Biological Terrorism: Anthrax

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Biological Terrorism: Anthrax

  1. 1. On September 18, 2001, one week following the destruction of the twin towers by terrorists, another terrorist used the U.S. Postal Service to deliver mail containing anthrax spores that ultimately killed five people, infected seventeen people, and exposed thousands of others to this deadly bacteria. While only a few people were killed compared to the destruction of the twin towers, the anthrax scare reached across America affecting every citizen.
  2. 2. The contamination spread throughout the postal system to office buildings and residences of intended targets. The potential existed for cross contamination from a few pieces of contaminated mail to anyone, anywhere in the United States. Most of us knew little about anthrax then, and most of us know little about anthrax now. Do you know how anthrax is spread? Do you understand the seriousness of anthrax infection, that it has a high death rate? Would you recognize possible anthrax spores? Would you know how to report suspected anthrax?
  3. 3. Do you know how anthrax is spread? Do you understand the seriousness of anthrax infection, that it has a high death rate? Would you recognize possible anthrax spores? Do you know how to report suspected anthrax?
  4. 4.  Throughout our history, anthrax has been described as a plague that has killed our livestock and diminished our population.  While descriptions are sometimes vague, fitting anthrax, bubonic plague, and other diseases, anthrax fits the description of the Biblical 5th and 6th plagues. Picture Source: Microsoft ClipartCNN. (2001). Timeline: Anthrax through the ages. Retrieved October 2, 2010, from: http://edition.cnn.com/2001/HEALTH/conditions/10/16/anthrax.timeline/
  5. 5.  Exodus 9:1-7 describes the fifth Egyptian plague which occurred approximately 1500 B.C.  This plague affected livestock, camels, horses, donkeys, sheep, and goats and was most likely anthrax (1.1).  The sixth plague, known as the plague of boils, also describes anthrax. Picture Source Microsoft Clipart.CNN. (2001). Timeline: Anthrax through the ages. Retrieved October 2, 2010, from: http://edition.cnn.com/2001/HEALTH/conditions/10/16/anthrax.timeline/
  6. 6.  If you believe that 2001 was the first attempt at using anthrax as a biological weapon against the United States, you would be wrong.  In 1915, during World War I, German agents injected horses, mules, and cattle with anthrax on their return to Europe (1.2). CNN. (2001). Timeline: Anthrax through the ages. Retrieved October 2, 2010, from: http://edition.cnn.com/2001/HEALTH/conditions/10/16/anthrax.timeline/
  7. 7.  In 1937, the Japanese began biological weapons testing in Manchuria that included the use of anthrax (1.3).  The United States acquired a lot of biological weapons information from the Japanese at the end of World War II. However, Japan was not the only nation experimenting with anthrax as a biological weapon.  Great Britain experimented with anthrax on Gruinard Island off the coast of Scotland in 1942 (1.4). (Gruinard Island was only recently decontaminated.)  In 1945 Iraq, approximately one million sheep were killed by anthrax (1.4). Gruinard Island Picture Source: http://en.wikipedia.org/wiki/File:Gruinard_Island.jpgCNN. (2001). Timeline: Anthrax through the ages. Retrieved October 2, 2010, from: http://edition.cnn.com/2001/HEALTH/conditions/10/16/anthrax.timeline/
  8. 8.  With information gathered from the Japanese and our allies, the United States worked on our own biological warfare program at Fort Detrick, Maryland during the 1950s and 1960s (1.5) .  However, in 1969 President Richard Nixon put an end to our offensive biological weapons program allowing only defensive work to continue (1.6). Picture Source: http://en.wikipedia.org/wiki/File:Leonid_Brezhnev_and_Richard_Nixon_talks_in_1973.png CNN. (2001). Timeline: Anthrax through the ages. Retrieved October 2, 2010, from: http://edition.cnn.com/2001/HEALTH/conditions/10/16/anthrax.timeline/
  9. 9.  In 1970, the Food and Drug administration approved a vaccine for anthrax that was primarily in tended for those working with livestock that might be at risk (1.7).  In 1972, an international convention outlawed stockpiling of biological weapons (1.7).  From 1978-1980, an anthrax epidemic occurred in Zimbabwe that infected over 6,000 people, killing well over 100 (1.7).  In 1979, the Soviet Union accidentally released aerosolized anthrax that spread from a military facility into a neighboring community killing 68 people (1.7). CNN. (2001). Timeline: Anthrax through the ages. Retrieved October 2, 2010, from: http://edition.cnn.com/2001/HEALTH/conditions/10/16/anthrax.timeline/
  10. 10.  While the 1980s were quiet regarding anthrax, it re- emerged during the 1990s. In 1991, our troops were vaccinated against anthrax in preparation for the Gulf War (1.8).  In 1993, the terrorist group, Aum Shinrikyo, released anthrax in Tokyo, but no one was reportedly infected (1.8).  In 1995, Iraq admitted to producing 8,500 liters of anthrax as part of its biological weapons program. In 1998, the Secretary of Defense approved a plan for all military service members to be immunized against anthrax (1.8). CNN. (2001). Timeline: Anthrax through the ages. Retrieved October 2, 2010, from: http://edition.cnn.com/2001/HEALTH/conditions/10/16/anthrax.timeline/
