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Both of these organisms ave been viewed as potential biological warfare agents. During World War I glanders was spread deliberately by central powers to infect large numbers of Russian horses and mules. This led to increase in human cases in Russia after World War I. The Japanese infected horses, civilians and prisoners of war with B. The United States studied both agents as possible biological weapons in but did not weaponize it.

The former Soviet Union is believed to have experimented with B. The incubation period is 10 - 14 days. In the acute forms, both glanders and melioidosis can present as an acute pulmonary infection or as an acute fulminant, rapidly fatal septicemic illness. These are the forms that would be expected in case of their use as bioweapons. Acute infection of the oral, nasal and conjunctival mucosa can cause bloody nasal discharge with septal and turbinate nodules and ulcerations. Systemic invasion can cause a papular or pustular rash that can be mistaken for small pox as well as hepatic, splenic and pulmonary abscesses.

Acute forms of the diseases carry a high mortality rate. The chronic form is characterized by cutaneous and intramuscular abscesses on the legs and arms. Osteomyelitis, meningitis, and brain abscesses have also been reported. Gram stain of the exudates show gram negative bacteria with bipolar staining. They stain irregularly with methylene blue or Wright's stain. The organisms can be cultured and identified with standard bacteriological methods. For B. Complement fixation tests are more specific and considered positive if the titer exceeds No vaccine is available for human use.

Standard precautions should be used for infection control purposes. They are similar, share many aspects of epidemiology and transmission and are often difficult to distinguish clinically. Natural infections are acquired by bites of a wide variety of mosquitoes. In natural epidemics severe and often fatal encephalitis in horses, mules, and donkeys precedes human cases. In a biological warfare attack with the virus disseminated as an aerosol, human disease would be a primary event or occur simultaneously with that in equidae.

The human infective dose of VEE is 10 - organisms. VEE is a febrile, relatively mild incapacitating illness. Encephalitis develops in a small percentage of patients. No specific therapy is available. Alpha-interferon and the interferon induce poly-ICLC have proven highly effective as post-exposure prophylaxis in experimental animals. A live attenuated vaccine is available as an investigational new drug. A formalin inactivated vaccine is available for boosting antibody titers in those initially receiving the live attentuated vaccine.

The viruses can be destroyed by heat 80OC for 30 minutes and standard disinfection. There is no evidence for human-to-human or horse to human transmission. Standard precautions and vector control are adequate infection control procedures while the patient is febrile. Ricin is a protein cytotoxin derived from the beans of the castor plant Ricinus communis. The castor plant is ubiquitous and the toxin is easy to export.

It is stable and highly toxic by several routes of exposure including inhalation 44, Following inhalational exposure, acute onset of fever, chest tightness, cough, dyspnea, nausea and arthralgia occur within 4 - 8 hours. Acute respiratory distress syndrome in 18 - 24 hours is followed by hypoxemia and death in 36 - 72 hours.

Retrospective diagnosis is provided by antibody testing in acute and convalescent sera. Gastric lavage and emetics are indicated for ingestion. Being a large molecule, charcoal is not useful for ricin poisoning. There is no vaccine or prophylactic immunotherapy available for human use.

Immunization appears promising in animal models. A protective mask is the best protection against inhalation. Secondary aerosols are not a danger to others and ricin in non volatile. Standard precautions are adequate for health care workers. Hypochloric solution 0. Clostridium perfringens produces 12 toxins One or more of them could be weaponized. The alpha toxin, a highly toxic phospholipase can be lethal when delivered as an aerosol. The toxin would cause vascular leaks and severe respiratory distress. It can also cause thrombocytopenia and liver damage.

The toxin can be detected from serum and tissue samples by a specific immunoassay. Bacteria can be cultured easily. There is some data to show that clindamycin or rifampin may decrease the toxin production by C. However, there is no specific prophylaxis against most of the C perfringens toxins. Some toxids are available for enteritis necroticans in humans. Veterinary toxids are widely used.

These toxins are proteins with a molecular weight of 23, - 29, daltons 44, Staphylococcus aureus produces a number of exotoxins and since they normally exert their effect on the GI tract thy are called Enterotoxins.

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They are also called Pyrogenic toxins because they cause fever. Staphylococcus Enterotoxin B SEB is a pyrogenic toxin that commonly causes food poisoning from improperly handled or refrigerated food. The effect of the inhaled SEB is markedly different. The diseases begins rapidly within 1 - 12 hours after ingestion with sudden onset of fever, chills, headache, myalgia and a nonproductive cough.

