The Role of Information Technologies and Science in the

Prevention of Bioterrorism

Eugene Shubnikov, MD, Institute of Internal Medicine, Russia;

Supercourse Team, Pittsburgh and the Rest of the world

Novosibirsk, Ebola Virus Laboratory, Vector

Steps in Developing of Russian/FSU Supercourse:

• Network of the scientists involved in Network of the scientists involved in prevention and the Internet in Russia and FSUprevention and the Internet in Russia and FSU

• Russian Language or Russia/ FSU’s connected Russian Language or Russia/ FSU’s connected Public Health Library of lectures at the Public Health Library of lectures at the Internet Internet

• I-prevention I-prevention ProgramProgram with relations between with relations between Russian, FSU, US and scientists from around Russian, FSU, US and scientists from around of the worldof the world

15 countries in FSU Supercourse

• Mailing list

• Sharing of lectures

• Personal E-mail contacts

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Communications between members

Our Help for Russian/ FSU Public Health Teachers

• Cutting edge, interesting lectures available from Supercourse

• Free access to the Supercourse web library of lectures

• Share knowledge, education and training systems with other public health professionals in FSU and worldwide

(www.pitt.edu/~super1/national/index.htm)

Phillip L. Coule, M.D. 10

Biological terrorism

• Dispersal of microbes or their toxins to produce illness, death and terror

• The paths of infection can be contaminated water, food, air and packages.

• Microbes– Bacteria– Viruses– Toxins

Types of Terrorism • Domestic terrorism involves groups whose

terrorist activities are directed at elements of our government without foreign involvement. Oklahoma City is a primary example.

• International terrorism involves groups whose terrorist activities are foreign-based and/or directed by countries or groups outside the United States. Sept. 11 is an example of International Terrorism.

the Center for National Security Studies

Methods of Terrorism

• Firearms

• Explosive and Incendiary Devices

• Chemical Agents

• Biological Agents

• Nuclear Weapon

J. David Piposzar, Allegheny County Health Department

J. David Piposzar, Allegheny County Health Department

Definition of bioterrorism

• Bioterrosim is the threat or use of biological agents by individuals or groups motivated by political, religious, ecological, social or for other ideological objectives to inculcate fear or cause illness or death in order to achieve their objective. (Carus 1998*).

Fred T Muwanga MD Msc

Response and prevention of bioterrorism

• Response involves: emergency measures to save

lives active case finding through

surveillance establish diagnostic

criteria(case definition) and case management

prevention and management of secondary contamination

Accurate laboratory work

• Prevention measures Strategy formulation that stress

deterrence as well as crisis and consequence management.

Do a threat analysis so as to define the requirements

contingency planning with clear definition of roles

global surveillance of disease outbreaks to create more understanding on emerging threats

Fred T Muwanga MD Msc

Questions for reflectionWith largely theoretical knowledge on

bioterrorism, how best can we understand the problem we are faced with ?

What ability and/or capacity does the world have to respond to the challenges of bioterrorism?

What is the dividing line between bioterrorism and criminal activity ?

Fred T Muwanga MD Msc

Bioterrorism BasicsBioterrorism Basics

Definition: The unlawful use, or threatened use, of microorganisms or toxins derived from living organisms to produce death or disease in humans, animals, or plants. The act is intended to create fear and/or intimidate governments or societies in pursuit of political, religious, or ideological goals.

Bioterrorism BasicsBioterrorism BasicsWhat makes the use of biological agents so attractive to the terrorist?

