Download Biothreats and Biosecurity - New Jersey Preparedness Training

New Developments
in
Biothreats and Biosecurity
Clifton R. Lacy, M.D.
October 17, 2007
A Taste of the New Jersey Experience
Imported Lassa Fever
Tularemia
Severe Acute Respiratory Syndrome
(SARS)
Emerging Infectious Diseases
New Diseases in Past 20 Years
Acanthamebiasis
AIDS
Anthrax
Antimicrobial and insecticide resistance
Australian Bat Lyssavirus
Babesiosis
Bartonella henselae
Botulism
Campylobacteriosis
New Diseases in Past 20 Years
Chikungunya
Cryptosporidiosis
Cyclosporiasis
Prion Disease, Creutzfeldt-Jacob (vCJD)
Ebola Hemorrhagic Fever
Encephalitozoon cuniculi
Encephalitozoon hellem
Enterocytozoon bieneusi
Ehrlichia chafeensis Ehrlichiosis
New Diseases in Past 20 Years
Escherichia coli 0157:H7
Enterovirus 71
Guanarito Virus
Hantaan Hemorrhagic Fever with Renal
Syndrome (HFRS)
Hantavirus Pulmonary Syndrome
Helicobacter pylori
Hendra Virus
Hepatitis C
New Diseases in Past 20 Years
Hepatitis E
HIV
Human herpesvirus 6 (HHV-6)
Human herpesvirus 8 (HHV-8)
Human Monkeypox
Influenza, H5N1
Lassa Fever
Legionnaires Disease
Lyme Borreliosis
New Diseases in Past 20 Years
Sabia Virus
SARS Coronavirus
Sindbis
Sin Nombre Virus
Staphylococcal Infection, MethicillinResistant, Vancomycin-Resistant
Streptococcal Infection (toxic shock
syndrome, necrotizing fasciitis, etc.)
Tuberculosis (MDR-TB, XDR-TB)
Tularemia
Malaria, Drug-Resistant
New Diseases in Past 20 Years
Marburg Hemorrhagic Fever
Monkeypox, Human
Nipah Virus
O’nyong’nyong Fever
Oropuche Fever
Parvovirus B-19
Plague
Rift Valley Fever
Rotavirus
West Nile Encephalitis
Whitewater Arroyo Virus
Selected New Infections By Year
1973: Rotavirus
1975: Parvovirus B-19
1976: Cryptosporidium
1977: Ebola
1977: Legionella pneumophilia
1977: Hantaan Virus
1977: Campylobacter jejuni
Selected New Infections By Year
1980: HTLV-1
1981: Staphylococcus aureus - Toxic Shock
1982: Escherichia coli 0157: H7
1982: HTLV-2
1982: Borrelia burgdorferi
1983: HIV
1983: Helicobacter pylori
1986: Cyclospora cayatanensis
1988: Human herpesvirus 6 (HHV-6)
1988: Hepatitis E
1989: Ehrlichia chafeensis
1989: Hepatitis C
Selected New Infections By Year
1991: Guanarito Virus
1991: Babesia species
1992: Vibrio cholerae 0139
1992: Bartonella henselae
1993: Sin Nombre Virus
1993: Encephalitozoon cuniculi
1993: Hantavirus Pulmonary Syndrome
1994: Sabia Virus
1995: Human herpesvirus 8 (HHV-8)
1996: Creutzfeldt-Jacob disease (vCJD)
1997: H5N1 Influenza
1998: Nipah Virus Encephalitis
1999: West Nile Encephalitis
Selected New Infections By Year
2000: Rift Valley Fever
2001: Anthrax Bioterrorism
2002: Vancomycin-Resistant
Staphylococcus aureus
2003: SARS Coronavirus
2004: Monkeypox, Human
Emerging Diseases
Over 2 billion airline passengers in 2006
Potential for faster and farther disease spread than
any time before in history
Outbreak or epidemic somewhere is only few hours
away from being public health threat elsewhere
Infectious diseases are emerging more rapidly
Since the 1970s, one or more new diseases have
been identified each year
Over 40 diseases now were unknown 20 years ago
Over 1100 epidemic events during last 5 years
Causes of Emergence/Re-Emergence
Population growth and urbanization
– overcrowding, unsanitary living conditions, lack of
clean water for drinking and washing, poor hygiene
Human encroachment on tropical rain forests
– populations with little or no disease resistance now
in contact with disease organisms and/or vectors
Economic and social exigencies
– inadequate health systems and public health
infrastructure
Causes of Emergence/Re-Emergence
Environmental change
– deforestation, road and building construction,
irrigation, increased crop and animal production,
urban sprawl, poor sanitation, pollution
Movement and encampment of population
displaced by wars, civil instability, or natural
disasters
– overcrowding, lack of clean water, unsanitary
conditions, poor hygiene, malnutrition, exposure
to new or re-emerging diseases
Human sexual behavior change
Causes of Emergence/Re-Emergence
Increased global travel, commerce, and
terrorism
– transport of disease-causing organisms/vectors
– global commerce of livestock and foodstuffs
Indiscriminate use pesticides/antimicrobials
– antibiotic resistance in organisms
New strains of all diseases
– different immunological characteristics, virulence,
contagion, and response to antibiotics
Immunosuppressed and compromised hosts
Examples of Emerging and Re-Emerging Infectious Diseases
