1. CHEMICAL AND BIOLOGICAL WARFARE AND TERRORISM By LCDR Rita McCarthy, MSC, USN Pharmacist

2. Early Biological Warfare • The use of filth, dead human bodies, animal carcasses, and contagion to cause disease in the enemy camps or cities • 400 BC Scythian archers dipped arrows in blood, manure, and dead bodies • 1346 Siege at Kaffa: Tartar soldiers launched bodies of their fellow soldiers who died of plague over the wall into the city

3. Early biological continued • 1710 Russian troops used plague infected bodies against Sweden • 1767 French and Indian Wars (Colonial America): • The British Commander orders small pox infected blankets to be given to the Indians loyal to the French defending Fort Carillon

4. Modern Development of BW • WWI: Germans infected horses with glanders that were being sold to Allied forces • Transferred from horses to humans • acute: coughing, fever and the release of an infectious nasal discharge, followed by septicemia and death within days. • Chronic: nasal and subcutaneous nodules develop, eventually ulcerating. Death can occur within months, while survivors act as carriers. • 1937-1945: Japan had program with live subjects in Manchuria • Chinese, Russian, and American prisoners of war; tens of thousands die of bubonic plague, cholera, anthrax and other diseases • Accidentally infected own military units on multiple occasions

5. Biological Warfare • The intentional use of disease producing microorganisms or biologically derived toxins as weapons to kill or injure humans, animals, or plants

6. Bio-Terrorism • The use of (or a threat to use) a biological or chemical agent by an individual or a group in order to intimidate or coerce a government of a society in the pursuit of political, religious, ecological, or other ideological objectives

7. Why use Chem/Bio agents for terror? • Cost • Biological agent $1 • Chemical agent $600 • Conventional explosive $2000 • Easily produced • Difficult to detect • FEAR & TERROR OF GENERAL PUBLIC!

8. Classification of Agents of Biological Origin • Pathogens • BACTERIA • Viruses • Toxins

9. Bacteria • Mechanism of disease • Invasion and infection of tissue • Produce toxins • Prevention • Immunization • Active: vaccine • Passive: from mother to child • Treatment • Specific antibiotics

10. What makes a good biological agent? • Availability and ease of production • Incapacitate or lethal? • Particle size • Ease of dissemination • Stability after production • Susceptibility of population

11. Bacterial Agents • Anthrax • Plague • Tularemia • Brucellosis • Q Fever

12. Anthrax • Bacillus anthracis • 1876: first disease for which a microbial cause was established (Koch) • 1881: Attenuated spore vaccine for livestock • 1949: human vaccine developed (licensed in 1970)

13. Why use Anthrax as a Weapon? • Easy to produce in large quantities • Spores can be spread by aerosol • Short incubation period • Highly lethal

14. Anthrax Epidemiology • Reservoir: Soil • Herbivores infected during grazing • Transmission to humans • Contact with contaminated animals, hides, wool • Ingestion of contaminated meat • Inhalation of dust with spores • Annual incidence: 2,000 cases world-wide

15. Anthrax Pathogenesis • Spore enters the body • Germinates and transported to lymph nodes • Local production of toxins lead to edema and tissue destruction • Spread from lymph nodes…bacteria and toxin into blood

16. Inhalation Anthrax • Incubation period: 1-7 days • Initial symptoms: mild and flu-like • Followed by shortness of breath, labored breathing, rapid heart rate • Rapid progression to shock and death if not treated soon enough

17. Treatment of Anthrax • High does antibiotics • Ciprofloxacin • Doxycycline • Penicillin

18. Plague • Bubonic • Malaise, high fever, tender lymph nodes • If untreated: • Blood poisoning, death • Pneumonic • High fever, chills, headache, coughing up blood, blood poisoning • If untreated: • Respiratory failure, circulatory collapse, heavy bleeding, death

19. Tularemia • Swollen glands, fever, headache, malaise, weight loss, nonproductive cough • Generally not fatal

20. Brucellosis • Can spread to humans if they come in contact with infected animals, or by eating or drinking unpasteurized milk or cheese. • May begin with mild flu-like symptoms, muscle pain, swollen glands • May be chronic and last for years • Generally not fatal

21. Q Fever • Fever, cough, chest pain • Generally not fatal

22. Viruses • Smallpox • Ebola • Venezuelan Equine Encephalitis • Yellow Fever

23. Smallpox History • 1500s: >3.5 million die after Europeans introduce smallpox to the New World • 1796: Vaccine developed by Jenner • 1813: Madison encouraged vaccination • 1949: last outbreak in the US • 1960: Worldwide eradication program • 1980: WHO declares earth free of smallpox

24. Smallpox as a BW or Terrorist Threat • Highly communicable disease (person-to-person transmission) • Vaccine use discontinued…makes a target population that is susceptible

25. Smallpox • Incubation 7-14 days • Fever, headache, general illness, vomiting • Skin “seeded” with virus • Scabs form 8-14 days after onset • Scabs infectious

26. Medical Management • Confirm • Quarantine all cases • Vaccination of all contacts: available from the CDC

27. Toxins • Saxitoxins and Conotoxins: marine animals • Botulinum: bacteria • Mycotoxins: fungus • Snake venom • Ricin: plant

