Bioterrorism

1. Bioterrorism UW- Eau Claire ENPH 210- Introduction to Environmental Health Sarah Arneson Todd Dennis Pamela Dohm Heather Rapala Daniel Rehberger Laura Suppes Kevin Wang

2. Definition • Bioterrorism is terrorism using germ warfare, an intentional human release of a naturally-occurring or human-modified toxin or biological agent 1

3. Case study • Sitting in an office opening up a piece of mail • Few weeks later you start to feel sick • You find out that you have anthrax • Course of antibiotics, mainly doxycycline • Everyone who was in your office is now sick • An act of bio – terrorism

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5. Brief overview • We will be covering 6 different topics. • FAQ • Past and present cases • Types of agents that are used and the effects that these agents have on the human body • How to prevent and protect yourself from bio – terrorism • Organizations that are trying to protect us from bio – terrorism and how much money it is costing us

6. Frequently Asked Questions

7. FAQ • What is the likelihood of a large-scale attack on the United States? • likelihood of a large-scale attack is low. • Not easy to spread a biologic agent that could infect lots people. • While a major attack could be devastating, preparations will minimize casualties. 3

8. FAQ • Is the U.S. health system prepared for an act of bioterrorism? • Centers for Disease Control and Prevention, the Public Health Service, Cook County Public Health Office conduct surveillance for a bioterrorist event. • Federal, state, and local authorities are working with physicians, hospitals, and the pharmaceutical industry to provide • information and communication systems and ensure the availability and rapid deployment of life-saving pharmaceuticals, vaccines, and antidotes; 3

9. FAQ • Should I be immunized against anthrax? • The anthrax vaccine is only available to military personnel and those who might come in contact with natural anthrax in their work (special-risk groups such as goat-hair mill or goatskin workers, wool or tannery workers, laboratory workers). • Physicians do not have this vaccine and cannot obtain it. • The anthrax vaccine is only recommended for people between 18 and 65 years of age. 3

10. FAQ • Should I be immunized against smallpox? • The last naturally occurring case of smallpox in the world occurred in 1977. • The vaccine is not generally available to the public. • 12 to 15 million doses of vaccine remaining in the United States. • no treatment for the disease, vaccine provides protection and serves to stop spread of the disease. 3

11. FAQ • Should I ask my doctor for antibiotics to have on hand in case of a bioterrorist attack? • No. Indiscriminant use of antibiotics could be harmful, particularly for pregnant women and children. • Keeping a supply of antibiotics on hand poses an additional problem because they have a limited shelf life and will lose potency over time 3

12. FAQ • What is the "National Pharmaceutical Stockpile" that health officials talk about on the news? • This is a large reserve of antibiotics, chemical antidotes, and other medical supplies set aside for emergencies. • CDC can move stockpiled material to affected areas in the United States within 1 to 2 hours of notification from a state’s Governor. 3

13. FAQ • Who do I contact regarding a possible exposure? • If you believe you have been exposed to an infectious bioagent or if you develop symptoms that you believe might be associated with such an exposure, immediately contact a physician. 3

14. FAQ • What can I do to protect my family and myself? • Although there is little that you as an individual can do in advance to protect yourself from a bioterrorist attack. • Government agencies, health care institutions, and public health agencies can and are doing more to improve capacity to protect the public following a bioterrorist attack. • We can all educate ourselves about this issue, make family preparations for a disaster, and find out ahead of time what our local communities suggest we do. 3

15. History of Biological Weapon Use(BC- 1986)

16. RYE ERGOT Used as early as 6th century B.C. Used by Assyrians against enemies (Israelites) to poison wells The plant is infected by the fungus Claviceps Purpurea Symptoms include: convulsions, gangrenous extremities, “madness” and death. 4 5, 6, 10

17. Animal Cadavers • 300 BC • Romans and Greeks used dead animalsto contaminate wells of their enemies and other water sources 7

18. 8 • Snake Venom • 190 BC • Hannibal at the battle of Eurymedon conquered King Eumerus II of Pergamon • Hannibal used poisonous snakes by putting them into enemy ships 7

19. Human Cadavers • 12th Century AD • Battle of Toptona • Barbossa used the bodies of dead soldiers to poison enemy wells • Also, Romans, Greeks and Persians dipped arrows into decomposing corpses to contaminate the arrow tips 7, 9

20. Plague 1346- breakout of plague in Tartar Army during the “Seige of Kaffa” Tartar soldiers threw plagued corpses over the walls of Kaffa and infected the city causing surrender Infected Kaffans may have contributed to the cause of the “Black Death Pandemic” Spread through transmission of flea to human host The plague bacilli invades the lymph nodes causing inflammation, which was what “buboes” were named after 11 10, 12

