Introduction
Definition:
Bioterrorism refers to the intentional release of viruses, bacteria, or their by-products (e.g., toxins) to cause illness or death in humans, animals, or plants.
Characteristics of Bioterrorism Agents:
These agents are naturally occurring organisms or toxins.
They can cause sporadic diseases under natural conditions.
In some cases, medical manipulation is attempted to:
Enhance resistance to antibiotics.
Increase the virulence of the organism.
Reasons for its Use as a Weapon:
Biological agents are relatively easy and cost-effective to acquire.
They are simple to distribute or disseminate.
They can instill widespread fear and panic, surpassing the extent of actual physical harm.
Key Features of Biologic Agents Used as Bioweapons
High Morbidity and Mortality: Capable of causing severe illness and a high death rate.
Person-to-Person Spread: Can easily transmit between individuals, increasing the outbreak's scale.
Low Infective Dose and High Infectivity via Aerosols: Only a small amount is needed to infect, and it spreads effectively through the air.
Lack of Rapid Diagnostic Tools: Difficulty in quickly identifying the pathogen leads to delayed response.
Absence of Universal Vaccines: No widely available or effective vaccine to protect the population.
Potential to Cause Anxiety: Can induce fear and panic among the public and authorities.
Pathogen Availability and Easy Production: Pathogens are accessible, and their production is feasible with technology.
Environmental Stability: Can survive in various environmental conditions, enhancing their spread.
Established Research Background: Data and studies from prior research aid in their potential use.
Ability to Be Weaponized: Can be modified or adapted for use in biological warfare.
Advantage to biological agent use?
Inexpensive and relatively easy to use.
Cost: (1970 study: Cost of 50% casualties over a one sq/km area)
Conventional Weapons : 2000
Nuclear : 800
Chemical : 600
Anthrax : 1
History
400 BC: Scythian archers used arrows dipped in blood and manure.
300 BC: Persian, Greek and Roman literature provide examples of using animal cadavers to contaminate water supplies.
190 BC : Hannibal hurled venomous snakes onto enemy ships of Kings Eunenes.
1155: Battle of Tortona - Barbarossa put dead bodies in enemy water supplies
1346- Siege of Caffa - Mongols catapulted bodies of plague victims over the city walls
1718 - Reval, Estonia - Russians tried the same tactic against Sweden.
1763-French & Indian War - During the Pontiac Rebellion in New England, British forces gave smallpox inoculated blankets to Native Americans
1915-18-World War I - German BW Program:
Developed anthrax, glanders, cholera, and wheat fungus as weapons.
1932-1945-World War II - Japanese BW Program:
Operated a secret facility (Unf31) testing BW agents on Chinese prisoners.
2001
Anthrax-related incidents occurred in the United States, with 11 cutaneous and 11 inhalational cases, five of which were fatal. The anthrax spores were mailed through the United States Postal Service to several government employees and news media outlets.
2014
A military peacekeeper from Nigeria was diagnosed with Ebola and transferred to the Netherlands. The patient was treated at the Major Incident Hospital of the University Medical Centre of Utrecht and fully recovered.
2020 Ricin, a poison found in castor beans, was mailed to the President of the United States and five residents of Texas. Ricin can cause death within 36 to 72 hours, and there is no known antidote,
Summary of the First-Kennedy “Bioterrorism Preparedness Act of 2001”
The “Bioterrorism Preparedness Act” emphasizes the need for the United States to develop and execute a coordinated strategy to prevent or respond to biological threats or attacks. Key goals outlined by Congress include:
Federal Assistance
Provide support to state and local governments during biological attacks.
Improvement of Preparedness
Strengthen public health systems, hospitals, laboratories, communication networks, and emergency response capabilities at state and local levels.
Rapid Development of Medical Resources
Accelerate the production of therapies, vaccines, and medical supplies needed for response.
Food and Agriculture Safety
Protect the nation's food supply and agriculture from biological threats and attacks.
Indian Scenario: Addressing Terrorism through UAPA
Legislation Against Terrorism
The Unlawful Activities (Prevention) Act, 1967 (UAPA) is a comprehensive law to counter terrorism in all forms.
Use of Biological Substances as Terrorism
As per Section 15(a) of UAPA, employing biological substances for terrorist activities is classified as a ‘terrorist act’, carrying strict punishment.
Authority to Enforce
Both Central and State law enforcement agencies are authorized to take action under the provisions of this Act.
Classification of Biologic Threats by CDC
The Centers for Disease Control and Prevention (CDC) classifies biologic threats into three categories: A, B, and C.
Category A Agents
Highest-priority pathogens with the following characteristics:
Easily disseminated or transmitted between individuals.
Cause high mortality rates.
Can significantly impact public health systems.
Likely to induce public panic and disrupt society.
Demand special measures for public health preparedness.
Examples of Category A Agents
Anthrax (Bacillus anthracis)
Botulism (Clostridium botulinum toxin)
Plague (Yersinia pestis)
Smallpox (Variola major)
Tularemia (Francisella tularensis)
Viral Hemorrhagic Fevers (VHFs):
Arenaviruses: Lassa, New World (Machupo, Junin, Guanarito, Sabia)
Bunyaviridae: Crimean-Congo, Rift Valley
Filoviridae: Ebola, Marburg
Flaviviridae: Yellow fever, Omsk fever, Kyasanur Forest disease
Category B Agents
These agents are classified as second-priority pathogens by the CDC and have the following characteristics:
Moderate Dissemination: Fairly easy to spread.
Moderate Morbidity: Cause moderate illness rates.