Pulmonary edema occurs in severe cases. GI symptoms can occur concomitantly due to inadvertent swallowing of the toxin after inhalatione US Bioweapons program possessed prior to its termination in There is no specific therapy available. Experimental immunization has been reported. No human vaccine is available. A candidate vaccine is in advanced development. Secondary aerosols are not a hazard and SEB does not pass through intact skin. Standard precautions for health care workers are recommended. Trichothecene mycotoxins are a group of more than 40 toxins produced by common molds like Fusarium, Myrotecium, Trichoderma, Stachybotrys and other filamentous fungi.

They are extremely stable in the environment and the only class of biological toxins that cause skin damage. Usual hypochlorite solution does not inactivate these toxins.

Biological and Chemical Terrorism:Strategic Plan for Preparedness and Response

They retain bioactivity even after autoclaving. Skin exposure causes pain, pruritus, reduess, vesicles, necrosis and sloughing. Severe irritant effects are seen on the respiratory tract, GI tract and eyes on contact. Severe intoxication results in shock and death. Diagnosis should be suspected if an aerosol attack occurs in the form of "yellow rain" with contamination of the clothes and the environment by pigmented oily fluids. Treatment is supportive only. Soap and water washing can prevent or significantly reduce dermal toxicity if done within 1 - 6 hours.

Superactivated charcoal should be used for oral intoxication. No prophylactic chemotherapy or immunotherapy is available in the field. Exposure during an attack should be prevented by mask and clothing. Secondary aerosols are not a hazard. Contact with contaminated skin and contaminated clothing can produce secondary dermal exposures. Until decontamination is accomplished, contact precautions are needed. Subsequently, standard precautions are recommended for health care workers. The agents in this group with the third highest priority include emerging pathogens that could be engineered for mass dissemination.

The characteristics that render them amenable to bioterrorism are - Availability Ease of production and dissemination Potential for high morbidity and mortality and major health impact. The agents included in this category are: Nipah virus Hantavirus - discussed in the presentation on viral hemorrhagic fevers Tick borne hemorrhagic fever viruses Tick borne encephalitis viruses Yellow fever - discussed in the presentation on viral hemorrhagic fevers Multidrug resistant tuberculosis. The - outbreak in Malaysia caused 1 million deaths in swine and encephalitis in humans. The disease was eradicated from swine but is still likely to be present in fruit bats.

Humans contracted Nipah virus by coming into direct contact with swine. Human-to-human transmission has not been documented. No cases have been documented in the United States. Tick borne hemorrhagic fevers include Crimean-Congo hemorrhagic fever, Omsk hemorrhage fever and Kyasanur Forest disease To enhance the preparedness at local and state levels, the CDC funded co-operative agreements with states and several large cities Five areas were emphasized for the first 3 years of this program -. The United States Food and Drug Administrations is participating in an interagency group preparing for response in a civilian emergency 55 The USAMRIID maintains an aeromedical isolation team to minimize the risk of transmission from the troops to air crews, caregivers and civilians Traditional first responders like firefighters and law enforcement officers are the most likely to respond to an announced attack, whereas physicians and other health care providers would be most likely to uncover an unannounced attack.

In either case, the medical community at large will be responsible for diagnosis and management of diseases caused by biological and chemical weapons. The Association for Professionals in Infection Control and Epidemiology APIC in cooperation with the CDC has prepared a Bioterrorism Readiness Plan to serve as a reference document and a template to facilitate preparation of bioterrorism readiness plans for individual institutions National Association of Counties conducted a survey of county Public Health directors A significant number of responding counties counties in 36 states reported less than optimal levels of preparedness for biological and chemical warfare and for policies and procedures to enforce a quarantine.

Among the reasons cited for unpreparedness were insufficient funding, insufficient work force and insufficient communications networks. In most cities, large health care institutions have disaster plans and various types of task forces with "experts" in different areas in place. However, they need to be updated and modified to include new information on biological and chemical weapons.

In addition to being able to recognize and manage diseases associated with bioterrorism events, health care providers will need to stay abreast of new developments. The same issue of Emerging Infectious Diseases August, has a review on the activity of humoral immunity against several biological agents and discusses the use of passive antibody administration Immediate Immunity as a specific defense against biological weapons Various models and estimates of the economic impact of bioterrorism attacks have been published.