– Ease of Acquisition Information readily accessible on World Wide Web American Type Culture Collection, other sources

– Ease and Economy of Production Only basic microbiology equipment necessary Small labs require no special licensing Investment to cause 50% casualty rate per sq. km:

Conventional weapon $2000, nuclear $800, anthrax $1– Lethality

50 kg aerosolized anthrax = 100,000 mortality Sverdlovsk experience, former USSR

Bioterrorism BasicsBioterrorism BasicsWhat makes the use of biological agents so attractive to the terrorist?– Stability– Infectivity

Weaponized agents may be easily spreadClinical symptoms days to weeks after

release– Low Visibility– Ease and Stealth of Delivery

Remote, delayed, undetectable releaseDifficult/impossible to trace origin of agent

Bioterrorism BasicsBioterrorism Basics

Routes of Delivery for Biological Agents

Aerosol is most likely method of dissemination

Easy, silent dispersal

Maximum number of victims exposed

Inhalation is most efficient and contagious route of infection

Food/Water-borne dispersal less likely

Less stable, ineffective for some agents

Inefficient compared to aerosol

Agents of BioterrorismAgents of Bioterrorism

Bacterial Agents

Bacillus anthracis (Anthrax)

Yersinia pestis (Plague)

Francisella tularensis (Tularemia)

Brucella spp. (Brucellosis)

Coxiella burnetii (Q Fever)

Burkholderia mallei (Glanders)

Vibrio cholerae (Cholera)

Agents of BioterrorismAgents of Bioterrorism

Viral AgentsVariola virus (Smallpox)Venezuelan Equine Encephalitis Virus (VEE)Hemorrhagic Fever Viruses: Ebola, Marburg, Lassa Fever, Argentine and Bolivian Hemorrhagic Fever Viruses, Hantavirus, Congo-Crimean Virus, Rift Valley Fever Virus, Yellow Fever Virus, Dengue Virus

Agents of BioterrorismAgents of Bioterrorism

Biological ToxinsBotulinum Toxins

Staphylococcal Enterotoxin B

Ricin

Mycotoxins (T2)

Agent TypeMinimum Dose

Incubation period

Initial Symptoms

Duration of illness Lethality

Animal Indicator

Anthrax Bacteria8,000 (spores) 1-6 days Flu-like 3-5 days High 90% Yes

Plague Bacteria100 organisms 2-3 days

Pneumonia / Flu-like 1-6 days High 90-100% Yes

Tuleramia Bacteria 10 organisms2-10 days (avg. 3-5) Flu-like >=2 w eeks

Moderate 5-30% Yes

Brucellosis Bacteria 10 organisms 5-60 days Flu-likeWeeks to months Low 2-10% Yes

Q Fever Rickettsia 1 organisms 10-40 days Flu-like 2-14 days Low 4% Yes

Smallpox Virus 10 organisms7-17 days (avg. 12) Flu-like 4 w eeks High 30%

Animal Varients

Encephalitides VEE, EEE, WEE Virus 10 organisms 2-6 days Flu-like

days to w eeks low Yes

Hemorrhagic Fevers Ebola, Marburg Virus 1 organism 4-21days Flu-like 7-16 days

High Marburg 25% Ebola 50-90% Yes

Botulinum Toxin 100 ng 1-5 daysmuscle w eakness 24-72 hours High 30% Yes

Characteristics of BT AgentsCharacteristics of BT Agents

Chotani, 2003Chotani, 2003

Bioterrorism BasicsBioterrorism BasicsEvents Suggesting the Release of a Bioweapon

Multiple people ill at the same time (epidemic) Previously healthy persons affected High morbidity and mortality among affected

individuals Identification of diseases and pathogens

unusual to a particular region Recent terrorist claims or activity Unexplained epizootic of sick or dead animals

Bioterrorism BasicsBioterrorism Basics

Events Suggesting the Release of a Bioweapon Severe respiratory disease in a healthy host An epidemic curve rising and falling rapidly Increase in fever, respiratory, and GI symptoms Lower attacks rates in people working indoors

vs. outdoors Seasonal disease during a different time of year Known pathogen with unusual antimicrobial

resistance pattern Genetically-identical pathogen in different areas

Bioterrorism BasicsBioterrorism BasicsWhat Can We Do As Medical Professionals? Maintain a high index of suspicion by including

biological agents in differential diagnoses Learn to recognize historical and physical examination

findings suggestive of bioweapon exposure Stay informed of local, regional and national

epidemiologic trends Be knowledgeable about treatment and prophylaxis of

patients exposed to biological agents Know whom to report suspected biological agent

exposures and illnesses to (Police, State Intelligence agency, Infectious Disease Specialists, Local and State Health Officials)

Phillip L. Coule, M.D. 29

Is this something new?