21. Small Pox 1753 Beginnings of the French and Indian War (1754-1763) Fort Pitt- Pennsylvania Frontier General Amherst The disease was spread by the British “peace gesture” of offering blankets infected with smallpox to Native Americans who were loyal to the French Ottowan Chief- Pontiac The fight during which the smallpox outbreak took place was named “Pontiac’s Rebellion” 1796 British soldiers infected the Continental Army with smallpox 15 10, 13, 14, 7

22. Robert Koch 1870 first person to discover that microorganisms cause infectious disease Does so by injecting mice with anthrax spores Mice contract the disease 16 10

23. First Vaccines 1882 Louis Pasteur Development of the first successful vaccine Prevents Anthrax in animals 17 10

24. Glanders--B- Mallei 1915 Germans use the agent Glanders to infect allied countries livestock Symptoms include: fever, rigors, sweats, headache, chest pain, and is almost always fatal without treatment 19 10, 18

25. Use of biological agents by the Japanese • 1937 • “Unit 731” in present day Sun Yang China, a base made for the construction of bombs containing deadly biological agents • The base was disguised as an “Epidemic Prevention and Water Supply Unit” • The base included 3 crematoriums and 2 secret prisons • It was the largest weapons of mass destruction center in the world • Various microorganisms were used on Chinese prisoners 10, 20, 21

26. Anthrax inhalation methods were found to be one of them, as well as the use of Plague, Cholera, Gas Gangrene, Brucellosis, Tularemia, and Glanders • Symptoms for Anthrax include: mild fever, muscle aches, sore throat, malaise and after a few days, they may progress into difficulty breathing and shock • Inhalation anthrax is usually fatal • Cholera : Vibrio cholerae is the bacterium which causes the disease in the intestinal track • It is a diarrheal illness • The disease itself is acute with little or no symptoms 22, 23, 24

27. Gas Gangrene: caused by Clostridium Perfringens bacterium • Symptoms include: pain and swelling around injury, fever, blisters filled with red fluid, increased heart rate • Caused by the infection of wounds • Brucellosis: from the genus Brucella • Symptoms include: sweating, weight loss, fatigue, headache, abdominal pain • Not a deadly disease but is highly contagious and can incapacitate a person for weeks • Tularemia: caused by the bacteria Francisella tularensis • Symptoms include: enlarged lymph nodes, sweating, headache, muscle pain, weight loss • Not very lethal, but also will incapacitate a person for a long period of time 22, 25, 26, 27

28. 29 • A testimonial from a Japanese scientist who worked on the base stated in a documentary done years later: • "I cut him open from the chest to the stomach and he screamed terribly and his face was all twisted in agony. He made this unimaginable sound, he was screaming so horribly. But then finally he stopped. This was all in a day's work for the surgeons, but it really left an impression on me because it was my first time." • The surgeon soon learned, as stated in the text, that he was subjected to this operation because the man had been purposely infected with the plague, and was there for scientific observation 28

29. Plague Infested Fleas • 1940 • Epidemic in China and Manchuria • Source of plague came from Japanese planes, which reportedly dropped containers full of plague infested fleas over cities

30. We know today that in 1945 the Japanese had plans to use biological warfare on the U.S. • The Japanese military developed long-distance traveling balloons • The balloons contained biological agents such as the ones used on Unit 751, and could reach U.S. shores • Kamikaze planes were also planned to crash into San Diego in 1945 while carrying plague infested fleas

31. Anthrax - British Military 1942 Guinard Islands Off the coast of Scotland, British military tested Anthrax spores by dumping the spores from planes The “Bomblet” used was created at the Crane Naval Air Station in Southern Indiana in 1941 The experiment killed all of the sheep on the island within 72 hours In 1986, the Island was so contaminated, it had to be disinfected To disinfect, Formaldehyde and sea water were used The island is now officially decontaminated 30 10

32. Anthrax- United States Military • 1942 • Camp Detrick • U.S. begins their biological weapons construction • 5,000 bombs filled with anthrax spores are made

33. U.S. development of vaccines • 1953 • The first mass development of vaccines to specifically protect U.S. troops against biological warfare • Other countermeasures, along with vaccines were developed as well 10

34. Executive order to stop weapon production • 1969 • Richard Nixon signs an executive order to stop all biological weapon production as well as research • 1971-1972 • All biological weapons in the U.S. are destroyed 10

35. “Biological Weapons Convention” • 1972 • Prohibition of the stockpiling of biological weapons for offensive purposes • Signed by many countries including the U.S., the former Soviet Union, and Iraq 10

