Transcript Principles of Industrial Hygiene

BIOLOGICAL TERRORISM
AND SECURITY
EMD545b
Lecture #9
Biological Terrorism
Intentional or threatened release of viruses,
bacteria, fungi or toxins derived from living
organisms to produce disease or death in humans,
animals, or plants
Outline
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Historical events
Potential agents of bioterrorism
Means of delivery
Monitoring and detection
Hazardous materials/emergency response
Security issues
Suspicious materials
Discussion and comments
Historical Events
6th Cent. BC: Rye ergot, plant toxins
1300’s:Plague-infected corpses catapulted into
defenders during Siege of Kaffa
1500’s:
Strategic value of smallpox-laden blankets
during Spanish conquest of Central and South
America
1700-1800’s: Smallpox-laden blankets repeatedly traded to
North American Indians
More Recent Events
WW II:
Japan’s Unit 731
1940’s-1969:
US offensive use research
1972:
Biological Weapons Convention Treaty
1978:
Assassination by KGB using ricin
1979-1982:
“Yellow-rain” by Soviet Army in Afghanistan
1979:
Accidental Soviet anthrax release at bioweapons
facility in Sverdlovsk - ca. 80 cases, 60+ deaths
Most Recent Events
1984:
Purposeful Salmonella contamination of
food by Oregon religious cult - 700+ cases
1995:
Sarin released in Tokyo subway religious cult
12 deaths, thousands exposed
1998:
Vengeful use of radiolabeled saxitoxin
stolen from Brown University laboratory
2001-2002:
Anthrax distribution in/on US Mail
1995 Tokyo Subway Sarin Release by Aum Shinrikyo
Why BioWeapons?
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Fear and hysteria
Overwhelm medical resources
Can be lethal or cause severe incapacitation
Delayed effects (but acute from toxins)
Relatively easy to obtain, produce, and use
Potential for secondary infections
Multiple routes for exposure
Compared to chemical and nuclear materials:
– Very difficult to detect in field
The Perfect BW
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Highly pathogenic/toxic
Highly infectious
Incapacitation may be preferable to lethality
Symptoms confused with non-BW diseases
Transmissible by desired route of exposure
Stable for packaging and delivery
Easily harvested, selected, or created
Vaccination/treatment only available to aggressor
Epidemiology of BW Attack
• Case chronology differences from natural epidemics
• Observations of signs/symptoms likely most
sensitive surveillance means
• Reportable symptoms and diseases
Time
Factors for Disease Transmission
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Presence of pathogenic organism
Viable
Infectious dose (minimum [ ] and qty)
Susceptible host
Effective route of exposure
Potential Agents of Bioterrorism
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Bacterial agents
Viral Agents
Biological/biologically-derived toxins
Recombinant organisms
Bacterial Agents
• Single cell microscopic organisms typically with
diameter 0.5 - 1.0 um
• Capable of causing disease by infection and/or
producing toxins
• Spore forms often very
stable in environment
Anthrax
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Bacillus anthracis (spore former)
Cutaneous, inhalational, and ingestion forms
Common among livestock and livestock product workers
Spore-form very stable
Flu-like illness, respiratory failure, shock, meningitis
Highest CFR from inhalation (90-100%)
Antibiotic treatment must
be early to be effective
• Vaccine available
Plague
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Yersinia pestis
Transmitted by flea bites or aerosol droplets
Wild rodents are natural reservoir
Bubonic and pneumonic forms (“black death”)
Swollen lymph nodes, rapid progressive pneumonia
High case fatality rates
Vaccine and antibiotic
therapies available
Tularemia
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Francisella tularensis (“rabbit fever”)
All routes of exposure, including vector
Low infectious dose
Fever, chills, headache, weight loss, pneumonia
Moderate case fatality rate untreated
Vaccine and antibiotic therapies
Brucellosis
• Brucella spp. (abortus, melitensis, ovix, others)
• Zoonotic, primarily from infected mammals and
contaminated milk/other dairy products
• Highly infectious by aerosolization
• Variable symptoms, but many “flu-like”
Viral Agents
• Very small particles (ca. 0.02 - 0.2 um diameter)
• Not truly “living”
• Outer shell and DNA or RNA, but no organelles for
metabolism or reproduction
• Rely exclusively upon host
cells - “parasites”
• Typically very short lived
outside of host or vector
Smallpox
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Variola major
Highly contagious by aerosols
Moderately high case fatality rate (~30%)
Incapacitating malaise, fever, vomiting, lesions and
pustules
• WHO initiative claims eradication (except for stored
specimens in US and Russia)
• Quarantine essential
• Vaccine available
Viral Equine Encephalites
• Venezuelan, Western, and Eastern
• Vector & aerosol transmission (vector primary in nature)
• Fever, headache, malaise, nausea/vomiting, neurological
damage from encephalitis
• Highly incapacitating, high lethality
(CFR for EEE 50 - 75%)
• Experimental vaccines
• Palliative care only
Viral Hemorrhagic Fevers
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e.g., Marburg, Ebola, Congo-Crimean
BL4 agents
Poorly understood, difficult to work with
Arthropod vectors, contact, possible aerosol routes
Natural epidemics with severe consequences - marked by
