BIOTERRORISM SKG.ppt

medical, health, bioterrorism

1. BIOTERRORISM
DR.SHRUTIKIRTI
CONSULTANT MICROBIOLOGIST

2. Bioterrorism
Definition
Biological agents—Categories ideal biological agents, routes of
administration
History –World and Indian perspective
Countermeasure against bioterrorism
Laboratory response Network
Laboratory diagnosis

3. Bioterrorism–
intentional use of biological agents
not related to any prophylactic, protective or other peaceful
purposes
inflict disease and death of human, animals or plants.
Biological weapons –
Microbial agents (bacteria, virus, fungi, protozoan)
Biologically derived bioactive substance eg; toxins and poisons
Artificially designed biological –mimicking substances

4. Source
•Natural environment
•Microbiology laboratory (ATCC) –creating and storing such agents

5. Mode of Delivering biological weapons
•scud missiles
•motor vehicle with spray
•hand pump sprayer
•humans ,books, letter guns
•remote control, robotic delivery

6. Ideal Biological Agents
Stable and resistant to environmental conditions
Inexpensive, grown and produced in large quantities
Easily disseminated
Small amount should produce devastating impact with Impact
multipling with time
Difficult to detect
Difficult eradicate or resistant to antibiotics

7. WHY TO WORRY ?
FACTORS
EASY DELIVARY
LOW VISIBILITY
INTERNET
AVAILABILITY
HIGH POTENCY
USE OF LOW
TECHNOLOGICAL
METHOD TO
;PRODUCE
CONCEALMENT
TRANSPORTATION
AND
DISSEMINATION IS
EASY

8. Types of agents
ANTI PLANT ANTI ANIMAL
ANTI
PERSONAL
ANTI
MATERIAL

9. Biowarfare
pathogen
Contagious
Lethal
Mass killing
Non lethal
Economic
destruction
Non contagious
Lethal
Area denial
Non lethal
Incapcitation

10. CATEGORIES OF BIOTERRORISM AGENTS
Category A
easily disseminated or transmitted easily
high mortality and greatly impact public health.
potential to create public panic
lead to disruption of daily lives.

special action for public health preparedness.
Category B-
less easy to disseminate
moderate morbidity and low mortality.
Category C
emerging pathogens
potential for mass dissemination.
.

11. Category A
Anthrax(Bacillus anthracis)
Botulism(Clostridium botulinumtoxin)
Plague(Yersinia pestis)
Smallpox(variola major)
Tularemia(Francisellatularensis)
Viral hemorrhagic fevers(e.g., Ebola, Marburg, Lassa, Machupo])

12. Category B
Brucellosis(Brucellaspecies)
Epsilon toxin of Clostridium perfringens
Food safety threats(e.g., Salmonellaspecies, Escherichia coliO157:H7, Shigella)
Glanders(Burkholderiamallei)
Melioidosis(Burkholderiapseudomallei)
Psittacosis (Chlamydia psittaci)
Q fever(Coxiella burnetii)
Ricin toxinfrom Ricinus communis(castor beans)
Staphylococcal enterotoxin B
Typhus fever (Rickettsia prowazekii)
Viral encephalitis (alphaviruses [e.g., Venezuelan equine encephalitis, eastern equine
encephalitis, western equine encephalitis])
Water safety threats (e.g., Vibrio cholerae, Cryptosporidium parvum)

13. Category C
Nipahvirus
Hanta virus
MDR tuberculosis
Corona virus <recent pandemic>

14. TARGET??
METROPOLITAN CITIES, URBAN
CONGLOMERATION, DISTRICT WITH
INTERNATIONAL BORDER

15. MODE OF SPREAD--
Depends on type of agent used
Aerosol mechanism in closed , confined areas
Contamination of food and water
Deliberate infiltration of infected animals, pests, vectors via border

16. Route of administration –Biological agents
oro-gastric route
Percutaneous administration-Toxins
Airborne route-Aerosols, droplets infection
fomite-(contact)

