This document discusses bioterrorism and bioterrorist agents. It defines bioterrorism and provides examples of historical bioterrorism incidents. It describes the three categories of bioterrorism agents according to the CDC based on their ease of transmission and potential for mortality. Priority agents are characterized by their ability to infect via aerosol and cause high morbidity and mortality. Sources of potential bioterrorism and impacts on direct infection, the environment and economy are reviewed. The anthrax attacks in the US in 2001 are summarized.
biological weapons, an weapons which can kill many and that also by means of biology this may refer as silent killer as being describe in many science fiction movies like resident evil etc
This presentation focuses on a short history of bioterrorism, description, its advantages and disadvantages and organisms incorporated into weapons are also shown here.
Introduction to bioterrorism , history of bioterrorism, key features of biological agents used as bioweapons, biological agents and effects, bioterrorism agents, effects of biological attacks, COVID-19 used as bioweapon , technology at work, preventive measures.
biological weapons, an weapons which can kill many and that also by means of biology this may refer as silent killer as being describe in many science fiction movies like resident evil etc
This presentation focuses on a short history of bioterrorism, description, its advantages and disadvantages and organisms incorporated into weapons are also shown here.
Introduction to bioterrorism , history of bioterrorism, key features of biological agents used as bioweapons, biological agents and effects, bioterrorism agents, effects of biological attacks, COVID-19 used as bioweapon , technology at work, preventive measures.
Bioterrorism is using living organsims as weapons of mass destruction or to cause panic in population. it has existed since ancient times and yet pose a potential future threat. this compilation is not exhaustive and contains references at the end for further reading
“Microbial forensics” has been defined as “a scientific discipline dedicated to analyzing evidence
from a bioterrorism act, biocrime, or inadvertent microorganism/toxin release for attribution
purposes” (Budowle et al., 2003). This emerging discipline is still in the early stages of
development and faces substantial scientific challenges to provide a robust suite of technologies
for identifying the source of a biological threat agent and attributing a biothreat act to a particular
person or group. The unlawful use of biological agents poses substantial dangers to individuals,
public health, the environment, the economies of nations, and global peace. It also is likely that
scientific, political, and media-based controversy will surround any investigation of the alleged
use of a biological agent, and can be expected to affect significantly the role that scientific
information or evidence can play. For these reasons, building awareness of and capacity in
microbial forensics can assist in our understanding of what may have occurred during a biothreat
event, and international collaborations that engage the broader scientific and policy-making
communities are likely to strengthen our microbial forensics capabilities. One goal would be to
create a shared technical understanding of the possibilities—and limitations—of the scientific
bases for microbial forensics analysis._ NCBI
Important Zoonotic disease and its prevention and control By: Dr.Manoj karkimanojj123
Zoonosis are those disease and infection which are naturally transmitted between animals and human. (WHO & FAO, 1959).
Zoonosis word derived from Greek word “ZOO” means Animals and “NOSES” means Disease.
One Health is not a new concept, but it has become more important in recent years because many factors have changed the interaction among human, animals and the environment. These changes have caused the emergence and re-emergence of many disease.
FMD is serious , acute and highly contagious animal disease.
Affecting all cloven hoofed animals(hoof split in to two toes)
High morbidity and low mortality.
FMD is disease of animals not humans and affecting livestock in every part of the world.
Animals include cattle , buffaloes, goats , sheep, swine and many wild animals including deer.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
local names, definition, etiology,epidemiology lifecycle, pathogenesis, clinical findings, necropsy finding, diagnosis,treatment, control and prevention
Biological Warfare.....
Straight and Short Information on Biological Warfare.....
Now In 2020, The COVID-19(The Novel Corona Virus) is the best example of Biological Warfare.......
