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Transcript
BIOLOGICAL TERRORISM AND SECURITY EMD545b Lecture #9 Biological Terrorism Intentional or threatened release of viruses, bacteria, fungi or toxins derived from living organisms to produce disease or death in humans, animals, or plants Outline • • • • • • • • Historical events Potential agents of bioterrorism Means of delivery Monitoring and detection Hazardous materials/emergency response Security issues Suspicious materials Discussion and comments Historical Events 6th Cent. BC: Rye ergot, plant toxins 1300’s:Plague-infected corpses catapulted into defenders during Siege of Kaffa 1500’s: Strategic value of smallpox-laden blankets during Spanish conquest of Central and South America 1700-1800’s: Smallpox-laden blankets repeatedly traded to North American Indians More Recent Events WW II: Japan’s Unit 731 1940’s-1969: US offensive use research 1972: Biological Weapons Convention Treaty 1978: Assassination by KGB using ricin 1979-1982: “Yellow-rain” by Soviet Army in Afghanistan 1979: Accidental Soviet anthrax release at bioweapons facility in Sverdlovsk - ca. 80 cases, 60+ deaths Most Recent Events 1984: Purposeful Salmonella contamination of food by Oregon religious cult - 700+ cases 1995: Sarin released in Tokyo subway religious cult 12 deaths, thousands exposed 1998: Vengeful use of radiolabeled saxitoxin stolen from Brown University laboratory 2001-2002: Anthrax distribution in/on US Mail 1995 Tokyo Subway Sarin Release by Aum Shinrikyo Why BioWeapons? • • • • • • • • Fear and hysteria Overwhelm medical resources Can be lethal or cause severe incapacitation Delayed effects (but acute from toxins) Relatively easy to obtain, produce, and use Potential for secondary infections Multiple routes for exposure Compared to chemical and nuclear materials: – Very difficult to detect in field The Perfect BW • • • • • • • • Highly pathogenic/toxic Highly infectious Incapacitation may be preferable to lethality Symptoms confused with non-BW diseases Transmissible by desired route of exposure Stable for packaging and delivery Easily harvested, selected, or created Vaccination/treatment only available to aggressor Epidemiology of BW Attack • Case chronology differences from natural epidemics • Observations of signs/symptoms likely most sensitive surveillance means • Reportable symptoms and diseases Time Factors for Disease Transmission • • • • • Presence of pathogenic organism Viable Infectious dose (minimum [ ] and qty) Susceptible host Effective route of exposure Potential Agents of Bioterrorism • • • • Bacterial agents Viral Agents Biological/biologically-derived toxins Recombinant organisms Bacterial Agents • Single cell microscopic organisms typically with diameter 0.5 - 1.0 um • Capable of causing disease by infection and/or producing toxins • Spore forms often very stable in environment Anthrax • • • • • • • Bacillus anthracis (spore former) Cutaneous, inhalational, and ingestion forms Common among livestock and livestock product workers Spore-form very stable Flu-like illness, respiratory failure, shock, meningitis Highest CFR from inhalation (90-100%) Antibiotic treatment must be early to be effective • Vaccine available Plague • • • • • • • Yersinia pestis Transmitted by flea bites or aerosol droplets Wild rodents are natural reservoir Bubonic and pneumonic forms (“black death”) Swollen lymph nodes, rapid progressive pneumonia High case fatality rates Vaccine and antibiotic therapies available Tularemia • • • • • • Francisella tularensis (“rabbit fever”) All routes of exposure, including vector Low infectious dose Fever, chills, headache, weight loss, pneumonia Moderate case fatality rate untreated Vaccine and antibiotic therapies Brucellosis • Brucella spp. (abortus, melitensis, ovix, others) • Zoonotic, primarily from infected mammals and contaminated milk/other dairy products • Highly infectious by aerosolization • Variable symptoms, but many “flu-like” Viral Agents • Very small particles (ca. 0.02 - 0.2 um diameter) • Not truly “living” • Outer shell and DNA or RNA, but no organelles for metabolism or reproduction • Rely exclusively upon host cells - “parasites” • Typically very short lived outside of host or vector Smallpox • • • • Variola major Highly contagious by aerosols Moderately high case fatality rate (~30%) Incapacitating malaise, fever, vomiting, lesions and pustules • WHO initiative claims eradication (except for stored specimens in US and Russia) • Quarantine essential • Vaccine available Viral Equine Encephalites • Venezuelan, Western, and Eastern • Vector & aerosol transmission (vector primary in nature) • Fever, headache, malaise, nausea/vomiting, neurological damage from encephalitis • Highly incapacitating, high lethality (CFR for EEE 50 - 75%) • Experimental vaccines • Palliative care only Viral Hemorrhagic Fevers • • • • • e.g., Marburg, Ebola, Congo-Crimean BL4 agents Poorly understood, difficult to work with Arthropod vectors, contact, possible aerosol routes Natural epidemics with severe