BT Reality of Threat 070918

BIOTERRORISM  Reality of the Threat: 

BIOTERRORISM Reality of the Threat MM&I 554 09/18/06

Terrorism – Why?: 

Terrorism – Why? Create terror, panic, uncertainity/uneasiness Advance political/religious/apocalyptic beliefs Asymmetrical response a.k.a. “even the playing field” Doable and affordable Effective

TerrorismMethods of Choice: 

Terrorism Methods of Choice

BIOTERRORISM: The intentional or threatened use of microorganisms or biologic toxins to kill or incapacitate people, animals or crops. : 

BIOTERRORISM: The intentional or threatened use of microorganisms or biologic toxins to kill or incapacitate people, animals or crops. Everything you want to know: www.bt.cdc.gov www.asm.org/Policy/index.asp?bid=6342

The Threat of Biological Terrorism: 

The Threat of Biological Terrorism ”This is the real deal!” VS “This is an unlikely threat”

Advantages of Biologics as Weapons: 

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

Bioterrorism: 

Bioterrorism U.S. vulnerability Emergency Response and PH infrastructure Historical precedence

BIOLOGICAL AND CHEMICAL TERRORISM AND WARFARE: A Historical Perspective: 

BIOLOGICAL AND CHEMICAL TERRORISM AND WARFARE: A Historical Perspective Early Attempts 429 BC - Spartans ignite pitch and sulfur to create toxic fumes in the Peloponnesian war. 1346-47 - Mongols catapult corpses contaminated with plague over the walls into Kaffa. 1763 - During the French and Indian wars, the British give small pox - contaminated blankets to hostile Indian tribes.

BIOLOGICAL AND CHEMICAL TERRORISM AND WARFARE: A Historical Perspective: 

BIOLOGICAL AND CHEMICAL TERRORISM AND WARFARE: A Historical Perspective Modern Era (I) 1914-1918 - Widespread use of BW and CW during WWI June 17, 1925 - “Geneva Protocol for the Prohibition of the Use in War of Asphyxiating, Poisonous or Other Gases and of Bacteriological Methods of Warfare.” 1932-1945 - Japan conducts BW research 1940 - Japan uses BW on China and Manchuria 1942 - U.S. begins offensive BW program

BIOLOGICAL AND CHEMICAL TERRORISM AND WARFARE: A Historical Perspective: 

BIOLOGICAL AND CHEMICAL TERRORISM AND WARFARE: A Historical Perspective Modern Era (II) 1969-70 - President Nixon unilaterally dismantles U.S. offensive BW and CW programs April 10, 1972 - “Convention on the Prohibition of the Development, Production and Stockpiling of Biological and Toxin Weapons and on Their Destruction.” , “The BWC” is developed 1972 to present - Suspected or proven violations of the BWC

For some sleepless nights…www.nlm.nih.gov/nichsr/esmallpox/biohazard_alibek.pdf: 

For some sleepless nights… www.nlm.nih.gov/nichsr/esmallpox/biohazard_alibek.pdf

Bioterrorism: 

Bioterrorism U.S. vulnerability Emergency Response and PH infrastructure Historical precedence Capabilities exist worldwide

Bioterrorism: 

Bioterrorism U.S. vulnerability Emergency Response and PH infrastructure Historical precedence Capabilities exist worldwide Actual BT Events

President Clinton’s Awakening?: 

President Clinton’s Awakening?

U.S. Incidents of Bioterrorism (I): 

U.S. Incidents of Bioterrorism (I) When: September - October, 1984 Where: The Dalles, Oregon What: Contamination of salad bars with Salmonella Typhimurium Who: Members of the Rajneeshi religious commune Why: Incapacitate voters in upcoming election Outcome: 751 ill, 45 hospitalized, 0 deaths

U.S. Incidents of Bioterrorism (II): 

U.S. Incidents of Bioterrorism (II) When: November, 1996 Where: Texas What: Contamination of muffins with Shigella dysenteriae, medical center lab - staff breakroom Who: ? Why: ? Outcome: 12/45 staff ill, 4 hospitalized, 0 deaths

Anthrax 2001: 

Anthrax 2001

Anthrax 2001: The Outcome: 

Anthrax 2001: The Outcome 4-5 letters containing anthrax spores sent in mail 4 regions initially affected in US Florida New York City / New Jersey Washington Metro Connecticut Mild contamination of other US postal facilities 22 human cases in US 11 inhalation (5 deaths) 11 cutaneous ~ 10,000 people prophylaxed Nationwide Effects Concerns/panic

 BIOTERRORISM AUTUMN 2001A Living Laboratory: 

BIOTERRORISM AUTUMN 2001 A Living Laboratory Inglesby, T.V., etal. Anthrax as a biological weapon, 2002: updated recommendations for management. JAMA, 2002; 287:2236-52 (http://pubs.ama-assn.org/bioterr.html#anthrax) Multiple authors. Bioterrorism-Related Anthrax. Emerging Infectious Diseases, October, 2002; 8(10). (http://www.cdc.gov/ncidod/eid/index.htm)

What We Thought We Knew!: 

What We Thought We Knew! Our enemies would be source of BT agent Anthrax hard to weaponize, deliver in mass Spores stay put; e.g. no re-aerosolization Must open letter to get exposed >8,000 spores required to get sick A massive dose will invariably lead to disease Inhalation anthrax is 90% fatal Decontamination straightforward

ANTHRAX ATTACK2001: 

ANTHRAX ATTACK 2001 THE POWER OF PANIC

 A recent headline...: 

A recent headline... “Smallpox offensive: Vaccinations now” - HEADLINE, WISCONSIN STATE JOURNAL, SEPTEMBER 2002 - ...who’d a thunk it!