28. Natural origin Stable More toxic Legitimate medical use Only one active on skin Man-made Less stable Less toxic Only use is weapons All active on skin Toxin vs. Chemical Agents

29. Botulinum Toxin • Clostridium botulinum • Tetanus • Botulism • One of the most toxic substances known • Neurotoxin • The toxin has a legitimate medical use • Botox • Treat muscle contractions and can offer relief from sweating of the hands, feet and underarms

30. Mucous in throat Difficulty swallowing Feels like a cold No fever Blurred vision Mental numbness Slow eye movements Dilated pupils Indistinct speech Difficulty walking Extreme weakness “Floppy Paralysis” Clinical Symptoms of Botulism3rd day post-exposure 4th day post-exposure

31. Medical Management • Vaccine is available but general use is not necessary • Treat with immunoglobulin before onset of symptoms (from the CDC) • May need to assist with breathing if severely affected or treatment not started in time • May lead to death

32. Saxitoxins • Paralytic Shellfish Poisoning: • From eating shellfish contaminated by "red tides" or algal blooms • Symptoms: tingling, numbness, weakness, limb paralysis • Onset of symptoms: almost immediate;exposure by inhalation leads to extremelyrapid development of symptoms with death occurring within minutes if not treated.

33. Conotoxins • Paralytic poisons from Pacific cone snails • Symptoms: burning pain; local numbness, spreading rapidly to involve the entire body but without pain; some cardiac and respiratory distress at the height of the poisoning • Onset of symptoms:almost immediate upon injection from the snail

34. Mycotoxins • Produced by microfungi that are capable of causing disease and death in humans and other animals • Some used as antibiotics, growth promotants, and other kinds of drugs; still others have been implicated as chemical warfare agents • Severity of mycotoxin poisoning can be compounded by other illnesses; mycotoxicoses can heighten vulnerability to microbial diseases, worsen the effects of malnutrition, and interact synergistically with other toxins • Almost no treatments for mycotoxin exposure

35. Ricin • Protein toxin from castor beans • Plant found world-wide • Toxin is fairly easy to produce • Castor oil used as lubricant for motors

36. Symptoms of Ricin Poisoning • Oral ingestion: least toxic (8-10 hours) • Bleeding and tissue damage in GI tract • Nausea, vomiting, diarrhea, cramps • Inhaled: most common • Nausea, vomiting, diarrhea, cramps, dilated pupils, fever, headache • Shock, edema, pneumonia • Death on 3rd or 4th day!

37. Medical Management • Identify if toxin, asthma, or chemical poisoning • Supportive care • For oral ingestion: administer activated charcoal to absorb toxin • No anti-toxin or immunization yet

38. Chemical Agents: Early Chemical Warfare • 423 BC Sparta used toxic and irritant smoke to capture a fort held by Athenians • 700 AD Greeks invent and use “Greek Fire” (pitch, sulfur, and rosin) which floated on water to set enemy ships on fire • Pitch: a viscous substance produced by plants or formed from petroleum • Sulfur: used to make gun powder • Rosin: type of resin • 15th and 16th Centuries: Venice used poison chests to contaminate water

39. Modern Chemical Warfare • 1st gas attack: April 22, 1915 • Chlorine gas used by Germany in Belgium • WWII no confirmed use by Germany on the battlefield, however, cyanide and other gasses were used in concentration camps • Cyanide makes the cells of an organism unable to use oxygen • 1980’s Iraq used chemical agents against Iran and against it’s own people (Kurds)

40. Chemical Agents • Lethal (toxic) agents • Nerve agents • Choking agents • Blood agents • Blister agents • Incapacitating agents • Irritants

41. Chemical Agents • Solid • Liquid • Gas • Persistent: effective for >12 hours • Non-persistent: inactivated <12 hours

42. Nerve Agents • Sarin (GB) • Soman (GD) • Tabun (GA • GF • VX

43. Sarin • Lethal agent • Developed in 1940s by Germany • Original use was an insecticide • Causes death by asphyxiation • Is a liquid at room temperature

44. Soman, Tabun, and VX • Lethal agents • Soman: synthesized by Germany in 1944; similar to sarin • Tabun: synthesized by Germany in 1936 • VX developed by USA • Victims of Soman, Tabun, and VX ,make it harder to treat casualities than with Sarin

45. Physical Properties • Clear colorless liquids (when fresh) • Not nerve gas! • Tasteless: each has identifiable odor • May be spread by fine vapor “gas” or as a liquid on skin • Onset of symptoms within seconds to minutes • Large exposure can cause death

46. Pinpoint pupils Sweating Drooling & runny nose Convulsions Involuntary urination Coma Possible death Decontamination Atropine Assist with breathing Anti-seizure drugs Nerve Agents Symptoms Treatment

47. Choking Agents • Chorine and Phosgene • Developed and used during WWI • Head delayed reation time • Causes lung damage • Can cause blindness if gets into eyes • Gas or liquid

48. Blister Agents • Mustard (H) • Nitrogen Mustard (HN) • Lewisite (L) • Phosgene oxime (CX) • Causes skin blisters • Usual/ly does not kill

49. Others • Blood agent • cyanide • Incapacitating agents • Psychological effects (LSPD and BZ) • Riot control agents • Peper spray, tear gas, mace

50. Treatment • Decontamination • Special antidotes • Anti-convulsant drugs • Supportive care