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Bioterrorism Basics (Biodefense) September 8, 2002 ASPH Conference : 

Bioterrorism Basics (Biodefense) September 8, 2002 ASPH Conference

History, origins, motivations, threats: 

History, origins, motivations, threats Differentials How conducted, launched, done Purpose – Motivation Clinical effects Teaching, Research, Planning and Preparedness differentials Detection Response & Treatment Containment

Violence Against Humans: 

Violence Against Humans

Examples of Terrorism: 

Examples of Terrorism Hostage-taking Aircraft piracy or sabotage Assassinations and kidnappings Threats and hoaxes Indiscriminate bombings Shootings High Explosives Weapons of Mass Destruction (WMD) vs. Weapons of Mass Casualties (WMC) Chemical, biological, radiological, nuclear, and explosives (CBRNE)

Scale of Attack and Response: 

Scale of Attack and Response (Small) (Medium) (Large)

Biological Warfare & Terrorism: 

Pre-Modern warfare - use of carcasses Early American colonial period WWI - Glanders WWII Japanese Unit 731 UK - US fear of Nazis Cold War - USSR; UK; US; France; PRC “Third World” - Iran; Iraq; North Korea; Libya; Syria; … The Dalles, Oregon - 1984 Iran-Iraq War - 1980s Aum Shin Rykio - 1990s Anthrax – 2001 Biological Warfare & Terrorism

A Paradigm: Biowar -- Bioterror: 

A Paradigm: Biowar -- Bioterror BioWar Stereotypical attack scenarios Cold War Big attacks 100,000s BioTerror Unconventional attack scenarios Creative terrorism “New” “War” Small attacks 10 – 100 Change: move away from big bio war to small bioterrorism, creative terrorism Implications for detection, response and containment

TERRORISM: 

TERRORISM CREATES CASUALTIES TRAUMATIZES POPULATION PRESSURES LEADERS ATEMPTS TO TEAR CIVIL SOCIETY AND DEMORALIZE IT INSPIRES TERRORIST AND THEIR BASE Courtesy: Ken Thompson, M.D.

Terrorism: 

Terrorism Easier to describe than define One definition: Unlawful [criminal] use or threat of violence against persons or property to further political or social objectives Intent is to intimidate or coerce a government, individuals or groups to modify their behavior or policies (VP Bush, Terrorism Task Force Report, February 1986) Unexpected attack against unwarned, unprotected civilians to cause death or provoke fear and panic (not just against U.S. persons)

Sources of Terrorist Attacks : 

Sources of Terrorist Attacks U.S. persons (OKC, Rashneesh, Anthrax) Self-supported (home grown, racist, identity, environmental, Aryan Nation, Neo-Nazis, millennial, disaffected, ....) Non-U.S. persons (Aum Shinrikyo) Trans-national (religious, ethnic, tribal, “nucs on the loose,” ....) Foreign government or organizations hostile to U.S. (World Trade Center) State-sponsored (Iraq, Sudan, Libya, ....) Foreign government in support of an armed conflict with the U.S. Theft from industry or research Sources: foreign and domestic

Who is the Bioterrorist?: 

Who is the Bioterrorist? Ability Intent Opportunity Benefit Not just the kid next door

Important Points: 

Important Points Terrorists becoming increasingly violent and indiscriminate; religious and cultural reasons Not big leap from big bomb mass casualties to biological agents Bioterrorism: attacks on non-combatants Purpose: panic, fear, traumatize public, pressure leaders Sources: foreign and domestic Coordination and collaboration among government and academia needed

A Date to Remember An Attack in America: 

A Date to Remember An Attack in America October 5, 2001 First U.S. death from anthrax caused by terrorism; a date to remember

CBRNE: 

CBRNE They’re not all the same!

