An Overview of Bioterrorism. SAEMS January 30, Charles A. Schable, M.S. Institutional Biosafety Committee University of Arizona

Transcription

1 An Overview of Bioterrorism SAEMS January 30, 2008 Charles A. Schable, M.S. Institutional Biosafety Committee University of Arizona

2 Bioterrorism Intentional or threatened use of viruses, bacteria, fungi, or toxins from living organisms to produce death or disease in humans, animals, or plants

3 Anthrax Bioterrorism United States, Oxford, CT 11/20 2. New York City 10/12 4. Trenton, NJ 10/17 3. Washington, DC 10/15 1. Palm Beach County 10/3

4 Using the Postal System for an Anthrax Attack, 2001

5 History of Biological Warfare 18th Century: Smallpox Blankets

6 History of Biological Warfare 20th Century: 1943: US bio-warfare program launched 1953: Defensive program established 1969: Offensive program disbanded

7 Biological Warfare Agreements 1925: Geneva Protocol 1972: Biological Weapons Convention 1975: Geneva Conventions Ratified

8 Biological Warfare Today

9 Biological Terrorism - A New Trend? 1979: Russia, Anthrax release 1984: Oregon, Salmonella attack 1994: Tokyo, Sarin attacks 1995: Arkansas, Ricin toxin threat 1996: Texas, Shigella attack 1997: Washington DC, Anthrax threat 1998-present: Numerous Anthrax threats

10 Advantages of Biologics as Weapons Infectious via aerosol Organisms fairly stable in environment Susceptible civilian populations High morbidity and mortality Person-to-person transmission (e.g., smallpox) Difficult to diagnose and/or treat Previous development for BW

11 Advantages of Biologics as Weapons Easy to obtain Inexpensive to produce Potential for dissemination over large geographic area Creates panic Can overwhelm medical services Perpetrators escape easily

12 Terror-Producing Aspects Public concern and uncertainty Availability of treatment Treatment effectiveness Disease transmission Personal vulnerability Contagious nature of fear Poor coping due to feelings of helplessness

13 The Biological Agents

14 Anthrax: Overview Bacillus anthracis Primarily disease of herbivores Natural transmission to humans by contact with infected animals or contaminated animal products Three Kinds Cutaneous Inhalational Gastrointestinal CDC: Gram stain of B. anthracis

15 Anthrax: Epidemiology Agricultural: Farm workers exposed to animals (rare) Non-industrial: Laboratorians exposed to B. anthracis spores or civilians exposed to animal products (rare) Industrial: Processors of wool, hair, hides, bones or other animal products (now extremely rare) Biological terrorism No person-to-person transmission of inhalational anthrax

16 Cutaneous Anthrax Lesion

17 Anthrax: Gastrointestinal Intestinal eschar similar to cutaneous anthrax lesion hemorrhagic Progression to generalized toxemia Mortality rate % despite treatment Intestinal lesion of GI anthrax Source: CDC

18 Anthrax: Inhalational Inhalation of spores Animal products mills that process goat hair Weaponized spores infectious particle < 5 microns Incubation: 1 to 43 days Onset in 2-20 days fever, cough, myalgia, malaise Highly fatal almost 100% even with treatment CXR with widened mediastinum of inhalational anthrax Source: CDC

19 Smallpox: Overview Global eradication Humans were only known reservoir Person-to-person transmission (aerosol/contact) Up to 30% mortality in unvaccinated CDC: Electron micrograph of Variola major

20 Smallpox: Clinical Features Prodrome (incubation 7-17 days) Acute onset fever, malaise, headache, backache, vomiting Transient erythematous rash

21 Smallpox: Clinical Features Exanthem (Rash) Begins on face, hands, forearms spreads to lower extremities then trunk. Synchronous progression: macules papules vesicles pustules scabs scars Later stage facial lesions of smallpox

22 Plague: Overview Yersinia pestis Natural vector - rodent flea Mammalian hosts rats, squirrels, chipmunks, rabbits, and carnivores CDC: Wayson s Stain of Y. pestis showing bipolar staining

23 Types of Plague Three types: Bubonic Septicemic Pneumonic

24 Plague: Overview About total cases/year in U.S. Mainly SW states Bubonic most common form Only 1-2 cases/yr. of pneumonic form

25 Tularemia: Overview Francisella tularensis Disease of Northern Hemisphere In U.S., most cases associated with rabbits/hares (winter) and ticks (summer) About cases/year in U.S. most in South central and Western states majority of cases in summer (tick exposure) Recent outbreak among prairie dogs: Texas, 2002

26 Tularemia: Overview Low infectious dose 1 to 10 organisms by aerosol or intradermal route No person-to-person transmission

27 Botulism: Overview 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 1ng/kg)

28 Botulism: Overview C. botulinum spores found in soil worldwide Approximately 100 reported cases/year in the U.S. infant most common (72%) Food-borne not common No person-to-person transmission

29 Viral Hemorrhagic Fevers (VHF): Overview Caused by several different virus groups Filoviruses (Ebola, Marburg) Arenaviruses (Lassa, Junin, Machupo, Sabia, Guanarito) Bunyaviruses CDC: Electron micrograph of Ebola virus

30 Viral Hemorrhagic Fevers (VHF): Overview Natural vectors - virus dependent rodents, mosquitoes, ticks No natural occurrence in U.S.

31 Public Health Response to Bioterrorism

32 Priorities for Public Health Preparedness Emergency Preparedness and Response Enhance Surveillance and Epidemiology Enhance Laboratory Capacity Enhance Information Technology Stockpile

33 Government Response to a Bioterrorist Attack USDA FEMA AIT CDC FBI NIH USAMRIID DHHS DoD PHHS DoT C/B-RRT? NRL DoE NMRI SBCCOM EPA ATSDR

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35 Public Health Response to Bioterrorism Detection, timely reporting, & surveillance Rapid laboratory diagnosis Rapid epidemiologic investigations and enhanced surveillance Emergency public health interventions

36 CDC s Strategic National Stockpile To maintain a national repository of life-saving pharmaceuticals and medical materiel that will be delivered to the site of a chemical or biological terrorism event in order to reduce morbidity and mortality in civilian populations.

37 Front Line Response Begins at the Local Level

38 Public perception is important.. Combined Response Efforts are a Must!

39 Information Resources Your local or state health department CDC Public Health Emergency Preparedness and Response Johns Hopkins Center for Civilian Biodefense Strategies