fever, malaise, headache, internal hemorrhaging, multiorgan failure
• Seriously incapacitating
• Very high CFRs: 25 - 90%
• Palliative care only
Biological Toxins
• Any toxic substance or compound produced by an
animal, plant, or microorganism
• Typically high MW proteins or toxic chemicals
• Hazardous by most routes of exposure - contact
facilitated by dermal penetrants like DMSO
• Range of effects from tissue necrosis to nervous
system interruption
• Most are readily inactivated by heat, steam, or
common chemicals
Comparative Toxicity
Agent
LD50 (ug/kg)
Source
Botulinum toxin
0.001
Bacterium
Tetanus toxin
0.002
Bacterium
Diptheria toxin
0.10
Bacterium
Ricin
3
Plant (Castor bean)
a-Conotoxin
5
Cone snail
Saxitoxin
10
Marine dinoflagellate
Sarin
100
Chemical/nerve agent
T-2 toxin
1,210
Fungal mycotoxin
Delivery and Release
• Acquisition/production in sufficient
quantity/concentration to achieve desired outcome
• Stability under storage conditions
• Packaging
• Actual delivery and release
• Exposure
Routes of Exposure
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Airborne - inhalational
Food/water supplies - ingestion
Contact - dermal
Vector - percutaneous
Sources of BW Agents
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Field, clinical, and veterinary samples
Type culture collections
Commercial distributors
Foreign laboratories and suppliers
Museums and universities
Genetically engineered (rDNA) or selected
Monitoring and Detection
• Comparison vs. chemical, explosive, and radioactive
• Medical signs and symptoms - healthcare providers
become first line of surveillance
• Laboratory analysis
– Antibody titers
– Cultures
– DNA fingerprinting
• Field tests
• Future/emerging methods (GC/MS, semi-conductors)
HAZWOPER
• OSHA standard (29 CFR Part 1910.120)
• “Hazardous waste operations and emergency
response”
• Comprehensive requirements for written safety
programs, training, protective equipment, field
exercises, medical surveillance, and at least annual
re-certifications
HAZWOPER/
Emergency Response
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First responders
Incident commander and IC system
Site/scene health and safety officer
Technician-level responders
Potential crime scene investigation issues
Other specialists as-needed
HAZWOPER/
Emergency Response
• All-hazards approach
– Biological, chemical, and radiological
• Site/perimeter controls
• Work zones
• Decontamination systems
Knowledge and Information
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Incident/facility information
Eyewitnesses critical
On-going process
Monitoring and predictions where possible
Weather and local environmental factors
HAZMAT Ensemble Levels
Low
D
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High
Safety shoes and glasses/goggles, work gloves,
and work clothing
Above plus more enclosing garments, and air
purifying respirator
Above plus even more enclosing garments, and
upgrading of respiratory protection to selfcontained breathing apparatus (SCBA)
Fully encapsulating garments, SCBA
HAZMAT Ensembles
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Key Selection Factors for
Protective Clothing
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Contaminants and concentration
Consequences of equipment failure
Permeation/penetration resistance
Anticipated duration of use
Exposure type (e.g., incidental contact, immersion)
Anticipated work activities (e.g., dexterity, tactility)
Cost, size, availability, manufacturer’s
differences
Personal Protective Equipment
• Low on controls hierarchy
• Advantages
• Disadvantages
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No one ensemble
Selection criteria
Training
Formal “fitting” process
Maintenance and inspection
Periodic review
Medical Interventions
• e.g., pre-exposure immunizations, blocker
administration, and immediate post-exposure
treatment
• Excellent protection but for only very limited
suite of exposures
• Duration of protection highly variable
• Potential contraindications of treatment
• Timing of administration critical
Biosecurity Issues
• “Select Agents” transfer rule
• Revisions now include “possession”
• Basic requirements:
– Registration of entity and individuals possessing, using,
storing, etc. “select” biological agents and toxins
– Inventory controls
– Physical security of storage and use
– Periodic inspections
– Emergency procedures and notifications
– Individual background/security clearances
Related Security Issues
• Building perimeter controls and access
• Public vs. non-public areas
• Mechanical equipment and HVAC intakes
– Collateral benefits of modern filtered HVAC systems
• Identify and report strangers/suspicious persons
Suspicious Materials
• Mail, packages, objects
• Return address, condition, and appearance (leaking,
discoloration, odor, etc)
• Expected or unexpected? Verify source if possible.
• Follow recommended procedures.
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Sources for More Information
• US Government:
Occupational Safety and Health Administration
Nuclear Regulatory Commission
National Institute for Occupational Safety and Health
Centers for Disease Control and Prevention
Federal Emergency Management Agency
Federal Bureau of Investigation/Department of Justice
• Advisory Groups:
American Biological Safety Association
American Industrial Hygiene Association
American and International Red Cross
Discussion and Comments