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Bioterrorism
Bioterrorism is terrorism by intentional release or dissemination of biological agents (bacteria, viruses or toxins); these may be in a naturally-occurring or in a human-modified form.
A bioterrorism attack is the deliberate release of viruses, bacteria, or other germs (Agents) used to cause illness or death in people, animals, or plants. These agents are typically found in nature, but it is possible that they could be changed to increase their ability to cause disease, make them resistant to current medicines, or to increase their ability to be spread into the environment. Biological agents can be spread through the air, through water, or in food. Terrorists may use biological agents because they can be extremely difficult to detect and do not cause illness for several hours to several days. Some bioterrorism agents, like the smallpox virus, can be spread from person to person and some, like anthrax, can not.
Types of biological agents
The CDC has defined and categorized bioterrorism agents according to priority [2] as follows:
Category A agents
These are biological agents with both a high potential for adverse public health impact and that also have a serious potential for large-scale dissemination. The Category A agents are anthrax, smallpox, plague, botulism, tularemia, and viral hemorrhagic fevers.
Anthrax
Anthrax is a bacterium with a highly resistant spore form. It is highly infectious and lethal when inhaled. It is a non-contagious disease which does not spread from one person to another. An anthrax vaccine does exist but requires many injections and has enough side effects that it is considered unsuitable for general use.
Smallpox
Smallpox is a highly contagious virus. It transmits easily through the atmosphere and has a high mortality rate (20-40%). Smallpox was eliminated in the world in the 1970s, thanks to a worldwide vaccination program. However, some virus samples are still available in Russian and American laboratories. Some believe that after the collapse of the Soviet Union, cultures of Smallpox have become available in other countries. Although people born pre-1970 will have been vaccinated for smallpox under the WHO program, the effectiveness of vaccination is limited since the vaccine provides high level of immunity for only 3 to 5 years. As a biological weapon smallpox is dangerous because of the highly contagious nature of both the infected and their pox. Smallpox occurs only in humans, and has no external hosts or vectors.
Botulinum toxin
Botulinum toxin is one of the deadliest toxins known, and is produced by the bacterium Clostridium botulinum. Botulism causes death by respiratory failure and paralysis.
Ebola
Ebola is a viral hemorrhagic fever, with fatality rates ranging from 50-90%. No cure currently exists, although vaccines are in development. The United States and the Soviet Union both investigated the use of Ebola for biological warfare, and the Aum Shinrikyo group possessed cultures of the virus. Ebola kills its victims through multiple organ failure and hypovolemic shock.
Plague
Plague is a disease caused by the Yersinia pestis bacterium. Rodents are the normal host of plague, and the disease is transmitted to humans by flea bites and occasionally by aerosol in the form of pneumonic plague. The disease has a history of use in biological warfare dating back many centuries, and is considered a threat due to its ease of culture and ability to remain in circulation among local rodents for a long period of time.
Marburg
Marburg is a viral hemorrhagic fever virus first discovered in Marburg, Germany. Fatality rates range from 25-100%, and although a vaccine is in development, no treatments currently exist aside from supportive care. As with Ebola, basic barrier nursing significantly reduces the virulence of the virus.
Tularemia
Tularemia, or rabbit fever, is a generally non-lethal and severely incapacitating disease caused by the Francisella tularensis bacterium. It has been widely produced for biological warfare due to its highly infective nature, and ease of aerosolization.
Category B agents
Category B agents are moderately easy to disseminate and have low mortality rates.
• Brucellosis (Brucella species)
• Epsilon toxin of Clostridium perfringens
• Food safety threats (e.g., Salmonella species, E coli O157:H7, Shigella)
• Glanders (Burkholderia mallei)
• Melioidosis (Burkholderia pseudomallei)
• Psittacosis (Chlamydia psittaci)
• Q fever (Coxiella burnetii)
• Ricin toxin from Ricinus communis (castor beans)
• Staphylococcal enterotoxin B
• Typhus (Rickettsia prowazekii)
• Viral encephalitis (alphaviruses, e.g.: Venezuelan equine encephalitis, eastern equine encephalitis, western equine encephalitis)
• Water supply threats (e.g., Vibrio cholerae, Cryptosporidium parvum)
Category C agents
Category C agents are pathogens that might be engineered for mass dissemination because they are easy to produce and have potential for high morbidity or mortality (examples: Nipah virus, hantavirus and multi-drug resistant Tuberculosis (MTB).
