bioterrorism notes by sanju sah for medical, microbiology and biotechnology students.pdf

Bioterrorism involves the intentional release of harmful biological agents, such as bacteria, viruses, or toxins, to cause illness or death in humans, animals, or plants. It poses a significant threat to public health and safety, requiring vigilance, preparedness, and effective response strategies to mitigate its impact.

1. Bioterrorism
Prepared by
SANJU SAH
St.
Xavier's College, Maitighar,
Kathmandu, Nepal

2. Biological warfare :
•intentional use of microorganisms and toxins usually of microbial,
plant or animal origin to produce disease and death among humans,
live stock and crops

3. Bioterrorism :
•the use or threatened use of microorganism or product of
microorganism to generate fear, morbidity or mortality among a
population.

4. History
•1346, Kaffa: Attacking Mongols threw cadavers of plague victims into
the city
•1710 : Russia used plague victims against Swedes
•1767, French and Indian War : Blankets from small pox hospital were
provided to Native Indians resulting in small pox epidemic
•World War 1: Germany sent infected horses and mules into the Allied
forces
•World War 2 : Japanese military unit 731 killed Chinese in the regions
of Ping Fan, Manchuria using various agents including anthrax

5. •During the Indo-Pakistan war of 1965, a scrub typhus outbreak in
northeastern India came under suspicion 2 incidents of intentional
bacterial contamination of food in US in 1971 & 1984
•Anthrax attacks in Japan in 1993
•Anthrax attacks in US in 2001 killing 5 people
•India's defenceand intelligence outfits were alert to the outbreak of
pneumonic plague

6. Agents
•CDC classification : into 3 types based on the risk, transmissibility,
mortality & morbidity produced
•Category A
•Category B
•Category C

7. Category A:
•High-priority agents include organisms that pose a risk to national
security because they:
1)can be easily disseminated or transmitted from person to person;
2)result in high mortality rates and have the potential for major public
health impact;
3)might cause public panic and social disruption; and
4)require special action for public health preparedness.

8. Agents / Diseases:
•Bacillus anthracis(Anthrax)
•Yersinia pestis(Plague)
•Francisellatularensis(Tularemia)
•Clostridium botulinumToxin (Botulism)
•Variolamajor (Small pox)
•Filovirusese.g. Ebola, Marburg ( Viral hemorrhagic fever )
•Arenavirusese.g. Lassa, Machupo(Viral hemorrhagic fever)

9. Category B :
•Second highest priority agents include those that
1) are moderately easy to disseminate;
2) result in moderate morbidity rates and low mortality rates; and
3) require specific enhancements of CDC's diagnostic capacity and
enhanced disease surveillance

10. Agent / Disease :
•Brucellaspecies (Brucellosis)
•Clostridium perfringensEpsilon
toxin
•Food safety threats
•Salmonella species,
•Escherichia coli O 157 : H7
•Chlamydia psittaci(Psittacosis)
•Coxiellaburnetii( Q fever)
•Staphylococcal enterotoxin B
•Rickettsia prowazekii(Typhus
Fever)
•Vibrio cholerae
•Cryptosporidium parvum( water
safety threats)
•Alphavirusese.g. Venezulan
Equine Encephalitis , Eastren
Equine Encephalitis , Western
Equine Encephalitis ( Viral
Encephalitis)

11. Category C
•Include emerging pathogens which could be engineered for mass
dissemination due to availability;
•ease of production and dissemination; and
•potential for high morbidity and mortality rates and major health
impact.
•Agents : NipahVirus & Hanta Virus

12. Centers with bioterrorism agents
•Approx1500 centers world wide
•Association for Professionals in Infection Control & Epidemiology
(APIC) associated with CDC. ( Anthrax, Small pox, Botulism & Plague)
•Bradford –Stockholm International Peace Research Institute
•(Cholera, Plague, Small Pox, Typhoid, Typhus, Yellow fever)

13. Bioweapon
•Weponizationof agents :
•Altering characters of agents to increase their Virulence &
transmissibility,
•Resistance to antibiotics,
•Evasion of vaccines & host immune system

14. Why use Biological Weapons?
•Large attack area
•Detection delayed
•Diagnosis delayed
•Ease of production

15. Delivery Mechanisms
1) Aerosol spray : easiest method of dispersal. Highest number of
people victimized
2) Food & Water contamination : more cumbersome. People victimized
are less & large quantities of agent required
3) Spores : Through envelops (Anthrax) easy dispersal.
4) Infected People/ Animals : People or animals in the prodromal or
latent illness where the organism can’t be identified. Very difficult and
very few people will be infected.

