Weaponized Bioagents

1. Weaponized Bioagents YSU – Agents of Mass Casualty

2. Agent Classification • Military • Foundations may be foreign • May have practical roots • Civilian • CDC Classification

3. Military “C” • “C” = Class • Chemical Classes • C01 to C24 • Biological Classes • C25 to C29

4. Chemical Agents • Sub-Codes – Examples C01 • GA • GB • GD • GF

5. Military Classes - Bioagents • C24 – Anti-Personnel • C25 – Anti-Personnel/Vector • C26 – Anti-Personnel/Ingestion • C27 – Anti-Animal • C28 – Anti-Plant • C29 - Simulants

6. CDC & EM Classification • Category A – Weaponized or Available • Variola virus • Bacillus anthracis • Yersinia pestis • Botulinum toxin • Francisella tularensis • Filoviruses & Arenaviruses

7. CDC & EM Classification • Category B – Lower Virulence/Possible Agents • Coxiella burnetii • Brucellae • Burkholderia mallei • Alphaviruses • Ricin • SEB • Foods Agents – E. coli 0157:H7, Salmonellae • Water Threat – Vibrio cholera, Cryptosporidium

8. CDC & EM Classification • Category C • Any other emerging pathogen or biological toxin that might be a threat.

9. Anthrax – B. anthracis • 12 hrs-5 days (except delay) • Inhalation – flu-like, fluid in lungs, severe difficulty breathing, broadening mediastinum • Not Contagious – Aerosol or powder • Treat With Antibiotics • Military Vaccine • 30% Mortality (untreated may be higher)

10. Botulinum Toxin • Affects in 12 hours to 3 days • Flu-like symptoms, difficulty speaking, swallowing, drooping eyelids, paralysis • Antitoxin available (not reversible damage) • No commercial vaccine • Probably disseminated in liquid droplets or on food.

11. Cholera – V. cholera • 12 hours to 5 days • Severe diarrhea, vomiting and weakness, leg cramps and fluid loss. • Not contagious – disseminated in food or water. • Treatable with antibiotics – high fluids • Newer vaccines not available in U.S. Old vaccine low effectiveness, short-lived

12. Glanders – B. mallei • 1-14 days • Fever and headache, muscle tightness, chest pain, tearing and light sensitivity • Not highly contagious – aerosol diss. • Treatable with antibiotics • Very few historical cases, up to 50% mortality possible. • No vaccine

13. Plague – Y. pestis • 1-6 days • Flu-like, lymph node pain (buboes), blood-streaked sputum, septic shock • Aerosol or food – pneumonic transmissible • Treatable with antibiotics – time is critical • Vaccine, once available did not prevent pneumonic form. Discontinued in 1999.

14. Q-Fever – C. burnetii • 2-3 weeks • High fever, throbbing headache, sweating, auditory and visual hallucinations, hepatitis • Aerosol or food dissemination, not very transmissible • Low mortality, most recover without treatment. • Vaccine not available to general public

15. Smallpox – V. major • 10-14 days • High fever, aches, rash starts in face and arms (then trunk – unlike chickenpox) • Aerosol or person-to-person. Contagious stage comes with symptoms. • Vaccination 3-5 days after exposure may avoid or lessen disease. • No treatment (supportive therapy only)

16. Tularemia – F. tularensis • 1-14 days in nature (3-5 in a deliberate act) • Flu-like + lethargy. Swollen lymph nodes in systemic infections, red, sore eyes, pneumonia • Disseminated as aerosol or on food – no human to human • Antibiotics. Some weaponized strains may be abx. resistant.

17. Mortality • 1970 World Health Organization • Assumed 50 kg of dried agent • Disseminated on a 2 km line • Upwind of a population of 500,000

18. Results

19. Other Concerns • Residential backflow protectors • Food QC • Availability of viral hemorrhagic fevers • Soviet brain drain

20. Soviet Bioweapons - Rating • Smallpox • Plague • Anthrax • VEE • Tularemia • Q-Fever • Marburg virus Others include the flu virus, glanders and epidemic typhus.

21. Detection • Rapid Dx Assays • Military • Botulinum, SEB, SEA-C-D • Dengue Fever, Q-Fever, Plague, Tularemia, Typhus, West Nile • Civilian • SMART Tickets • DNA Techniques

22. Decon

23. ER + Decon • Isolate small areas to 100 ft or more • Note weather, population, density and time of day • For airborne cloud – shelter-in-place • Field Detection – Not Recommended • PPE • General rule – Level A – Latex may not be fully protective

24. ER + Decon • Remove clothing (aerosol or powder) • Double bag • Wash w/soap + water • 10% bleach wash (10-15 minutes) • Rinse solutions should be retained if possible

25. ER + Decon • Careful of reaerosolization • Treat all items as Haz-Waste • Note airflow around patients (bioaerosols) • Always try to decon at site if possible

26. NPS or SNS • Future module will address • Located at secret locations around the nation (12 hour deployment on gov. req.) • Enough to treat, perhaps hundreds of thousands (depending on disease)

27. Antibiotics • May be classified: • By spectrum • Method of administration • Activity (bacteriacide vs. bacteriastat) • Chemical structure • Useful because those in the same class will show similar side-effects, action, toxicity etc.

28. Antibiotics • Penicillins • Cephalosporins • Fluoroquinolones • Tetracyclines • Aminoglycosides

29. Antibiotics • Penicillins • Oldest • Similar in chemistry to cephalosporins • Bacteriacidal • Natural penicillins (“G”) (methycillin) • Aminopenicillins (Amoxil) – broader may require penicillinase inhibitor

30. Antibiotics • Cephalosporins • Bacteriacidal • May show similar allergic problems to pen. • 1st, 2nd and 3rd generation • 3rd generation cross blood-brain barrier • Work on anaerobes

31. Antibiotics • Fluoroquinolones • Synthetic • Reach deep tissues • Bacteriacidal • Cipro, Penetrex, Floxin, Trovan

32. Antibiotics • Tetracyclines • Derrived from strep bacteria • Bacteriostatic • Effective against rickettsia + parasites • Macrolides • Emycin, Z-pak, Clarithromycin • Effective to penetrate lung tissue • Spectrum similar to penicillins