  11. 11. In September 2001, letters containing anthrax spores were mailed several news media offices and two Senators. The FBI case investigating this incident became known as Amerithrax (1.9). Picture Source: Microsoft ClipartCNN. (2001). Timeline: Anthrax through the ages. Retrieved October 2, 2010, from: http://edition.cnn.com/2001/HEALTH/conditions/10/16/anthrax.timeline/
  12. 12. Anthrax occurs worldwide primarily in herbivores such as sheep, goats, horses, and cattle. Humans who come in contact with infected animals may become infected. The most common entry route for anthrax is through the skin with gastrointestinal and inhalation anthrax being much less common. Reference: Friedlander, A.M. (1997). Medical aspects of chemical and biological warfare. U.S. Army. Retrieved October 2, 2010 from http://www.bordeninstitute.army.mil/published_volumes/chemBio/Ch22.pdf Picture Source: Microsoft Clipart
  13. 13.  However, inhalation anthrax occurred for the first time from people working with wool and goat hair who caused aerosols of the spores that were subsequently inhaled.  This occurred during the later part of the 19th century which probably makes anthrax the first occupational respiratory illness.  The infectiousness of anthrax spores combined with its high mortality rate, especially when inhaled, makes it ideal for use as a biological weapon. Picture Source: Microsoft ClipartReference: Friedlander, A.M. (1997). Medical aspects of chemical and biological warfare. U.S. Army. Retrieved October 2, 2010 from http://www.bordeninstitute.army.mil/published_volumes/chemBio/Ch22.pdf
  14. 14.  Bacteria, fungi, algae, and viruses are micro- organisms that most of us are familiar with. Bacteria are usually round, spiral, or rod shaped single- celled micro-organisms that may be gram positive or gram negative.  Bacteria typically live in soil, water, organic matter, plants, and animals (2.1). Reference: Meriam-Webster.com. (2010). Bacterium. Retrieved November 2, 2010, from http://www.merriam-webster.com/dictionary/bacterium Picture Source: Microsoft Clipart
  15. 15.  Anthrax is a bacteria that is a non-motile, spore forming rod (2.2) (CDC, Slide 3, 2001.)  Spores are reproductive structures. They are similar to seeds, but lack the stored food of seeds (2.3). Spores can survive very harsh conditions. (Stephens, slide 22, 2001.)  When conditions are favorable, spores develop into new organisms. These spores can be spread from animals to humans. Physical contact, ingestion, and inhalation of spores results in infection (Stephens, slide 22, 2001.) Picture Source: Stephens, D.S. (2001). Clinical Anthrax. CDC. Retrieved October 2, 2010, from http://www.bt.cdc.gov/documentsapp/Anthrax/Clinical/ClinicalAnthrax.pdf References: CDC. (2001). Bacillus anthracis. CDC. Retrieved October 2, 2010, from http://www.bt.cdc.gov/agent/anthrax/SlideSetAnthrax.pdf Stephens, D.S. (2001). Clinical Anthrax. CDC. Retrieved October 2, 2010, from http://www.bt.cdc.gov/documentsapp/Anthrax/Clinical/ClinicalAnthrax.pdf
  16. 16. Anthrax is spread by contact with spores, not person to person. There are three clinical forms or manifestations of anthrax. They are:  cutaneous,  intestinal,  and inhalation. Reference: Friedlander, A.M. (1997). Medical aspects of chemical and biological warfare. U.S. Army. Retrieved October 2, 2010 from http://www.bordeninstitute.army.mil/published_volumes/chemBio/Ch22.pdf
  17. 17. Cutaneous anthrax is the most common, naturally occurring form of anthrax.  Cutaneous anthrax begins with spores entering the skin through an opening such as a scrape or cut.  It first appears as a papule that progresses through a vesicular stage before becoming a depressed black necrotic ulcer called an eschar.  Cutaneous anthrax is the most common naturally occurring form of the disease.  The incubation period for cutaneous anthrax is 1-5 days (3.1) Eschar, Day 10. (Stephens, slide 9, 2001.) Reference: Friedlander, A.M. (1997). Medical aspects of chemical and biological warfare. U.S. Army. Retrieved October 2, 2010 from http://www.bordeninstitute.army.mil/published_volumes/chemBio/Ch22.pdf Picture Source: Stephens, D.S. (2001). Clinical Anthrax. CDC. Retrieved October 2, 2010, from http://www.bt.cdc.gov/documentsapp/Anthrax/Clinical/ClinicalAnthrax.pdf
  18. 18. Intestinal anthrax begins with spores entering the digestive system when grazing animals ingest spores on contaminated land or when eating contaminated feed.  Likewise, humans acquire intestinal anthrax by ingesting contaminated food.  Gastrointestinal anthrax begins with nausea, vomiting, and fever.  Severe abdominal follows along with the possibility of vomiting with blood and a buildup of fluid in the abdominal cavity.  The incubation period for gastrointestinal anthrax is 2-5 days (3.2). Reference: Friedlander, A.M. (1997). Medical aspects of chemical and biological warfare. U.S. Army. Retrieved October 2, 2010 from http://www.bordeninstitute.army.mil/published_volumes/chemBio/Ch22.pdf