16. Bioterrorism Indicators
•Clinicians to identify a bioterrorism attack :
1) Clustering of cases,
2) Disease in no-risk individuals
3) Atypical conditions like unusual age groups, or seasons

17. Epidemiological Clues:
•Clues from unlikely source ER or Family Practice
•Clinic/Office Pharmacy mortality, severe morbidity, or respiratory
illnesses
•Large epidemic of acutely ill patients or multiple, simultaneous
epidemics

18. Role of Microbiologist
•Microbiologists / Infectious disease consultants for the diagnosis of
the organism
•CDC proposed a network of laboratories for the effective control of
any bitoerrorismthreat / attack

19. Laboratory Diagnosis
•DISEASE/ AGENT SPECIMEN SELECTION
•SPECIMENT PLATING AND PROCESSING

20. Laboratory Network
•Sentinel Laboratories
•Reference Laboratories
•National Laboratories

21. Sentinel Laboratories :
•Sentinel Laboratories play a key role in the early detection of
biological agents provide routine diagnostic services, rule-out, and
referral steps in the identification process.
•estimated 25,000 private and commercial laboratories in the United
States

22. Reference Laboratories
•responsible for investigation and/or referral of specimens
•state and local public health, military, international, veterinary,
agriculture, food, and water testing laboratories

23. National Laboratories
•responsible for specialized strain characterizations, bioforensics,
select agent activity, and handling highly infectious biological agents.
•National laboratories, including those operated by CDC, U.S. Army
Medical Research Institute for Infectious Diseases (USAMRIID), and
the Naval Medical Research Center (NMRC),

24. Post Exposure Prophylaxis,Vaccines& Decontamination
•Prophylaxis : action taken to prevent disease, especially by specified
means or against a specified disease
•Post-exposure prophylaxis (PEP): short-term antiretroviral treatment
to reduce the likelihood of HIV infection after potential exposure,
either occupationally or through sexual intercourse. Within the health
sector, PEP should be provided as part of a comprehensive universal
precautions package that reduces staff exposure to infectious hazards
at work.

25. prophylactic vaccination
•selective exposure to a weakened or diluted form of an infectious
agent to encourage a patient to form antibodies.
•If the patient is exposed to the infectious agent in the wild, the
antibodies will prevent the onset of infection.
•Numerous conditions are preventable through vaccination.
•The elimination and reduction of vaccine-preventable illnesses
likepolioand smallpox has been a significant victory forpublic health.
•In a prophylactic vaccination, the goal is to prevent the development
of disease. This contrasts with a therapeutic vaccine used in the
treatment of disease.

26. Decontamination of Patients and Environment
•The need for decontamination depends on the suspected exposure
and in most cases will not be necessary.
•The goal of decontamination after a potential exposure to a
bioterrorism agent is to reduce the extent of external contamination
of the patient and contain the contamination to prevent further
spread.
•Decontamination should only be considered in instances of gross
contamination.
•Decisions regarding the need for decontamination should be made in
consultation with local health departments and Healthcare
Epidemiology.

27. •Decontamination of exposed individuals prior to receiving them at
UTMB may be necessary to ensure the safety of patients and staff
while providing care.
•Depending on the agent, the likelihood for re-aerosolization, or a risk
associated with cutaneous exposure, clothing of exposed persons
may need to be removed. Patients may be decontaminated prior to
entry into the Emergency Department or may be instructed (or
assisted if necessary) to immediately shower with soap and water.

28. Summary
•Bioterrorism is favored form of warfare.
•Co-ordination of several agencies required for effective control
•Prevention the best
•Early recognistion& appropriate action are required