Rapid implementation of a post-attack prophylaxis program is the single most important means of reducing the huge economic impact The model proposed by Kaufamnn et al. In the field of Infectious Diseases, reality is stranger than anything a writer could dream up. The most menacing bioterroist is Mother Nature herself.

Their assistance in collecting the most recent literature and helping convert thoughts and rough drafts into a presentable review was invaluable.

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Skip to main content. Internal Medicine. Overview of Potential Agents of Biological Terrorism. Bioterrorism , National Security and Law Bioterrorism has now been defined as the intentional use of a pathogen or biological product to cause harm to a human, animal, plant or other living organisms to influence the conduct of government or to intimidate or coerce a civilian population 4.

Historical Perspective and Trends Related to Bioterrorism The intentional use of living organisms or infected materials derived from them has occurred over centuries during war and "peace" time by armies, states, groups and individuals 14,15, Some of the more recent events of biological warfare are chronicled below - The Tartars catapulted bodies infected with plague into Caffa now Ukraine in at the end of a 3 day siege. The inhabitants of Central and South America were decimated by small pox and measles that accompanied the Spanish conquistadors. British forces used blankets contaminated with small pox to infect North American Indians in the 18th century.

The modern era of biological weapons development began immediately before and during World War II. The Japanese released fleas infected with plague in Chinese cities in the 's and 's. Between and Japanese unit dropped bombs containing up to 15 million plague infected fleas on two Chinese cities - Quxian and Ning-hsien, resulting in at least deaths. Water supplies and food items were contaminated with B. Cholera, Shigella spp. Weather Underground , a United States revolutionary group intended to obtain agents at Ft.

Detrick by blackmail and to temporarily incapacitate United States cities to demonstrate the impotence of the federal government. Report originated with a US Customs informant. College students influenced by ecoterrorist idealogy and 's drug culture planned on using agents of typhoid fever, diphtheria, dysentery and meningitis to target the entire world population initially and later narrowed the plan to five cities near Chicago. The attack was aborted when cultures were discarded. Bulgarian defector Georgi Markov was assassinated in Lauda using ricin-filled pellet infected with a spring-loaded device disguised in an umbrella.

Similar device used against a second defector in the same area was unsuccessful. Sverdlovsk, Russia Accidental release of anthrax from Soviet bioweapons facility caused an epidemic of inhalational anthrax with at least 77 cases and 60 deaths. Red Army Faction Members of a Marxist revolutionary ideology group allegedly cultivated botulinum toxin in a Paris safe-house and planned attacks against at least 9 German officials and civilian leaders.

This probably was an erroneous report, later repudiated by the German government. Rajneeshee Cult Indian religious cult headed by Rajneeshee plotted to contaminate restaurant salad bars with Salmonella typhimanice in Dallas, Oregon. The motivation was to incapacitate voters to win local elections and seize political control of the county. The incident resulted in a large community outbreak of salmonellosis involving patients and at least 45 hospitalizations. The plot was revealed when the cult collapsed and members turned informants.

Minnesota Patriots Council Right wing "Patriot" movement obtained Ricin extracted from castor beans by mail order. Aum Shinrikyo New Age Doomsday cult seeking to establish a theocratic state in Japan attempted at least 10 times to use anthrax, botulinum toxin, Q fever agent and Ebola virus in aerosol form. All attempts with biological weapons failed.


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Multiple chemical weapon attacks with Sarin, Vx, hydrogen cyanide in Matsumato, Tokyo and an assassination campaign were conducted. Nerve gas Sarin killed 12 and injured in Tokyo subway. Texas Intentional contamination of muffins and donuts with laboratory cultures of Shigella dysenteriae. The event caused gastroenteritis in 45 laboratory workers and 4 were hospitalized. Larry Wayne Harris Allegedly threatened to release "military grade anthrax" in Las Vegas, Nevada.

Obtained plague and anthrax vaccine strains , repeatedly isolated several other bacteria. Made vague threats against US federal officials on behalf of right wing "patriot" groups. Arrested when he talked openly about biological weapons terrorism. Intentional dissemination of anthrax spores through the US Postal System leading to the death of five people, infection of 22 others and contamination of several government buildings. Investigation into the attacks so far has not led to any conclusions. Chronology of Anti-Bioterrorism Biosafety Actions The United States signs but fails to ratify the treaty.

