Biological Terrorism - VZA€¦ · Biological Terrorism •Definition, situate biological terrorism...
Transcript of Biological Terrorism - VZA€¦ · Biological Terrorism •Definition, situate biological terrorism...
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Biological Terrorism
Prof.Renaat A.A.M.PelemanChiefMedicalOfficerGhentUniversityHospital,Belgium
NorbertFraeymanSuperiorHealthcouncil
BiologicalTerrorism
• Definition, situate biological terrorism within terrorism
• History
• Agents, Disease, Diagnosis, Treatment
• Detection, Response, Surveillance
• The future, some myths
• Summary
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CategoriesofWeaponsUsedbyTerrorists
• Conventional
• Biological
• Chemical
• Nuclear
• Cyber
DefinitionofBiologicalWarfare
“Biological warfare is the deliberate spreading of(infectious) diseases among humans, animals, andplants in order to cause incapacitation or death of thetarget population.”
Hon. Prof. Graham S. Pearson CBFormer Director General Chemical & Biological Defence EstablishmentPorton Down, Salisbury, England
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DefinitionofBiologicalWarfare
Somehistory…
Year Event
1155 EmperorBarbarossapoisonswaterwellswithhumanbodies,Tortona,Italy
1346 MongolscatapultbodiesofplaguevictimsoverthecitywallsofCaffa,CrimeanPeninsula
1495 SpanishmixwinewithbloodofleprosypatientstoselltotheirFrenchfoes,Naples,Italy
1650 Polishfiresalivafromrabiddogstowardstheirenemies
1675 FirstdealbetweenGermanandFrenchforcesnottouse'poisonbullets'
1763 BritishdistributeblanketsfromsmallpoxpatientstonativeAmericans
1797 NapoleonfloodstheplainsaroundMantua,Italy,toenhancethespreadofmalaria
1863 ConfederatessellclothingfromyellowfeverandsmallpoxpatientstoUniontroops,USA
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FeaturesofBioterrorism
• Weapon: Microbe or Toxin
• Premeditation
• Goals: Political, Religious, Ideological
• Motivation: Fear, Disruption, Instability
DesirableFeaturesofBiologicalAgentsasWeapon
• Inexpensive
• Available
• Easily transported/concealed and dispersed
• Incubation period “Hides Tracks” of perpetrator
• Modifiable (resistance, virulence)
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• Botulinum neurotoxins• Botulinum neurotoxin-producingspeciesofClostridium• Ebolavirus• Francisella tularensis• Marburg virus• Bacillusanthracis• Burkholderia mallei• Burkholderia pseudomallei• Variolamajorvirus(smallpox)• Yersiniapestis• Foot-and-mouthdiseasevirus(aphthovirus)
BiologicalWarfare:tier1
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• Anthrax
• Plague
• Smallpox
• Botulism
• Tularemia
• ViralHemorrhagicFever
HighestConcernCDCdesignated“A”ListofBiologicAgents
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• Inhalationanthrax:aerosol
• Symptoms:initiallynon-specificinfluenza-like;progressintopneumonia,meningitis
• Mortality:high:45%inAmerithrax,90%whencomplicatedwithmeningitis
• Diagnosis:cultures,lungscans(longincubationtimebetween1dayupto6weeks)
• Treatment:ABC-procedures,fluoroquinolone (e.g.ciprofloxacin)
• PEP:vaccinelowerstheburden
• (accidentalreleaseofanthraxfromamilitaryinstallationinSverdlovsk(Russia)with64deaths)
Anthrax(Bacillusantracis)
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• TheworldhasbeendeclaredfreefromsmallpoxbytheWHOin1982!
• Spreadbyaerosol;hightransmissionpersontoperson
• Diagnosis:cultures,lungscans(longincubationtime,10-12days)
• Treatment:nolicensedtreatmentsavailable.Vaccinesstockpiledbythemilitary
• Lethality:3%inrecentlyvaccinatedvictims;40%innon-vaccinatedpersons
• Vaccinationafterexposureisadvisable
Smallpox(varialomajor)
• Within3days-preventorsignificantlylessenseverityofsymptoms
• 4-7daysafterexposure-someprotection,maymodifyseverity
BenefitofVaccineFollowingExposure
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• Bacterialdisease;YersiniaPestis
• Diagnosis:initiallydifficulttodistinguishfromordinaryinfluenza(incubationtime1-3days)
• Lethality:whenuntreated:nearly100%
• Treatment:aminoglycosides(streptomycin…)
• Novaccineavailable
• (1300’s:50-20010e6deathsinAsiaandEurope)
Pneumonicplague(Pest)
• ToxinofClostridiumbotulinum
• Spreadduringattackbyaerosol
• Diagnosis:paralysiswithinhoursafterexposure,lethalityisveryhigh
• Treatment:nospecifictreatmentavailable;ABC-procedures
• Novaccineavailable
Botulism
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• ToxinofFrancisella Turalensis
• Diagnosis:difficulttodistinguishfrompneumonia,cultures,PCR,staining…
• Treatment:10daytreatmentwithaminoglycosides(streptomycin,gentamycin…)
• PEP:7daywithdoxicyclin,ciprofloxacin
• Navaccineavailable.• (Veryrare,lastcaseinTheNetherlandsin1953)
Tularemia
Nominallethality/1,000kgsofdifferentbiologicalweapens
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CluestoBioterrorism• Severediseasemanifestationsinpreviously
healthypeople
• Higherthannormalnumberofpatientswithfeverandrespiratory/G.I.Complaints
• Multiplepeoplewithsimilarcomplaintsfromacommonlocation
• Anendemicdiseaseappearingduringanunusualtimeofyear
CluestoBioterrorism• Unusualnumberofrapidfatalcases
• Greaternumberofill/deadanimals
• Rapidrisingandfallingepidemiccurve
• Greaternumbersofpatientswith:1)Severepneumonia2)Sepsis3)Sepsiswithcoagulopathy4)Feverwithrash5)Diplopiawithprogressiveweakness
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KeepAlert
• Earlydetection
• Highindexofsuspicion
• Immediatereportingofsuspectedcasestoauthorithies
StandardInfectionControl(I.C.)Precautions(forallbio-terroristthreats)
• WashhandsandWeargloves• Wearfaceshield• Wearcap/gown• Processcontaminatedequipmentandlinen• Cleananddisinfectenvironmentalsurfaces• Adheretooccupationalhealthandblood-borne
pathogenrequirements• Placepatientsatriskforenvironmentalcontamination
inprivateorcohortlocation
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AirborneInfectionControl(I.C.)Precautions(SmallpoxandHemmorhagic Fever)
• Placepatientinnegativepressureroom,whenpossible
• Applyhigh-intensityairfilterrespiratoryprotection
• Limitpatienttransport
• Placetightsealingmaskonpatientwhentransporting
• Biotechnologyallowstoconstructnewbacteria,newtoxins.
