USAF School of Aerospace Medicine

1. USAF School of Aerospace Medicine MEDICAL ASPECTS OF BIOLOGICAL WARFARE And a Bit of Shameless RAM Recruiting W. Mark “Sparky” Matthews Captain, USAF, MC, FS Resident, Aerospace Medicine (2002)

2. Biological Warfare Intentional use of viruses, bacteria, fungi, or toxins derived from living organisms to produce death or disease in humans, animals, or plants.

3. Biological Warfare Agent Microbial or other biological agent or toxin, whatever it’s origin or method of production, of type and in quantity that have no justification for prophylactic, protective or other peaceful purposes.

4. Overview • History of Biological Warfare • Biological Warfare Agents • Using a Biological Warfare Agent • Protection Against Biological Weapons • Who has the Goods? • Synthesis: Pros and Cons of BW agents

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6. History of Biological Warfare

7. History of Biological Warfare Biological warfare is a modern problem for a modern world, right?

8. History of Biological Warfare • 300 BC – Greeks polluted wells and other water supplies with animal carcasses • So successful that this was emulated by Romans and Persians • 1155 AD – Barbarossa polluted water supply of Tortona, Italy with bodies of dead soldiers and animals

9. History of Biological Warfare • 1346 AD – Tartar siege of Kaffa • Outbreak of Plague among Tartar siege forces • Tartars flung Plague cadavers over city walls with siege machines • Subsequent Plague epidemic within city resulted in the fall of Kaffa

10. History of Biological Warfare • 1763 – French and Indian War • 2 blankets and a handkerchief from Ft. Pitt Smallpox hospital were given by British commanders to local hostile Indian chiefs in accordance with British command directives • French used similar tactics with hostile Indians

11. History of Biological Warfare • American Revolution • British troops routinely inoculated for the prevention of Smallpox • Smallpox outbreaks in North America gave British forces the advantage over the Continental Army • General Washington instituted a smallpox inoculation program after the winter at Valley Forge

12. History of Biological Warfare • 1863 – Vicksburg, MS • General Johnson polluted drinking water of opposing forces with bodies of sheep and pigs • Germany allegedly carried out biological attacks against targets in Europe and America during WWI

13. History of Biological Warfare • Japanese occupation of Manchuria – WWII • BW research was a major part of Japanese military planning and tactics • 18 research units located in China, Manchuria, Singapore, Thailand, and Burma • POW and criminals infected • 10,000 lives lost • 12 large-scale field trials, including Plague-infected tick air drop • First admitted use of laboratory-produced agents

14. History of Biological Warfare • PM Churchill decided to develop Anthrax as retaliatory weapon after successful open-air livestock testing on Gruinard Island in 1941 • Bombs with anthrax spore detonated • Aerial bomb dispersal • Anthrax spores survived explosions • As of 1979, disease-causing levels of spore still existed • Soil spray with sea water/formaldehyde used to decontaminate island • Certified free of anthrax as of October 1987

15. History of Biological Warfare • Allied Soldiers received auto-injectors with botulinum toxin antidote for Normandy landings • Shortly before invasion, Hitler had issued orders that biological weapons were not to be used by German forces • German research lagged far behind the rest of the world in BW – threat never materialized

16. History of Biological Warfare • US civilian War Reserve Service began research on Anthrax and Brucellosis at Camp Detrick, MD • No successful product for WWII • 1950 - exposure exercise in San Francisco • Clouds of S. marcescens released as BW simulant, to evaluate and track exposure

17. History of Biological Warfare • Executive Orders 35, 44 (Nixon) • Terminated BW research program • Directed destruction of BW agent stockpiles • Established policy to never use biological weapons under any circumstances

18. History of Biological Warfare International Biological Warfare Agreements • 1925 Geneva Protocol – ineffective and ignored • 1972 Biological Weapons Convention - Parties agree: • Never to develop, produce, stockpile, acquire or retain any biological agent for other than peaceful purposes • To destroy stocks of BW agents, equipment and delivery systems • Not to transfer of BW technology • To submit voluntary annual reports to UN

19. History of Biological Warfare BW Convention difficult to enforce • Lack of routine inspection program • Uncertainty as to quantity subject to treaty • Definition of “defensive” research • Classification of “toxin” agents • UN Security Council members can veto inspections

20. History of Biological Warfare Offensive BW Program: Former USSR • Continued after 1972 BWC • Heavy resource commitment • Program inherited by Russia

21. History of Biological Warfare • 1978, London and Paris • KGB operatives attempted to assassinate Bulgarian dissidents Georgi Markov and Vladimir Kostov • Both were stabbed with umbrella tips containing a covert injector • Each were injected with a pellet containing one grain of ricin • Markov died, Kostov sought medical care and was spared when pellet was excised

22. History of Biological Warfare • Sverdlovsk Incident – April, 1979 • Anthrax epidemic downwind from Sverdlovsk, Russia • Soviets claimed contaminated meat • US suspected release from bioweapons research lab • In 1992, Yeltsin admitted to existence of illegal weapons program at Sverdlovsk

23. History of Biological Warfare More Recent BW Concerns: Iraq • BW program suspected pre-Gulf War • BW high priority issue during Desert Storm • Many Iraqi BW facilities escaped destruction (and detection) • 1991: Iraqis admit to basic research-anthrax, C. botulinum, C. perfringens toxins • 1995: Iraqis admit to weaponizing anthrax spores, botulinum toxin, aflatoxin

