New Developments in Biothreats and Biosecurity Clifton R. Lacy, M.D. October 17, 2007

1. New Developments in Biothreats and Biosecurity Clifton R. Lacy, M.D. October 17, 2007

2. A Taste of the New Jersey Experience • Imported Lassa Fever • Tularemia • Severe Acute Respiratory Syndrome (SARS)

3. Emerging Infectious Diseases

4. New Diseases in Past 20 Years • Acanthamebiasis • AIDS • Anthrax • Antimicrobial and insecticide resistance • Australian Bat Lyssavirus • Babesiosis • Bartonella henselae • Botulism • Campylobacteriosis

5. New Diseases in Past 20 Years • Chikungunya • Cryptosporidiosis • Cyclosporiasis • Prion Disease, Creutzfeldt-Jacob (vCJD) • Ebola Hemorrhagic Fever • Encephalitozoon cuniculi • Encephalitozoon hellem • Enterocytozoon bieneusi • Ehrlichia chafeensis Ehrlichiosis

6. New Diseases in Past 20 Years • Escherichia coli 0157:H7 • Enterovirus 71 • Guanarito Virus • Hantaan Hemorrhagic Fever with Renal Syndrome (HFRS) • Hantavirus Pulmonary Syndrome • Helicobacter pylori • Hendra Virus • Hepatitis C

7. New Diseases in Past 20 Years • Hepatitis E • HIV • Human herpesvirus 6 (HHV-6) • Human herpesvirus 8 (HHV-8) • Human Monkeypox • Influenza, H5N1 • Lassa Fever • Legionnaires Disease • Lyme Borreliosis

8. New Diseases in Past 20 Years • Sabia Virus • SARS Coronavirus • Sindbis • Sin Nombre Virus • Staphylococcal Infection, Methicillin-Resistant, Vancomycin-Resistant • Streptococcal Infection (toxic shock syndrome, necrotizing fasciitis, etc.) • Tuberculosis (MDR-TB, XDR-TB) • Tularemia • Malaria, Drug-Resistant

9. New Diseases in Past 20 Years • Marburg Hemorrhagic Fever • Monkeypox, Human • Nipah Virus • O’nyong’nyong Fever • Oropuche Fever • Parvovirus B-19 • Plague • Rift Valley Fever • Rotavirus • West Nile Encephalitis • Whitewater Arroyo Virus

10. Selected New Infections By Year • 1973: Rotavirus • 1975: Parvovirus B-19 • 1976: Cryptosporidium • 1977: Ebola • 1977: Legionella pneumophilia • 1977: Hantaan Virus • 1977: Campylobacter jejuni

11. Selected New Infections By Year • 1980: HTLV-1 • 1981: Staphylococcus aureus - Toxic Shock • 1982: Escherichia coli 0157: H7 • 1982: HTLV-2 • 1982: Borrelia burgdorferi • 1983: HIV • 1983: Helicobacter pylori • 1986: Cyclospora cayatanensis • 1988: Human herpesvirus 6 (HHV-6) • 1988: Hepatitis E • 1989: Ehrlichia chafeensis • 1989: Hepatitis C

12. Selected New Infections By Year • 1991: Guanarito Virus • 1991: Babesia species • 1992: Vibrio cholerae 0139 • 1992: Bartonella henselae • 1993: Sin Nombre Virus • 1993: Encephalitozoon cuniculi • 1993: Hantavirus Pulmonary Syndrome • 1994: Sabia Virus • 1995: Human herpesvirus 8 (HHV-8) • 1996: Creutzfeldt-Jacob disease (vCJD) • 1997: H5N1 Influenza • 1998: Nipah Virus Encephalitis • 1999: West Nile Encephalitis

13. Selected New Infections By Year • 2000: Rift Valley Fever • 2001: Anthrax Bioterrorism • 2002: Vancomycin-Resistant Staphylococcus aureus • 2003: SARS Coronavirus • 2004: Monkeypox, Human

14. Emerging Diseases • Over 2 billion airline passengers in 2006 • Potential for faster and farther disease spread than any time before in history • Outbreak or epidemic somewhere is only few hours away from being public health threat elsewhere • Infectious diseases are emerging more rapidly • Since the 1970s, one or more new diseases have been identified each year • Over 40 diseases now were unknown 20 years ago • Over 1100 epidemic events during last 5 years

15. Causes of Emergence/Re-Emergence • Population growth and urbanization • overcrowding, unsanitary living conditions, lack of clean water for drinking and washing, poor hygiene • Human encroachment on tropical rain forests • populations with little or no disease resistance now in contact with disease organisms and/or vectors • Economic and social exigencies • inadequate health systems and public health infrastructure

16. Causes of Emergence/Re-Emergence • Environmental change • deforestation, road and building construction, irrigation, increased crop and animal production, urban sprawl, poor sanitation, pollution • Movement and encampment of population displaced by wars, civil instability, or natural disasters • overcrowding, lack of clean water, unsanitary conditions, poor hygiene, malnutrition, exposure to new or re-emerging diseases • Human sexual behavior change