Contents-
#Historical Events
#Biological Warfare
#Bio-Weapons
#Biological Agents
#Weapons Development Cycle
#Advantages
#Disadvantages
#Conclusion
#References
#Case Study
Bioterrorism is using living organsims as weapons of mass destruction or to cause panic in population. it has existed since ancient times and yet pose a potential future threat. this compilation is not exhaustive and contains references at the end for further reading
“Microbial forensics” has been defined as “a scientific discipline dedicated to analyzing evidence
from a bioterrorism act, biocrime, or inadvertent microorganism/toxin release for attribution
purposes” (Budowle et al., 2003). This emerging discipline is still in the early stages of
development and faces substantial scientific challenges to provide a robust suite of technologies
for identifying the source of a biological threat agent and attributing a biothreat act to a particular
person or group. The unlawful use of biological agents poses substantial dangers to individuals,
public health, the environment, the economies of nations, and global peace. It also is likely that
scientific, political, and media-based controversy will surround any investigation of the alleged
use of a biological agent, and can be expected to affect significantly the role that scientific
information or evidence can play. For these reasons, building awareness of and capacity in
microbial forensics can assist in our understanding of what may have occurred during a biothreat
event, and international collaborations that engage the broader scientific and policy-making
communities are likely to strengthen our microbial forensics capabilities. One goal would be to
create a shared technical understanding of the possibilities—and limitations—of the scientific
bases for microbial forensics analysis._ NCBI
Important Zoonotic disease and its prevention and control By: Dr.Manoj karkimanojj123
Zoonosis are those disease and infection which are naturally transmitted between animals and human. (WHO & FAO, 1959).
Zoonosis word derived from Greek word “ZOO” means Animals and “NOSES” means Disease.
One Health is not a new concept, but it has become more important in recent years because many factors have changed the interaction among human, animals and the environment. These changes have caused the emergence and re-emergence of many disease.
FMD is serious , acute and highly contagious animal disease.
Affecting all cloven hoofed animals(hoof split in to two toes)
High morbidity and low mortality.
FMD is disease of animals not humans and affecting livestock in every part of the world.
Animals include cattle , buffaloes, goats , sheep, swine and many wild animals including deer.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
local names, definition, etiology,epidemiology lifecycle, pathogenesis, clinical findings, necropsy finding, diagnosis,treatment, control and prevention
Biological Warfare.....
Straight and Short Information on Biological Warfare.....
Now In 2020, The COVID-19(The Novel Corona Virus) is the best example of Biological Warfare.......
Contents-
#Historical Events
#Biological Warfare
#Bio-Weapons
#Biological Agents
#Weapons Development Cycle
#Advantages
#Disadvantages
#Conclusion
#References
#Case Study
Ganoderma sulit dimatikan, karena serangannya di dalam tanah, tetapi jika lahan diganti dengan komoditi semusim selama beberapa tahun, akan sangat berkurang. Pilihan lainnya adalah hidup bersama Ganoderma, pohon kelapa sawit tetap hidup dan produktif, Ganoderma tetap hidup juga, jadi hidup berdampingan.
Bioterrorism
Introduction
Bioterrorism is the intentional or threatened use of viruses, bacteria, fungi, or toxins from living organisms to produce death or disease in humans, animals or plants to accomplish political or social objectives. Agents of bioterrorism can be altered or mutated in such a way soas to increase their virulence and ability to cause disease. They can be engineered to resist current medications. They can be spread through air, food, water, fomites, or through infected hosts (including humans, animals, insects, and other reservoirs)
Definition
Biological Agents as Causes of Mass Destruction
Sources of Biological Agents
Types of Biological Agents
Epidemics
Bioterrorism
History : Major events across the globe
Impact of Biological Disaster
Prevention of Biological Disaster
Bio Whepon and COVID 19 - Is Corona Virus a Bio Weapon?Ravi Kumudesh
Is Corona Virus a Bio Weapon?
The Internet was brimming with conspiracies about the coronavirus, and, perhaps, one of the most prominent ones was that the virus could be a bioweapon.
According to an ET Prime report, a group of Chinese scientists in Canada were accused of spying and were stripped of their access to Canada’s National Microbiology Lab (NML) which is known to work on some of the most deadly pathogens.The alleged ‘policy breach’, highlighted the bioweapon program of other countries including China. Dr Francis Boyle, the creator of Bio Weapons Act, also claims that ‘the coronavirus is an offensive biological warfare weapon with DNA-genetic engineering’.Again, the claims about coronavirus being a biological weapon are unsubstantiated.