The treaty contained no provision for verifications and inspection. International pressures mount to draw up new treaties to curb such weapons. November 25, President Richard M. Nixon unilaterally renounces the use of biological weapons in war by the United States and restricts research to immunization and safety efforts.

Three months later, he extends the ban to include toxins. The Biological and Toxin weapons Convention entered into force March 26, There are now states parties to the convention and an additional 18 signatories Article VI of the Convention that provides for actions against noncompliance has proved to be an inadequate mechanism. May 13, Shortly after the Allied victory against Iraq, President George Bush announced that the United States will renounce the use of chemical weapons for any reason. April, Russian President Boris N. Yeltsin declares that Russia's biological weapons program is being discontinued..

January, President George Bush signs the Chemical Weapons treaty at the convention banning the production and use of chemical weapons. January 7, The Presidential Advisory Committee on Gulf War Veterans' illnesses, finds no conclusive evidence linking Gulf War Syndrome to exposure to chemical or biological weapons.

April 15, New regulations aimed at limiting access to chemicals and pathogens that could be made into weapons go into effect under the Antiterrorism and Effective Death Penalty Act. April 29, The Chemical Weapons Convention went into effect. It has more than signatories and 65 ratifications. July 25, The United States rejected a protocol to strengthen the Biological Weapons Convention as well as the whole approach to it Like the Chemical Weapons Conventions CWC , a strong bioweapons protocol could add to the deterrence of bioweapons which are a much greater threat. The Threat of Biological Weapons The Biological weapons system is comprised of four components; a payload, munition, delivery system and dispersion system.

Types of Bioterrorism Attacks A bioterrorist attack may occur in 2 scenarios - overt and covert. Agents of Bioterrorism Attacks Based on the ease of transmission, severity of morbidity, mortality, and likelihood of use, biological agents can be classified into 3 categories Table 1 Table 1 Table 2 Category A Agents Category A includes the highest priority agents that pose a risk to national security because of the following features - i. Plague Microbiology and Epidemiology Plague is caused by Yersinia pestis , previously called Pasturella pestis.

Clinical Features Y. Laboratory Diagnosis A high index of clinical suspicion and a careful clinical and epidemiologic history and physical examination are required to allow timely diagnosis of plague. Antimicrobial Therapy. Post Exposure Prophylaxis Close contact for purposes of initiating antimicrobial prophylaxis is defined as contact with a patient at less than 2 meters. Vaccination A licensed killed whole cell vaccine was available in the United States from to late Infection Control Procedures Standard precautions should be used for bubonic plague patients. Category B Agents This category 47 contains the second highest priority agents because they a.

Diagnosis - The incubation period is 2 - 14 days, varies according to number of organisms inhaled. Management - All suspected cases of Q fever should be treated to reduce the risk of complications. Brucellosis Also called undulant fever, Mediterranean Fever, Malta Fever Epidemiology and Microbiology Brucellosis is a zoonotic disease caused by infection with one of the six species of Brucellae, a group of facultative intracellular gram negative coccobacilli 36,44, Diagnosis The usual incubation period is 8 - 14 days but may be longer. Management The United States military recommends doxycycline mg Q12 hr plus rifampin mg a day for six weeks.

Glanders and Melioidosis Epidemiology and Microbiology Caused by Burkholderia mallei and Burkholderia pseudomallei respectively Diagnosis The incubation period is 10 - 14 days.

Killer Strain: Anthrax

Epsilon Alpha Toxin Clostridium perfringens produces 12 toxins Enterotoxin B These toxins are proteins with a molecular weight of 23, - 29, daltons 44, T-2 Mycotoxins Trichothecene mycotoxins are a group of more than 40 toxins produced by common molds like Fusarium, Myrotecium, Trichoderma, Stachybotrys and other filamentous fungi.

The characteristics that render them amenable to bioterrorism are - Availability Ease of production and dissemination Potential for high morbidity and mortality and major health impact The agents included in this category are: Nipah virus Hantavirus - discussed in the presentation on viral hemorrhagic fevers Tick borne hemorrhagic fever viruses Tick borne encephalitis viruses Yellow fever - discussed in the presentation on viral hemorrhagic fevers Multidrug resistant tuberculosis Nipah virus The - outbreak in Malaysia caused 1 million deaths in swine and encephalitis in humans.