Low Mortality: Associated with a low death rate.
Special Diagnostic Needs: Require improved diagnostic tools for effective detection.
Examples of Category B Agents
Pulmonary Agents (Affecting the respiratory system):
Glanders (Burkholderia mallei)
Melioidosis (Burkholderia pseudomallei)
Psittacosis (Chlamydophila psittaci)
Q Fever (Coxiella burnetii)
Ricin Toxin (Derived from Ricinus communis, or castor beans)
Non-Pulmonary Agents:
Brucellosis (Brucella species)
Epsilon Toxin (Produced by Clostridium perfringens)
Food Safety Threats:
Salmonella species
Escherichia coli O157:H7
Shigella species
Staphylococcal Enterotoxin B
Category C Agents
These are third-priority agents with the following key features:
Future Engineering Potential: Can be modified for easier dissemination.
High Mortality Risk: Potential to cause severe disease outbreaks.
Examples of Category C Agents
Influenza (Novel strains)
Nipah Virus
Typhus Disease (Rickettsia prowazekii)
Viral Encephalitis (Alphaviruses):
Venezuelan Equine Encephalitis
Eastern Equine Encephalitis
Western Equine Encephalitis
Water Safety Threats:
Vibrio cholerae (Cholera)
Cryptosporidium parvum
Anthrax
Overview
Cause:
Caused by Bacillus anthracis, a gram-positive, spore-forming rod.
Transmission:
Occurs primarily through contact with animal products (e.g., animal skins) where spores are present.
Historical Context
In 2001, anthrax was used as a bioterrorism agent in the United States, leading to 22 cases via the postal system.
Disease Mechanism
Entry of Spores:
Spores enter through skin (subcutaneous) or inhalation.
Spore Activation:
Spores convert to the vegetative form, replicate, and secrete toxins.
Key Features:
Thick capsule prevents phagocytosis.
Toxins (edema factor and lethal factor) cause:
Local spread
Edema (swelling)
Hemorrhage
Tissue necrosis
Diagnosis
Culture samples from:
Blood
Sputum
Pleural fluid
Cerebrospinal fluid (CSF)
Skin
Treatment
Ciprofloxacin
Doxycycline
Smallpox
Overview
Causative Agent: Variola virus, belonging to the Poxviridae family.
Eradication:
Declared eradicated globally in 1977.
Now considered a potential bioterrorism agent.
Bioterrorism Concerns
Category A Agent: Classified by the CDC due to:
Increasing number of unvaccinated individuals.
High contagiousness.
Transmission via aerosols.
Virus Stockpiles:
Stored at CDC (USA) and Russian State Research Center for research purposes.
Diagnosis
Primarily clinical.
RT-PCR testing is available only at the CDC.
Treatment
Supportive Care: Focuses on symptom management.
Cidofovir: Shows some effectiveness in animal models.
Plague
Overview
Causative Agent: Yersinia pestis, responsible for several pandemics in human history.
Transmission
Rodent-Infected Flea Bites: Primary mode of transmission.
Infected Animal Contact: Scratches or bites from infected animals.
Human Exposure: Spread from infected individuals.
Bioterrorism: Potential use as a biological weapon.
Diagnosis
Clinical Diagnosis:
Often challenging due to non-specific symptoms.
Laboratory Diagnosis:
Culture: Yersinia pestis can be cultured from sputum or blood using standard laboratory media.
Additional Diagnostic Methods:
Serology: Detects antibodies.
Rapid Testing:
ELISA (Enzyme-Linked Immunosorbent Assay).
PCR (Polymerase Chain Reaction), mostly for field applications.
Treatment
First-Line Drug:
Streptomycin.
Alternative Drugs:
Gentamycin.
Doxycycline
Role of Physicians in Bioterrorism Detection
High Level of Suspicion:
Physicians must distinguish between a bioterrorism event and naturally occurring infections.
Early recognition is crucial, though challenging due to non-specific initial symptoms.
Systematic Evaluation:
Use a structured approach for all febrile respiratory illnesses.
Remain vigilant for unusual clinical findings or patterns.
Contacting Public Health Authorities:
Notify public health agencies when:
Specific clinical signs suggest a potential bioterrorism event.
Epidemiological features point to an emerging infectious disease.
Role of the Public Health System in Bioterrorism
Being Prepared
Educating Key Stakeholders:
Provide training for the medical community and public.
Prepare special response teams with hands-on training for various scenarios.
Participation in Simulations:
Conduct exercises to test preparedness for different bioterrorism scenarios.
Development of Communication Systems:
Create robust communication channels.
Establish interagency protocols for effective collaboration.
Initial Response to Bioterrorism-Induced Disease
Early Detection and Surveillance:
Rapidly assess and detect potential threats through surveillance systems.
Laboratory Mobilization:
Confirm the agent, its source, and identify the initial at-risk population.
Alert Medical Infrastructure:
Notify medical professionals, emergency rooms, and laboratories.
Disease-Specific Plans:
Implement tailored plans (e.g., for smallpox).
Coordinated Actions
Resource Management:
Assess resource needs and consider quarantine measures if necessary.
Collaboration:
Work with local, state, and national agencies for a unified response.
Communication:
Monitor networks for updates and provide accurate, timely information to the public.
Continued Efforts
Epidemiologic Investigation:
Refine the identification of at-risk populations through ongoing research.
Environmental Assessment:
Evaluate contamination levels and take corrective measures.
Treatment and Prophylaxis:
Ensure access to biological stockpiles for affected populations.
Provide or coordinate diagnostic testing, treatments, and preventive measures.