Response to Potential Biological Incidents

1. Response to PotentialBiological Incidents Dr. Marty Soehnlen, Acting Division Director of Infectious Diseases Shannon Sharp, Bioterrorism Training Coordinator Michigan Department of Health and Human Services Bureau of Laboratories Mark E. Davidson, SABT/WMDC FBI-Detroit Prevent Disease – Promote Wellness – Improve Quality of Life

2. Objectives • Define bioterrorism • Describe historical incidents of bioterrorism attacks • Determine steps to take when there is a suspicious powder incident • List contact information for who to call during suspicious powder incidents

3. Bioterrorism Definition • A bioterrorism attack is the deliberate release of viruses, bacteria, or other biological agents used to cause illness or death in people, animals, or plants. • In the hands of the wrong people, materials intended for legitimate scientific, medical, or commercial use have the potential to harm large numbers of people, animals or plants. CDC Federal Select Agent Program

4. BIOLOGICAL • Biological Weapons Anti-Terrorism Statute of 1989, (BWAT) Title 18, USC §175 • Illegal to use, threaten, attempt or conspire to use a WMD, including any biological agent, toxin or vector Includes: threats to humans, animals and plants. • EMERGING CONCERNS-Genome Technology Breakthroughs(CRISPER) and SYNTHETIC BIOLOGY.

5. Historical Biological Events • Bioterrorism attacks have been used for some time • One of the earliest recorded instances of bioterrorism, Persian armies in the 6th century BC poisoned wells with a fungus that affects rye plants (rye ergot). • During the American Civil War, it was reported that a Kentucky physician provided clothing exposed to smallpox and yellow fever to Union troops. CDC Federal Select Agent Program

6. Historical Anthrax Events • First act of aggression was recorded during WWI • 1914-1918: German army infected livestock traded to Allied nations by neutral partners • 1932: Japan produced anthrax as a biological weapon and attacked 11 Chinese cities by spraying it from aircraft. • 1942: US & Great Britain began bioweapon experiments with anthrax • 1979: Deadly anthrax outbreak in Sverdlovsk, USSR • Air filters from biologic facility were not properly reinstalled after cleaning. https://www.cdc.gov/anthrax/resources/history/index.html

7. AMERITHRAX – October 2001 • 5 Fatalities(1 AMI, 2 USPS, 2 cross contamination. • 22 Sick • Widespread contamination • DeCON - $Millions USAMRIID AMI Bldg

8. Anthrax Timeline https://www.cdc.gov/anthrax/resources/history/index.html

9. Ricin Assassination • Bulgarian dissident Georgi Markov was killed by poison dart filled with ricin and fired from an umbrella in London in 1978. • He developed a high temperature and in four days was dead. • A post mortem established that he had been killed by a tiny pellet containing a 0.2 milligram dose of the poison ricin. • His assassin has never been captured. Scotland Yard says the case remains open.

10. Shannon Dawn Richardson • In May 2013, Richardson sent three letters laced with ricin, one to the President, the Mayor of New York City, and a gun control advocacy group. • Richardson was an actress. She had no known scientific training or experience.

11. Teamwork! Crim-Epi Response Ann Arbor Police Department Michigan Department of Health and Human Services(Microbiology Lab) Michigan Department of Agriculture and Rural Development Washtenaw County Health Department MSP-EMHSD MIOC/DSEMIIC FBI-JTTF

12. Laboratory Response Network for Biological Threats (LRN-B) • The LRN-B was founded in 1999 by the Centers for Disease Control and Prevention (CDC), Federal Bureau of Investigation (FBI) and the Association of Public Health Laboratories (APHL) to coordinate laboratory response to biological, chemical, radiological threats and other high priority public health emergencies, including emerging infectious diseases American Society for Microbiology (asm.org)

13. LRN-B cont. • National Laboratories, including the CDC, U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), and the Naval Medical Research Center (NMRC), are responsible for specialized strain characterization, bioforensics, select agent activity and handling of highly infectious biological agents. • Reference Laboratories, are responsible for investigation and confirmatory testing. • Sentinel Laboratories, comprised of hospital-based and commercial laboratories, are responsible for the early detection and the rule-out or referral of potential biothreat agents. American Society for Microbiology (asm.org)

14. Federal Select Agent Program • Regulates the possession, use, and transfer of biological select agents and toxins that have the potential to pose a severe threat to public, animal or plant health, or to animal or plant products. • Laboratory Personnel undergo background screening. CDC Federal Select Agent Program

15. Select Agent Program Results • Since 2003 (the beginning of the program in its current regulatory form), there have been: • No confirmed thefts of a select agent or toxin from a registered entity • No deaths among laboratory workers • No reported cases of illness or death in the general public due to work with these agents in regulated laboratories CDC Federal Select Agent Program