Got to Rethink: 

Got to Rethink Detection: release, illness, clinician, laboratory, autopsy Response: local and State, then Federal support Containment: isolation, decon, respiratory support What are the implications? Research Education Clinical (Practice and Service) Application

Bioterror Preparedness and Response Functions: 

Bioterror Preparedness and Response Functions Planning Detection Response Containment Follow-up

Bioterror Planning Needs: 

Bioterror Planning Needs Understand Threats Policy Hospital and Clinic Capacity, Cost and Impact Modeling Mutual Aid Agreements Health and Emergency Services Departments Metropolitan Medical Response System (MMRS) Education and Training Stockpiling Research Legal and Law Enforcement Public Information

Bioterror Detection Needs: 

Bioterror Detection Needs Symptom and Patient Surveillance Pattern Recognition Laboratory Capabilities Education and Re-Education of Clinicians Sensors and Diagnostics Computer-Based Surveillance Autopsy Results

Detection: 

Detection Law Enforcement and Intelligence: Foreign and domestic intelligence; law enforcement; pathogen registration and controls Agent release: Air-breathing samplers; mail sorting Illness: Work and school absences; purchases; prescriptions Clinical visit: Doctor and nurse education and recognition input to a Realtime Outbreak Disease Surveillance System (RODS); Laboratory workup: Good microbiology; suspicion; technology available Autopsy: Suspicion; not natural; age; history; Agent release Illness Clinical visit Laboratory workup Autopsy Law Enforcement +Intelligence

How Do We Know We’ve Been Attacked?: 

How Do We Know We’ve Been Attacked? Detect agent release Air-breathing sensors Many sensors Networked solution Wide geographic area Logistically complicated Detect illness Emergency rooms Diagnostic skills One out of many Proper recording Syndromic surveillance Who to warn and treat? How to warn? How to protect?

Bioterror Response Needs: 

Bioterror Response Needs Case Treatment and Protocols Epidemiological Investigations Hospital Care Non-Medical Facility Care Long-Term Care Psychiatric and Risk Communications Non-UPMC-HS Relations Local and mutual aid planning Relations with State and Federal assisters Health and Emergency Services Departments Mortuary

Bioterror Containment Needs: 

Bioterror Containment Needs Identify Population at Risk Infection Control Contagious Disease Control Decontaminate Public Health Education Medical Research

Bioterror Follow-up Needs: 

Bioterror Follow-up Needs Investigations Legal Apprehension Prosecution Financial and Health Economics

Slide25: 

Clinician: What is your diagnosis? Contact dermatitis? Teen-age acne? Smallpox (Variola)? Courtesy: Dr. Michael Allswede Herpes? Measles? Chickenpox?

Slide26: 

Diagnosis -- Smallpox (Variola) Courtesy: Dr. Michael Allswede

Slide27: 

At any given time, about 60% of the world’s population is awake. Some of them are up to no good. Courtesy: Dr. Michael Allswede

Definitely a Date to Remember: October 5, 2001 : 

Definitely a Date to Remember: October 5, 2001 Changed the way we look at threats to health and security A new multi-faceted integrated approach needed for preparedness and response against terrorists using biological pathogens B. anthracis, gram stained spores

In Pittsburgh we’ve tackled bioterrorism: 

In Pittsburgh we’ve tackled bioterrorism Education -- developing curricula in MPH program; teaching, resource; community groups; students; outreach; lecture program; Certificate in Public Health Preparedness and Disaster Management Research -- in terrorism preparedness and response Service / Practice -- to the Pittsburgh community in mass casualty response planning; MMRS; education; resource to local planners, elected officials and local and State Health Departments; hospital preparedness Create a catalyst and create synergy for the region and nation

President’s Visit to the University of Pittsburgh – February 5, 2002: 

President’s Visit to the University of Pittsburgh – February 5, 2002 Dr. William Pasculle and Ms. Liz Forster– UPMC Microbiology Laboratory

Contact Information:: 

Contact Information: Samuel J. Watson 412-383-7985 / 7475 412-624-3040 (fax) watsons@pitt.edu c/o University of Pittsburgh 130 DeSoto Street Room A730 Crabtree Hall Pittsburgh, Pennsylvania 15261 USA