Download CHEMICAL AND BIOLOGICAL WARFARE AND TERRORISM

CHEMICAL AND
BIOLOGICAL WARFARE
AND TERRORISM
By LCDR Rita McCarthy, MSC, USN
Pharmacist
Early Biological Warfare
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The use of filth, dead human bodies, animal
carcasses, and contagion to cause disease in
the enemy camps or cities
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400 BC Scythian archers dipped arrows in blood,
manure, and dead bodies
1346 Siege at Kaffa: Tartar soldiers launched
bodies of their fellow soldiers who died of plague
over the wall into the city
Early biological continued
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1710 Russian troops used plague infected
bodies against Sweden
1767 French and Indian Wars (Colonial
America):
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The British Commander orders small pox infected
blankets to be given to the Indians loyal to the
French defending Fort Carillon
Modern Development of BW
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WWI: Germans infected horses with glanders that
were being sold to Allied forces
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Transferred from horses to humans
acute: coughing, fever and the release of an infectious nasal
discharge, followed by septicemia and death within days.
Chronic: nasal and subcutaneous nodules develop, eventually
ulcerating. Death can occur within months, while survivors act
as carriers.
1937-1945: Japan had program with live subjects in
Manchuria
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Chinese, Russian, and American prisoners of war; tens of
thousands die of bubonic plague, cholera, anthrax and other
diseases
Accidentally infected own military units on multiple occasions
Biological Warfare
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The intentional use of disease producing
microorganisms or biologically derived toxins
as weapons to kill or injure humans, animals,
or plants
Bio-Terrorism
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The use of (or a threat to use) a biological or
chemical agent by an individual or a group in
order to intimidate or coerce a government of
a society in the pursuit of political, religious,
ecological, or other ideological objectives
Why use Chem/Bio agents for terror?
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Cost
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Biological agent
Chemical agent
Conventional explosive
$1
$600
$2000
Easily produced
Difficult to detect
FEAR & TERROR OF GENERAL PUBLIC!
Classification of Agents of Biological
Origin
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Pathogens
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BACTERIA
Viruses
Toxins
Bacteria
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Mechanism of disease
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Invasion and infection of tissue
Produce toxins
Prevention
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Immunization
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Active: vaccine
Passive: from mother to child
Treatment
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Specific antibiotics
What makes a good biological agent?
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Availability and ease of production
Incapacitate or lethal?
Particle size
Ease of dissemination
Stability after production
Susceptibility of population
Bacterial Agents
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Anthrax
Plague
Tularemia
Brucellosis
Q Fever
Anthrax
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Bacillus anthracis
1876: first disease for which a microbial
cause was established (Koch)
1881: Attenuated spore vaccine for livestock
1949: human vaccine developed (licensed in
1970)
Why use Anthrax as a Weapon?
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Easy to produce in large quantities
Spores can be spread by aerosol
Short incubation period
Highly lethal
Anthrax Epidemiology
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Reservoir: Soil
Herbivores infected during grazing
Transmission to humans
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Contact with contaminated animals, hides, wool
Ingestion of contaminated meat
Inhalation of dust with spores
Annual incidence: 2,000 cases world-wide
Anthrax Pathogenesis
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Spore enters the body
Germinates and transported to lymph nodes
Local production of toxins lead to edema and
tissue destruction
Spread from lymph nodes…bacteria and
toxin into blood
Inhalation Anthrax
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Incubation period: 1-7 days
Initial symptoms: mild and flu-like
Followed by shortness of breath, labored
breathing, rapid heart rate
Rapid progression to shock and death if not
treated soon enough
Treatment of Anthrax
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High does antibiotics
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Ciprofloxacin
Doxycycline
Penicillin
Plague
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Bubonic
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Malaise, high fever, tender lymph nodes
If untreated:
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Blood poisoning, death
Pneumonic
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High fever, chills, headache, coughing up blood,
blood poisoning
If untreated:
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Respiratory failure, circulatory collapse, heavy bleeding,
death
Tularemia
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Swollen glands, fever, headache, malaise,
weight loss, nonproductive cough
Generally not fatal
Brucellosis
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Can spread to humans if they come in
contact with infected animals, or by eating or
drinking unpasteurized milk or cheese.
