BIOTERRORISM: SOUTH CAROLINA AT RISK

1. BIOTERRORISM: SOUTH CAROLINA AT RISK

2. OBJECTIVES • To understand the concept of terrorism • To understand the rationale for the use of biological agents as terrorist weapons • To describe the characteristics of those biologic agents thought to be the choice of terrorists

3. Bioterrorism is one form of terrorism. Terrorism is defined as the unlawful use of force or violence against persons or property to intimidate or coerce a government or civilian population in the furtherance of political or social objectives.

4. Terrorists use weapons of mass destruction. These are destructive devices which include bombs, missiles, poison chemicals, disease organisms, radiation or radioactivity at levels dangerous to human life.

5. The 9/11 Commission Report stated referring to the terrorist threat…… • ………..we are not safe • Time is not on our side…………..

6. Biologic agents are likely to be used by terrorists as weapons because: • They are capable of damaging populations, economies, and food supplies • Certain agents are inexpensive to make • They can be directed at a small group of people or an entire population • They can be used to attack people, economies and food supplies • They cause fear, panic and social disruption

7. Characteristics of biological agents that could be used as bioterrorist agents • They have a wide range of effects • They are obtained from nature • They are easily made by relatively unsophisticated methods • They are invisible to the senses • Their effects may be delayed • They can produce mass casualties

8. DIFFERENCES BETWEEN A BIOLOGICAL ATTACK AND A NATURAL OCCURENCE • A biological terrorist attack may mimic a large scale naturally occurring disease outbreak. There are differences. A biological attack: • Results from a deliberate act • Will be treated as a crime scene • May not be immediately recognized

9. BIOLOGICAL ATTACK VS. NATURAL OCCURRENCE • May be preceded by verbal or written threats from a terrorist group • May find abandoned spray devices may be found • Claims by a terrorist group to have released a biologic agent • May result in contamination of critical facilities • May expand rapidly from different source cases • Will cause widespread public panic

10. ROUTES OF ENTRY INTO THE HUMAN BODY • Ingestion • Dermal penetration • Inhalation

11. AEROSOL INHALATION • The use of aerosols is an efficient way to affect the maximum number of people with a single attack.

12. BIOWEAPONS RECENT HISTORY • Bioweapons have a long history. Recent uses include: • U.S, Canada, Great Britain, Japan, and the U.S.S.R experiment with anthrax during World War II (W.W.II) • In 1991, Iraq threatens use of bioweapons against U. S. troops in Persian Gulf war • Post W.W.II , NATO and the Warsaw Pact nations had bioweapons programs

13. BIOWEAPONS RECENT HISTORY • In 1969, U. S. unilateral decision to destroy bioweapons • In 1972, Bioweapons Convention created in which U. S. and U. S. S. R. were signatories • Possible/probable active offensive bioweapons programs in N. Korea, Iran, China, Egypt, Algeria, India, Pakistan, Syria, Israel

14. BIOWEAPONS RECENT HISTORY • In 1986, Bhagwan cult poisons Oregon salad bars with salmonella-715 people sick • In 1995, Aryan Nation orders plague bacteria from supply house in Maryland and Minnesota Patriots Council members convicted for planning ricin use in assassination attempt

15. BIOLOGICAL AGENTS • There are several types of agents. They are classified as: • Bacteria • Rickettsia • Viruses • Biotoxins

16. Single celled organisms capable of causing disease. These agents, grown on culture to produce large quantities, can be modified or “weaponized” for greater destruction Produces inflamation in tissues and/or toxins EXAMPLES ANTHRAX SMALL POX PLAGUE TYPHOID CHOLERA TULAREMIA BACTERIA

17. Vector borne (ticks, lice, mosquitos) parasitic form of bacteria Diseases are difficult to treat Variants exist worldwide EXAMPLES TYPHUS ROCKY MT. SPOTTED FEVER Q FEVER INDIA TICK FEVER MEDITERANEAN TICK FEVER RICKETTSIA

18. Smaller than bacteria RNA or DNA in a protein coat Use living cells to reproduce Not affected by antibiotics EXAMPLES EBOLA LASSA FEVER INFLUENZA VIRAL HEPATITIS VIRAL HEMORRHAGIC FEVERS VIRUSES

19. Are poisonous by-products of bacteria, fungi, marine animals or plants Do not replicate in the host Are not communicable Highly toxic when delivered as an aerosol EXAMPLES BOTULINUM STAPHLOCCOCAL ENTEROTOXIN B RICIN BIOTOXINS

