Module 0

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Module 0 Weapons of Mass Destruction (WMD)
Bioterrorism Awareness
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Instructor
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Introductions

• Name
• Department/Organization
• Bioterrorism Preparedness Background/Experience
• Course expectations

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Suspicious Illnesses
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Suspicious Illnesses

• Whats going on?
• What is that?
• What do we do now?

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Course Goals

• DEFINE the fundamentals of bioterrorism and
  biological agents of concern.
• DESCRIBE the dispersion methods, characteristics
  and advantages / disadvantages of using
  biological agents as weapons.
• LIST the primary responsibilities of clinical and
  non-clinical staff in bioterrorism preparedness

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Course Goals (continued)

• RECOGNIZE the presence of biological materials
  from biohazard postings (colors and symbols),
  container shapes/types, or unusual signs that may
  indicate the threat of a biological incident, and
  appropriately COMMUNICATE the need for additional
  resources during a bioterrorism incident.

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Bioterrorism is the single most dangerous threat
to U.S. national security in the foreseeable
future.
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Definition of Bioterrorism
"Bioterrorism - The unlawful use, or
threatened use, of microorganisms or toxins
derived from living organisms to produce death or
disease in humans, animals, or plants. The act
is intended to create fear and intimidate
governments or societies in the pursuit of
political, religious, or ideological goals.
Note There is no single, universally accepted
definition of bioterrorism.
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Increasing Bioterrorism Risk

• Biotechnology renaissance
• Availability of information
• Internet, etc
• Availability of expertise
• Unemployed Former Soviet Scientist
• Proliferation of equipment that may be easily
  converted for biological weapons production

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Increasing Bioterrorism Risk

• Availability of seed cultures
• World Dictionary of Collections of Cultures and
  Microorganisms
• 453 worldwide repositories in 67 nations
• 54 will sell and ship anthrax
• 18 will sell and ship plague
• International black-market sales
• Most doctors have never seen a case of plague or
  anthrax--it could be days before we realize what
  we have

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Biological Weapon Advantages

• Inexpensive / relatively easy to produce
• Cost (1970 Study - Cost of 50 casualties over a
  1sq/km area)
• Conventional weapons - 2,000
• Nuclear - 800
• Chemical - 600
• Anthrax - 1

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Biological Weapon Advantages

• Threat alone may create panic
• Large attack areas may be covered
• Detection may be difficult
• Odorless, Colorless, Tasteless
• First Sign of Attack is Human Illness
• Some pathogens are contagious
• Perpetrators may protect themselves and escape
  before effects are felt

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Biological Weapon Disadvantages

• Controllability
• Effective dispersion is difficult
• Perpetrators may become infected
• Results may be so effective that retribution
  toward those responsible may be enormous

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Common Characteristics

• Can be a liquid or powder
• Successfully dispersed as aerosols when particle
  sizes are 1 to 5 microns
• Can be released from a Line Source or Point
  Source
• Weather is a key factor - Inversions are needed
  for successful aerosol delivery.
• May also be delivered orally through food or
  water contamination.

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Biological Delivery Methods

• Food / Water
• Aircraft sprayers
• Vehicle sprayers
• Hand sprayers
• Mail

• Air handling systems
• Human Vector
• Animal Vector

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Thermal Inversions
Normal Conditions Warm air rises, disperses
pollutants, cool air circulates downward
Thermal Inversions Warm air is trapped between
cool air layers trapping pollutants at ground
level
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Point Source Release
0.005 Kilo (5 gram) Anthrax Release over St. Louis

• Anthrax Model
• Single point release
• Release 1 38.6283 N / 90.1937 W
• Altitude 200 meters
• NE corner of Bell Building
• Total mass of Inventory .013 Kg
• Total mass expelled .005 Kg
• Surface Moisture Normal
• Surface Type Urban
• Cloud Cover Clear Overcast
• Particle Size 4.85 to 5.12 microns
• Fixed winds 12 mph

