Bioterrorism 2018

P.G. Students: Dr. Sangeeta Sonawne (JR I)
Dr. Rupam Kumar (JR II)
P.G. Teachers: Dr. M. Kakeri Madam
Dr. P. Howal Sir
Dr. M. Sadawarte Sir

The use of
intentionally
indiscriminate violence as a means to
create terror
among masses of people

1) INTRODUCTION
2) HISTORICAL ASPECT
3) BIO-AGENTS
4) IDENTIFYING A BIO-TERROR ATTACK
5) GLOBAL PREPAREDNESS
6) INDIAN PREPAREDNESS
7) FUTURE THREATS
6)REFERENCES

Intentional or threatened use of
Viruses
Bacteria
Fungi
Toxins
(from living organisms)
to produce death or disease in
humans, animals or plants

 Bioterrorism is not a modern era novelty.
 It poses greater threat to health, environment and
national security.
 Technology for the cultivation of pathogens and
vaccinology developed over time.
 Their effects manifest after an incubation period
allowing the infectors to move away from the site of
attack.

 600 BC- animal
carcasses in
enemy’s water body
 400 BC-Arrows
dipped in blood or
manures
 190 BC- venomous
snakes were used

The hurling of the
dead bodies of
plague victims over
the walls of the city
of Kaffa by the
Tartar army in
1346

The spreading of
smallpox via
contaminated
blankets by the
British to the
American Indian
population loyal to
the French in 1767.

20th century: Rajneeshee Cult,
Salmonella - Oregon, 1984
Members of the
Rajneeshee cult
intentionally
contaminated
restaurant salad
bars in Oregon
with Salmonella
typhimurium.

 No confirmed incidents of bioterrorism attack in India yet
 An incident: In 2001, the office of the Deputy Chief
Minister of Maharashtra had received an envelope having
anthrax spore.
 Due to this, several incidents were suspected to be acts of
bioterrorism retrospectively
 Some of them are as follows:
 1994, Pneumonic plague attack in Surat
 1996, Dengue hemorrhagic fever attack in Delhi
 1999, Anthrax attack in Midnapore
 2001, the Mystery ‘encephalitis’ attack in Siliguri.

 High morbidity and mortality
 Potential for person-to-person spread
 Low infective dose and highly infectious by
aerosol
 Lack of rapid diagnostic capability
 Lack of universally available effective
vaccine
 Potential to cause anxiety
 Environmental stability
 Database of prior research and development

 Can be produced in large quantity
 Can infect large number of people
 Can be stable when stored
 Retain virulency after areosol dissminations

o Scud missiles
o Motor vehicle with spray
o Handpump sprayers
o Guns
o Remote control devices
o Robotic delivery.

What exactly are these Bio-weapons?

Category A-
High-priority
agents include
organisms that
pose a risk to
national
security
Category B-
Second highest
priority agents
are less
dangerous than
Category A
Category C-
Third highest
priority agents
include
emerging
pathogens that
could be
engineered for
mass
dissemination
the future

Category A Category B
 They 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
 Require special action
for public health
preparedness.
 They are moderately
easy to disseminate
 Result in moderate
morbidity rates and
low mortality rates
 Require specific
enhancements of
diagnostic capacity
and enhanced
disease surveillance.

Category A Category B
Agents/Diseases
 Anthrax (Bacillus
anthracis)
 Botulism (Clostridium
botulinum toxin)
 Plague (Yersinia pestis)
 Smallpox (variola major)
 Tularemia (Francisella
tularensis)
 Viral hemorrhagic fevers
including
 Filoviruses (Ebola, Marburg)
 Arenaviruses (Lassa,
Machupo)
Agents/Diseases
 Brucellosis (Brucella speci
es)
 Clostridium perfringens
 Food safety threats
(Salmonella species,
Escherichiacoli O157:H7,
Shigella)
 Q fever (Coxiella
burnetii)
 Water safety threats
(Vibrio
cholerae, Cryptosporidiu
m parvum)

Characteristics Agents/diseases
Future use depends
upon
 Their availability
 Ease of production
and dissemination
 Potential for high
morbidity and
mortality rates and
major health impact.
Emerging infectious
diseases such as
 Nipah virus
 Hantavirus

 Anthrax is the prototypic disease of bioterrorism
 U.S. and British government scientists studied
anthrax as a biologic weapon beginning
approximately at the time of World War II (WWII).
 Soviet Union in the late 1980s stored hundreds of
tons of anthrax spores for potential use as a
bioweapon
 At present there is suspicion that research on
anthrax is ongoing by several nations and extremist
groups
 One example of this is the release of anthrax spores
by the Aum Shrinrikyo cult in Tokyo in 1993.
Fortunately, there were no casualties associated
with this episode.

