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Biologic Weapons in War

Biologic Weapons in War. The use of germs to kill, immobilize or demoralize the Enemy. It WILL happen. Again. Vicken Y. Totten MD, MS FACEP. Warfare agents. Projectiles and explosives – physical injuries incompatible with life Chemical and nuclear – poisoning incompatible with life

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Biologic Weapons in War

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  1. Biologic Weaponsin War The use of germs to kill, immobilize or demoralize the Enemy. It WILL happen. Again. Vicken Y. Totten MD, MS FACEP

  2. Warfare agents • Projectiles and explosives – physical injuries incompatible with life • Chemical and nuclear – poisoning incompatible with life • Eco devastation – the environment will no longer sustain human life • Carthage • Genetic imperialism • Rape and forced impregnation change a genome • “Germ Warfare”

  3. Purpose of bioterrorism • To instill fear, change lifestyles • Immobilize populations • Waste resources • Occupy trained personnel • Weaken the Enemy

  4. Germ Warfare (BioWar) • Different agents have different infectious dose, germ survival in the environment, effectiveness, availability & LD-50, but: all should be feared. • Psychological impact almost as lethal as their physical effects. • Hot zones where contracting these germs means sure but slow! and contagious! death. • 1 to 2 weeks turn your body into liquefied, virus - infected tissue culture. You • Hemorrhage virus infected blood: potential to wipe out 20-99% of population

  5. The Salt Lake Tribune (5/12, May) “ if "a killer flu strikes, with several thousand sick or injured and no room to spare in understaffed hospitals, care will be denied to the sickest adults and children." Individuals "who are severely burned, have incurable and spreading cancer, fatal genetic diseases, end-stage multiple sclerosis or severe dementia will be turned away. They can be sent elsewhere for comfort care, such as painkillers, but they will not be treated for the flu, according to the guidelines.

  6. BioWeapons = Germ Warfare • Not new: used for thousands of years • What’s new is “Weaponizing” • increases virulence • Assists in spread by technology • Biologic capability is relatively inexpensive and widespread. • Risk of a serious bioterrorism incident.

  7. Serendipitous and deliberate • Zoonoses in the “New World” • Deliberate small pox in the New World • Actual infection is not even required: post attack, US anthrax hoaxes had many of the effects hoped-for from actual infections: Disrupting business, life styles and demoralizing the Enemy.

  8. Ashdod of the Philistines1320-1000 BC • I Samuel: The Philistines stole the Israelites’ Ark of the Covenant. • Rats (mice) appeared, then “the Lord’s hand on the people of Ashdod and its vicinity, throwing [the city] into a great panic. He afflicted the people of the city, both young and old, with an outbreak of tumors (emerods) in the groin.” • As a result, the Philistines returned the Ark of the Covenant with “five golden emerods and five golden mice.”

  9. Plague of Athens (430-426 BCE) • Thucydides’ “The Peloponnesian War” attributed the success of the war to the plague. • The plague arrived in the first days of summer, during the second year of the war, at the same time as Archidamus, son of the king of Lacedaemon.

  10. Plague of Athens • Spartans besieging the city were not affected by the disease. • Many Athenians died, and eventually capitulated. • Plague probably came by boat with the alleys up from Egypt, with immune soldiers.

  11. 14th and 15th century Europe. • Armies would fling diseased and decaying cadavers (especially of slaughtered enemy soldiers) over protective town walls to demoralize and sicken the besieged cities. • 1346 -1347. Tartars defeated Genoese army by catapulting plague-dead soldiers over the walls into Kaffa (Caffa), by the Black Sea • 1422. Lithuanians flung dead soldiers and 2000 cart loads of excrement into Carolstein. • These battles contributed to the 25 million victims of the European Black Plague

  12. THE BLACK DEATH PANDEMIC • Worst from 1346 and 1352 with outbreaks till 1800s • Killed 25 million people(1/3 of the world’s population at that time) • 30-60% of the populations of large cities died from the disease • final “foray” occurred in Marseilles in 1720. • Still around

  13. World War II British • tested anthrax in Gruinard Island off the coasts of Scotland. • Anthrax can live decades in soil. • Cleaning the Island years later was very costly.