16. Response Protocol • (Public Safety #1) • Secure Area/Item of Interest/Remove Personnel • Coordinate with local LE/FS/HAZMAT/EM/PH • Contact WMD Coordinator(586.530.5206) • Screen for Explosive/Chemical and/Radiological Hazards-NO BIO FIELD SCREEN • Package for transport to LRN • Seek medical assistance as appropriate. • REMAIN CALM!!!!! • https://emergency.cdc.gov/bioterrorism/responders.asp

17. Steps to Take for Suspicious Powder • Contact appropriate law enforcement authorities. • Law Enforcement will provide samples to Michigan Department of Health and Human Services, Bureau of Laboratories (MDHHS BOL) for testing. • Do NOTattempt to perform any laboratory testing on environmental samples-MDHHS BOL performs testing once FBI/local law enforcement/fire/HAZMAT screens sample for radiological material and chemicals.

18. Roles of BOL Staff Bureau of Laboratory Main Phone Number: 517-335-8063 MDHHS After Hours Emergency Phone Number: 517-335-9030

19. Screening and Confirmation Testing • The Bureau of Labs (one of the country’s advanced laboratories) will perform a multi-agent screening panel to rapidly test samples. • Results are generally available in less than 6 hours from receipt • Results are provided to appropriate authorities (i.e. FBI) • When necessary, confirmatory testing of single or multiple agents is performed.

20. In the Event of Clinical Cases • If a BT threat results in potential clinical cases, then the LRN sentinel laboratory system activates.

21. Clinical Cases Cont. • Patients may arrive showing non-specific symptoms: • Fever • Dyspnea • Cough • Chest Discomfort • Length of time between exposure and symptom onset is specific to each agent, however it may range from 2 - >10 days

22. Example of Appropriate Sample Collection for Bacillus anthracis APHL Clinical Laboratory Preparedness and Response Guide pg. 77

23. Bacillus anthracis • Gram Stain • Large Gram positive rods • Spores may be found in cultures grown in 5% CO2 but are not usually seen in clinical samples APHL Clinical Laboratory Preparedness and Response Guide

24. Bacillus anthracis • Colony Morphology • Grows well on Blood (BAP) & Chocolate (CHOC) agar • Non-hemolytic on BAP • Does not grow on MacConkey (MAC) APHL Clinical Laboratory Preparedness and Response Guide

25. Bacillus anthracis • Additional Tests • Catalase: Positive • Motility: Non-motile • Common Misidentifications • May not be identified in common automated ID systems, including MALDI TOF, and possible misidentifications may include: Bacillus megaterium and other Bacillus species. Note:Bacillus cereus Group includes B. anthracis, but automated ID systems may not alert microbiologist beyond this group identification. Catalase Motility APHL Clinical Laboratory Preparedness and Response Guide

26. American Society for Microbiology (ASM)https://www.asm.org/ Additional guidelines: BT Readiness Plan & Packaging and Shipping

27. Steps for Suspect Patient Samples APHL Clinical Laboratory Preparedness and Response Guide

28. Steps for Suspect Patient Samples Cont. APHL Clinical Laboratory Preparedness and Response Guide

29. Destruction of Samples & Return of Evidence • Within 7 calendar days after confirmation, the select agent or toxin must be transferred in accordance with § 73.16 or destroyed on-site by a recognized sterilization or inactivation process. • Use On-site autoclave or chemical decontamination • Positive blood culture bottles must be autoclaved onsite or transferred to the BOL for autoclaving. • Perform decontamination before transport to a medical waste contractor for final destruction and disposal. APHL Clinical Laboratory Preparedness and Response Guide

30. Destruction of Samples & Return of Evidence • Chemical Decontamination Process • Prepare a fresh 1:10 household bleach solution in a receptacle large enough to submerge all containers/plates containing select agents. • Working in a BSC, completely immerse open culture containers in the bleach solution and leave containers in bleach solution overnight. • Once overnight inactivation is complete, turn the sink faucet on and discard the bleach solution down the drain with running tap water. • Package the inactivated culture plates and containers with other biohazardous waste that is transported off site by a medical waste management contractor for final treatment and disposal. APHL Clinical Laboratory Preparedness and Response Guide

31. Destruction of Samples & Return of Evidence • The select agent or toxin must be secured against theft, loss, or release during the period between identification and transfer or destruction. Any theft, loss, or release of such agent or toxin must be reported. APHL Clinical Laboratory Preparedness and Response Guide

32. Resources • http://www.Michigan.gov/mdhhslab • On main page click on “Bioterrorism Laboratory Preparedness” hyperlink • A wide selection of resources and tools available for download are provided • Contact information for the Bureau of Labs is available on the site (pg. 7-8 of Clinical Laboratory Preparedness & Response Guide)

33. Questions?