• 14th Century – Kaffa– City on Crimean

Peninsula• Hurled plague infested

corpses over walls of city to infest it

• 1346 – Tatar army hurls its plague ridden dead over the walls of the city

Phillip L. Coule, M.D. 30

Is this something new?• 18th Century French and

Indian War– British Officers gave

blankets from smallpox victims to Indians aligned with French

– Caused an epidemic in tribes

– Effective means of incapacitating group

Reported Cases of Bioterrorism• World war II - Polish resistance

organizations used biological agents against German forces

• 1952 - Mau Mau, an independence movement in Kenya , used a plant toxin to poison livestock.

• 1966 - Dr.Mitsuru Suzuki a Japanese physician, infected healthcare providers and patients with Salmonella typhi

• 1981 - Dark harvest group got anthrax contaminated soil from Gruinard Island and damped it on Porton Down.

• 1984 - Rajneeshees in Portland, Oregon(USA)used Salmonella typhimurium to contaminate restaurant salad bars.

• 1995 - AUM Shinrikyo used sarin nerve gas in the Tokyo subway in Japan

• 2001 - Anthrax contaminated s mail sent to various people in USA.

Fred T Muwanga MD Msc

Biological Terrorism - A New Trend?

• 1978: Bulgarian exile injected with ricin in London• 1979: Sverdlovosk, USSR – accidental anthrax released –

40 fatalities • 1984: Oregon, Salmonella – Rajneeshee cult• 1991: Minnesota, ricin toxin• 1994: Tokyo, Sarin and biological attacks• 1995: Arkansas, ricin toxin• 1995: Indiana, Y. pestis purchase• 1997: Washington DC, ‘Anthrax/plague’ hoax• 1998: Nevada , nonlethal strain of B. anthracis• 1998-9: Multiple ‘Anthrax’ hoaxes • 2001: Anthrax Outbreak USA

CasualtiesIncident Number of Cases Number of deaths

Polish Resistance Not reported 200 Germans

Mau Mau Not reported 33 head of cattle

Dark Harvest None None

Rajneeshes 751(45 hospitalised)

no deaths

AUM Shrinkyo 5500 ( 641 seen atSLIH* on day 1 &349 following week)

106 hospitalised atSLIH. 12 deaths (2at SLIH)

Dr.Suzuki 200 4 deaths

Anthrax(USA) 22 4 deaths

Fred T Muwanga MD Msc

Motive for bioterrorismIncident Motive

Polish resistance Resistance against foreign occupation

Mau Mau Resistance against colonialism

Dark Harvest Send a political message

Rajneeshes Win a local election by incapacitating thenon-Rajneeshee voters

AUM Shrinkyo Seize control of Japan through massmurder, causing fear and apprehension

Dr.Suzuki Revenge for unfair treatment he receivedat the medical training

Anthrax (USA) Inculcate fear

Fred T Muwanga MD Msc

Lessons learnt• Motives for bioterrorism vary and

could include: - murder(Aum Shrinkyo) - gaining political mileage (Mau Mau and

Dark harvest) - desire for revenge (Dr.Suzuki) - Cause fear (Anthrax cases) - Incapacitation (Rajneeshes) - anti-agriculture (Mau Mau)• Terrorists do not usually announce their

intent• secondary contamination can occur

(SLIH workers)

• There are various methods of dissemination:

Direct application (Dr.Suzuki) Food or water contamination

(Rajneeshes) Aerosol contamination (Aum

Shrinkyo and anthrax cases)• The effects of bioterrorism can

be immediate(illness and death) or long term (Post-stress disorder)

Fred T Muwanga MD Msc

Responses to Bioterrorism

• Early detection of active and potential cases

• Emergency measures to save lives

• Prevention and management of secondary contamination

Anatomy of a Bioterrorist Attack

Preparation5 years

Execution 1 day

Diagnosed case 3 days

First Death

Multiple deaths

Terrorism takes much Time and planning