  14. United States, Post WWII • 1950, Germany accuses US of releasing Colorado beetles over German crops. • China, North Korea, and the Soviet Union accused the US of using biological weapons during the Korean War.

  15. Second Sino-Japanese War • The Imperial Japanese Army bombed Ningbo with fleas carrying bubonic plague. • 1941. More plague-contaminated fleas airdropped by 40 planes onto Changde. • These operations caused epidemic plague outbreaks.

  16. United States 1980s • September 1984, The Dalles, OR, dozens got food poisoning: Salmonella enterica typhimurium. • 1st: Shakey’s Pizza. Later, 10 more restaurants. • More than 700 ill; the only hospital ran out of beds.  • CDC involved. Deliberate contamination was proved; the Rajneesh cult was suspected but never convicted.

  17. Weaponized Super-Germs vs common organisms • Small inoculums will infect large populations (highly infectious) • Easily transmitted from person to person: airborne better than contact. • Either lethal or prolonged illness with lasting morbidity (ties up Enemy resources and diverts them from War Effort; demoralizes) • Treatment: none

  18. Properties for “Maximum Credible Threat” • highly lethal & toxic • easily produced in large quantities. • environmental & aerosol stability • Dispersal capability to (1 mm to 5 mm particle size) • person to person communication • no treatment or vaccine.

  19. Potential human biological pathogens. • NATO handbook lists 39 agents including bacteria, viruses, rickettsiae, and toxins. • Biologic agents spread on their own; therefore, the “dose” needed is less. • Highly toxic poision, Ricin: 8 metric tons vs 1 kg anthrax for same number casualties

  20. Comparison * Not effective after symptoms develop

  21. Anthrax, Plague and Smallpox: best candidates Highly lethal: Anthrax, untreated anthrax > 80% die; Variola Major: 30% of unvaccinated patients die; Septicemic Plague 100% All can be produced in quantity Plague available world wide; no need to raid containment facilities Anthrax & Smallpox stable for aerosol transmission; Anthrax spores survive for decades; smallpox can be freeze-dried.

  22. All Weaponized. Iraq produced anthrax for use in Scud missiles; former Soviet Union produced smallpox virus by the ton; Japanese weaponized plague All uncommon diseases with non-specific initial presentation Delayed recognition will allow for secondary spread Vaccines poor or limited in availability.

  23. Treaties: honored in the breach • 1972 Biological Weapons Convention • Soviet Union in 1979 accidentally released anthrax • Iraq in 1995 had anthrax, botulinum toxin, and aflatoxin

  24. United States 1969 stockpile: • Bacillus anthracis, • botulinum toxin, • Francisella tularensis, • Brucella suis, • Venezuelan equine encephalitis virus, • staphylococcal enterotoxin B • Coxiella burnetti (9).

  25. smallpox, plague, anthrax, botulinum toxin, equine encephalitis viruses, tularemia, Q fever Marburg melioidosis Typhus Soviet Union stockpile:

  26. More details about: • Plague (Yersinia pestis), • Smallpox (Variola major and minor) • Anthrax (Bacillus anthracis), • Tularemia (Francisella tularensis) • Influenza is seldom mentioned but would be an excellent BioWeapon • Many diseases have been accused of being BioWeapons, including SARS, Swine Flu and HIV

  27. Plague

  28. Plague (Yersinia pestis), • gram-negative, anaerobic coccobacillus. • transmitted to humans through fleas, rodents, or droplet infection. • Human-to-human transmission quick • Called “Black death” because the septic shock causes cyanosis, & peripheral gangrene • “Blackening”

  29. Rodents and fleas • Endemic in rodents; fleas transmit but don’t sicken. • The next mammal is the next victim. • 10,000 years of human garbage attracting flea-ridden rats. Less a disease of nomads.