Five areas were emphasized for the first 3 years of this program - Preparedness, planning and readiness assessment Surveillance and epidemiology capacity Biological laboratory capacity Chemical laboratory capacity Health alert network and training The United States Food and Drug Administrations is participating in an interagency group preparing for response in a civilian emergency 55 The USAMRIID maintains an aeromedical isolation team to minimize the risk of transmission from the troops to air crews, caregivers and civilians We would like to conclude this discussion with a quote "Modern adventurers like to up the ante, but even the most extreme sports wouldn't produce the adrenaline of a race against pandemic influenza or a cloud of anthrax at the Super Bowl.

References Diamond J. Guns, Germs and Steel. Publication NIE Heymann, DL. Hearing on the Threat of bioterrorism and the Spread of Infectious Diseases. September September 15, Shining light on dark winter. Clinical Infectious Diseases. Lessons learned from a full-scale bioterrorism exercise. Emerging Infectious Diseases.

Large scale quarantine following biological terrorism in the United States. Henderson DA. Gostin LO,. Biodefense Quarterly. Anna SGJ. Bioterrorism, Public health and civil liberties. New England Journal Of Medicine. Biological warfare and bioterrorism. Bioterrorism preparedness: What practitioners need to know. Infections in Medicine. Tucker JB. Historical trends related to bioterrorism: An empirical analysis.

Historical overview of biological warfare. Medical aspects of chemical and biological warfare. Washington, DC: Borden Institute; Biological warfare. A historical perspective. CQ Press. Chemical and Biological weapons. The CQ Researcher. Wheelis M. Investigating disease outbreaks under a protocol to the biological and toxin weapons convention. Dorey E. US rejects stronger bioweapons treaty.

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Nature Biotechnology. Davis CJ. Nuclear blindness: An overview of the biological weapons programs of the former Soviet Union and Iraq. Rorberts B. New Challenges and new policy priorities for the ;s. In: Biologic Weapons; weapons of the future. Washington: Center for Strategic and International Studies; Bartlett JG. Thoughts on Bioterrorism. Annals of Internal Medicine. Carus WS. Henderso DA. Bioterrorism as a public health threat. Daplan E, Marchell A. The Cult at the End of the World.

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New York: Crown Publishing Group; Potential biological weapons threats. Zalinskas RA. Iraq's biological weapons: The past or future? Emergency physicians and biological terrorism. Ann Emerg Med. Biological weapons - a primer for microbiologists. Annu Rev Microbiol. Danzig R, Berkowsky PB. Why should we be concerned about biological weapons.


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The economic impact of a bioterrorist attack: Are prevention and past attack intervention programs justifiable? Miller JM. Agents of bioterrorism; preparing for bioterrorism at the community health care level. Infect Dis Clinc North Am. Plague as a biological weapon: Medical and public health management. Pneumonic plague - Arizona, Yersinia pestis - etiologic agent of plague. Clinical Microbiol Rev. Fatal human plague - Arizona and Colorado, Multidrug resistance in Yersinia pestis mediated by a transferable plasmid.

New England Journal of Medicine. Threats in bioterrorism. US Army. Glanders in a military research microbiologist.


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N England J Medicine. American Public health Association. In: Benenson AS, ed. Control of Communicable Diseases Manual. Public Health assessment of potential biological terrorism agents. The American Journal of Medicine. Biological Warfare. Preparing for the Unthinkable Emergency. Viral encephalitis; familiar infections and emerging pathogens. The Lancet. Hemorrhagic fever viruses as biological weapons. Clinical recognition and management of patients exposed to biological warfare agents. Bioterrorism preparedness for the public health and medical communities.

May Clin Proc. Public health preparedness for biological terrorism in the USA. Zoon KC. Air evacuation under high-level biosafety containment: The Aeromedical Isolation Team. English JF et al. Bioterrorism readiness Plan: A template for Healthcare Facilities. April 13, National Association of Counties. Use of automated ambulatory care encounter records for detection of acute illness clusters, including potential bioterrorism events. Casadeva;; A.

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The Economic Impact of a bioterrorist attack: Are prevention and post attack intervention programs justifiable. The Geneva Protocol prohibits the use of biological and chemical weapons in war. The Soviet Union and United States build arsenals of biological and chemical weapons. President Richard M. Convention on the prohibition of the development, production, and stockpiling of bacteriological biological and toxin weapons and their destruction opened for signature at Washington, London, and Moscow on April 10, The Reagan administration presented a draft treaty to ban the production and storage of chemical weapons to the Conference on Disarmament in Geneva.

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