Modern bioterrorist incidents
1984 Rajneeshee Salmonella attack
In 1984, followers of the Bhagwan Shree Rajneesh attempted to control a local election by infecting salad bars in 10 restaurants with Salmonella typhimurium in the city of The Dalles, Oregon. The attack caused about 751 people to get sick (no fatalities). This incident was the first known bioterrorist attack in the United States in the 20th century.
2001 anthrax attack
In September and October of 2001, several cases of anthrax broke out in the United States in the 2001 anthrax attacks, caused deliberately. This was a well-publicized act of bioterrorism. It motivated efforts to define biodefense and biosecurity, where more limited definitions of biosafety had focused on unintentional or accidental impacts of agricultural and medical technologies.
2003 ricin incidents
Planning for and reacting to a bioterrorist attack
Planning may involve the development of biological identification systems.
Until recently in the United States of America, most biological defense strategies have been geared to protecting soldiers on the battlefield rather than ordinary people in cities. Financial cutbacks have limited the tracking of disease outbreaks. Some outbreaks, such as food poisoning due to E. coli or Salmonella, could be of either natural or deliberate origin.
Biosurveillance strategies
In 1999, the University of Pittsburgh's Center for Biomedical Informatics deployed the first automated bioterrorism detection system, called RODS (Real-Time Outbreak Disease Surveillance). RODS is designed to draw collect data from many data sources and use them to perform signal detection, that is, to detect the a possible bioterrorism event at the earliest posible moment. RODS, an other systems like it, collect data from sources including clinic data, laboratory data, and data from over-the-counter drug sales. In 2000, Michael Wagner, the codirector of the RODS laboratory, and Ron Aryel, a subcontractor, conceived of the idea of obtaining live data feeds from "non-traditional" (non-health-care) data sources. The RODS laboratory's first efforts eventually led to the establishment of the National Retail Data Monitor, a system which collects data from 20,000 retail locations nation-wide.
On February 5, 2002, President Bush visited the RODS laboratory and used it as a model for a $300 million spending proposal to equip all 50 states with biosurveillance systems. In a speech delivered at the nearby Masonic temple, Bush compared the RODS system to a modern "DEW" line (referring to the Cold War ballistic missile early warning system).
The principles and practices of biosurveillance, a new interdisciplinary science, were defined and described in HANDBOOK OF BIOSURVEILLANCE, edited by Michael Wagner, Andrew Moore and Ron Aryel, and published in 2006 by Elsevier's Academic Press division. Biosurveillance is the science of real-time disease outbreak detection. Its principles apply to both natural and man-made epidemics (bioterrorism).
Data which potentially could assist in early detection of a bioterrorism event include many categories of information. Health-related data such as that from hospital computer systems, clinical laboratories, electronic health record systems, medical examiner record-keeping systems, 911 call center computers, and veterinary medical record systems could be of help; researchers are also considering the utility of data generated by ranching and feedlot operations, food processors, drinking water systems, school attendance recording, and physiologic monitors, among others. Intuitively, one would expect systems which collect more than one type of data to be more useful than systems which collect only one type of information (such as single-purpose laboratory or 911 call-center based systems), and be less prone to false alarms, and this appears to be the case.
In Europe, disease surveillance is beginning to be organized on the continent-wide scale needed to track a biological emergency. The system not only monitors infected persons, but attempts to discern the origin of the outbreak.
Researchers are experimenting with devices to detect the existence of a threat:
• tiny electronic chips that would contain living nerve cells to warn of the presence of bacterial toxins (identification of broad range toxins)
• fiber-optic tubes lined with antibodies coupled to light-emitting molecules (identification of specific pathogens, such as anthrax, botulinum, ricin)
Plants as sensors
Recently, publicly-funded research has been approved to create genetically modified plants as an easily producible early warning system. The plants would be modified to change color when in contact with a predetermined chemical or biological agent, and would be distributed in public places to provide a monitoring grid capable of detecting the spread of a contaminant.