  30. Plague – mode of transmission • Natural: Fleas from infected rodents • BioWar: aerosolized • Large aerosol droplets contain 100-500 organisms • Person-to-person transmission

  31. Plague • Worldwide: one of most feared diseases throughout history • As many as 200 million deaths in last 1000 years. • Not gone! India had outbreak in 1994. • Endemic in US Southwest in rodents

  32. Plague: Clinical Manifestations Cervical bubo Ecchymosis, septicemia Gangrene, septicemia Inglesby T, et al. JAMA 2000;383:2281

  33. Plague • 3 forms: bubonic, pneumonic and septicemic; Bubonic is classic. • infected individuals die within 2 -3 days • Bubonic has a mortality of 30 - 75 %; pneumonic & septicemic forms have mortality of 90 - 100 % respectively • Septicemic plague usually occurs secondary to bubonic or pneumonic plague.

  34. Plague:Black lesions & bubos(fingers & toes, penis & nose)

  35. AMS: Hallucinations, headache, fever, chills. semiconscious to lethargic. " Madness” (agitated delirium) Hematemesis, bloody diarrhea Lymphadenopathy: swollen, tender lymph nodes (buboes) in armpits, groin; even supra-clavicular and cervical buboes rupture & suppurate Black blisters and hematemesis Recovered victims disabled: muscular tremors, “withered thighs and tongues“ Symptoms: Bubonic Plague

  36. Plague bubo

  37. Plague Septicemia • Non-specific gram-negative septicemic symptoms: • Flu-like illness rapidly progresses to pneumonia, hemoptysis. • Blood cultures +, but no lymphadenopathy; respiratory contagion at 2 to 5 feet. • Pneumonic plague is 100% fatal unless treatment is given with 24 hours of the onset of symptoms.

  38. Pneumonic Plague • Most contagious and deadly: pneumonic plague • Airborne person-to-person airborne spread. • Y. pestis is not spore forming, and is viable for only 60 minutes as an aerosol. • Doesn’t live long on surfaces.

  39. Pneumonic Plague: CXR

  40. Plague Diagnosis and Treatment • CXR nonspecific • Suspicion, setting, environment • Standard treatment of bubonic, septicemic, or pneumonic plague is streptomycin, 30mg/kg IM q 12 h x 10 days. • alternatives: chloramphenicol, gentamicin, or doxycycline. • Chemoprophylaxis includes treatment with tetracycline or doxycycline.

  41. Plague Vaccine • Not a generally viable option • The Greer vaccine is an inactivated form of the disease, and requires a course of injections over 6 months. • A recombinant sub-unit vaccine is being investigated. • Outbreak would spur vaccine development – too late

  42. Smallpox

  43. Smallpox Communicability • Contact: fomites, person to person • Aerosol: communicability by aerosol requires negative-pressure isolation. • One single case -> 10 to 20 others. • No more than 20% of the population has any immunity from prior vaccination • No acceptable treatment

  44. Smallpox: Mode of transmission Patient-to-patient transmission likely Droplets, Large & Small More infectious if coughing or bleeding

  45. Smallpox – the Virus • 2 Wild types • Variola major • Variola minor • Variola called "smallpox" to distinguish it from Syphilis, the "great pox" • Smallpox is believed to have emerged in human populations about 10,000 BC.

  46. Pustules up close. Note: thick covering of skin. not like typical blisters.

  47. Small Pox Symptoms: • Maculopapular rash, then • Raised fluid-filled blisters • characteristic scars, commonly on the face, which occur in 65–85% of survivors. • Blindness resulting from corneal ulceration and scarring; Limb deformities due to arthritis and osteomyelitis are less common complications, 2–5% of cases.

  48. Variola Diseases • V. major produces a more serious disease than V. minor • V. major mortality 30–35% • V. minor causes a milder form of disease (also known as alastrim, cottonpox, milkpox, whitepox, and Cuban itch; kills about 1% of its victims. • ?Protective immunity?

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