24. History of Biological Warfare Terrorists: • Japan - Aum Shinrikyo Cult • 1995 Chemical attack in Tokyo subway • Working on BW weaponization • US • Oregon(?) cult spiked local salad bars with Salmonella in an attempt to swing elections

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26. Biological Warfare Agents

28. Biological Warfare Agents Potential BW Agents* BacterialViral Anthrax Smallpox Brucellosis Crimean-Congo Hemorrhagic Fever Cholera Rift Valley Fever Melioidosis Venezuelan Equine Encephalitis (VEE) Plague Q fever *(NATO AMedP-6(B)1966; Annex B Tularemia [unclassified]; not to be interpreted as sanctioned “threat list”)

29. Biological Warfare Agents Potential BW Agents: Toxins • Botulinum • Ricin • Staph Enterotoxin B (SEB) • T2 Mycotoxins • Saxitoxin • C. perfringens toxins NATO AMedP-6(B) 1996; unclassified; not to be interpreted as sanctioned “threat list”

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31. Aspects of a Biological Warfare Agent

32. Aspects of a Biological Warfare Agent • Dispersed by aerosol - invisible, silent, odorless, tasteless • Relatively inexpensive to produce • Simple technology for delivery - insecticide sprayers, airplane, artillery, boat, car • Terrain, equipment, infrastructure usually spared

33. Aspects of a Biological Warfare Agent • User could tailor arsenal to fit needs • May be used in combination with other weapons • Large area of coverage • Create fear, terror, panic

34. Aspects of a Biological Warfare Agent Biological Warfare Agents as Threats • Strategic • Cover large populations/geographic areas • May be directed against crops & livestock resulting in famine, economic disruption • Tactical • Limitations due to incubation times • Possibly effective against fixed positions • Terrorists - Easy to deliver, difficult to detect

35. Aspects of a Biological Warfare Agent Lethal vs. Incapacitating Anthrax Q fever Influenza Tularemia SEB Cholera Plague VEE Incapacitating agents may be more effective • Unit unable to perform mission • Casualties consume scarce medical and evacuation assets • Do not incite the same degree of rage

36. Aspects of a Biological Warfare Agent Acquisition of Etiologic Agents • Multiple culture collections • Universities (UTSA Resident Physician?) • Commercial chemical/biologics suppliers • Foreign laboratories or weapons facilities • Field samples or clinical specimens

37. Aspects of a Biological Warfare Agent Production of BW Agents • Easy to make, easy to conceal • Utilizes common fermentation (dual purpose) technology • Baby formula factory - Iraq • Some are byproducts of other industrial processes • Genetic engineering to enhance virulence • Low Cost

38. Aspects of a Biological Warfare Agent Production Costs (to cause casualties over 1 sq. Km.) Conventional weapons $ 2000 Nuclear weapons 800 Chemical weapons (nerve agent) 600 Biological weapons 1 (Chemical-Biological Expert Panel, UN, 1969)

39. Aspects of a Biological Warfare Agent Airplane dissemination of 50 kg of Agent Along a 2 km line Upwind of a Population Center of 500,000 DownwindCasualties AgentSpread (km)DeadIncapacitated Rift Valley Fever 1 400 35,000 Tick-borne Enceph. 1 9,500 35,000 Typhus 5 19,000 85,000 Brucellosis 10 500 100,000 Q-fever >20 150 125,000 Tularemia >20 30,000 125,000 Anthrax >>20 95,000 125,000 *Health Aspects of Chemical and Biological Weapons, WHO, 1970

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41. Protection Against Biological Weapons

42. Protection Against Biological Weapons Goal: Minimize potential impact of BW Primary Prevention --> Prevent Exposure Secondary Prevention --> Prevent Disease Tertiary Prevention --> Prevent Morbidity & Mortality

43. Protection Against BWPrimary Prevention • Treaties/Disarmament • Preemptive Strikes • Defensive Counter-air • Air-to-Air Defense • Anti-Missile Defense • Environmental Detection and Warning

44. Protection Against BWSecondary Prevention • Disaster Planning • Collective Protection • Individual Protective Equipment • Decontamination • Immunization • Chemoprophylaxis

45. Protection Against BWSecondary Prevention Disaster Planning • Up-to-date, exercised disaster plan • Stockpile needed countermeasures • Vaccines • Antidotes • Antibiotics • Include provisions to minimize terror and psychological effects

46. Protection Against BWSecondary Prevention Collective Protection Little to none available!!!

47. Protection Against BWSecondary Prevention Individual Protective Equipment • MOPP gear • Effective if worn; Removes 1-5u particles • Masks: • Currently fielded chemical masks protective if properly fitted and in use at time of exposure • Surgical masks ineffective due to difficulty obtaining seal

48. Protection Against BWSecondary Prevention Improvised Airway Protection for Toxin Aerosols Airway Protection Time to Death • Ricin (large protein) • Control Animals 48 - 72 hr (n = 6) • 1 Layer T-shirt 55, 70 hr and 6 days • 1 Layer Cravat 72 & 72 hr; 1 survived • 2 Layer T-shirt All Survived (n = 3) • 2 Layer Cravat All Survived (n = 3) • Saxitoxin (low molecular weight) • Control Animals 6 - 10 min (n=4) • 2 Layer T-shirt All Survived (n = 4) • 2 Layer Cravat All Survived (n = 4)

49. Protection Against BWSecondary Prevention Decontamination • Need for decontamination prior to removal of protective equipment • If available, wash with a 0.5% sodium hypochlorite solution (contact time of 10-15 minutes) • Dermal exposure from a suspected BW agent • Immediate soap and water decontamination

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