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The Role of Information Technologies and Science in the Prevention of Bioterrorism: 

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

Slide2: 

Novosibirsk, Ebola Virus Laboratory, Vector

Steps in Developing of Russian/FSU Supercourse:: 

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

Slide5: 

15 countries in FSU Supercourse

Communications between members : 

Mailing list Sharing of lectures Personal E-mail contacts Personal meetings Communications between members

Our Help for Russian/ FSU Public Health Teachers : 

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

Slide8: 

(www.pitt.edu/~super1/national/index.htm)

Biological terrorism: 

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

Types of Terrorism : 

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: 

Methods of Terrorism Firearms Explosive and Incendiary Devices Chemical Agents Biological Agents Nuclear Weapon

Slide13: 

J. David Piposzar, Allegheny County Health Department

Slide14: 

J. David Piposzar, Allegheny County Health Department

Definition of bioterrorism : 

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 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 emerging threats Fred T Muwanga MD Msc

Questions for reflection: 

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: 

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: 

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: 

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: 

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: 

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: 

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: 

Agents of Bioterrorism Biological Toxins Botulinum Toxins Staphylococcal Enterotoxin B Ricin Mycotoxins (T2)

Characteristics of BT Agents: 

Characteristics of BT Agents Chotani, 2003

Bioterrorism Basics: 

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: 

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: 

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?: 

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

Is this something new?: 

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

Reported Cases of Bioterrorism : 

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 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. Fred T Muwanga MD Msc

Biological Terrorism - A New Trend?: 

Biological Terrorism - A New Trend? 1978: Bulgarian exile injected with ricin in London 1979: Sverdlovosk, USSR – accidental anthrax released – 40 fatalities 1984: Oregon, Salmonella – Rajneeshee cult 1991: Minnesota, ricin toxin 1994: Tokyo, Sarin and biological attacks 1995: Arkansas, ricin toxin 1995: Indiana, Y. pestis purchase 1997: Washington DC, ‘Anthrax/plague’ hoax 1998: Nevada , nonlethal strain of B. anthracis 1998-9: Multiple ‘Anthrax’ hoaxes 2001: Anthrax Outbreak USA

Casualties: 

Casualties Incident Number of Cases Number of deaths Polish Resistance Not reported 200 Germans Mau Mau Not reported 33 head of cattle Dark Harvest None None Rajneeshes 751 (45 hospitalised) no deaths AUM Shrinkyo 5500 ( 641 seen at SLIH* on day 1 & 349 following week) 106 hospitalised at SLIH. 12 deaths (2 at SLIH) Dr.Suzuki 200 4 deaths Anthrax(USA) 22 4 deaths Fred T Muwanga MD Msc

Motive for bioterrorism: 

Motive for bioterrorism Incident Motive Polish resistance Resistance against foreign occupation Mau Mau Resistance against colonialism Dark Harvest Send a political message Rajneeshes Win a local election by incapacitating the non- Rajneeshee voters AUM Shrinkyo Seize control of Japan through mass murder, causing fear and apprehension Dr.Suzuki Revenge for unfair treatment he received at the medical training Anthrax (USA) Inculcate fear Fred T Muwanga MD Msc

Lessons learnt: 

Lessons learnt Motives for bioterrorism vary and could include: - murder(Aum Shrinkyo) - gaining political mileage (Mau Mau and Dark harvest) - desire for revenge (Dr.Suzuki) - Cause fear (Anthrax cases) - Incapacitation (Rajneeshes) - anti-agriculture (Mau Mau) Terrorists do not usually announce their intent secondary contamination can occur (SLIH workers) There are various methods of dissemination: Direct application (Dr.Suzuki) Food or water contamination (Rajneeshes) Aerosol contamination (Aum Shrinkyo and anthrax cases) The effects of bioterrorism can be immediate(illness and death) or long term (Post-stress disorder) Fred T Muwanga MD Msc

Responses to Bioterrorism: 

Responses to Bioterrorism Early detection of active and potential cases Emergency measures to save lives Prevention and management of secondary contamination

Slide37: 

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