Bioterrorism Preparedness

1. Bioterrorism Preparedness Daniel W. Saylak, D.O., FACOFP Senior Medical Officer Texas-1 Disaster Medical Team National Disaster Medical Service

2. The United States of America Responds to Disasters at Numerous Levels

3. Combination Civilian/Military Agencies

4. Disaster Preparedness

5. Bioterrorism Does the TV series “24” represent the threats?

6. A University of Arizona researcher has created a method and map that shows the relative level of threat of bioterrorism in 132 major cities in the United States. The map displays the level of risk based critical industries, ports, railroads, population, natural environment and other factors.

7. What is Bioterrorism? The history of bioterrorism goes back as far as human warfare, in which there have always been efforts to use germs and disease as weapons. In the late 20th century, violent non-state actors began seeking to acquire or develop biological agents to use in attacks on civilians. The reported risk has led the U.S. government to expend immense resources for biodefense in the early part of the 21st century.

8. Class A Biological Diseases • Bioterrorism refers to the intentional release of toxic biological agents to harm and terrorize civilians, in the name of a political or other cause. The U.S. Center for Disease Control has classified the viruses, bacteria and toxins that could be used in an attack. Category A Biological Diseases are those most likely to do the most damage. They include: • Anthrax (Bacillus anthracis) • Botulism (Clostridium botulinum toxin) • The Plague (Yersinia pestis) • Smallpox (Variola major) • Tularemia (Francisella tularensis) • Hemorrhagic fever, due to Ebola Virus or Marburg Virus

9. A Brief History of Bioterrorism Sixth Century B.C.One of the earliest reported uses of bioterrorism. Assyrians poison enemy wells with rye ergot, a fungus that causes convulsions if ingested.1346Plague breaks out in the Tartar army during its siege of Kaffa (at present-day Feodosia in Crimea). Attackers hurl the corpses of plague victims over the city walls, causing an epidemic that forces the city to surrender. Some infected Kaffa residents who left the city may have inadvertently started the Black Death pandemic. 1754During the French and Indian wars, it's suspected British forces distribute smallpox-laden blankets to native American Indians who were loyal to the French. 1870German scientist Robert Koch proves that microorganisms cause infectious diseases by injecting anthrax spores into mice. The mice contract the disease.1882In France, Louis Pasteur develops the first successful vaccine to prevent anthrax in animals.

10. Bioterrorism 1900 - 2009 This century biological and chemical warfare has reached new heights of ingenuity.1910-20 On April 22, 1915, the Germans used poison gas for the first time at Ypres in Belgium. By 1918, one in four shells on the western front was a gas shell, and its use resulting in more than one million casualties and more than 100,000 deaths.1930-40 Japan reportedly used plague and other bacteria in the war against China in the 1930s and 1940s.1983-88 More recently, there is evidence Iraq used chemical weapons extensively during the Iran-Iraq war between 1983 and 1988 and subsequently against the Kurds.The threat now that most countries have agreed to destroy military stockpiles of chemical and biological weapons, the biggest remaining threat is terrorism.1984 In 1984, a safe house belonging to the German Red Army Faction, a militant group, was reportedly uncovered in Paris, France.1993 The bomb that damaged the World Trade Center in New York in 1993 reportedly also contained cyanide, but the chemical apparently evaporated in the explosion.1994 In 1994 two members of a religious cult in Oregon successfully used salmonella to poison the salad bars of local restaurants in an attempt to affect the outcome of local elections. More than 700 people were believed to be affected, though none were apparently killed, and the reason for the outbreak was not uncovered for a year.1995 The series of Sarin gas attacks made on the Tokyo subway system by a cult in March 1995 that killed a dozen people and injured thousands brought the use of chemical and biological weapons to international attention. Inside the safe house an improvised laboratory was said to have been found containing flasks of deadly botulism toxin.

11. Pulling In The Reins Although several countries are suspected to retain some chemical or biological weapons capabilities, nearly all have formally agreed to renounce their military use.Even as early as ancient times, the Greeks and Romans condemned the use of poison as a violation of the rules of war, though they continued to use it.1925 After World War I, the Geneva Protocol of 1925 outlawed the use of both chemical and biological weapons in war, but countries were unable to agree on a treaty to ban stockpiles.1956 In 1956 Marshal Zhukov announced to the Soviet Congress that chemical and biological warfare weapons would be used as weapons of mass destruction in future warsThis caused the US to renew its own programs, but in 1969, US President Nixon ordered the termination of all research on biological warfare and the disarmament of all such weapons.This outlawed the production, stockpiling and use of biological weapons. In July 1995, however, Iraq admitted that it had tried to build up stocks of biological weapons after UN inspectors found large amounts of anthrax, botulinum and other toxins.1993 In January 1993 a ban on the production, stockpiling and use of chemical weapons - The Chemical Weapons Convention was signed by 130 countries. Iraq has yet to sign this ban, however, and of the 165 countries which have now signed, 62 have yet to ratify the agreement. The current Gulf crisis stems from UN Security Council resolution 687, which calls for the elimination of Iraq's weapons of mass destruction.1975 The Biological and Toxin Weapons Convention (BWC), which prohibits the acquisition of biological materials for hostile purposes and armed conflict, entered into force in 1975 and now has the participation of 140 nations (158 nations have signed the BWC, but only 140 of these have also ratified it). However, there is no monitoring mechanism associated with the BWC.

12. So… How do we prepare? • Awareness • Development of Contingency Plans • Focus on Class A Agents • Avoidance of High Risk Areas • Use of mass inoculations • Rapid delivery of pharmaceuticals • Tested at 2009 Presidential Inauguration

16. Class A Agents

17. Be Prepared Boy Scout Motto