Bioterrorism: An Overview
Rick Roman, M.H.S.A.
Senior Epidemic Support Coordinator
Bioterrorism Preparedness and Response Program
Centers for Disease Control and Prevention
Bioterrorism
Intentional or threatened use of viruses,
bacteria, fungi, or toxins from living
organisms to produce death or disease in
humans, animals, or plants
Compaq Customer:
History of
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Biological Warfare
14th Century: Plague at Kaffa
History of
Biological Warfare
18th Century: Smallpox Blankets
History of
Biological Warfare
20th Century:
– 1943: USA program launched
– 1953: Defensive program
established
– 1969: Offensive program
disbanded
Biological Warfare
Agreements
1925 Geneva Protocol
1972 Biological Weapons
Convention
1975 Geneva Conventions
Ratified
Bioterrorism
Bioterrorism:
Who are 1st Responders?
Primary Care Personnel
Hospital ER Staff
EMS Personnel
Public Health Professionals
Other Emergency Preparedness Personnel
Laboratory Personnel
Law Enforcement
Potential Bioterrorism
Agents
Bacterial Agents Viruses
– Anthrax – Smallpox
– Brucellosis – VEE
– Cholera – VHF
– Plague, Pneumonic Biological Toxins
– Tularemia – Botulinum
– Q Fever – Staph Entero-B
– Ricin
Source: U.S. A.M.R.I.I.D. – T-2 Mycotoxins
Biological Agents of
Highest Concern
Variola major (Smallpox)
Bacillus anthracis (Anthrax)
Yersinia pestis (Plague)
Francisella tularensis (Tularemia)
Botulinum toxin (Botulism)
Filoviruses and Arenaviruses (Viral hemorrhagic
fevers)
ALL suspected or confirmed cases should be
reported to health authorities immediately
Smallpox
Parapox Anthrax
Advantages of Biologics
as Weapons
Infectious via aerosol
Organisms fairly stable in environment
Susceptible civilian populations
High morbidity and mortality
Person-to-person transmission (smallpox, plague,
VHF)
Difficult to diagnose and/or treat
Previous development for BW
Advantages of Biologics
as Weapons
Easy to obtain
Inexpensive to produce
Potential for dissemination over large
geographic area
Creates panic
Can overwhelm medical services
Perpetrators escape easily
Bioterrorism:
How Real is the Threat?
Hoax vs. Actual BT Event
Anthrax Bioterrorism
San Francisco Chronicle, 20 December 1998
Threats reported to FBI
250
200
150
100
50
0
1996 1997 1998 1999*
* first four months of 1999
Source: FBI personal communication
Chemical & Biological
Terrorism
1984: The Dalles, Oregon, Salmonella (salad bar)
1991: Minnesota, ricin toxin (hoax)
1994: Tokyo, Sarin and biological attacks
1995: Arkansas, ricin toxin (hoax)
1995: Ohio, Yersinia pestis (sent in mail)
1997: Washington DC, “Anthrax” (hoax)
1998: Nevada , non-lethal strain of B. anthracis
1998: Multiple “Anthrax” hoaxes
Salmonellosis Caused by
Intentional
Contamination
The Dalles, Oregon in Fall of 1984
751 cases of Salmonella
Eating at salad bars in 10 restaurants
Criminal investigation identified
perpetrators as followers of Bhagwan
Shree Rajneesh
SOURCE: Torok et al. JAMA 1997;278:389
Source: ASAHI SHIMBUN SIPA
Clinical Status of Patients Exposed to Sarin
on March 21, 1995
Dead 8
Critical 17
Severe 37
Moderate 984
Outpatient 4,073
Unknown 391
Total 5,510
Shigellosis Caused by
Intentional Contamination
Dallas, Texas in Fall of 1996
12 (27%) of 45 laboratory workers in a large medical center
had severe diarrheal illness
8 (67%) had positive stool cultures for S. dysenteriae type 2
Eating muffins or donuts in staff break room implicated
PFGE patterns indistinguishable for stool, muffin, and
laboratory stock isolates
Criminal investigation in progress
SOURCE: Kolavic et al. JAMA 1997;278:396
Federal Agencies
Involved in Bioterrorism
NSC PHS
DOD CDC
FEMA Secret Service
DOJ USDA
DHHS FDA
Treasury SBCCOM
EPA USAMRIID
FBI OEP
Cost of Bioterrorism
Agent Transmission
Routes of Infection
Skin
– Cuts
– Abrasions
– Mucosal membranes
Routes of Infection
Gastrointestinal
– Food
• Potentially significant route of delivery
• Secondary to either purposeful or accidental exposure
to aerosol
– Water
• Capacity to affect large numbers of people
• Dilution factor
• Water treatment may be effective in removal of agents
Routes of Infection
Respiratory
– Inhalation of spores, droplets & aerosols
– Aerosols most effective delivery method
– 1-5F droplet most effective
Medical Response to
Bioterrorism
Medical Response
Pre-exposure
– active immunization
– prophylaxis
– identification of threat/use
Medical Response
Incubation period
– diagnosis
– active and passive immunization
– antimicrobial or supportive therapy
Medical Response
Overt disease
– diagnosis
– treatment
• may not be available
• may overwhelm system
• may be less effective
– direct patient care will predominate
Public Health Response
to Bioterrorism
Priorities for Public
Health Preparedness
Emergency Preparedness and Response
Enhance Surveillance and Epidemiology
Enhance Laboratory Capacity
Enhance Information Technology
Stockpile
Components of a Public
Health Response to
Bioterrorism
* Detection - Health Surveillance
* Rapid Laboratory Diagnosis
* Epidemiologic Investigation
* Implementation of Control
Measures
Laboratory Response Network
For Bioterrorism
D - Highest level characterization (Federal)
Level D Lab
BSL-4
C - Molecular assays, reference capacity
Level C Lab
BSL-3 B - Limited confirmation and Transport
Level B Lab
BSL-2 facility + BSL-3 Safety
Practices A - Rule-out and forward organisms
Level-A Lab
Use Class II Biosafety Cabinet
CDC BT Rapid Response and
Advanced Technology Lab
BSL -3
Agent Identification and Specimen Triage
Refer to and Assist Specialty Lab
Confirmation
Evaluate Rapid Detection Technology
Rapid Response Team
Bioterrorism:
What Can Be Done?
Awareness
Laboratory Preparedness
Plan in place
Individual & collective protection
Detection & characterization
Bioterrorism:
What Can Be Done?
Emergency response
Measures to Protect the Public’s Health and
Safety
Treatment
Safe practices
