BIOLOGICAL TERRORISM AND SECURITY

1. BIOLOGICAL TERRORISM AND SECURITY EMD545b Lecture #9

2. Biological Terrorism Intentional or threatened release of viruses, bacteria, fungi or toxins derived from living organisms to produce disease or death in humans, animals, or plants

3. Outline • Historical events • Potential agents of bioterrorism • Means of delivery • Monitoring and detection • Hazardous materials/emergency response • Security issues • Suspicious materials • Discussion and comments

4. Historical Events 6th Cent. BC: Rye ergot, plant toxins 1300’s: Plague-infected corpses catapulted into defenders during Siege of Kaffa 1500’s: Strategic value of smallpox-laden blankets during Spanish conquest of Central and South America 1700-1800’s: Smallpox-laden blankets repeatedly traded to North American Indians

5. More Recent Events WW II: Japan’s Unit 731 1940’s-1969: US offensive use research 1972: Biological Weapons Convention Treaty 1978: Assassination by KGB using ricin 1979-1982: “Yellow-rain” by Soviet Army in Afghanistan 1979: Accidental Soviet anthrax release at bioweapons facility in Sverdlovsk - ca. 80 cases, 60+ deaths

6. Most Recent Events 1984: Purposeful Salmonella contamination of food by Oregon religious cult - 700+ cases 1995: Sarin released in Tokyo subway religious cult 12 deaths, thousands exposed 1998: Vengeful use of radiolabeled saxitoxin stolen from Brown University laboratory 2001-2002: Anthrax distribution in/on US Mail

7. 1995 Tokyo Subway Sarin Release by Aum Shinrikyo

9. Why BioWeapons? • Fear and hysteria • Overwhelm medical resources • Can be lethal or cause severe incapacitation • Delayed effects (but acute from toxins) • Relatively easy to obtain, produce, and use • Potential for secondary infections • Multiple routes for exposure • Compared to chemical and nuclear materials: • Very difficult to detect in field

10. The Perfect BW • Highly pathogenic/toxic • Highly infectious • Incapacitation may be preferable to lethality • Symptoms confused with non-BW diseases • Transmissible by desired route of exposure • Stable for packaging and delivery • Easily harvested, selected, or created • Vaccination/treatment only available to aggressor

11. Epidemiology of BW Attack • Case chronology differences from natural epidemics • Observations of signs/symptoms likely most sensitive surveillance means • Reportable symptoms and diseases Time

12. Factors for Disease Transmission • Presence of pathogenic organism • Viable • Infectious dose (minimum [ ] and qty) • Susceptible host • Effective route of exposure

13. Potential Agents of Bioterrorism • Bacterial agents • Viral Agents • Biological/biologically-derived toxins • Recombinant organisms

14. Bacterial Agents • Single cell microscopic organisms typically with diameter 0.5 - 1.0 um • Capable of causing disease by infection and/or producing toxins • Spore forms often very stable in environment

15. Anthrax • Bacillus anthracis (spore former) • Cutaneous, inhalational, and ingestion forms • Common among livestock and livestock product workers • Spore-form very stable • Flu-like illness, respiratory failure, shock, meningitis • Highest CFR from inhalation (90-100%) • Antibiotic treatment must be early to be effective • Vaccine available

16. Plague • Yersinia pestis • Transmitted by flea bites or aerosol droplets • Wild rodents are natural reservoir • Bubonic and pneumonic forms (“black death”) • Swollen lymph nodes, rapid progressive pneumonia • High case fatality rates • Vaccine and antibiotic therapies available

17. Tularemia • Francisella tularensis (“rabbit fever”) • All routes of exposure, including vector • Low infectious dose • Fever, chills, headache, weight loss, pneumonia • Moderate case fatality rate untreated • Vaccine and antibiotic therapies

18. Brucellosis • Brucella spp. (abortus, melitensis, ovix, others) • Zoonotic, primarily from infected mammals and contaminated milk/other dairy products • Highly infectious by aerosolization • Variable symptoms, but many “flu-like”

19. Viral Agents • Very small particles (ca. 0.02 - 0.2 um diameter) • Not truly “living” • Outer shell and DNA or RNA, but no organelles for metabolism or reproduction • Rely exclusively upon host cells - “parasites” • Typically very short lived outside of host or vector

20. Smallpox • Variola major • Highly contagious by aerosols • Moderately high case fatality rate (~30%) • Incapacitating malaise, fever, vomiting, lesions and pustules • WHO initiative claims eradication (except for stored specimens in US and Russia) • Quarantine essential • Vaccine available

