This document summarizes a presentation on bioterrorism. It begins with defining bioterrorism as the intentional release of pathogens to harm people, livestock or crops. It then provides a brief history of bioterrorism from ancient times to modern examples. It classifies biological agents into categories A, B and C based on their ability to cause harm. It discusses the challenges of bioterrorism for public health and strategies for preparedness, including surveillance, communication and stockpiling medical resources.

1. BIOTERRORISM
Presenter: Dr. Kumar Mrigesh
Facilitator: Dr. Ekta Gupta
Moderator: Dr. J.G. Prasuna

2. Plan of presentation
• Definition
• History of bioterrorism
• Features of bioweapons
• Classification of bio-warfare agents
• BT and public health
• Challenges
• Anti BT preparedness.
• References

3. Definition
• Intentional release of viruses, bacteria, fungi, or other
germs that can sicken or kill people, livestock or
crops.
Centers for Disease Control and Prevention (CDC)

4. HISTORY
Ancient:
• 184 BC: in a naval battle between Hannibal and king
Eumenes II of Pergomon, former hurled earthen pots
filled with poisonous snake.
•6th
century BC:
– the poisoning of water supplies in the with the
fungus Calviceps purpurea (rye ergot) by the
Assyrians.
– Siege of Krissa: Solon, poisoned water supply with
hellebore.

5. Medieval age:
• 1346 AD: Siege of Kaffa- hurling of the dead bodies
of plague victims over the walls of the city of Kaffa
by the Tartar army.
• 1422 AD: The battle of Karlstein- catapulted plague
stricken soldiers and 2000 cartloads of excreta.
• 15th
century: Pizzarro gifted the native Americans
clothing infested with smallpox virus.
• 1760: Sir Jeffery Amherst distributed smallpox
infested blankets and handkerchief to native Indians
during France and India war.
Microsoft
PowerPoint 97-2003 Slide Show

6. Modern age
• 1924 AD: Germany weaponised anthrax and
Pseudomonas mallei (glanders), and used them on
cattles, horses etc.
• 1932 AD: Japanese invaded Manchuria under Shiro
Ishii. Established a lab there by the name of “Unit-
731” where they tested for the lethality of
bioweapons on Chinese prisoners for war.
• They also dropped plague infested fleas over China
leading to several deaths.

7. • 1979: The accidental release of spores into the
atmosphere from a Soviet Union bioweapons
facility in Sverdlosk
• 1993 AD: The release of anthrax spores by the
Aum Shrinrikyo cult in Tokyo in 1993.

8. Key Features of Biologic Agents Used as
Bioweapons
• Highly infectious.
• Aerosolized
• Readily grown and produced
• Stable on storage
• Resistant to climate change.
• Resistant to conventional antibiotics and treatment.

9. Category A agents: “high mortality”
Bacterial agents
•Anthrax (Bacillus anthracis)
•Plague (Yersinia pestis)
•Tularemia (Francisella tularensis)
Viral agents
•Variola (smallpox)
•Arenaviruses: Lassa, New World (Machupo, Junin,
Guanarito, and Sabia)
•Bunyaviridae: Crimean Congo, Rift Valley
•Filoviridae: Ebola, Marburg
•Flaviviridae: Yellow fever; Omsk fever; Kyasanur
Forest
Toxins Botulism (Clostridium botulinum toxin)
PPT File
PPT File
PPT File
PPT File

10. Category B agents: “require enhanced
diagnostic capacity”
Bacterial agents
•Brucellosis (Brucella spp.)
•Food safety threats:
– Salmonella sp.
– Escherichia coli 0157:H7
– Shigella sp.
•Water safety threats
– Vibrio cholerae
•Glanders (Burkholderia mallei)
•Melioidosis (B. pseudomallei)
•Psittacosis (Chlamydia psittaci)
•Q fever (Coxiella burnetii)

11. Viral agents
•Viral encephalitis
– alphaviruses (e.g., Venezuelan, eastern, and
western equine encephalitis)
Toxins
•Ricin toxin from Ricinus communis (castor beans)
•Staphylococcal enterotoxin B
Category C agents
•Peolple lacks immunity.
•Could be genetically engineered for mass destruction
•SARS, Nipah and hanta virus.

12. Bioterrorism and public health
• Early detection through surveillance/ rapid
assessment of reports
• Mobilize laboratory
• Rapid confirmation of agent, site, initial at-risk
population, prophylaxis and/or treatment
• Alert medical community, ER team, labs
• Implement disease specific plans (e.g. Smallpox)
• Determine resource needs and possible quarantine
• Coordinate with partner agencies
(local/state/national/international)

13. Continued…..
• Closely monitor communication network for new
information
• Provide, accurate, timely information to public
• Continue epidemiologic investigation to refine at risk
population
• Assess environmental contamination
• Provide or coordinate testing/ prophylaxis/ treatment
to at-risk population
• Access biological stockpiles as necessary

14. Global Outbreak Alert and Response
Network :GOARN
• Head quarter: Geneva
• There are 200 technical institution worldwide that
respond to acute public health events.
• Objectives:
1. Provides international public health resources to
control outbreak and public health emergencies.
2. Networking international resources to save lives.
3. Connecting health resources for better health outcome.

15. GOARN: Recent activities
• Outbreak (2 pregnant and 1 elderly) of zika virus
were reported between february 2016 to january 2017
in Bapunagar Ahmedabad, Gujarat. WHO confirmed
it on may 15th
2017.
• WHO dispersed 3.5 million doses of yellow fever
vaccine in response to a outbreak in Brazil. (10th
april
2017)
• Uptil 10th
march 2017 national health and family
planning commission of China (NHHPC) notified
1307 cases of avian influenza (H7N9).