May begin with mild flu-like symptoms,
muscle pain, swollen glands
May be chronic and last for years
Generally not fatal
Q Fever
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Fever, cough, chest pain
Generally not fatal
Viruses
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Smallpox
Ebola
Venezuelan Equine Encephalitis
Yellow Fever
Smallpox History
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1500s: >3.5 million die after Europeans
introduce smallpox to the New World
1796: Vaccine developed by Jenner
1813: Madison encouraged vaccination
1949: last outbreak in the US
1960: Worldwide eradication program
1980: WHO declares earth free of smallpox
Smallpox as a BW or Terrorist Threat
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Highly communicable disease (person-toperson transmission)
Vaccine use discontinued…makes a target
population that is susceptible
Smallpox
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Incubation 7-14 days
Fever, headache, general illness, vomiting
Skin “seeded” with virus
Scabs form 8-14 days after onset
Scabs infectious
Medical Management
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Confirm
Quarantine all cases
Vaccination of all contacts: available from the
CDC
Toxins
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Saxitoxins and Conotoxins: marine animals
Botulinum: bacteria
Mycotoxins: fungus
Snake venom
Ricin: plant
Toxin vs. Chemical Agents
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Natural origin
Stable
More toxic
Legitimate medical use
Only one active on skin
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Man-made
Less stable
Less toxic
Only use is weapons
All active on skin
Botulinum Toxin
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Clostridium botulinum
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Tetanus
Botulism
One of the most toxic substances known
Neurotoxin
The toxin has a legitimate medical use
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Botox
Treat muscle contractions and can offer relief from
sweating of the hands, feet and underarms
Clinical Symptoms of Botulism
3rd day post-exposure
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Mucous in throat
Difficulty swallowing
Feels like a cold
No fever
Blurred vision
4th day post-exposure
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Mental numbness
Slow eye movements
Dilated pupils
Indistinct speech
Difficulty walking
Extreme weakness
“Floppy Paralysis”
Medical Management
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Vaccine is available but general use is not
necessary
Treat with immunoglobulin before onset of
symptoms (from the CDC)
May need to assist with breathing if severely
affected or treatment not started in time
May lead to death
Saxitoxins
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Paralytic Shellfish Poisoning:
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From eating shellfish contaminated by "red tides" or
algal blooms
Symptoms: tingling, numbness, weakness, limb
paralysis
Onset of symptoms: almost immediate;
exposure by inhalation leads to extremely
rapid development of symptoms with death
occurring within minutes if not treated.
Conotoxins
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Paralytic poisons from Pacific cone snails
Symptoms: burning pain; local numbness,
spreading rapidly to involve the entire body but
without pain; some cardiac and respiratory
distress at the height of the poisoning
Onset of symptoms: almost immediate upon
injection from the snail
Mycotoxins
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Produced by microfungi that are capable of causing
disease and death in humans and other animals
Some used as antibiotics, growth promotants, and
other kinds of drugs; still others have been implicated
as chemical warfare agents
Severity of mycotoxin poisoning can be compounded
by other illnesses; mycotoxicoses can heighten
vulnerability to microbial diseases, worsen the effects
of malnutrition, and interact synergistically with other
toxins
Almost no treatments for mycotoxin exposure
Ricin
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Protein toxin from castor beans
Plant found world-wide
Toxin is fairly easy to produce
Castor oil used as lubricant for motors
Symptoms of Ricin Poisoning
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Oral ingestion: least toxic (8-10 hours)
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Bleeding and tissue damage in GI tract
Nausea, vomiting, diarrhea, cramps
Inhaled: most common
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Nausea, vomiting, diarrhea, cramps, dilated
pupils, fever, headache
Shock, edema, pneumonia
Death on 3rd or 4th day!
Medical Management
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Identify if toxin, asthma, or chemical poisoning
Supportive care
For oral ingestion: administer activated
charcoal to absorb toxin
No anti-toxin or immunization yet
Chemical Agents: Early Chemical Warfare
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423 BC Sparta used toxic and irritant smoke to
capture a fort held by Athenians
700 AD Greeks invent and use “Greek Fire” (pitch,
sulfur, and rosin) which floated on water to set
enemy ships on fire
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Pitch: a viscous substance produced by plants or formed
from petroleum
Sulfur: used to make gun powder
Rosin: type of resin
15th and 16th Centuries: Venice used poison chests
to contaminate water
Modern Chemical Warfare
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1st gas attack: April 22, 1915
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WWII no confirmed use by Germany on the
battlefield, however, cyanide and other
gasses were used in concentration camps
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Chlorine gas used by Germany in Belgium
Cyanide makes the cells of an organism unable to
use oxygen
1980’s Iraq used chemical agents against
Iran and against it’s own people (Kurds)
Chemical Agents
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Lethal (toxic) agents
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Nerve agents
Choking agents
Blood agents
Blister agents
Incapacitating agents
Irritants
Chemical Agents
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Solid
Liquid
Gas
Persistent: effective for >12 hours
Non-persistent: inactivated <12 hours
Nerve Agents
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Sarin (GB)
Soman (GD)
Tabun (GA
GF
VX
Sarin
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Lethal agent
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Developed in 1940s by Germany
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Original use was an insecticide
Causes death by asphyxiation
Is a liquid at room temperature
Soman, Tabun, and VX
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Lethal agents
Soman: synthesized by Germany in 1944;
similar to sarin
Tabun: synthesized by Germany in 1936
VX developed by USA
Victims of Soman, Tabun, and VX ,make it
harder to treat casualities than with Sarin
Physical Properties
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Clear colorless liquids (when fresh)
Not nerve gas!
Tasteless: each has identifiable odor
May be spread by fine vapor “gas” or as a
liquid on skin
Onset of symptoms within seconds to
minutes
Large exposure can cause death
Nerve Agents
Symptoms
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Pinpoint pupils
Sweating
Drooling & runny nose
Convulsions
Involuntary urination
Coma
Possible death
Treatment
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Decontamination
Atropine
Assist with breathing
Anti-seizure drugs
Choking Agents
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Chorine and Phosgene
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Developed and used during WWI
Head delayed reation time
Causes lung damage
Can cause blindness if gets into eyes
Gas or liquid
Blister Agents
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Mustard (H)
Nitrogen Mustard (HN)
Lewisite (L)
Phosgene oxime (CX)
Causes skin blisters
Usual/ly does not kill
Others
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Blood agent
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Incapacitating agents
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cyanide
Psychological effects (LSPD and BZ)
Riot control agents
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Peper spray, tear gas, mace
Treatment
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Decontamination
Special antidotes
Anti-convulsant drugs
Supportive care