1. Bioterrorism • Preparation • Recognition • And Response

2. Bioterrorism is defined by the Centers For Disease Control as the deliberate release of infectious agents with the intent to cause disease or Death in animals people or plants. 1

3. First Reference to Bioterrorism? • The old testament with the plague of god that kills all of the first-born of Egypt in retaliation for Pharoh Ramses' threat to kill the son of Moses

4. History of Biological Warfare or Bioterrorism We get our English word for poison or toxin from the Greek word toxikon, which in turn is derived from the Greek word for arrow, toxon. Herodotus, a Greek historian of the fifth century B.C.E. Describes the Scythians archers of the black sea as employing poison-tipped arrows. (2).

5. Adder Venom, Dung, and Blood Yum Yum In the 5th century B.C.E., Scythians used the decomposed bodies of several venomous adders indigenous to their region, mixed human blood and dung into sealed vessels and buried this mixture until it was sufficiently putrefied. This poison would certainly contain the bacteria of gangrene and tetanus

6. In the 14th Century, the Tartar army used a combination of psychological warfare and bio-warfare. The ubiquitous rat and an outbreak of the bubonic plague among their own troops worked for the Tartar army besieging Kaffa in 1346. Tartars catapulted bodies of plague victims over the walls of Kaffa in an attempt to initiate an epidemic upon the residents.2

7. The first recoded "weaponized" biological agent in North America occurred during the French and Indian Wars . The agent was smallpox. The method of delivery was blankets not bombs. Sir Jeffrey Amherst who was the commander of British forces in North America formulated a plan to "reduce," as he so clinically expressed it, the size of the Native American tribes that were hostile to the crown.

8. Bioterrorism vs Biological Warfare • What is the difference?

9. While Germany dabbled with biological weapons in World War I, the Japanese military practiced biowarfare on a mass scale in the years leading up to and throughout World War II. Directed against China, the onslaught was spearheaded by a notorious division of the Imperial Army called Unit 731.

10. In occupied Manchuria, starting before WWII, Japanese scientists used scores of human subjects to test the lethality of various disease agents, including anthrax, cholera, typhoid, and plague. As many as 10,000 people were killed.5

11. In active military campaigns, several hundred thousand people—mostly Chinese civilians—fell victim. In October 1940, the Japanese dropped paper bags filled with plague-infested fleas and grain over Chinese cities. Other attacks involved contaminating wells and distributing poisoned foods. The Japanese army never succeeded, though, in producing advanced biological munitions, such as pathogen-laced bombs. 5

12. Soviet Union and the U.S. reached new heights in the anxious climate of the Cold War. Both nations explored the use of hundreds of different bacteria, viruses, and biological toxins

13. In 1995 The apocalyptic religious sect Aum Shinrikyo released sarin gas in a Tokyo subway, killing 12 commuters and injuring thousands

14. This sect also released anthrax and botulinum toxin, but failed to weaponize them adequately.

15. The median inhaled human lethal dose of botulinum is ~ 3 nanograms. This means that ~ 10 lbs if evenly distributed, is enough to kill every person in the world.

16. First Anthrax Victim in 2001 Attacks In early October 2001, just days after Bob Stevens hiked through North Carolina's Chimney Rock Park and drank from a waterfall, government officials were retracing his steps. They were desperate to know why the 63-year-old man lay gravely ill in a Florida hospital. His diagnosis: anthrax.6

17. Mr. Stevens and several of his co-workers were exposed to anthrax in a mailed envelope. These attacks sickened 22 people, killed 5 and resulted in tens of millions of dollars in decontamination that included post offices and congressional office buildings

18. …and this was the first instance of bioterrorism in the U.S. Since smallpox infected blankets were given to American Indians

19. “Bioterrorism Funding Withers As Death Germs Thrive In Labs, Nature” Article by Lynn Peeples Huffington Post Reporter on 2-10-12

20. Why Big Nations Lose Small Wars

21. Asymmetric warfare is war between belligerents whose relative military power differs significantly, or whose strategy or tactics differ significantly

22. Before ~ 1950’s wartime victory of the strong over the weak was the general rule,but after that era that began to change.