Reaction to a bioterrorist attack includes:• setting up local emergency rooms and offices to immediately deal with the outcome in case of an attack
• performing mass decontamination on victims or potential victims (persons suspected of harboring contamination that they might knowingly or unknowingly spread to others)
• quarantine to prevent the spread of disease, or temporary quarantine for decontamination
• instruction and training for local communities
• protective clothing for military personnel
• locating persons buying biological warfare materials
Once the biological agent has been identified, it can be fought through vaccination of people before they are exposed. However, vaccines are not considered to be a perfect solution. A bioterrorist could develop novel, possibly artificial, pathogens against which conventional vaccines would be useless.
Consequently, some suggest that researchers should look for ways of developing vaccines quickly enough for them to be created, mass-produced and distributed after an attack. This would require significant progress in DNA sequencing so that an unknown pathogens' genes could be decoded quickly. The resulting sequences could help in the development of a DNA vaccine.
Another major issue with vaccines is that they sometimes have dangerous side-effects, and hence a massive inoculation program may result in deaths and illness which would be unnecessary if no biological attack occurs. This concern has been raised with modern anthrax vaccines. The 1976 swine flu scare highlights the dangers of the mass-vaccination approach.
Limitations of bioterrorism
Bioterrorism is inherently limited as a warfare tactic because of the uncontrollable nature of the agent involved. A biological weapon is useful to a terrorist group mainly as a method of creating mass panic and disruption to a society. However, technologists such as Bill Joy have warned of the potential power which genetic engineering might place in the hands of future bio-terrorists[1]; a bacterial agent might be engineered for genetic or geographical selectivity. Such a scenario formed the plot of the science fiction novel The White Plague.
Dr Abdul Aziz Awan
MPH Student 3rd semester
+92-333-5493357
Bioterrorism is terrorism by intentional release or dissemination of biological agents (bacteria, viruses or toxins); these may be in a naturally-occurring or in a human-modified form.
A bioterrorism attack is the deliberate release of viruses, bacteria, or other germs (Agents) used to cause illness or death in people, animals, or plants. These agents are typically found in nature, but it is possible that they could be changed to increase their ability to cause disease, make them resistant to current medicines, or to increase their ability to be spread into the environment. Biological agents can be spread through the air, through water, or in food. Terrorists may use biological agents because they can be extremely difficult to detect and do not cause illness for several hours to several days. Some bioterrorism agents, like the smallpox virus, can be spread from person to person and some, like anthrax, can not.
Types of biological agents
The CDC has defined and categorized bioterrorism agents according to priority [2] as follows:
Category A agents
These are biological agents with both a high potential for adverse public health impact and that also have a serious potential for large-scale dissemination. The Category A agents are anthrax, smallpox, plague, botulism, tularemia, and viral hemorrhagic fevers.
Anthrax
Anthrax is a bacterium with a highly resistant spore form. It is highly infectious and lethal when inhaled. It is a non-contagious disease which does not spread from one person to another. An anthrax vaccine does exist but requires many injections and has enough side effects that it is considered unsuitable for general use.
Smallpox
Smallpox is a highly contagious virus. It transmits easily through the atmosphere and has a high mortality rate (20-40%). Smallpox was eliminated in the world in the 1970s, thanks to a worldwide vaccination program. However, some virus samples are still available in Russian and American laboratories. Some believe that after the collapse of the Soviet Union, cultures of Smallpox have become available in other countries. Although people born pre-1970 will have been vaccinated for smallpox under the WHO program, the effectiveness of vaccination is limited since the vaccine provides high level of immunity for only 3 to 5 years. As a biological weapon smallpox is dangerous because of the highly contagious nature of both the infected and their pox. Smallpox occurs only in humans, and has no external hosts or vectors.