20. Biological Agents most likely to be used in a terrorist attack • Bacteria - anthrax, plague, tularemia • Virus - small pox, viral hemorrhagic fever • Biotoxin - botulism

21. ANTHRAX • Infectious agent: Bacillus anthracis – gram +, spore forming bacteria • May enter the body from skin (cutaneous), digestive system or by inhalation (most likely route to be used by terrorists)

22. ANTHRAX • Symptoms: itching, lesions, fever, fatigue, non-productive cough, respiratory failure and hemodynamic collapse • Transmission: none person to person except with cutaneous • Incubation period: 1 to 6 days • Mortality: 5 to 20% percutaneous, 80 to 90% inhalation • Treatment: antibiotics • Prevention: vaccine

23. PLAGUE • In nature, fleas living on rodents spread infection to humans. As a bioterrorist weapon – inhalation of aerosol leads to pneumonia, sepsis and infections of bodily organs • Infectious agent: Yersinia pestis – a gram neg., non-motile bacillus • May be bubonic ( infection of lymph nodes) or pneumonic (infection of lungs)or septicemic • Symptoms: cough with bloody sputum, fever, chill, shortness of breath

24. PLAGUE • Transmission: may occur person to person by respiratory droplet inhalation • Incubation period: 2 to 3 days • Mortality: 50 to 60% • Treatment: antibiotics • Prevention: vaccine ineffective against aerosol exposure

25. TULAREMIA • A zoonotic, bacterial infection caused by Francisella tularensis, a gram negative coccobacillus • In nature, bacteria is commonly found in ticks living on rabbits and transmitted by handling the animal or by tick bite. Inhalation of aerosol leads to pneumonia and sepsis

26. TULAREMIA • Symptoms:sudden and influenza-like with fever,chills, headache and nausea • Transmission: not usually person to person • Incubation period:3 to 5 days(range 1 to 14) • Mortality:low unless untreated • Treatment:antibiotics if early, vaccine available • Prevention: in nature, avoid tick bites and using gloves when handling infected animals

27. BOTULISM • Infectious agent: Clostridium botulinum – a spore forming, anaerobic bacillus • In nature, may be food borne, wound, or intestinal. As a bioterrorist weapon, ingestion or inhalation leads to production of the neurotoxin and resulting flaccid paralysis

28. BOTULISM • Symptom: fatigue, weakness, blurred vision, difficulty in swallowing and speaking, descending muscle paralysis and respiratory failure • Transmission: none person to person • Incubation period: 12 to 72 hours • Mortality: most lethal compound per weight • Treatment: antitoxins, respiratory support • Prevention: vaccine available for types A and B

29. SMALL POX • Infectious agent: Variola virus - Orthopox virus • Declared eradicated in 1980, but stockpiles may exist • Not naturally acquired. It can be disseminated as and inhaled as an aerosol • Symptoms: Fever, muscular rigidity, headaches, and vomiting. Severe cases experience prostration and hemorrhage into skin and mucous membranes

30. SMALL POX • Rash appears after about three weeks; progresses from macules (initial skin lesions) to papules to pustular vesicles, to scabs • Transmission: may occur person to person by respiratory droplets or skin inoculation. Highly contagious when rash appears • Incubation period: 10 to 12 days • Mortality: less than 1% in the minor form and 20 to50 % in the major form • Treatment: supportive • Prevention: vaccine

31. VIRAL HEMORRHAGIC FEVERS • These are highly infectious viral illnesses caused by the Filoviruses (Ebola and Marburg), Arenaviruses (Lassa fever), Bunyaviruses (Congo hemorragic fever and Hantaviral disease), and Flaviviruses • Symptoms: vary from one type to the next. They include: sudden onset of fever, muscle aches, headache, followed by vomiting, diarrhea, and rash and internal bleeding • Complications: In severe forms, multiorgan failure occurs, primarily due to hemorrhagic and pulmonary complications

32. VIRAL HEMORRAGIC FEVERS • Mode of transmission: handling infected wild animals, but may be used as an aerosol bioterrorist weapon • Incubation period: 2 to 21 days • Reservoir: gorillas and chimpanzees • Transmission: some may be spread person to person by contact with body secretions • Mortality: Ebola rates have reached 90% but vary • Treatment: supportive • Prevention: Avoid contact with infected monkeys or other animal hosts

33. Will we be ready? • Let’s look at how South Carolina responds in the next section