PLAGUE
MICROBIOLOGICAL FEATURES:
gram-negative, cocco-baccillus,, facultative anaerobic
bipolar staining, non-motile, non-sporulating
BIOLOGICAL SURVIVAL:
15 minutes in 55° C/ few hours in sunlight
weeks in water, grains, moist soil, dry sputum, flea feces
lives months/years at just above 0°C
HOST RANGE:
zoonotic disease of rodents: rats, mice, ground squirrels
intracellular organism: monocytes/macrophages
=> Circumstances for natural human outbreaks:
disasters/ disruption of rat habitats/ rat dis- or relocation

4 ROUTES FOR HUMAN INFECTION
1. Flea-bite (most common)
2. Handling infected animals (skin contact,
scratch, bite)
3. Inhalation of contaminated aerosol
(human/animal)
4. Ingestion of infected meat

 A member of the family of Orthopoxviridae
 The largest viral genome: double-stranded
DNA

 Prodrome (day 1-3)
 Erythematous rash
(days 2-3)
 Maculopapular rash
(days 4-6)
 Vesicular  pustular
rash (days 8-14+)
40% mortality in
susceptible population
(Fenner F et al. Smallpox and its eradication. WHO 1998.
http://whqlibdoc.who.int/smallpox/9241561106.pdf )

 Single index case spent time in Iraq
 11 contacts developed smallpox
 100 secondary cases in contacts and
other hospital patients
 14 tertiary cases
 Spread to other cities
 Total 175 cases, 35 deaths

 Live vaccinia vaccines
 Lister-Elstree
 NYCBH
 2nd generation live
 (Modified vaccinia and others)
 Given by scarification

HOW TO IDENTIFY A BIO-TERROR ATTACK?

• The intentional or threatened use of viruses,
bacteria, fungi or toxins from living organisms
to produce death or disease in humans,
animals or plants.
What is bio terrorism?
• A disease outbreak is the occurrence of
disease cases in excess of normal expectancy.
The number of cases varies according to the
disease causing agent and the size and type of
previous and existing exposure to the agent
What is a natural outbreak?

Natural disease Bioterrorism
 Recent endemic
exposure
 Recent travel to
endemic area
 Sporadic, infrequent
cases
 Multiple cases
associated with
exposure to the same
food product or water
source
 No known endemic
exposure
 Point source in urban,
crowded setting
 Cluster of severe and
fatal illness
 Cases that don’t respond
to recommended
antibiotic treatment

Covert
Unannounced
Overt
Announced
Hoax

What do we do when
it is an overt attack?
Confirm it is not a
hoax!
Treat the affected,
prevent the spread

What to do in a
covert attack?
Detect and confirm
the attack!
Treat the affected,
prevent the spread
How to detect and
confirm the attack?
Syndrome based
criteria
Epidemiological
features

 Syndrome description - typical combination
of clinical features of the illness at
presentation
 These are specific for every agent
 Do not wait for laboratory diagnostic
confirmation
 Eg: Flu like symptoms with
typical eschar
ANTHRAX

 A rapidly increasing disease incidence in a
normally healthy population.
 An epidemic curve that rises and falls during
a short period of time.
 An unusual increase in the number of people
seeking care.
 An endemic disease rapidly emerging at an
uncharacteristic time or in an unusual
pattern

 Lower attack rates among people who had
been indoors
 Clusters of patients arriving from a single
locale.
 Large numbers of rapidly fatal cases
 Any patient presenting with a disease that is
relatively uncommon and has bioterrorism
potential (e.g., pulmonary anthrax,
tularemia, or plague)

Recommended for primary identification of
biological agents and their specific genes
•Antibody-based Immuno-assays
•Biochemical Testing
•Mass Spectrometry
•Microbiological Culturing
•Genomic Analysis Using PCR
(used in Biowatch program of USA)

Decontamination Triage Psychological
aspect
Post exposure
immunization

 Contain the contamination to
prevent further spread
 Remove contaminated clothing
 Wash with soap and water
 Rinse eyes with clean water or
normal saline
 Contaminated clothing handled
by personnel wearing appropriate
PPE, and placed in an impervious
bag

 Establishing networks of
communication and
lines of authority
required to coordinate
onsite care.
 Identifying sources able
to supply available
vaccines, immune
globulin, antibiotics
 Planning for the
efficient evaluation and
discharge of patients

 Minimize panic by
 clearly explaining risks
 offering careful but rapid
medical evaluation and
treatment
 avoiding unnecessary isolation
or quarantine.
Treat anxiety in unexposed
persons who are experiencing
somatic symptoms

To potentially exposed
healthcare workers
Maintenance of
accurate occupational
health records will
facilitate
 Identification
 Contact assessment
 Delivery of post-exposure
care

Geneva protocol: ( 17 June 1925)
The Protocol for the Prohibition of the Use in
War of Asphyxiating, Poisonous or other
Gases, and of Bacteriological Methods of
Warfare, usually called the Geneva
Protocol, is a treaty prohibiting the use
of chemical and biological weapons in
international armed conflicts.