SMALLPOX -Why is it a threat?: 

SMALLPOX -Why is it a threat? Potential clandestine stockpiles Satisfy most criteria of a good BW Aerosol infectivity; highly infectious Communicability Long incubation period Potential for large scale production Highly pathogenic; high mortality Lack of population immunity Limited vaccine *; no treatment Very limited diagnostic capability* Induce panic * No longer the case

Smallpoxhttp://www.bt.cdc.gov/agent/smallpox/index.asp: 

Smallpox http://www.bt.cdc.gov/agent/smallpox/index.asp

SMALLPOX Prevention and Control - 2007  : 

SMALLPOX Prevention and Control - 2007 Vaccination Pre-exposure Preventive Vaccination Post-release Vaccination Ring Vaccination and mass vaccination Community Containment Strategy Identify cases Isolate cases Critical to break chain of transmission Isolate at home if possible Institutional isolation Designated hospitals Hotels, old nursing homes, etc. Observation of close contacts for 17 day Fever (> 101°) watch Is forced quarantine acceptable, doable?

Laboratory DiagnosisAcute Generalized Vesicular or Pustular Rash Illness Protocol: 

Laboratory Diagnosis Acute Generalized Vesicular or Pustular Rash Illness Protocol

Biological and Chemical Terrorism: 

Biological and Chemical Terrorism ”This is the real deal!” VS “This is an unlikely threat”

Biological and Chemical TerrorismAn Unlikely threat?: 

Biological and Chemical Terrorism An Unlikely threat? Infrequent use of CBW Technical difficulties Need for a “weapons system” Moral and social constraints Hazard to perpetrator Unpredictability Fear of retribution … but don’t forget Autumn of 2001!

BIOLOGICAL and CHEMICAL TERRORISM: 

BIOLOGICAL and CHEMICAL TERRORISM The bottom lines: “ The threat is very real!” “A low probability, high consequence threat” “It will happen somewhere, sometime…again!” “BT preparedness and response planning is a national public health priority” “…but preparedness should follow an ‘all-hazards’ philosophy.”

MMWRRecommendations and ReportsApril 21, 2000 /Vol. 49 / No. RR-4: 

MMWR Recommendations and Reports April 21, 2000 /Vol. 49 / No. RR-4 Biological and Chemical Terrorism: Strategic Plan for Preparedness and Response Recommendations of the CDC Strategic Planning Workgroup

Priority Bioterrorism Agents: 

Priority Bioterrorism Agents Category A Agents Anthrax (Bacillus anthracis) Botulism (Clostridium botulinum toxin) Plague (Yersinia pestis) Smallpox (variola major) Tularemia (Francisella tularensis) Viral hemorrhagic fevers (e.g., Ebola, Marburg, Lassa) Category B Agents Brucellosis (Brucella) Epsilon toxin of C. perfringens Food Threats (e.g., Salmonella, E. coli O157:H7, Shigella) Glanders (Burkholderia mallei) Melioidosis (Burkholderia pseudomallei) Psittacosis (Chlamydia psittaci) Q Fever (Coxiella burnetii) Ricin toxin from castor beans Staphylococcal enterotoxin B Typhus fever (Rickettsia prowazekii) Viral encephalitis (e.g., VEE, EEE) Water threats

CDC Program Announcement 99051Public Health Preparedness & Response to BioterrorismEMERGENCY SUPPLEMENTAL: 2002-2006: 

CDC Program Announcement 99051 Public Health Preparedness & Response to Bioterrorism EMERGENCY SUPPLEMENTAL: 2002-2006 Preparedness Planning and Readiness Assessment Surveillance & Epidemiology Capacity Laboratory Capacity - Biological Agents Laboratory Capacity - Chemical Agents Health Alert Network Communication and Health Information Dissemination Education and Training

EID Threats of the New Millennium“Mother Nature is the Ultimate Bioterrorist”: 

EID Threats of the New Millennium “Mother Nature is the Ultimate Bioterrorist” “Avian Flu” and the threat of Pandemic Influenza XDR tuberculosis E.coli 0157:H7/Salmonella “Novel pathogens”: Bocavirus, Chikungunya virus Community-acquired MRSA/ “Epidemic” C. difficile Norovirus – “Not just the cruise ship virus anymore” Mumps Pertussis (“Whooping Cough”) Monkeypox SARS West Nile Virus Anthrax, ricin and other bioterrorism agents