36. Accidental release of Anthrax spores • 1979 • Sverdlovsk, Russia • Accidental release of airborne Anthrax spores • 66 confirmed deaths • Studies indicated that the spores contained 4 different strains of anthrax 10

37. Salmonella • 1984 • The Rajneeshee cult contaminated a salad bar in Oregon • attempting to influence a local election by incapacitating voters • Symptoms include: stomach cramping, bloody diarrhea and nausea • The fatality rate is small for this disease 10

38. Bioterrorist Attacks 1986-Present

39. Aum Shinrikyo • The first bioterrorist attack on U.S. soil was not noticed by many. Almost a decade later another cult created a large amount of media attention. • In 1995, the Aum Shinrikyo cult of Japan released sarin gas in the Tokyo subway. The attack killed 12 and injured thousands. • The religious group also attempted to spray botulisim and anthrax in Tokyo ten times from 1993 to 1995. • The failure of the attacks is blamed on insufficient particle size and a non-virulent strain of anthrax. 31, 34

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41. Disgruntled Hospital Worker • In October 1996, 12 lab hospital workers became sick after eating some free doughnuts and muffins. • Upon analysis of the sick workers Shigella dysenteries type 2 was found in their stool. Analysis of an uneaten muffin contained the same strain. • A lab technician later admitted to committing the crime and also similarly caused her boyfriend to become sick with infected food. 33

42. Insurance Fraud in Japan • Another attack on people’s food occurred at a summer festival in Japan in 1998. At the event 67 people ate curry rice and later became sick. • At first cyanide poisoning was suspected but later it was discovered to be arsenic added to the rice. Four people died from the attack. • It is believed that Masumi and Kenji Hayashi carried out the poisoning but Kenji has never admitted guilt for the event. Kenji was a termite exterminator which would have given him access to arsenic. • While the mass-poisoning in Wakayama instilled terror in the population, the intent was allegedly to perpetrate insurance fraud, which Masumi had done in the past. 33

43. Anthrax Letters • In the fall of 2001, letters containing anthrax spores were mailed to many prominent people in the U.S. • Tom Brokaw, Senator Tom Daschle, and the offices of the New York Post were among those who were targeted. • According to the CDC 23 people were infected and five died. 34, 35

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45. Types of Biological Agents

46. AIDS • Stands for Acquired Immunodeficiency Syndrome • Viral disease caused by HIV, Human Immunodeficiency Virus • Attacks body’s immune system and leaves it vulnerable to other infections and diseases • Currently no cure, but there are many drug treatment options • AIDS is becoming a threat to national security around the world but especially in Sub-Saharan Africa where the disease evolved • AIDS can be transmitted only through sexual intercourse with an infected person, contact with contaminated blood, transmission from an infected mother to her child before or during birth or during breastfeeding 38

47. AIDS • Symptoms start out as flu-like with nausea, fever, sore throat, and headache which last around 4 weeks, after that time has passed the body starts to battle the HIV and the person can enter a symptom free period of ten or more years • AIDS could be used for a bio-terrorist weapon because there is no current cure • AIDS has a huge impact on the communities that it thrives in which leads to undermining government relations such as has what has happened in some parts in Africa where AIDS is virtually uncontrolled 38

48. Anthrax • caused by Bacillus Anthracis, a bacterium that forms spores. • Spore is a cell that is dormant but may come to life with the right conditions • Three types of anthrax: -Skin (cutaneous) -Lungs (inhalation) -Digestive (gastrointestinal) • not known to spread from person to person • infection from infected animals, handling products or infected meat, of breathing anthrax spores • Classified as a Category A agent by the Centers for Disease Control and Prevention which means that: -It poses the greatest possible threat for a bad effect on public health -Spreads across a large area and needs public awareness -Needs a great deal of planning to protect the public’s health 39

49. Anthrax • Symptoms include: • Cutaneous- small sore develops into a blister then develops into a skin ulcer with a black area in the center. (These sores do not usually hurt) • Gastrointestinal- nausea, loss of appetite, bloody diarrheas, fever, stomach pain • Inhalation- cold and flu-like symptoms, sore throat, fever, cough, shortness of breath, muscle aches • Symptoms appear around 7 days after contact for all 3 types; inhalation can take a week to 42 days to appear 39

50. Anthrax • Treatment is 60 days of antibiotics • The CDC is preparing for an anthrax bio-terrorist attack by -Planning the response to an attack -Training emergency response teams -Educate health care providers -Educate general public -Develop national electronic database to track potential cases of anthrax -Making sure there are enough supplies in case of an attack 39, 40