Biological Weapons Convention (BWC)
or Biological and Toxin Weapons
Convention (BTWC) in 1972
 The Convention on the Prohibition of the
Development, Production and Stockpiling
of Bacteriological (Biological) and Toxin
Weapons and on their Destruction
 The first multilateral disarmament treaty
banning the production of an entire category
of weapons

 The Health Alert Network (HAN)
 National Electronic Disease Surveillance
System (NEDSS)
 The Epi-X Project
 The Laboratory Response Network (LRN)
 CDC’s Bioterrorism Preparedness and
Response Program’s website:
https://emergency.cdc.gov/bioterrorism/ind
ex.asp.

 An environmental monitoring program in
United States.
 Test the air samples 24 hours a day, 7 days
a week.
 Located in undisclosed cities
 The specimens are sent to the LRN and
tested for various agents.
 A report is sent to emergency managers and
public health professionals in the
communities in which the agents were
detected.
 These reports are termed “BioWatch
Actionable Results” (BARs)

Public Health Security and Bioterrorism Preparedness and
Response Act of 2002 (the Bioterrorism Act)
The Bioterrorism Act is divided into five titles--
Bioterrorism Act of 2002, United States
• National Preparedness for Bioterrorism
and Other Public Health EmergenciesTitle I
• Enhancing Controls on Dangerous
Biological Agents and ToxinsTitle II
• Protecting Safety and Security of Food
and Drug SupplyTitle III
• Drinking Water Security and SafetyTitle IV
• Additional ProvisionsTitle V

Two large State Research Centers of the
Russian Ministry of Public Health
 Applied Microbiology (Obolensk)
 Virology and Biotechnology VECTOR
(Koltosovo).

 National Disaster Management Authority
(NDMA)
 National Disaster Response Force (NDRF) –
trained to deal with chemical, biological,
radiological, and nuclear (CBRN) threats.
 2004 – Integrated Disease Surveillance
Project (IDSP), a decentralized and state-
based surveillance program

 These are formulated under
the chairmanship of Lt Gen J.R.
Bhardwaj, NDMA in July 2008.
 Prepare action plans for
management of all disasters.
 MoH&FW is the nodal ministry
(Ministry of Health and Family
Welfare)

 According to a report on Bio Weapons in India, there are 400
trained personnel to handle bio-terrorism in India.
 Defence Research and Development Organisation (DRDO)
heading India for bio-defence.
 Detection, diagnosis and decontamination --primary fields
under focus.

Microorganisms are classified on the basis of
the risks levels that their handling entails
Category Individual risk Community risk
Risk Group-I Low Low
Risk Group-II Moderate Limited
Risk Group-III High Low
Risk Group-IV High High

 It consists of a combination of laboratory
practices, equipment and facilities suitable
to the procedures being performed and
hazards of the pathogen.
Name Location Year
High Security
Animal Disease
Laboratory
(HSADL)
Bhopal, Madhya
Pradesh
1998
Centre for
Cellular and
Molecular Biology
Hyderabad,
Telangana
2009
Microbial
Containment
Complex
Pune, Maharashtr
a
2012

Strengths Weakness
 Easy to prepare
 Covert attacks
 Larger target
achieved
 Deaths and
disability
 No dedicated
national bio-
defence
 Gets inactivated in
environment
 No assurance of
target achieved
 The agents might
attack the attacker
 Causing only
morbidity when
mortality is intended

•Poison food stocks
•Pollute water with pathogenic
organisms
•Gene editing

 Biological warfare is a reality.
 There is an urgency to develop out the
capabilities of human, agricultural and
veterinary bioterrorism.
 A clear vision, political will, careful planning
and organization by integrating local, state
and central capabilities is a must
 We can deal with bioterrorism and not
overreact to it.

 A. H. Suryakantha; Community Medicine with Recent
Advances; 4th edition; Jaypee Brothers; page no. 979-981
 https://www.cdc.gov/biosafety/publications/bmbl5/bmbl
5_sect_iv.pdf
 http://www.iitb.ac.in/safety/sites/default/files/BIO%20SA
FETY%20IITB_1.pdf
 https://en.wikipedia.org/wiki/Biological_Weapons_Conven
tion
 https://www.lawctopus.com/academike/bioterrorism/
 https://www.unog.ch/80256EE600585943/(httpPages)/04F
BBDD6315AC720C1257180004B1B2F?OpenDocument
 https://emergency.cdc.gov/agent/agentlist-category.asp
 https://www.linkedin.com/pulse/indias-bioterrorism-
preparedness-abhijeet-kumar-singh

 https://en.wikipedia.org/wiki/Biosafety_level#List_o
f_BSL-4_facilities
 http://www.ejbiotechnology.info/index.php/ejbiotec
hnology/article/view/v2n3-2/827
 https://www.ncbi.nlm.nih.gov/pubmed/12737427
 file:///C:/Users/COMPAQ/Downloads/3959.pdf
 https://pdfs.semanticscholar.org/64b6/5c641d06d06
5b4d6df51a26c881a6a441d1f.pdf
 https://www.nap.edu/read/11848/chapter/14#116
 https://emergency.cdc.gov/bioterrorism/pdf/13apr9
9APIC-CDCBioterrorism.pdf
 https://www.medicalnewstoday.com/articles/321030
.php

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