CHEMICAL AND BIOLOGICAL WARFARE AND TERRORISM

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CHEMICAL AND BIOLOGICAL WARFARE AND TERRORISM

• By LCDR Rita McCarthy, MSC, USN
• Pharmacist

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Early Biological Warfare

• The use of filth, dead human bodies, animal
  carcasses, and contagion to cause disease in the
  enemy camps or cities
• 400 BC Scythian archers dipped arrows in blood,
  manure, and dead bodies
• 1346 Siege at Kaffa Tartar soldiers launched
  bodies of their fellow soldiers who died of
  plague over the wall into the city

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Early biological continued

• 1710 Russian troops used plague infected bodies
  against Sweden
• 1767 French and Indian Wars (Colonial America)
• The British Commander orders small pox infected
  blankets to be given to the Indians loyal to the
  French defending Fort Carillon

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Modern Development of BW

• WWI Germans infected horses with glanders that
  were being sold to Allied forces
• Transferred from horses to humans
• acute coughing, fever and the release of an
  infectious nasal discharge, followed by
  septicemia and death within days.
• Chronic nasal and subcutaneous nodules develop,
  eventually ulcerating. Death can occur within
  months, while survivors act as carriers.
• 1937-1945 Japan had program with live subjects
  in Manchuria
• Chinese, Russian, and American prisoners of war
  tens of thousands die of bubonic plague, cholera,
  anthrax and other diseases
• Accidentally infected own military units on
  multiple occasions

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Biological Warfare

• The intentional use of disease producing
  microorganisms or biologically derived toxins as
  weapons to kill or injure humans, animals, or
  plants

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Bio-Terrorism

• The use of (or a threat to use) a biological or
  chemical agent by an individual or a group in
  order to intimidate or coerce a government of a
  society in the pursuit of political, religious,
  ecological, or other ideological objectives

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Why use Chem/Bio agents for terror?

• Cost
• Biological agent 1
• Chemical agent 600
• Conventional explosive 2000
• Easily produced
• Difficult to detect
• FEAR TERROR OF GENERAL PUBLIC!

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Classification of Agents of Biological Origin

• Pathogens
• BACTERIA
• Viruses
• Toxins

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Bacteria

• Mechanism of disease
• Invasion and infection of tissue
• Produce toxins
• Prevention
• Immunization
• Active vaccine
• Passive from mother to child
• Treatment
• Specific antibiotics

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What makes a good biological agent?

• Availability and ease of production
• Incapacitate or lethal?
• Particle size
• Ease of dissemination
• Stability after production
• Susceptibility of population

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Bacterial Agents

• Anthrax
• Plague
• Tularemia
• Brucellosis
• Q Fever

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Anthrax

• Bacillus anthracis
• 1876 first disease for which a microbial cause
  was established (Koch)
• 1881 Attenuated spore vaccine for livestock
• 1949 human vaccine developed (licensed in 1970)

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Why use Anthrax as a Weapon?

• Easy to produce in large quantities
• Spores can be spread by aerosol
• Short incubation period
• Highly lethal

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Anthrax Epidemiology

• Reservoir Soil
• Herbivores infected during grazing
• Transmission to humans
• Contact with contaminated animals, hides, wool
• Ingestion of contaminated meat
• Inhalation of dust with spores
• Annual incidence 2,000 cases world-wide

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Anthrax Pathogenesis

• Spore enters the body
• Germinates and transported to lymph nodes
• Local production of toxins lead to edema and
  tissue destruction
• Spread from lymph nodesbacteria and toxin into
  blood

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Inhalation Anthrax

• Incubation period 1-7 days
• Initial symptoms mild and flu-like
• Followed by shortness of breath, labored
  breathing, rapid heart rate
• Rapid progression to shock and death if not
  treated soon enough

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Treatment of Anthrax

• High does antibiotics
• Ciprofloxacin
• Doxycycline
• Penicillin

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Plague

• Bubonic
• Malaise, high fever, tender lymph nodes
• If untreated
• Blood poisoning, death
• Pneumonic
• High fever, chills, headache, coughing up blood,
  blood poisoning
• If untreated
• Respiratory failure, circulatory collapse, heavy
  bleeding, death

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Tularemia

• Swollen glands, fever, headache, malaise, weight
  loss, nonproductive cough
• Generally not fatal

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Brucellosis

• Can spread to humans if they come in contact with
  infected animals, or by eating or drinking
  unpasteurized milk or cheese.
• May begin with mild flu-like symptoms, muscle
  pain, swollen glands
• May be chronic and last for years
• Generally not fatal

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Q Fever

• Fever, cough, chest pain
• Generally not fatal

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Viruses

• Smallpox
• Ebola
• Venezuelan Equine Encephalitis
• Yellow Fever

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Smallpox History

• 1500s gt3.5 million die after Europeans introduce
  smallpox to the New World
• 1796 Vaccine developed by Jenner
• 1813 Madison encouraged vaccination
• 1949 last outbreak in the US
• 1960 Worldwide eradication program
• 1980 WHO declares earth free of smallpox

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Smallpox as a BW or Terrorist Threat

• Highly communicable disease (person-to-person
  transmission)
• Vaccine use discontinuedmakes a target
  population that is susceptible

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Smallpox

• Incubation 7-14 days
• Fever, headache, general illness, vomiting
• Skin seeded with virus
• Scabs form 8-14 days after onset
• Scabs infectious

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Medical Management

• Confirm
• Quarantine all cases
• Vaccination of all contacts available from the
  CDC

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Toxins

• Saxitoxins and Conotoxins marine animals
• Botulinum bacteria
• Mycotoxins fungus
• Snake venom
• Ricin plant

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Toxin vs. Chemical Agents

• Natural origin
• Stable
• More toxic
• Legitimate medical use
• Only one active on skin