23. Ring Around the RosyPocketful of PosiesAshes Ashes We All Fall down

25. Ring around the rosy(The feverous face encircled with pustules)A pocket full of posies(Flowers placed on the foul smelling victim)Ashes, ashes(Septic shock that precedes death, wearing of mourning ashes, or burning of the corpses of the plague victims?)All fall down(The victim dies)

26. 1918 to 1919 Spanish Flu Pandemic. The world population was ~ 1.7 Billion 1st transatlantic flight was in 1919

27. How many deaths were caused by this pandemic??

28. A. 100,000 B. 500,000 C 4,000,000 D 40,000,000

29. Citing fears of an “unimaginable catastrophe,” a government-appointed board on Tuesday explained why it recently recommended censoring details of new research on deadly bird flu virus.

30. “Our concern is that publishing these experiments in detail would provide information to some person, organization, or government that would help them to develop similar ... viruses for harmful purposes,” the 23 voting members of the National Science Advisory Board for Biosecurity wrote in a statement published jointly Tuesday by the journals Science and Nature.

31. Have we had this level of security since the Manhattan Project?

32. CDC Categories of Biologic Agents • Category A • can be easily disseminated or transmitted from person to person; • result in high mortality rates and have the potential for major public health impact; • might cause public panic and social disruption; and • require special action for public health preparedness.

33. Six Agents/DiseasesComprise Category A-------------------------------------------Anthrax (Bacillus anthracis)*Botulism (Clostridium botulinum toxin) *Plague (Yersinia pestis)* Smallpox (variola major) Tularemia (Francisella tularensis)* Viral hemorrhagic fevers (filoviruses [e.g., Ebola, Marburg] and arenaviruses [e.g., Lassa, Machupo])* (* can affect dogs and cats)

34. Tularemia is one of the most infectious diseases known, inhalation of as few as 10 organisms will cause disease

35. NOT tularemia

36. Smallpox

37. Cutaneous Anthrax

38. Category BDefinitionSecond highest priority agents include those thatare moderately easy to disseminate;result in moderate morbidity rates and low mortality rates; andrequire specific enhancements of CDC's diagnostic capacity and enhanced disease surveillance.

39. Brucellosis (Brucella species) Epsilon toxin of Clostridium perfringensFood safety threats (e.g., Salmonella species, Escherichia coli O157:H7, Shigella)Glanders (Burkholderia mallei)Melioidosis (Burkholderia pseudomallei)Psittacosis (Chlamydia psittaci) Q fever (Coxiella burnetii) Ricin toxin from Ricinus communis (castor beans)Staphylococcal enterotoxin BTyphus fever (Rickettsia prowazekii)Viral encephalitis (alphaviruses [e.g., Venezuelan equine encephalitis, eastern equine encephalitis, western equine encephalitis])Water safety threats (e.g., Vibrio cholerae, Cryptosporidium parvum)

40. We have now reached a point where pathogens can be genetically engineered and even hybridized which can yield increased virulence and atypical presentations

41. Prions are pieces of misfolded proteins that are particularly difficult to destroy. They are very slow acting and have recently been found to cross species barriers more readily than believed

42. Agroterrorism is a subset of bioterrorism, and is defined as thedeliberate introduction of an animal or plant disease with the goal of generating fear,causing economic losses, and/or undermining social stability.3

43. We are the land of milk and honey, and that makes us particularly vulnerable to agricultural terrorism.

44. Agroterrorism lacks the “shock value” of traditional terrorist targets but the American agricultural system is uniquely vulnerable.

45. Farms are geographically disbursed in unsecured environments. Livestock are frequently concentrated in confined locations, and transported or commingled with other herds.

46. Agricultural diseases are relatively easy to obtain, handle and distribute..

47. International trade in food products often is tied to disease-free status.

48. The FMD outbreak in the U.K. was estimated to cause a ~ 6 billion loss. These impacts exceed the value of the animalsbecause of the number of industries affected by the outbreak, ranging from feedsuppliers to tourism.

49. A similar outbreak in the U.S. has been estimated to cost about $25 billion.It is further estimated that 25 miles of trench would be required to shoot and bury the livestock. The psychological impact on farmers would be indescribable

50. These impacts exceed the value of the animalsbecause of the number of industries affected by the outbreak, ranging from feedsuppliers to tourism.