Biological Terrorism - vza.be .Biological Terrorism •Definition, situate biological terrorism within

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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

    HighestConcernCDCdesignatedAListofBiologicAgents

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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

    (1300s: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-Schnemann

    The Lancet, Volume 387, Issue 10021, Pages 846-847 (February 2016)

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