bioterrorism basics biodefense september 8 2002 asph conference
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Bioterrorism Basics (Biodefense) September 8, 2002 ASPH Conference. History, origins, motivations, threats. Differentials How conducted, launched, done Purpose – Motivation Clinical effects Teaching, Research, Planning and Preparedness differentials Detection Response & Treatment

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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
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
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
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

A Paradigm: Biowar -- Bioterror
  • 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.

terrorism1
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 RememberAn 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 +Intelligence

Laboratory workup

Illness

Autopsy

Agent release

Clinical visit

  • 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;
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

How Do We Know We’ve Been Attacked?
  • 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)?
  • Herpes?
  • Measles?
  • Chickenpox?

Courtesy: Dr. Michael Allswede

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)

[email protected]

c/o

University of Pittsburgh

130 DeSoto Street

Room A730 Crabtree Hall

Pittsburgh, Pennsylvania 15261 USA

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