• CRISPR/Cas9astargetedgenomeediting
• Thiscouldleadtonewcompounds/bacteries :
• Modificationoftheresistancetoantibiotics
• Enhancementoftransmission
• Completelynewanddangerousmicroorganismswithoutanyknowntreatment
Thefuture…..
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Thefuture…..
Thefuture…..
• Wolfgang Rudischhauser, Director of the Weapons of Mass Destruction Non-Proliferation Centre at NATO said: 'ISIS actually has already acquired the knowledge, and in some cases the human expertise, that would allow it to use CBRN materials as weapons of terror.'
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MythsofDeterrenceAgainstBioterrorism
• Morally Repugnant
• Effective Treaties
• Consequences too numerous or terrible
• Science too difficult
• Not easily weaponized
• The infective dose of the potential biological agent• The method of attack on the target population (e.g.,inhalation, ingestion, or by an insect vector)
• The means of dispersion of the biological agent• The ability of the biological agent to survive until itreaches the target
• The time to effect or cause disease in the targetpopulation
• The biological agent needs to be producible
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KnowledgerequiredtoManufactureBiologicalWeapons
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• The methods for making aerosols stay airborne arewidely available.
• The tools for making pathogens in high quantities infermenters are on ebay.
• The recipes for making stable formulations ofpathogens are on the internet.
• The equipment for disseminating these weapons is inhardware or agricultural supply stores.
• This information and technology is almost entirely dualuse - in the sense that it has both legitimate anddangerous uses in the world. 31
TheCapabilitytoMakeBiologicalWeapons
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• Noeventshaveoccurredsincetheanthraxoutbreakin2001
• Technicallydifficulttodisseminateaninfectiousagentortoxin,butpossible
• Smallpoxandanthraxareconsideredthegreatestthreats.Smallpoxvaccinenowstockpiled
• Responseprocessrequiresateamapproach• Recognitionmaybechallenging• Newcomputerizedsurveillancesystemsofferpromiseforearlydetection
Bioterrorism:summary
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History
• 6° century
• 10° century
• 1346 : siege of Caffa : dead bodies from plague ; spread of “black death” in Europe ?
• 1763 : British trying to kill native Americans near fort Pitt
• WWII : Churchill commands the weaponisation of antrax, tularemia…..
• 2013, Afghanistan (53 death), 2006, Iraq (7 death), 2001, USA (5 death), 1987, Philippines (19 death), 1978, Georgetown (913 death), ……
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CharacteristicsBio-warfareMode: AerosolIncubationPeriod: 17d(10-12d)Onset: AbruptDuration: 4weeksLethality: Moderate(20-40%in
unvaccinated;3%inrecentlyvaccinated)
Transmission: High(persontoperson)
Smallpox(Variola virus)
AnthraxCase4/October19,2001
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Smallpox(Variola virus)– Diseaseprogression
• Aerosolized releaseoverdenselypopulated area
• Anthraxmeningitisin50%patwithinhalation anthrax
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0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Release
Num
bero
fCases
SymptomOnset SevereIllness
Source:MarcyLayton,NYCDOH
RationaleforSyndromic Surveillance
EID2006www.cdc.gov/ncidod/EID/vol10no5/03-0646.htm
Syndromic Surveillance:NYC2001-02
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Uniquenessof BiologicalAttacks
• Biological‒ Onset - incubation, primary cases
‒ Secondary Cases – contagion, contamination
• Responders - medical
• Response System - untested
• Medical System may be a target
Syndromic surveillance during the Paris terrorist attacksStephanie Vandentorren, Annie-Claude Paty, Elsa Baffert, Pascal Chansard, Celine Caserio-Schönemann
The Lancet, Volume 387, Issue 10021, Pages 846-847 (February 2016)
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DoNot
• Actonrumor
• Giveantibioticsondemand-withoutmedicalindication
• Ordernasalcultures-withoutmedicalindication