  19. 19. Inhalational anthrax begins with spores entering the lungs from breathing in anthrax spores.  At first inhalation anthrax develops non-specific symptoms that include malaise, fatigue, muscle aches, and fever.  There might also be a nonproductive cough with chest discomfort. These symptoms last 2-3 days.  A slight period of improvement may follow. This is followed by a sudden onset of respiratory distress with labored breathing, stridor (a shrill noise), bluing of the skin, increased chest pain, and severe sweating.  The chest and neck area may also become swollen.  The incubation period for inhalation anthrax is 1-6 days (3.3). Reference: Friedlander, A.M. (1997). Medical aspects of chemical and biological warfare. U.S. Army. Retrieved October 2, 2010 from http://www.bordeninstitute.army.mil/published_volumes/chemBio/Ch22.pdf Anthrax Chest X-ray. (Stephens, slide 17, 2001.) Picture Source: Stephens, D.S. (2001). Clinical Anthrax. CDC. Retrieved October 2, 2010, from http://www.bt.cdc.gov/documentsapp/Anthrax/Clinical/ClinicalAnthrax.pdf
  20. 20. Each of these forms of anthrax has a different mortality rate.  The mortality rate for cutaneous anthrax is 20% when untreated and 1% when treated with antibiotics (3.4).  The mortality rate for gastrointestinal anthrax is 25-60% with an unknown role for antibiotics (3.5).  The mortality rate for inhalation anthrax is about 97% when untreated and about 75% when treated with antibiotics (3.6). Antibiotic treatment immediately after exposure, before any symptoms appear, greatly improves chances of survival! Reference: CDC. (2001). Bacillus anthracis. CDC. Retrieved October 2, 2010, from http://www.bt.cdc.gov/agent/anthrax/SlideSetAnthrax.pdf
  21. 21. Modern research for developing anthrax as a biological weapon began over 80 years ago. This research seeks to genetically enhance anthrax and to weaponize it. Genetic enhancements to anthrax make it more resistant to antibiotics and vaccines, easier to handle, and deadlier (4.1). Reference: Inglesby, T.V. (2002.) Anthrax as a Biological Weapon, 2002. JAMA. 2002;287:2236-2252. Retrieved November 12, 2010 from http://jama.ama-assn.org/cgi/content/full/287/17/2236
  22. 22. Weaponization of anthrax makes it easier to deliver through the air.  This process starts with drying the spores, then proceeds to milling the spores, then neutralizing the spores so they will float in the air.  Unaltered weaponized anthrax appears as a grayish-white powder (4.2) Picture Source: Microsoft Clipart.Reference: Park, A.(2001.) How anthrax is weaponized. Time. Retrieved November 12, 2010 from http://www.time.com/time/magazine/article/0,9171,1001161,00.html#ixzz1578Sp0ZK
  23. 23.  Once anthrax has been weaponized, it can be delivered by a variety of means.  Aerosolized delivery of anthrax could be made by a bomb, crop duster, fire extinguisher, or heating and ventilation system of a building (4.3) Picture Source: Microsoft Clipart
  24. 24.  Other methods of delivery systems include mail and consumable goods (4.4).  Anthrax spores can even be implanted in cigarettes and given to unsuspecting Sailors in foreign ports as an apparent gesture of goodwill (4.4) Picture Source: Microsoft Clipart
  25. 25. If you suspect anthrax, CALL 9-1-1 immediately.  Key elements for reporting suspected anthrax includes:  identifying yourself,  your location,  where the suspected anthrax is located,  a description of the suspected anthrax, and if you and others have been exposed (5.1) Reference: http://en.wikipedia.org/wiki/IPad
  26. 26. The first responder on the scene (law enforcement officer, fireman, or emergency medical technician) will take charge of the scene as the Incident Command until relieved by other competent authority. You and others may require decontamination prior to receiving treatment or being transported to a hospital. Decisions like this will be the responsibility of the Incident Commander. As additional resources arrive, the first responder might be relieved by others as the Incident Command System expands to accommodate the size of the emergency. The Incident Command System is a flexible tool for command, control, and coordination of emergency services (5.2).
  27. 27. If the substance is identified as anthrax, the Homeland Security Advisory System will likely change. Each level requires specific actions by the government. The five color-coded levels are identified by the chart on the right (5.3). Picture Source: Wikipedia. Downloaded on October 23, 2010 from: http://en.wikipedia.org/wiki/File:Hsas-chart_with_header.svg Reference: Wikipedia. Downloaded on October 23, 2010 from: http://en.wikipedia.org/wiki/Homeland_Security_Advisory_System
  28. 28. Follow the instructions of the Incident Commander at the scene, and watch for additional instructions by our government after any incident or change in the Homeland Security Advisory System.

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