• Man-made
• Less stable
• Less toxic
• Only use is weapons
• All active on skin

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Botulinum Toxin

• Clostridium botulinum
• Tetanus
• Botulism
• One of the most toxic substances known
• Neurotoxin
• The toxin has a legitimate medical use
• Botox
• Treat muscle contractions and can offer relief
  from sweating of the hands, feet and underarms

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Clinical Symptoms of Botulism 3rd day
post-exposure 4th day post-exposure

• Mucous in throat
• Difficulty swallowing
• Feels like a cold
• No fever
• Blurred vision

• Mental numbness
• Slow eye movements
• Dilated pupils
• Indistinct speech
• Difficulty walking
• Extreme weakness
• Floppy Paralysis

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Medical Management

• Vaccine is available but general use is not
  necessary
• Treat with immunoglobulin before onset of
  symptoms (from the CDC)
• May need to assist with breathing if severely
  affected or treatment not started in time
• May lead to death

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Saxitoxins

• Paralytic Shellfish Poisoning
• From eating shellfish contaminated by "red tides"
  or algal blooms
• Symptoms tingling, numbness, weakness, limb
  paralysis
• Onset of symptoms almost immediateexposure by
  inhalation leads to extremelyrapid development
  of symptoms with death occurring within minutes
  if not treated.

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Conotoxins

• Paralytic poisons from Pacific cone snails
• Symptoms burning pain local numbness, spreading
  rapidly to involve the entire body but without
  pain some cardiac and respiratory distress at
  the height of the poisoning
• Onset of symptoms almost immediate upon
  injection from the snail

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Mycotoxins

• Produced by microfungi that are capable of
  causing disease and death in humans and other
  animals
• Some used as antibiotics, growth promotants, and
  other kinds of drugs still others have been
  implicated as chemical warfare agents
• Severity of mycotoxin poisoning can be compounded
  by other illnesses mycotoxicoses can heighten
  vulnerability to microbial diseases, worsen the
  effects of malnutrition, and interact
  synergistically with other toxins
• Almost no treatments for mycotoxin exposure

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Ricin

• Protein toxin from castor beans
• Plant found world-wide
• Toxin is fairly easy to produce
• Castor oil used as lubricant for motors

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Symptoms of Ricin Poisoning

• Oral ingestion least toxic (8-10 hours)
• Bleeding and tissue damage in GI tract
• Nausea, vomiting, diarrhea, cramps
• Inhaled most common
• Nausea, vomiting, diarrhea, cramps, dilated
  pupils, fever, headache
• Shock, edema, pneumonia
• Death on 3rd or 4th day!

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Medical Management

• Identify if toxin, asthma, or chemical poisoning
• Supportive care
• For oral ingestion administer activated charcoal
  to absorb toxin
• No anti-toxin or immunization yet

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Chemical Agents Early Chemical Warfare

• 423 BC Sparta used toxic and irritant smoke to
  capture a fort held by Athenians
• 700 AD Greeks invent and use Greek Fire (pitch,
  sulfur, and rosin) which floated on water to set
  enemy ships on fire
• Pitch a viscous substance produced by plants or
  formed from petroleum
• Sulfur used to make gun powder
• Rosin type of resin
• 15th and 16th Centuries Venice used poison
  chests to contaminate water

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Modern Chemical Warfare

• 1st gas attack April 22, 1915
• Chlorine gas used by Germany in Belgium
• WWII no confirmed use by Germany on the
  battlefield, however, cyanide and other gasses
  were used in concentration camps
• Cyanide makes the cells of an organism unable to
  use oxygen
• 1980s Iraq used chemical agents against Iran and
  against its own people (Kurds)

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Chemical Agents

• Lethal (toxic) agents
• Nerve agents
• Choking agents
• Blood agents
• Blister agents
• Incapacitating agents
• Irritants

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Chemical Agents

• Solid
• Liquid
• Gas
• Persistent effective for gt12 hours
• Non-persistent inactivated lt12 hours

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Nerve Agents

• Sarin (GB)
• Soman (GD)
• Tabun (GA
• GF
• VX

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Sarin

• Lethal agent
• Developed in 1940s by Germany
• Original use was an insecticide
• Causes death by asphyxiation
• Is a liquid at room temperature

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Soman, Tabun, and VX

• Lethal agents
• Soman synthesized by Germany in 1944 similar to
  sarin
• Tabun synthesized by Germany in 1936
• VX developed by USA
• Victims of Soman, Tabun, and VX ,make it harder
  to treat casualities than with Sarin

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Physical Properties

• Clear colorless liquids (when fresh)
• Not nerve gas!
• Tasteless each has identifiable odor
• May be spread by fine vapor gas or as a liquid
  on skin
• Onset of symptoms within seconds to minutes
• Large exposure can cause death

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Nerve Agents Symptoms Treatment

• Pinpoint pupils
• Sweating
• Drooling runny nose
• Convulsions
• Involuntary urination
• Coma
• Possible death

• Decontamination
• Atropine
• Assist with breathing
• Anti-seizure drugs

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Choking Agents

• Chorine and Phosgene
• Developed and used during WWI
• Head delayed reation time
• Causes lung damage
• Can cause blindness if gets into eyes
• Gas or liquid

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Blister Agents

• Mustard (H)
• Nitrogen Mustard (HN)
• Lewisite (L)
• Phosgene oxime (CX)
• Causes skin blisters
• Usual/ly does not kill

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Others

• Blood agent
• cyanide
• Incapacitating agents
• Psychological effects (LSPD and BZ)
• Riot control agents
• Peper spray, tear gas, mace

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Treatment

• Decontamination
• Special antidotes
• Anti-convulsant drugs
• Supportive care