Novel Coronavirus thought to have transferred to Human from the seafood market in Wuhan, China become a one of the most dangerous viruses in the subfamily Orthocoronavirinae. According to the literature, the genome size of RNA of this viruses are greater than 20 kilobases.
Genetic engineers has committed to change the genes of some organisms to create new features of them, and this can be applied for the Coronavirus as well.
Biological terrorism dates as far back as ancient Roman civilization. This early version of biological terrorism was used to destroy enemy forces. It continued on into the 14th century.
Biological weapons infectious agents (bacteria, virus, fungi, protozoan etc.) used to intentionally inflict harm on humans.
Generally, the types of agents used as biological weapons cause systemic diseases, hemorrhagic fevers, pneumonias, or involve toxins and biological poisons.
Its all about Bio terrorism. Here i am trying to involve all content(maximum) those are available on online like ready.gov; CDC. i think it will cover all information that are need to know.
Bioterrorism is a form of terrorism involving the intentional release of biological agents bacteria, viruses, or germs to harm people and spread fear. It is carried out by terrorists to create outbreaks of infectious diseases which will cause mass casualties, terror, societal disruption, or economic loss. Such outbreaks of infectious diseases pose a major threat to global health. Bioterrorism is regarded as a great threat to society as it involves the release of an organism without any warning. Bioterrorism and its potential for mass destruction have been subjects of increasing international concern. This paper provides an introduction to bioterrorism. Paul A. Adekunte | Matthew N. O. Sadiku | Sarhan M. Musa "Bioterrorism: An Introduction" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-5 , August 2020, URL: https://www.ijtsrd.com/papers/ijtsrd31660.pdf Paper Url :https://www.ijtsrd.com/humanities-and-the-arts/social-science/31660/bioterrorism-an-introduction/paul-a-adekunte
This is a presentation I gave at Skepticamp Ohio 2009 on Virus Evolution. The goal was to give audience the scientific background to skeptically evaluate claims being made about the current Swine Flu Epidemic.
Similar to Bioterrorism and veterinary public health (20)
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. Definition of BioterrorismDefinition of Bioterrorism
Bioterrorism is the threat of use of biologicalBioterrorism is the threat of use of biological
agents by individuals or groups motivated byagents by individuals or groups motivated by
political, religious, ecological, social or for otherpolitical, religious, ecological, social or for other
ideological objectives to inculcate fear or causeideological objectives to inculcate fear or cause
illness or death in order to achieve theirillness or death in order to achieve their
objectivesobjectives
(Carus 1998).(Carus 1998).
3. According to the United States Centers forAccording to the United States Centers for
Disease Control and Prevention (CDC)Disease Control and Prevention (CDC) aa
bioterrorism attack is the deliberate release ofbioterrorism attack is the deliberate release of
viruses, bacteria or other germs (agents) orviruses, bacteria or other germs (agents) or
toxins used to cause illness or death in people,toxins used to cause illness or death in people,
animals or plantsanimals or plants..
4. BIOLOGIC WARFARE: HISTORY
1414THTH
century, Caffa: Attacking Tatar force catapulted cadavers of plaguecentury, Caffa: Attacking Tatar force catapulted cadavers of plague
victims into city – outbreak of plague led to defeatvictims into city – outbreak of plague led to defeat
1818thth
century, Fort Pitt, North America: Blankets from smallpox hospitalcentury, Fort Pitt, North America: Blankets from smallpox hospital
provided to Native Americans – resulted in epidemic of smallpox amongprovided to Native Americans – resulted in epidemic of smallpox among
tribes in Ohio River valleytribes in Ohio River valley
Gen. Jeffrey
Amherst, in a letter
dated 16 Jully 1763,
approved the plan to
spread smallpox
to Delaware Indians
5. 1932-45, Manchuria: Japanese military physicians infected1932-45, Manchuria: Japanese military physicians infected
10,000 prisoners with biological agents (10,000 prisoners with biological agents (B. anthracis, N.B. anthracis, N.
meningitidis, Y. pestis, V. choleraemeningitidis, Y. pestis, V. cholerae) –) – 11 Chinese cities11 Chinese cities
attacked via food/water contamination, spraying via aircraftattacked via food/water contamination, spraying via aircraft
The Japanese army used Chinese
prisoners to test bioweapons.