Population Affected (Census Point Data) Deaths
3,027
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Point Source Release
2.27 Kilo (5 lb) Anthrax Release over St. Louis

• Anthrax Model
• Single point release
• 38.6283 N / 90.1937 W
• Altitude 200 meters
• NE corner of Bell Building
• Total mass of Inventory 5.67 Kg
• Total mass expelled 2.27 Kg
• Surface Moisture Normal
• Surface Type Urban
• Particle Size 4.85 to 5.12 microns
• Fixed winds used 12 mph
• streams

Population Affected (Census Point Data) DEATHS
62,503
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Potential Bioterrorism Agents

• Potentially thousands
• NATO NBC Handbook lists 31 agents
• CDC created Category A, B, C lists
• Based on
• Ease of dissemination
• Potential for Public Health Impact
• Potential for Public Panic and Social Disruption

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Likely Bioterrorism Agents

• Category A
• B.anthacis (Anthrax)
• variola major (Smallpox)
• Y.pestis (Plague)
• botulinum toxin (Botulism)
• F.tularensis (Tularemia)
• filo and arena viruses (Hemorrhagic Fevers)

Source Centers for Disease Control and
Prevention, Critical Biological Agents for Public
Health Preparedness, 1999
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Likely Bioterrorism Agents

• Category B
• C. burnetti (Q Fever)
• brucella spp. (Brucellosis)
• burkholderia mallei (Glanders)
• burkholderia pseudomallei (Melioidosis)
• alphaviruses (Viral Encephalitis)
• rickettsia prowazekii (Typhus)
• Toxins (Ricin)
• Staph Enterotoxin B
• chlamydia psittaci (Psittacosis)
• Foodborne agents
• Waterborne agents

Source Centers for Disease Control and
Prevention, Critical Biological Agents for Public
Health Preparedness, 1999
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Likely Bioterrorism AgentsFBI Critical Agent List

• Anthrax
• Botulinum Toxins
• Ricin Toxin
• Staph Enterotoxin B
• Aflatoxin

• Abrin Toxin
• E Coli 0157H7
• Salmonella
• Shigella
• Nicotine

• Pathogens weaponized by State-Sponsored Programs
  in the past.
• Pathogens weaponized and used by bioterrorists
  in the past.

Based on ease of acquisition, weaponization, and
dissemination
Source NIJ/FBI Chemical/Biological Agent Threat
Assessment, 2002 (unpublished data presented
April 2002, NDMS Conference, Atlanta, GA)
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Recognition of Suspicious Items

• Substance Names
• HAZMAT Labeling
• Suspicious Containers

Biohazard Logos
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Role of Clinical Staff

• General Concepts
• High level of suspicion
• Hoofbeats could be a zebra
• Unusual epidemiologic trends
• Case clustering
• Severe, fulminant disease in otherwise healthy
• Unusual for the region
• Similar disease in animals

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Role of Clinical Staff

• For specific Bioterrorism (BT) diseases
• Recognize typical BT disease syndromes
• Perform appropriate diagnostic testing
• Initiate appropriate treatment/prophylaxis
• Report suspected cases to proper authorities
• 1) Local health department
• 2) Hospital epidemiologist
• 3) Infectious Disease consultants

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Role of Non-Clinical StaffThese apply to ALL
healthcare workers

• Be Flexible
• May receive additional training for specialized
  teams (e.g. patient decontamination)
• May be reassigned wearing different hats
• Be Prepared
• Have family arrangements in place to take care of
  family, pets, etc. in case your facility requires
  a lock-down or quarantine
• Protect Yourself
• Always practice good hygiene, especially hand
  washing, to reduce risk of disease exposure or
  spread

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Questions and Discussion
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Thank you!

• Office for Domestic Preparedness (ODP), Office of
  Homeland Security
• Saint Louis University, Institute for Biosecurity
• BJC Healthcare
• Washington University, School of Medicine