17. HISTORY
Pre 20
th
century
600 B.C. –crude filth, cadaver animal carcasses , animal bodies
1155 -Emperor Barbarossa poisons water wells with human bodies in
Tortona, Italy
1346 AD-epidemic plague converted to black death(pandemic
plague) covering Europe , east and north Africa
1495 Spanish mix wine with blood of leprosy patients to sell to their
French foes in Italy

18. 1675 German and French forces agree to not use “poisonesbullets”
1710 Russian troops catapult human bodies of plague victims into Swedish
cities
1763 British distribute blankets from smallpox patients to Native Americans
1797 Napoleon floods the plains around Mantua, Italy, to enhance the
spread of malaria
1863 Confederates sell clothing from yellow fever and smallpox patients to
Union troops during the US Civil War

19. World War I German and French agents use glanders and anthrax
World War II Japan uses plague, anthrax, and other diseases; several other
countries experiment with and develop biological weapons programs
Early to mid 20
th
century-

20. Late 20
th
century
1980–1988 Iraq uses mustard gas, sarin, and tabun against Iran and
ethnic groups inside Iraq during the Persian Gulf War
1995 Aum Shinrikyo uses sarin gas in the Tokyo subway system

21. Early 21
st
century
2001-Bacillus anthracis was used against civillians via sevral letters
laced with spores in U.S.
Events in India (??)
1994-Plague episodes in Surat
1996—Dengue outbreak in Delhi
2001–Eastern India (Siliguri) suffered from encephalitis

22. Counter measure for Bioterrorism
Deterrence –state actor and non state actor
Prevention
surveillance
Lab investigation and research
Medical management
Dissemination of public safety

23. DETERRANCE
Geneva protocol –
world war 1 1925
prohibit 1
st
use of asphyxiating, poisonous, and other bacteriological
method in war
ratified in 2013 signed by 137 country
prohibit the use & possession, production of biological warfare
Other programs
National security decision memorandum 35 –1969
Toxin weapon programs 1970
Biological weapon convention-1975 (169 countries)

24. 18 research laboratories and centre
60 000 staff
research over biological weapons of
VECTOR, ISBM
at present Russian federation ministry of defense microbiology scientific
research institute
collection of dangerous pathogen like Ebola Marburg Lassa virus
UNESCOM-U.N. special commission
site inspection of Iraq’s biological , chemical, missile capabilities
Iraq Russia and china were also investigated

25. Non state actors
1990-1999 -185 documented biological weapons
27 cases-terrorist
56 –criminals
97 were uncertain
Sep 1984 religious cult contaminated salad bars along Oregon interstate
highway with salmonella typhimurium
UNESCOM resolution
Require all country to set laws to prevent biological attacks by preventing
production delivery and dissemination

26. Indian perspective
India have defensive biological weapon capabilities
conducted research on diseases like plague, brucellosis, and
smallpox.
Biological and Toxin Weapons Convention (BWC)
July 15, 1974
India has improved its capabilities in biotechnology & other
peaceful capacity.

27. Defense Research and Development Establishment (DRDE) at
Gwalior
Centers for countering disease threats such as anthrax, brucellosis,
cholera, plague, smallpox, viral hemorrhage fever, and botulism
Central Industrial Security Force (CISF)
Prepare group of specially-trained first responders for nuclear or
biological attack.

28. Prevention
Global conference-2004
launches $ 1 million grant for preventing bioterrorism
examine risk of bioterror, case studies, attack prevention, law
enforcement and legal political frame work
National Disaster Management Authority (NDMA)
eight battalions -1000 trained personal
Training of existing existing force to deal with chemical, biological,
radiological, and nuclear (CBRN) threats

29. Under NDMA India enforce revised international health regulation in
June 2007
deal with outbreaks and other emergencies related to national and
international concern

30. Survillence and asssessment
System must be timely , sensitive, specific, and practical,
Key elements---
Harnessing information<epidemiological clues of bioterror attack
Verification and confirmation of cases
Initiation of appropriate prevention and control measures

31. When to suspect??????
similar disease or syndrome, in a discrete population .
unexplained diseases or deaths
severe disease than expected
Unusual routes of exposure to pathogen e.g. inhalational route for
diseases that occur through other exposures
disease unusual in geographic area or season
Disease normally transmitted by a vector that is not present in the local
area