AS Fauci
Examples of Emerging Infections
Henipaviruses
–Hendra Virus
–Nipah Virus
Avian Influenza H5N1
Intentional Biothreats
Anthrax
Terrorism
Bioterrorism
Terrorism
Repeated violent action
Anxiety-provoking
Intimidation, coercion, propaganda
Main target not the direct target of violence
Assassination / Guerrilla Warfare
Assassination:
Main target is the direct target of violence
Conventional and guerrilla warfare:
Violence/threat to create fear only in victims
Bioterrorism
Deliberate release of biological agents (viruses, bacteria,
fungi, etc.) to cause illness and/or death in people,
animals, or plants
Biological agents are insidious
– difficult to detect
– illness propagates over hours, days, weeks
Some biological agents are infectious and contagious
– can be spread from person to person (smallpox)
Some biological agents are infectious but not contagious
– cannot be spread from person to person (anthrax)
Bioterrorism agents are divided into three categories,
based on on ease of contagion and severity of illness
Select Agents – Category A
Category A Agents – highest risk
Easily spread or transmitted person-to-person
High death rates and potential major public
health impact
Can cause public panic and social disruption
Require special action for public health
preparedness
Select Agents – Category A
Anthrax (Bacillus anthracis)
Smallpox (Variola major)
Plague (Yersinia pestis)
Botulism (Clostridium botulinum toxin)
Tularemia (Francisella tularensis)
Viral hemorrhagic fevers
– filoviruses like Ebola and Marburg
– arenaviruses like Lassa and Machupo
Select Agents – Category B
Category B Agents – second highest priority
Moderate illness rates and low death rates
Require specific laboratory enhancements
and disease monitoring
Select Agents – Category B
Brucellosis (Brucella species)
Glanders (Burkholderia mallei)
Melioidosis (Burkholderia pseudomallei)
Psittacosis (Chlamydia psittaci)
Q Fever (Coxiella burnetii)
Epsilon toxin of Clostridium perfringens
Food safety threats
(Salmonella species, E coli 0157:H7, Shigella)
Ricin toxin from Ricinus communis
Staphylococcal enterotoxin B
Typhus (Rickettsia prowazekii)
Viral encephalitis (Alpha viruses: Venezuelan Equine
Encephalitis, Eastern Equine Encephalitis, Western
Equine Encephalitis)
Water supply threats
(Vibrio cholerae, Cryptosporidium parvum)
Select Agents – Category C
Category C Agents – third highest priority
Include emerging pathogens that could be
engineered for mass spread in the future
Easily available
Easily produced and spread
Potential for high morbidity and mortality rates
and major health impact
Nipah Virus
Hanta virus
Multi-Drug-Resistant Tuberculosis.
Biowarfare History
Poisoned wells
Contaminated arrows
Venomous snakes
Dead/infected animals
Dead/Infected humans
Infected fomites
Infected insects
Food poisoning
Bioagent release
Synthetic Biothreats
Genetic engineering of bioagents
Creation of bioagents
Re-creation of bioagents
Purchase of DNA sequences
Genomics and Future Biological Weapons
Modify infectivity
Modify virulence
Modify antigenic properties
Enhance antibiotic resistance
Transfer pathogenic properties
Alter to make harder to detect, diagnose, and treat
Sneak stealth viruses covertly into genome
– Population-specific
– Triggered at a later time
Target genome of specific population
– Design specific pathogen
Synthetic Biothreats
“…DNA can be synthesized from the
[genetic] sequence, and this could be
done by any third-rate terrorist.”
– Vincent Racaniello
Virologist, Columbia University
Synthetic Biothreats
“The most worrisome thing… is that the
field of synthetic biology is going to enable
people to create potentially very
dangerous diseases that don't otherwise
exist or to re-create ones that have been
wiped off the face of the earth.”
– Edward Hammond, biological weapons expert
System Failures and Human Error
Mistakes – Accidents – Operator/System Failures
– Errors of Commission
– Errors of Omission
Poor Judgment
Carelessness
Inadequate or Lapsed Training
Unintentional Environmental Releases
Intentional Releases
Containment Breaches and Security Failures
Missing Laboratory Samples or Animals
World Health Organization
World Health Report 2007
A Safer Future
Global Public Health Security
in the 21st Century
Impact Public Health
Commerce and travel
Reduced vigilance and lapsed programs
False rumors
Armed conflict
Poverty
Resistant organisms
Weather and climate
Intentional and unintentional releases
Industrial accidents
Natural phenomena