consequences - marked by fever, malaise, headache, internal hemorrhaging, multiorgan failure • Seriously incapacitating • Very high CFRs: 25 - 90% • Palliative care only Biological Toxins • Any toxic substance or compound produced by an animal, plant, or microorganism • Typically high MW proteins or toxic chemicals • Hazardous by most routes of exposure - contact facilitated by dermal penetrants like DMSO • Range of effects from tissue necrosis to nervous system interruption • Most are readily inactivated by heat, steam, or common chemicals Comparative Toxicity Agent LD50 (ug/kg) Source Botulinum toxin 0.001 Bacterium Tetanus toxin 0.002 Bacterium Diptheria toxin 0.10 Bacterium Ricin 3 Plant (Castor bean) a-Conotoxin 5 Cone snail Saxitoxin 10 Marine dinoflagellate Sarin 100 Chemical/nerve agent T-2 toxin 1,210 Fungal mycotoxin Delivery and Release • Acquisition/production in sufficient quantity/concentration to achieve desired outcome • Stability under storage conditions • Packaging • Actual delivery and release • Exposure Routes of Exposure • • • • Airborne - inhalational Food/water supplies - ingestion Contact - dermal Vector - percutaneous Sources of BW Agents • • • • • • Field, clinical, and veterinary samples Type culture collections Commercial distributors Foreign laboratories and suppliers Museums and universities Genetically engineered (rDNA) or selected Monitoring and Detection • Comparison vs. chemical, explosive, and radioactive • Medical signs and symptoms - healthcare providers become first line of surveillance • Laboratory analysis – Antibody titers – Cultures – DNA fingerprinting • Field tests • Future/emerging methods (GC/MS, semi-conductors) HAZWOPER • OSHA standard (29 CFR Part 1910.120) • “Hazardous waste operations and emergency response” • Comprehensive requirements for written safety programs, training, protective equipment, field exercises, medical surveillance, and at least annual re-certifications HAZWOPER/ Emergency Response • • • • • • First responders Incident commander and IC system Site/scene health and safety officer Technician-level responders Potential crime scene investigation issues Other specialists as-needed HAZWOPER/ Emergency Response • All-hazards approach – Biological, chemical, and radiological • Site/perimeter controls • Work zones • Decontamination systems Knowledge and Information • • • • • Incident/facility information Eyewitnesses critical On-going process Monitoring and predictions where possible Weather and local environmental factors HAZMAT Ensemble Levels Low D C B A High Safety shoes and glasses/goggles, work gloves, and work clothing Above plus more enclosing garments, and air purifying respirator Above plus even more enclosing garments, and upgrading of respiratory protection to selfcontained breathing apparatus (SCBA) Fully encapsulating garments, SCBA HAZMAT Ensembles B C D A Key Selection Factors for Protective Clothing • • • • • • • Contaminants and concentration Consequences of equipment failure Permeation/penetration resistance Anticipated duration of use Exposure type (e.g., incidental contact, immersion) Anticipated work activities (e.g., dexterity, tactility) Cost, size, availability, manufacturer’s differences Personal Protective Equipment • Low on controls hierarchy • Advantages • Disadvantages – – – – – – No one ensemble Selection criteria Training Formal “fitting” process Maintenance and inspection Periodic review Medical Interventions • e.g., pre-exposure immunizations, blocker administration, and immediate post-exposure treatment • Excellent protection but for only very limited suite of exposures • Duration of protection highly variable • Potential contraindications of treatment • Timing of administration critical Biosecurity Issues • “Select Agents” transfer rule • Revisions now include “possession” • Basic requirements: – Registration of entity and individuals possessing, using, storing, etc. “select” biological agents and toxins – Inventory controls – Physical security of storage and use – Periodic inspections – Emergency procedures and notifications – Individual background/security clearances Related Security Issues • Building perimeter controls and access • Public vs. non-public areas • Mechanical equipment and HVAC intakes – Collateral benefits of modern filtered HVAC systems • Identify and report strangers/suspicious persons Suspicious Materials • Mail, packages, objects • Return address, condition, and appearance (leaking, discoloration, odor, etc) • Expected or unexpected? Verify source if possible. • Follow recommended procedures. ??? Sources for More Information • US Government: Occupational Safety and Health Administration Nuclear Regulatory Commission National Institute for Occupational Safety and Health Centers for Disease Control and Prevention Federal Emergency Management Agency Federal Bureau of Investigation/Department of Justice • Advisory Groups: American Biological Safety Association American Industrial Hygiene Association American and International Red Cross Discussion and Comments