32. Simultaneous or serial epidemics in same population
single case of disease by an uncommon agent
Unusual strains or variants of organisms,
Higher attack rates in certain areas
Disease outbreaks of the same illness occurring in non-contiguous areas
Intelligence report showing suspect of a potential attack

33. India-------
Integrated Disease Surveillance Project (IDSP)
Decentralized and state-based surveillance program, November 2004
Integrates the public sector, private sector, rural and urban health system,
Health Agencies (WHO, CDC, NIC, etc.)
Regulate surveillance activities
Strengthening of public health laboratories,
Human resource development
Use of information technology for collection,compilation, analysis, and
dissemination of data

34. Lab investigation–role of clinical microbiology
LABORATORY REFERENCE NETWORK
1999, collaboration of CDC, APHL AND
FBI
Integration of National & International
network of laboratories that are fully
equipped to respond quickly to acts of
chemical or biological terrorism,
emerging infectious diseases, and other
public health threats and emergencies

35. Sentinel laboratory
•Capable of analysing or referring samples containing infectious agent
•Able to perform all complex testing as per ASM 1988 guideline and Clinical
Laboratory Improvement Amendments of 1988
•Packing and shipping of infectious agents according to standard protocol
•Maintain testing protocol in accordance to ASM guidelines and participate in
proficiency test
•Biosafety level II
•Not required to register with Select Agent rules, but must be familiar

36. Confirmatory reference laboratory
Typically public health laboratories, which represent states, countries, in large
metropolitan areas.
160 reference laboratories,
To confirm or rule out suspected bioterrorism agents
responsibility to produce high-confidence test results for threat analysis
National laboratories
Definativecharacterisation OF samples
CDC and U.S. Army Medical Research Institute for Infectious Diseases (USAMRIID)
Biosafety level IV (BSL-4) facilities.

37. List of some laboratories in india linked to NACD
NACD, New Delhi; National Institute of Cholera and Enteric Diseases
Department of Microbiology, AIIMS (Virology)
National Institute of Virology, Pune
Enterovirus Research Centre, Mumbai (polio)
Vector Control Research Centre, Pondicherry (vectors, filariasis)
Centre for Research in Medical Entomology, Madurai (vectors and other
vector-borne diseases);
Defense Research Development Establishment, Gwalior.

38. SELECT AGENTS
agents derived from biological sources
cause significant harm to public health and safety.
Listed by U.S. Department of Health and Human Services (HHS) humans) & the U.S.
Department of Agriculture (USDA)
Updated in October2012,
13 tier1 agents were identified.
The criteria for a tier1 agents
mass casualty and economic devastation
communicability
low infectious dose,
history of interest in weaponization.
The 2012 update also added the SARS-associated coronavirus and Chapareand Lujoviruses
(Arena viridae) to the list

39. Ebola virus Ebola hemorrhagic fever
Francisellatularensis Tularemia
Marburg virus Marburg hemorrhagicfever
Variola major virus Smallpox
Variola minor virus Smallpox
Yersinia pestis Plague
Botulinum neurotoxin Botulism
Botulinum neurotoxin producing species
ofClostridium
Botulism
Bacillus anthracis Anthrax
Bacillus cereusBiovaranthracis Anthrax
Burkholderia mallei Glanders
Burkholderia pseudomallei Melioidosis
Foot and Mouth Disease virus FMDV
Rinderpest virus Cattle plague
SELECT AGENT DISEASE

41. MEDICAL MANAGEMENT -PREVENTIVE PROMOTIVE AND
CURATIVE SERVICE
Biothreat may disrupt health care delivery even in well-resourced health system
Increase resilience, HHS -the National Bioterrorism Hospital Preparedness Program
(NBHPP),2002
Funding and guidance to hospitals
Provided more than $2 billion to states, territories, and eligible municipalities
Administered by the Health Resources and Services Administration (HRSA) until
2006,
At present by ASPR
renamed as hospital preparedness programe(HPP)
All hazards –biowarfare or any health outbreak

