Propagation
• Infectious via aerosol
• Organisms fairly stable in environment
• Susceptible civilian populations
• The guilty can escape to fight another day
• High morbidity and mortality
• Person-to-person transmission (smallpox,
  plague, VHF)
• Difficult to diagnose and/or treat

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Potential Targets in Your Area

• Government Offices
• Political Organizations and Emotionally Charged
  Issues!!!
• Professional Sporting Events
• Amusement Parks
• Concerts and Outdoor Events
• Convention Centers
• Commercial Retail Facilities

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Possible Delivery Systems

• Point Source Delivery
• Upwind line delivery
• (eg. Crop Duster)
• Human Carrier Outbreak

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Aerosol / Infectivity Relationship
Particle Size (Micron, Mass Median Diameter)
Infection Severity
The ideal aerosol contains a homogeneous
population of 2 or 3 micron particulates that
contain one or more viable organisms
Less Severe More Severe
18-20 15-18 7-12 4-6 (bronchioles) 1-5
(alveoli)
Maximum human respiratory infection is a
particle that falls within the 1 to 5 micron size
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What Constitutes a Reasonable Threat?
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Identifying Suspicious Packages and Envelopes

• Excessive postage
• Handwritten or poorly typed addresses
• Misspellings of common words
• Strange or absent return address
• Incorrect titles or title without a
• name
• Not addressed to a specific person
• Marks such as Personal, Confidential, or Do
  Not X- Ray
• Marked with threatening language
• Postmark that does not match the return address

• Powdery substance felt through or appearing on
  the package or envelope
• Oily stains, discolorations or odor
• Lopsided or uneven envelope
• Excessive packaging material such as masking tape
  or string
• Excessive weight
• Ticking sound
• Protruding wires or aluminum foil

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The Metropolitan Medical Response System

• MMRS is a local system intended to prepare for
  and respond to weapons of mass destruction
  incidents.
• It is the intent of most MMRS plans to provide
  self-sufficiency for a 24 hour period, after
  which it is reasonable to assume that state and
  federal assistance will be deployed if needed.

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MMRS Essential Components
MMST or Capability

• Command Control
• MMST or Capability
• Emergency Patient Transportation
• Hospital Emergency Services
• Mental Health Services
• Mass Fatality Management
• Forward Movement via NDMS

Hospital Emergency Services
Emergency Patient Transportation
Command Control
Mass Fatality Management
Mental Health Services
Forward Movement via NDMS
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Ever Vigilant

• Syndromic Surveillance many of the biological
  threats have very similar presenting symptoms.
• Is every respiratory outbreak a terrorism
  incident?
• The ideal system is real time reporting of
  patients with specific symptom complexes with
  immediate processing of this information by the
  health department, and rapid feedback to the
  medical care providers.

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CDC Category A Agents

• Anthrax (Bacillus anthracis)
• Botulism (Clostridium botulinum toxin)
• Plague (Yersinia pestis)
• Smallpox (Variola major)
• Tularemia (Francisella tularensis)
• Viral Hemorrhagic Fevers (Filoviruses Ebola and
  Marburg and Arenaviruses Lassa and Machupo)

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Category A Characteristics

• These agents are particularly dangerous to our
  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.

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CDC Category B Agents

• Brucellosis (Brucella species)
• Epsilon toxin of Clostridium perfringens
• Food safety threats (e.g., Salmonella species,
  Escherichia coli O157H7, Shigella)
• Glanders (Burkholderia mallei)
• Melioidosis (Burkholderia pseudomallei)
• Psittacosis (Chlamydia psittaci)
• Q fever (Coxiella burnetii)
• Ricin toxin from Ricinus communis (castor beans)
• Staphylococcal enterotoxin B
• Typhus fever (Rickettsia prowazekii)
• Viral encephalitis (alphaviruses e.g.,
  Venezuelan equine encephalitis, eastern equine
  encephalitis, western equine encephalitis)
• Water safety threats (e.g., Vibrio cholerae,
  Cryptosporidium parvum)

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CDC Category C Agents

• Emerging infectious disease threats such as Nipah
  virus and Hanta virus.

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ANTHRAX

• There are three types of infection in humans
• Cutaneous
• Gastrointestinal
• Inhalation

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Smallpox Overview

• 1980 - Global Eradication?
• Samples in the US USSR.
• Humans were the only known reservoir.
• Person-to-person transmission (aerosol and
  contact with sores)
• Up to 30 mortality in the unvaccinated.

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Clinical Features of Smallpox

• Incubation period of
• 7-17 days
• Acute onset of fever, malaise, headache,
  backache and vomiting
• I REALLY DONT FEEL GOOD!!!

• Typical Rash
• Begins on face and hands. Spreads to the
  forearms, lower extremities and then the trunk
  over 7 days
• Synchronous Progression
• Macules ? Vesicles ? Pustules ? Scabs

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Bubonic Plague

• Incubation 1-7 days
• Sudden onset of headache, malaise, muscle pain,
  fever, tender lymph nodes
• Regional Lymphadenitis (Buboes)
• Cutaneous Findings
• Possible papule, vesicle, or pustule at the
  inoculation site
• Purpuric lesions (bruising) are a late sign

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Pneumonic Plague

• From aerosol (Dont breath on me!) or
  septicemic spread to the lungs.
• Rapid decompensation due to fluid collection
  poor oxygenation.
• 100 mortality
• if untreated

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Recovering (?) from the Plague
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Tularemia

• N0 PERSON TO PERSON TRANSMISSION
• Infective dose is 10-50 organisms (Very
  Infectious)
• Incubation period of 1-14 days (average 3-5
  days)
• Duration of illness is 2 weeks
• Mortality is low if treated with antibiotics and
  moderate if untreated.
• Infection via Arthropod vector, eating infected
  foods, handling soiled objects or materials and
  inhalation of aerosols.
• Vaccine efficacy 80

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Botulism

• Caused by toxin from Clostridium botulinum
• Toxin types A, B, E, most commonly associated
  with human disease
• Most potent lethal substance known to man
  (lethal dose of 1ng/kg)
• C. botulinum spores found in the soil worldwide
• Approximately 100 reported cases/year in the U.S.
• Infant most common (72)
• Food-borne illness is not common
• No person-to-person transmission

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Botulism Clinical Presentation

• The incubation period is 18 to 36 hours depending
  on dose and route.
• Alert, oriented and normal sensory exam that then
  may progress to
• Nausea, vomiting and diarrhea
• Cranial Nerve Symptoms
• Drooping eyelids, blurry/double vision,
  difficulty swallowing/talking and decreased
  salivation

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Viral Hemorrhagic Fevers (VHF)

• Caused by several different viral families
• Filoviruses (Ebola, Marburg)
• Arenaviruses (Lassa, Junin, Machupo, Sabia,
  Guanarito)
• Bunyaviruses
• Flaviviruses

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Typical VHF Patient History

• Typical patient history in Naturally Acquired VHF
• Foreign travel to endemic or epidemic area
• Rural environments
• Nosocomial exposure
• Contact with arthropod or rodent reservoir
• Domestic animal blood exposure

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VHF Clinical Presentation

• Signs/Symptoms
• Prostration
• Pharyngeal, chest, or abdominal pain
• Mucous membrane bleeding and bruising
• Shock
• Usually improving or moribund within a week
  (exceptions HFRS, arenaviruses)
• CNS involvement and marked liver enzyme elevation
  indicate a poor prognosis
• Mortality Virus dependent (10 to 90)