Biological Agents of Warfare

Categories

Prioritized by the CDCCategory A

– Higher potential for weaponizing– More history-based risk– Higher risk of transmission

Category BCategory C

BW Category A

Small pox* Anthrax* Plague* Botulism Tularemia Viral hemorrhagic

fever

Variola major Bacillus anthracis Yersinia pestis Clostridium botulinum

toxin Ebola,marburg, lassa

Small Pox Victim

Small Pox History

1754-67 British BW during French-Indian wars in North America. – Infected blankets intentionally given to American

Indians resulting in >50% mortality. 1977 WHO eradicated small pox 1978/80s stopped vaccinations in USA &

worldwide– Soviet Union secretly weaponized

WHO approved repositories of variola in CDC and Institute for Viral Preparations (Moscow)

Small Pox Vaccine Impact on Mortality

Never vaccinated Post exposure vax < 10 years ago 11-20 years ago >20 years ago

52% case fatality 29% 1.4% 7% 11%

Similar Conditions Confused with Small Pox

Varicella Scabies Erythema multiforme Herpes zoster/simplex Impetigo Drug reactions

(eruptions) Contact dermatitis

Case Contacts of case Contacts of contacts

Lesions progress from macules to papules to vesicles to pustules to crusting & finally separation of crusts

Anthrax

Bacillus anthracis lives in certain soilsHardy forms (spores) survive in soil or

objects for yearsAnimals are infected when they ingest

spores while grazing, breathe in spores or eat infected animals

Once inside the host the bacteria multipy

Anthrax Types & Symptoms

Cutaneous Intestinal Inhalation

– Most dangerous form, spreads quickly from lungs to bloodstream

Symptoms – Resemble Flu– Fever, sweating, labored breathing

Bioterrorism Threat

Easy to manufactureSmall amount can lead to widespread

danger, fear, disruption, destabilizing chaos and death.

October 2001 USA– Via US Mail to a tabloid publishing company

in Boca Raton, Florida & NBC studios, NY– Spore filled letters indirectly affected thousands

of people– 11 with inhalation, killing 5

Anthrax Post-exp prophylaxis

1991 Iraq acknowledged weaponizing wet anthrax

1995 Aum Shinrikyo terrorist group unsuccessfully attempted release in Tokyo subway before using sarin

Vax + cipro x 30 days Ciprofloxacin 60 days Doxycycline 60 days Amoxicillin 60 days

If symptoms Hospital IV and po meds

Anthrax Vaccine?

1880 development began in animals1930 live spore vax for livestockWWII work began on inactivated vax

against bacteria1970 licensed Anthrax Vaccine Adsorbed

– Primarily used to protect troops

Does is Work?

CDC Study of mill workers at risk for cutaneous anthrax

5 unvaccinated workers developed inhalation anthrax, 4 of whom died

None of the vaccinated workers became ill90% of vaccinated animals survive lethal

doses of inhalation anthrax www.anthrax.osd.mil/vaccine/project2.asp

Side Effects

Redness, pain, swelling, burning, itching at injection site

Lump forms under skin subsides in a few days

Serious adverse event 1 in 100,000Since 1940 vax lab workers followed- so far

no long term health problems have arisen

A Study in BlackAcute infection primarily in rats & rodents

who have been bitten by infected fleasTypes

– Bubonic plague (swollen lymph glands)– Pneumonic plague (respiratory distress)– Septicemic plague (severe, rapid systemic dz)

Spreads– Contact with infected fleas

• trapping & hunting animals• Rats living in close proximity to humans

Yersinia pestis (Plague)

Environmental Cycle: – Flea bite Bubonic Plague Septicemia

Pneumonic Plague Contagious Respiratory droplets Treatment:

– Infected in natural setting• Streptomycin or gentamycin

– Mass exposure• Doxycycline, ciprofloxacin, chloramphenicol

– Vaccine discontinued 1999

Plague as a Bioweapon

1346 Tartar army hurled infected corpses into Kaffa– Possible start of Europe’s “Black Death”

WWII Japanese army dropped plague infected fleas in China

Post war USA & USSR aerosolized plague

Plague in History

First Pandemic– Plague of Justinian 6th century- recurring

periodically every 200 yearsSecond Pandemic

– Black Death/Great Plague 14th-17th century-recurring every 17-25 yrs from 1348-1750

Third Pandemic – 19th-20th century (1890-1930)

Early TheoriesCorruption of atmosphere

– Move to country, block windows, use of homeopathic remedies

Will of God or astrological influences– Resulting in death & persecution of religious

and social minorities (Jews, prostitutes and homosexuals)

Contagion through the air– Isolation, quarantine, blindfolded (to keep the

spirit of the infected from entering your eyes)

Medieval Infection Control 1500 AD

The Plague Doctor Beaked Mask

– Filter air stuffed with herbs

– Feverfew, chamomile, hemp

– Glass over eyeholes– Precursor to gas mask

Stick in hand Cloak of sealed canvas Frighten spirits not

microbes