42. Activation of National Disaster Medical System (NDMS)
the Medical Reserve Corps (MRC)-groups of health care volunteers
Disaster medical assistance teams (DMATs) -to aid medical facility
U.S. ->300 units of MRC

43. MEDICAL COUNTERMEASURES
Easy availability of Diagnostic tests, drugs, vaccines and other equipment
and supplies needed to respond emergency.
Formation of medical teams for easy and efficient delivery of services
migration of health professional at effected site
Applying Triage
Public Health Emergency Medical Countermeasures Enterprise (PHEMCE),
mitigate the adverse health consequences associated with biological
threats

44. ANTHRAX
Zoonotic disease,
Aerosol and Inhalational-pulmonary anthrax (hemorrhagic pneumonia) most
common
Orogastric route causing bloody diarrhoea
High fatality rate
Easily extracted from soil (spores) around the world.
It’s cheap and can be grown in large quantities.
Anthrax as war weapon has been explored by many times over a century
dipicolinicacid –stability and germinatiion

45. Diagnosis (cdc, 2001)
Presumptive diagnosis(SLN)-any large gram positive bacilli with cultural
properties similar to B. anthracis
Confirmatory test(CLN & NLN)-
Initial –gamma phage lysis (PHAGE W)
--direct immunofluroscence test
Final-PCR (primer –BA pX01 & BA pX02)

46. •Bio Thrax-Antitoxin
•Raxibacumab
PRE-EXPOSURE
PROPHYLAXIS
•Ciprofloxacin+ Doxycycline/Amoxicillin –60
Day
POST EXPOSURE
PROPHYLAXIS
•Ciprofloxacin/Doxycycline + Clindamycin
&/Or Rifampicin –60 Day
TREATMENT
MANAGEMENT
PREVENTION
Decontamination of
animal products
Proper handling of
infected materials
As well as following
proper hygiene
Disposal of animal
carcasses
Decontamination of
animal products
Disposal of animal
carcasses

47. Extra-
MDR Bacillus
Functional hybrid nickel nanostructures as recyclable SERS
substrates

48. Small pox
DNA virus-orthopoxvirus–variola(major and minor)
-vaccina
Exclusive reservoir –human
Eradicated 8may 1980
Accidental laboratory spread 1978
Only two laboratories hold stocks-
Institute of Virus Preparations in Moscow, Russia
CDC in Atlanta, USA

49. Potentioal biowarfare-
No vaccination after 1980
Highly contagious and aerosole
No subclinical stage or carrier state
High case fatality rate
Severe complication-hemorrhagic small pox

50. Lab diagnosis
collected by someone recently vaccinated with all PPE
pustular fluid or scabs
BSL-4
Presumptive diagnosis
electron microscopy rapid method
Serological-immunofluorescent assay, enzyme immunoassay
Immunoglobulin M capture
Immunoglobulin G enzyme-linked immunosorbent assay
Definative method
Viral culture
polymerase chain reaction (PCR) E9L, A25R,HA, HTI, crmB

51. Yersinia pestis aka pasteurella pestis .
Vector-rat flea (Xenopsylla cheopis ,X.astia)
Incubation period-1-7 days
Plague

52. TOXINS

53. Summary of characteristics of selected bioterrorism agents
Agent
Incubation
period
Person-to-
person spread
Morbidiity/mort
ality if
untreated
Diagnosisa
B. anthracis1-5 days Cutaneous High/highCulture,
serology
Y. pestis 2-3 days Yes High/highCulture,
serology
F. tularensis2-10 days
Skinlesion
High/lowCulture,
serology
Brucella spp.5 days-2
months
No High/lowCulture,
serology
Botulinum
toxins
1-5 days No High/highELISA or mouse
inoculation for
toxin detection
Variola virus7-17 days Yes High/highDetection via
ELISA, PCR, or
virus isolation

54. Developing technologies
•Antibody fragments
•Aptamers and peptide ligands
•Biochips
•Evanescent wave biosensor
•Cantilever
•Microarray