16. Challenges
• Large geographical area/mobile population
Real-time reporting & mapping applications
 communication strategy focusing on effective use of
news media
• Early signs/symptoms nonspecific
 Provider education through multiple means

17. • Medical and laboratory communities not
familiar with rare BT diseases
establish syndromic surveillance
provide training to increase awareness
enhance collaboration between medical
community and Public Health

18. Anti BT preparedness
1. Community level:
a)Co-ordination between firearm and policemen.
b)Schools, temples etc can be used as a relief
point.
c)Public support: dispensing drugs, mobilize
others for vaccination, surveillance of disease.
2. Staff preparedness:
a)Increase number of staff- increase working
hours, supplemental calling.
b)Training: audio video tapes, paintings, and web
based knowledge

19. Contd….
3. Communication preparedness:
a)External communication: Accurate, non-
confusing and non-contradictory messages
should be delivered so that no false message
spread in the community and thus panic can be
avoided.
b)Internal communication : Intradepartmental
communication in hospital.
4.Government policy: Manage road and transport
system, water supply.
Increase number of beds in the hospital.

20. Contd….
• Bioterrorism act can be passed (like America)
• Toll free no. for 24*7 support.
• Point of dispensing of drugs, food, water can be
created beforehand.
• Real time Outbreak Disease Surveillance (RODS)
like software can be generated.
PPT File
PPT File

21. References
• Park K. Park’s textbook of preventive and social
medicine. 23rd
ed. Jabalpur: M/s Banarsidas Bhanot;
2015.
• Ray T.K. Bioterrorism a public health challenge. 1st
ed. Bangalore: Ahuja Publishing House; 2010.
• Sunder L, Adarsh, Pankaj. Textbook of community
medicine preventive and social medicine. 4th
ed. New
Delhi: CBS Publishers &Distributors Pvt Ltd;2014.

22. • National Health Portal [internet]. [updated Feb 5 2016; cited
May 25, 2017]. Available from
https://www.google.com/url?q=https%3A%2F%2Fwww.nhp.gov.in
• Bioterrorism and millitary health risk[internet].[updated
january 25 2003; cited May 25, 2017]. Available from
http://www.google.com/url?q=http%3A%2F%2Fwww.who.int%2F

23. • Paul John. Three zika virus cases reported in Ahemdabad
since january. New York Times. May 27 2017 [internet].
Available from http://www.google.com/url?q=http%3A%2F
%2Fm.timesofindia.com%2Fcity%2Fahmedabad%2Fwho-
confirms-indias-1st-zika-virus-cases-in-ahmedabad
%2Farticleshow%2F58876030.cms%3Futm_source
%3Dtoiiphoneapp%26utm_medium%3DSms
%26utm_campaign
%3Dshow&sa=D&sntz=1&usg=AFQjCNEO2wzCZIRMKRv
oYP3UcHTuSoS78Q
• American anthrax outbreak of 2001.UCLA department of
epidemiology fielding of school and public health [internet].
[updated may 03 2002; cited May 26, 2017]. Available from
http://www.google.com/url?q=http%3A%2F%2Fwww.ph.ucla.edu%

24. • Zika virus fact sheet. WHO [internet]. [updated sept 6,2016;
cited may 15, 2017]. Available from
http://www.google.com/url?q=http%3A%2F%2Fwww.who.int
%2Fmediacentre%2Ffactsheets%2Fzika%2Fen
%2F&sa=D&sntz=1&usg=AFQjCNFLjrHDt8K2RBtTukqGzk
pr_Ie5fA
• United States of America, disease outbreak news. WHO
[internet]. [updated feb 20,2017; cited may 15, 2017].
Available from http://www.google.com/url?q=http%3A%2F
%2Fwww.who.int%2Fcsr%2Fdon%2Farchive%2Fcountry
%2Fusa%2Fen
%2F&sa=D&sntz=1&usg=AFQjCNGlUA4n_cQnJpulASlTm
EutgevQuA

25. • Anthrax: Public health response plan for Australia, Disease
containment. The Department of Health[internet]. [updated
december 5,2012; cited may 17, 2017]. Available from
http://www.google.com/url?q=http%3A%2F
%2Fwww.health.gov.au%2Finternet%2Fpublications
%2Fpublishing.nsf%2FContent%2Fohp-anthrax-toc~ohp-
anthrax-05-
disease&sa=D&sntz=1&usg=AFQjCNEjXZo2vwPFVZvVef
MmVWgob17A-A
• The smallpox eradication programme-SEP (1966-1980)
WHO [internet]. [updated may 2010; cited may 17, 2017].
Available from http://www.google.com/url?q=http%3A%2F
%2Fwww.who.int%2Ffeatures%2F2010%2Fsmallpox%2Fen
%2F&sa=D&sntz=1&usg=AFQjCNHVfJuJP6hNgXoQn9UM
1A3UnWqVZQ

26. • Epidemiological aspect of smallpox in Yugoslavia in 1972. WHO
[internet]. ]. [updated may 10, 1973; cited may 17, 2017].
Available from https://www.google.co.in/url?
url=http://apps.who.int/iris/bitstream/10665/67617/1/WHO_SE_73
.57.pdf&rct=j&sa=U&ved=0ahUKEwjYr9iLx5LUAhVFrY8KHa
D2CWAQFghfMAk&sig2=TgLIJHoVNg6QcW7ztKdK5g&q=yug
oslavia+smallpox+outbreak&usg=AFQjCNF3UDQe6fbzcBC6452
QDDNiPfl3tQ

27. Thankyou !