Botulinum toxin
Botulinum toxin is one of the deadliest toxins known, and is produced by the bacterium Clostridium botulinum. Botulism causes death by respiratory failure and paralysis.
Ebola
Ebola is a viral hemorrhagic fever, with fatality rates ranging from 50-90%. No cure currently exists, although vaccines are in development. The United States and the Soviet Union both investigated the use of Ebola for biological warfare, and the Aum Shinrikyo group possessed cultures of the virus. Ebola kills its victims through multiple organ failure and hypovolemic shock.
Plague
Plague is a disease caused by the Yersinia pestis bacterium. Rodents are the normal host of plague, and the disease is transmitted to humans by flea bites and occasionally by aerosol in the form of pneumonic plague. The disease has a history of use in biological warfare dating back many centuries, and is considered a threat due to its ease of culture and ability to remain in circulation among local rodents for a long period of time.
Marburg
Marburg is a viral hemorrhagic fever virus first discovered in Marburg, Germany. Fatality rates range from 25-100%, and although a vaccine is in development, no treatments currently exist aside from supportive care. As with Ebola, basic barrier nursing significantly reduces the virulence of the virus.
Tularemia
Tularemia, or rabbit fever, is a generally non-lethal and severely incapacitating disease caused by the Francisella tularensis bacterium. It has been widely produced for biological warfare due to its highly infective nature, and ease of aerosolization.
Category B agents
Category B agents are moderately easy to disseminate and have low mortality rates.
• Brucellosis (Brucella species)
• Epsilon toxin of Clostridium perfringens
• Food safety threats (e.g., Salmonella species, E coli O157:H7, Shigella)
• Glanders (Burkholderia mallei)
• Melioidosis (Burkholderia pseudomallei)
• Psittacosis (Chlamydia psittaci)
• Q fever (Coxiella burnetii)
• Ricin toxin from Ricinus communis (castor beans)
• Staphylococcal enterotoxin B
• Typhus (Rickettsia prowazekii)
• Viral encephalitis (alphaviruses, e.g.: Venezuelan equine encephalitis, eastern equine encephalitis, western equine encephalitis)
• Water supply threats (e.g., Vibrio cholerae, Cryptosporidium parvum)
Category C agents
Category C agents are pathogens that might be engineered for mass dissemination because they are easy to produce and have potential for high morbidity or mortality (examples: Nipah virus, hantavirus and multi-drug resistant Tuberculosis (MTB).
Modern bioterrorist incidents
1984 Rajneeshee Salmonella attack
In 1984, followers of the Bhagwan Shree Rajneesh attempted to control a local election by infecting salad bars in 10 restaurants with Salmonella typhimurium in the city of The Dalles, Oregon. The attack caused about 751 people to get sick (no fatalities). This incident was the first known bioterrorist attack in the United States in the 20th century.
2001 anthrax attack
In September and October of 2001, several cases of anthrax broke out in the United States in the 2001 anthrax attacks, caused deliberately. This was a well-publicized act of bioterrorism. It motivated efforts to define biodefense and biosecurity, where more limited definitions of biosafety had focused on unintentional or accidental impacts of agricultural and medical technologies.
2003 ricin incidents
Planning for and reacting to a bioterrorist attack
Planning may involve the development of biological identification systems.
Until recently in the United States of America, most biological defense strategies have been geared to protecting soldiers on the battlefield rather than ordinary people in cities. Financial cutbacks have limited the tracking of disease outbreaks. Some outbreaks, such as food poisoning due to E. coli or Salmonella, could be of either natural or deliberate origin.
Biosurveillance strategies
In 1999, the University of Pittsburgh's Center for Biomedical Informatics deployed the first automated bioterrorism detection system, called RODS (Real-Time Outbreak Disease Surveillance). RODS is designed to draw collect data from many data sources and use them to perform signal detection, that is, to detect the a possible bioterrorism event at the earliest posible moment. RODS, an other systems like it, collect data from sources including clinic data, laboratory data, and data from over-the-counter drug sales. In 2000, Michael Wagner, the codirector of the RODS laboratory, and Ron Aryel, a subcontractor, conceived of the idea of obtaining live data feeds from "non-traditional" (non-health-care) data sources. The RODS laboratory's first efforts eventually led to the establishment of the National Retail Data Monitor, a system which collects data from 20,000 retail locations nation-wide.