17. Causes of Emergence/Re-Emergence • Increased global travel, commerce, and terrorism • transport of disease-causing organisms/vectors • global commerce of livestock and foodstuffs • Indiscriminate use pesticides/antimicrobials • antibiotic resistance in organisms • New strains of all diseases • different immunological characteristics, virulence, contagion, and response to antibiotics • Immunosuppressed and compromised hosts

18. Examples of Emerging and Re-Emerging Infectious Diseases AS Fauci

19. Examples of Emerging Infections • Henipaviruses • Hendra Virus • Nipah Virus • Avian Influenza H5N1

20. Intentional Biothreats • Anthrax • Terrorism • Bioterrorism

21. Terrorism • Repeated violent action • Anxiety-provoking • Intimidation, coercion, propaganda • Main target not the direct target of violence

22. Assassination / Guerrilla Warfare • Assassination: Main target is the direct target of violence • Conventional and guerrilla warfare: Violence/threat to create fear only in victims

23. Bioterrorism • Deliberate release of biological agents (viruses, bacteria, fungi, etc.) to cause illness and/or death in people, animals, or plants • Biological agents are insidious • difficult to detect • illness propagates over hours, days, weeks • Some biological agents are infectious and contagious • can be spread from person to person (smallpox) • Some biological agents are infectious but not contagious • cannot be spread from person to person (anthrax) • Bioterrorism agents are divided into three categories, based on on ease of contagion and severity of illness

24. Select Agents – Category A • Category A Agents – highest risk • Easily spread or transmitted person-to-person • High death rates and potential major public health impact • Can cause public panic and social disruption • Require special action for public health preparedness

25. Select Agents – Category A • Anthrax (Bacillus anthracis) • Smallpox (Variola major) • Plague (Yersinia pestis) • Botulism (Clostridium botulinum toxin) • Tularemia (Francisella tularensis) • Viral hemorrhagic fevers • filoviruses like Ebola and Marburg • arenaviruses like Lassa and Machupo

26. Select Agents – Category B • Category B Agents – second highest priority • Moderate illness rates and low death rates • Require specific laboratory enhancements and disease monitoring

27. Select Agents – Category B • Brucellosis (Brucella species) • Glanders (Burkholderia mallei) • Melioidosis (Burkholderia pseudomallei) • Psittacosis (Chlamydia psittaci) • Q Fever (Coxiella burnetii) • Epsilon toxin of Clostridium perfringens • Food safety threats (Salmonella species, E coli 0157:H7, Shigella) • Ricin toxin from Ricinus communis • Staphylococcal enterotoxin B • Typhus (Rickettsia prowazekii) • Viral encephalitis (Alpha viruses: Venezuelan Equine Encephalitis, Eastern Equine Encephalitis, Western Equine Encephalitis) • Water supply threats (Vibrio cholerae, Cryptosporidium parvum)

28. Select Agents – Category C • Category C Agents – third highest priority • Include emerging pathogens that could be engineered for mass spread in the future • Easily available • Easily produced and spread • Potential for high morbidity and mortality rates and major health impact • Nipah Virus • Hanta virus • Multi-Drug-Resistant Tuberculosis.

29. Biowarfare History • Poisoned wells • Contaminated arrows • Venomous snakes • Dead/infected animals • Dead/Infected humans • Infected fomites • Infected insects • Food poisoning • Bioagent release

30. Synthetic Biothreats • Genetic engineering of bioagents • Creation of bioagents • Re-creation of bioagents • Purchase of DNA sequences

31. Genomics and Future Biological Weapons • Modify infectivity • Modify virulence • Modify antigenic properties • Enhance antibiotic resistance • Transfer pathogenic properties • Alter to make harder to detect, diagnose, and treat • Sneak stealth viruses covertly into genome • Population-specific • Triggered at a later time • Target genome of specific population • Design specific pathogen

32. Synthetic Biothreats • “…DNA can be synthesized from the [genetic] sequence, and this could be done by any third-rate terrorist.” • Vincent Racaniello Virologist, Columbia University

33. Synthetic Biothreats • “The most worrisome thing… is that the field of synthetic biology is going to enable people to create potentially very dangerous diseases that don't otherwise exist or to re-create ones that have been wiped off the face of the earth.” • Edward Hammond, biological weapons expert

34. System Failures and Human Error • Mistakes – Accidents – Operator/System Failures • Errors of Commission • Errors of Omission • Poor Judgment • Carelessness • Inadequate or Lapsed Training • Unintentional Environmental Releases • Intentional Releases • Containment Breaches and Security Failures • Missing Laboratory Samples or Animals

35. World Health Organization World Health Report 2007 A Safer Future Global Public Health Security in the 21st Century

36. Impact Public Health • Commerce and travel • Reduced vigilance and lapsed programs • False rumors • Armed conflict • Poverty • Resistant organisms • Weather and climate • Intentional and unintentional releases • Industrial accidents • Natural phenomena