21. Viral Equine Encephalites • Venezuelan, Western, and Eastern • Vector & aerosol transmission (vector primary in nature) • Fever, headache, malaise, nausea/vomiting, neurological damage from encephalitis • Highly incapacitating, high lethality (CFR for EEE 50 - 75%) • Experimental vaccines • Palliative care only

22. Viral Hemorrhagic Fevers • e.g., Marburg, Ebola, Congo-Crimean • BL4 agents • Poorly understood, difficult to work with • Arthropod vectors, contact, possible aerosol routes • Natural epidemics with severe consequences - marked by fever, malaise, headache, internal hemorrhaging, multi-organ failure • Seriously incapacitating • Very high CFRs: 25 - 90% • Palliative care only

23. Biological Toxins • Any toxic substance or compound produced by an animal, plant, or microorganism • Typically high MW proteins or toxic chemicals • Hazardous by most routes of exposure - contact facilitated by dermal penetrants like DMSO • Range of effects from tissue necrosis to nervous system interruption • Most are readily inactivated by heat, steam, or common chemicals

24. Comparative Toxicity

25. Delivery and Release • Acquisition/production in sufficient quantity/concentration to achieve desired outcome • Stability under storage conditions • Packaging • Actual delivery and release • Exposure

26. Routes of Exposure • Airborne - inhalational • Food/water supplies - ingestion • Contact - dermal • Vector - percutaneous

27. Sources of BW Agents • Field, clinical, and veterinary samples • Type culture collections • Commercial distributors • Foreign laboratories and suppliers • Museums and universities • Genetically engineered (rDNA) or selected

28. Monitoring and Detection • Comparison vs. chemical, explosive, and radioactive • Medical signs and symptoms - healthcare providers become first line of surveillance • Laboratory analysis • Antibody titers • Cultures • DNA fingerprinting • Field tests • Future/emerging methods (GC/MS, semi-conductors)

29. HAZWOPER • OSHA standard (29 CFR Part 1910.120) • “Hazardous waste operations and emergency response” • Comprehensive requirements for written safety programs, training, protective equipment, field exercises, medical surveillance, and at least annual re-certifications

30. HAZWOPER/Emergency Response • First responders • Incident commander and IC system • Site/scene health and safety officer • Technician-level responders • Potential crime scene investigation issues • Other specialists as-needed

31. HAZWOPER/Emergency Response • All-hazards approach • Biological, chemical, and radiological • Site/perimeter controls • Work zones • Decontamination systems

32. Knowledge and Information • Incident/facility information • Eyewitnesses critical • On-going process • Monitoring and predictions where possible • Weather and local environmental factors

33. HAZMAT Ensemble Levels Low D Safety shoes and glasses/goggles, work gloves, and work clothing C Above plus more enclosing garments, and air purifying respirator B Above plus even more enclosing garments, and upgrading of respiratory protection to self- contained breathing apparatus (SCBA) A Fully encapsulating garments, SCBA High

34. HAZMAT Ensembles B C D A

35. Key Selection Factors for Protective Clothing • Contaminants and concentration • Consequences of equipment failure • Permeation/penetration resistance • Anticipated duration of use • Exposure type (e.g., incidental contact, immersion) • Anticipated work activities (e.g., dexterity, tactility) • Cost, size, availability, manufacturer’s differences

36. Personal Protective Equipment • Low on controls hierarchy • Advantages • Disadvantages • No one ensemble • Selection criteria • Training • Formal “fitting” process • Maintenance and inspection • Periodic review

37. Medical Interventions • e.g., pre-exposure immunizations, blocker administration, and immediate post-exposure treatment • Excellent protection but for only very limited suite of exposures • Duration of protection highly variable • Potential contraindications of treatment • Timing of administration critical

38. Biosecurity Issues • “Select Agents” transfer rule • Revisions now include “possession” • Basic requirements: • Registration of entity and individuals possessing, using, storing, etc. “select” biological agents and toxins • Inventory controls • Physical security of storage and use • Periodic inspections • Emergency procedures and notifications • Individual background/security clearances

39. Related Security Issues • Building perimeter controls and access • Public vs. non-public areas • Mechanical equipment and HVAC intakes • Collateral benefits of modern filtered HVAC systems • Identify and report strangers/suspicious persons

40. Suspicious Materials • Mail, packages, objects • Return address, condition, and appearance (leaking, discoloration, odor, etc) • Expected or unexpected? Verify source if possible. • Follow recommended procedures. ???

41. Sources for More Information • US Government: Occupational Safety and Health Administration Nuclear Regulatory Commission National Institute for Occupational Safety and Health Centers for Disease Control and Prevention Federal Emergency Management Agency Federal Bureau of Investigation/Department of Justice • Advisory Groups: American Biological Safety Association American Industrial Hygiene Association American and International Red Cross

42. Discussion and Comments