On February 5, 2002, President Bush visited the RODS laboratory and used it as a model for a $300 million spending proposal to equip all 50 states with biosurveillance systems. In a speech delivered at the nearby Masonic temple, Bush compared the RODS system to a modern "DEW" line (referring to the Cold War ballistic missile early warning system).
The principles and practices of biosurveillance, a new interdisciplinary science, were defined and described in HANDBOOK OF BIOSURVEILLANCE, edited by Michael Wagner, Andrew Moore and Ron Aryel, and published in 2006 by Elsevier's Academic Press division. Biosurveillance is the science of real-time disease outbreak detection. Its principles apply to both natural and man-made epidemics (bioterrorism).
Data which potentially could assist in early detection of a bioterrorism event include many categories of information. Health-related data such as that from hospital computer systems, clinical laboratories, electronic health record systems, medical examiner record-keeping systems, 911 call center computers, and veterinary medical record systems could be of help; researchers are also considering the utility of data generated by ranching and feedlot operations, food processors, drinking water systems, school attendance recording, and physiologic monitors, among others. Intuitively, one would expect systems which collect more than one type of data to be more useful than systems which collect only one type of information (such as single-purpose laboratory or 911 call-center based systems), and be less prone to false alarms, and this appears to be the case.
In Europe, disease surveillance is beginning to be organized on the continent-wide scale needed to track a biological emergency. The system not only monitors infected persons, but attempts to discern the origin of the outbreak.
Researchers are experimenting with devices to detect the existence of a threat:
• tiny electronic chips that would contain living nerve cells to warn of the presence of bacterial toxins (identification of broad range toxins)
• fiber-optic tubes lined with antibodies coupled to light-emitting molecules (identification of specific pathogens, such as anthrax, botulinum, ricin)
Plants as sensors
Recently, publicly-funded research has been approved to create genetically modified plants as an easily producible early warning system. The plants would be modified to change color when in contact with a predetermined chemical or biological agent, and would be distributed in public places to provide a monitoring grid capable of detecting the spread of a contaminant.
Reaction to a bioterrorist attack includes:• setting up local emergency rooms and offices to immediately deal with the outcome in case of an attack
• performing mass decontamination on victims or potential victims (persons suspected of harboring contamination that they might knowingly or unknowingly spread to others)
• quarantine to prevent the spread of disease, or temporary quarantine for decontamination
• instruction and training for local communities
• protective clothing for military personnel
• locating persons buying biological warfare materials
Once the biological agent has been identified, it can be fought through vaccination of people before they are exposed. However, vaccines are not considered to be a perfect solution. A bioterrorist could develop novel, possibly artificial, pathogens against which conventional vaccines would be useless.
Consequently, some suggest that researchers should look for ways of developing vaccines quickly enough for them to be created, mass-produced and distributed after an attack. This would require significant progress in DNA sequencing so that an unknown pathogens' genes could be decoded quickly. The resulting sequences could help in the development of a DNA vaccine.
Another major issue with vaccines is that they sometimes have dangerous side-effects, and hence a massive inoculation program may result in deaths and illness which would be unnecessary if no biological attack occurs. This concern has been raised with modern anthrax vaccines. The 1976 swine flu scare highlights the dangers of the mass-vaccination approach.
Limitations of bioterrorism
Bioterrorism is inherently limited as a warfare tactic because of the uncontrollable nature of the agent involved. A biological weapon is useful to a terrorist group mainly as a method of creating mass panic and disruption to a society. However, technologists such as Bill Joy have warned of the potential power which genetic engineering might place in the hands of future bio-terrorists[1]; a bacterial agent might be engineered for genetic or geographical selectivity. Such a scenario formed the plot of the science fiction novel The White Plague.
Dr Abdul Aziz Awan
MPH Student 3rd semester
+92-333-5493357
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