An Unusual Case of Chemical Terrorism

1. An Unusual Case of Chemical Terrorism By Paul Rega MD, FACEP

2. Introduction We have been made acutely aware of the standard agents of chemical terrorism such as vesicants, nerve gas, etc., and the dangers of an aerosol release of these agents, but we must also be wary of other agents that are readily available and which can be disseminated in other fashions. The following timeline illustrates one such example.

3. 12/31/02-1/01/03 • Four families (18 members) complain to one supermarket in Michigan of becoming ill following the consumption of ground beef they bought there. • Symptoms include • Burning of the mouth • Nausea, vomiting. • Dizziness • One case of atrial fibrillation treated at a local ED

4. 1/03/03 • The supermarket notifies the Michigan Department of Agriculture (MDA) Food and Dairy Division and the US Department of Agriculture (USDA) of its intent to recall 1,700 lbs. of ground beef because of customer complaints.

5. 1/08/03 • The supermarket issues a press release about the recall of all ground beef with a “sell-by” date between 1/01/03 and 1/03/03. • After the initial recall, 36 other customers report illness associated with the ground beef. • 120 customers return the tainted product.

6. 1/10/03 • The supermarket notifies MDA that their own independent lab determined that the beef was contaminated with nicotine (300mg/kg in submitted beef samples). • The USDA and the FBI become involved in the investigation

7. 1/17/03 • The supermarket issues a press release that the ground beef in question contains unspecified non-bacterial contaminants that are unable to be rendered harmless by cooking. • The contamination appears to be localized at the one supermarket since other supermarkets receiving the beef from one meat processing plant report no problems.

8. 1/23/03 • The local health department alert local EDs and selected medical practices about the situation.

9. 1/24/03 • The supermarket issues a press release that the contaminant was nicotine.

10. Health Department Activities • Develops a case definition • Conducts epidemiological investigation • 148 interviews • 92 persons had illness consistent with the case definition • Median age: 31 yrs. (range: 1-76 yrs.) • 50% female • Cases occurred immediately after sale and as late as 49 days after sale suggesting that the beef was frozen for later consumption • 3% sought medical attention

11. 2/12/03 • Grand jury indicts one supermarket employee with the intentional poisoning of 200 lbs. of ground beef with nicotine. • Source of the nicotine was from an insecticide called Black Leaf 40 (40% nicotine).

12. Nicotine • Overstimulates the nicotinic receptors • Immediate symptoms include burning in the mouth and throat, nausea, and vomiting • More toxic symptoms include cardiac tachyarrythmias, seizures, hypertensive crisis • Lethal dose: 0.5-1.0mg/kg body weight • Symptoms can occur with a dose as low as 2-5 mg of nicotine (children: as low as 1 mg of nicotine)

13. Question? • Why did it take so long before the emergency departments and other facets of the local medical infrastructure were alerted?

14. Reference • Nicotine Poisoning After Ingestion of Contaminated Ground Beef- Michigan, 2003. MMWR 2003; 52(18):413-416.