Download Russia, Supercourse and bioterrorism preparedness

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
Steps in Developing of
Russian/FSU Supercourse:
• Network of the scientists involved in
prevention and the Internet in Russia and FSU
• Russian Language or Russia/ FSU’s connected
Public Health Library of lectures at the
Internet
• I-prevention Program with relations between
Russian, FSU, US and scientists from around
of the world
15 countries in FSU Supercourse
Communications between
members
• Mailing list
• Sharing of lectures
• Personal E-mail contacts
• Personal meetings
Our Help for Russian/ FSU
Public Health Teachers
• Cutting edge, interesting lectures
available from Supercourse
• Free access to the Supercourse web
library of lectures
• Share knowledge, education and training
systems with other public health
professionals in FSU and worldwide
(www.pitt.edu/~super1/national/index.htm)
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
Phillip L. Coule, M.D.
10
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
Fred T Muwanga MD Msc emerging threats
Questions for reflection
With 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 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 Basics
What 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 Basics
What makes the use of biological agents so
attractive to the terrorist?
– Stability
– Infectivity
 Weaponized agents may be easily spread
 Clinical symptoms days to weeks after
release
– Low Visibility
– Ease and Stealth of Delivery
 Remote, delayed, undetectable release
 Difficult/impossible to trace origin of agent
Bioterrorism 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 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 Bioterrorism
Viral Agents
Variola 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 Bioterrorism
Biological Toxins
Botulinum Toxins
Staphylococcal Enterotoxin B
Ricin
Mycotoxins (T2)
Characteristics of BT Agents
Agent
Type
Anthrax
Bacteria
Plague
Bacteria
Tuleramia
Bacteria
Brucellosis
Q Fever
Bacteria
Rickettsia
Smallpox
Virus
Encephalitides
VEE, EEE, WEE Virus
Hemorrhagic
Fevers
Ebola, Marburg Virus
Botulinum
Chotani, 2003
Toxin
Minimum
Dose
8,000
(spores)
100
organisms
Incubation Initial
Duration
period
Symptoms of illness
1-6 days
2-3 days
2-10 days
10 organisms (avg. 3-5)
Animal
Lethality Indicator
Flu-like
Pneumonia /
Flu-like
3-5 days
High 90%
1-6 days
Flu-like
>=2 w eeks
Weeks to
months
2-14 days
High 90-100% Yes
Moderate
5-30%
Yes
10 organisms 5-60 days
1 organisms 10-40 days
7-17 days
10 organisms (avg. 12)
Flu-like
Flu-like
10 organisms 2-6 days
Flu-like
1 organism
4-21days
100 ng
1-5 days
Flu-like
muscle
w eakness
Flu-like
4 w eeks
days to
w eeks
Low 2-10%
Low 4%
High 30%
Yes
Yes
Yes
Animal
Varients
7-16 days
low
Yes
High
Marburg 25%
Ebola 50-90% Yes
24-72 hours
High 30%
Yes
Bioterrorism Basics
Events 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 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 Basics
What 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)
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.
29
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
Phillip L. Coule, M.D.
30
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
Fred T Muwanga MD Msc
• 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.
Biological Terrorism - A New Trend?
• 1978:
• 1979:
•
•
•
•
•
•
•
•
•
1984:
1991:
1994:
1995:
1995:
1997:
1998:
1998-9:
2001:
Bulgarian exile injected with ricin in London
Sverdlovosk, USSR – accidental anthrax
released – 40 fatalities
Oregon, Salmonella – Rajneeshee cult
Minnesota, ricin toxin
Tokyo, Sarin and biological attacks
Arkansas, ricin toxin
Indiana, Y. pestis purchase
Washington DC, ‘Anthrax/plague’ hoax
Nevada , nonlethal strain of B. anthracis
Multiple ‘Anthrax’ hoaxes
Anthrax Outbreak USA
Casualties
Incident
Number of Cases
Number of deaths
Polish Resistance
Not reported
200 Germans
Mau Mau
Not reported
33 head of cattle
Dark Harvest
Rajneeshes
AUM Shrinkyo
Dr.Suzuki
None
None
751
(45 hospitalised)
5500 ( 641 seen at
SLIH* on day 1 &
349 following week)
200
no deaths
22
4 deaths
Anthrax(USA)
Fred T Muwanga MD Msc
106 hospitalised at
SLIH. 12 deaths (2
at SLIH)
4 deaths
Motive for bioterrorism
Incident
Motive
Polish resistance Resistance against foreign occupation
MauMau
Resistance against colonialism
Dark Harvest
Send a political message
Win a local election by incapacitating the
non-Rajneeshee voters
AUM Shrinkyo Seize control of Japan through mass
murder, causing fear and apprehension
Revenge for unfair treatment he received
Dr.Suzuki
at the medical training
Anthrax (USA) Inculcate fear
Rajneeshes
Fred T Muwanga MD Msc
Lessons learnt
• Motives for bioterrorism • There are various methods
of dissemination:
vary and could include:
- murder(Aum Shrinkyo)
Direct application
(Dr.Suzuki)
- gaining political mileage
(Mau Mau and Dark
Food or water
harvest)
contamination (Rajneeshes)
- desire for revenge
Aerosol contamination
(Dr.Suzuki)
(Aum Shrinkyo and
- Cause fear (Anthrax cases) anthrax cases)
- Incapacitation (Rajneeshes) • The effects of bioterrorism
- anti-agriculture (Mau Mau) can be immediate(illness
and death) or long term
• Terrorists do not usually
(Post-stress disorder)
announce their intent
• secondary contamination can
occur (SLIH workers)
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
Preparation
5 years
Execution 1 day
Diagnosed case 3 days
First Death
Multiple deaths
Terrorism takes much
Time and planning