6. Reported cases of bioterrorism
World war II – Polish resistance organizations used
biological agents against German
forces
1952 – Mau Mau, an independence movement in
Kenya, used a plant toxin to poison
livestock
1966 – Dr. M. Suzuki, a Japanese physician,
7. 1981 – Dark harvest groups got anthrax
contaminated soil from Gruinard Island and
damped it on Porton Down.
1984 – Rajaneesh in Portland, Oregon (USA) used
S. thphimurium to contaminate restaurants salad
bars
1995 – AUM Shinrikyo used sarin nerve gas in the
Tokyo subway in Japan.
2001- Anthrax contaminated mails sent to various
people in USA
8. CasualtiesCasualties
Incident Number of cases Number of deaths
Polish
resistance
Not reported 200 Germans
Mau Mau Not reported 33 head of cattle
Dark Harvest None None
Rajaneesh 751 (45 Hospitalized No deaths
AUM Shrinkyo 5500 (641 seen at SJIH on day
I & 349 following week
106 hospitalized at SLIH, 12
deaths ( 2 at SLIH)
Dr. Suzuki 200 4 deaths
Anthrax (USA) 22 4 deaths
9. Motive for Bioterrorism
Incident Motive
Polish resistance Resistance against foreign occupation
Mau Mau Resistance against colonialism
Dark Harvest Send a political message
Rajneesh Win a local election by incapacitating the non-
Rajneeshees voters
AUM Shrinkyo Seize control of Japan through mass murder
causing fear and apprehension
Dr. Suzuki Revenge for unfair treatment he received at the
medical training
Anthrax (USA) Inculcate fear
10. BIOTERRORISM: WHY NOW?BIOTERRORISM: WHY NOW?
Nuclear arms have great killing capacity but areNuclear arms have great killing capacity but are
hard to get.hard to get.
chemical weapons are easy to get but lack suchchemical weapons are easy to get but lack such
killing capacitykilling capacity
Biological agents have both qualitiesBiological agents have both qualities..
11. TRENDSTRENDS FAVORING BIOLOGICALFAVORING BIOLOGICAL
WEAPONSWEAPONS
Biological weapons have an unmatched destructive potentialBiological weapons have an unmatched destructive potential
Technology for dispersing biologic agents is becoming more sophisticated.Technology for dispersing biologic agents is becoming more sophisticated.
The lag time between infection and appearance of symptoms generally isThe lag time between infection and appearance of symptoms generally is
longer for biological agents than with chemical exposures.longer for biological agents than with chemical exposures.
Lethal biological agents can be produced easily and cheaply.Lethal biological agents can be produced easily and cheaply.
Biological agents are easier to produce clandestinely than are either chemicalBiological agents are easier to produce clandestinely than are either chemical
or nuclear weapons.or nuclear weapons.
12. TRENDS FAVORING BIOLOGICAL WEAPONSTRENDS FAVORING BIOLOGICAL WEAPONS
Global transportation links facilitate the potential forGlobal transportation links facilitate the potential for
biological terrorist strikes to inflict mass casualtiesbiological terrorist strikes to inflict mass casualties
Urbanization provides terrorists with a wide array ofUrbanization provides terrorists with a wide array of
lucrative targetslucrative targets
The emergence of global, real-time media coverage increasesThe emergence of global, real-time media coverage increases
the likelihood that a major biological incident will inducethe likelihood that a major biological incident will induce
panicpanic
13.
14. CENTERS FOR DISEASE CONTROLCENTERS FOR DISEASE CONTROL
BIOTERRORIST AGENTS: CATEGORY ABIOTERRORIST AGENTS: CATEGORY A
Easily disseminated or transmittedEasily disseminated or transmitted
person-to-personperson-to-person
High mortality, with potential for publicHigh mortality, with potential for public
health impacthealth impact
Require special action for public health preparedness .Require special action for public health preparedness .
Viruses:Viruses: Variola major (smallpox),Variola major (smallpox),
Filoviruses (Ebola, Marburg),Filoviruses (Ebola, Marburg),
Arenaviruses (Lassa, Junin)Arenaviruses (Lassa, Junin)
BacteriaBacteria:: Bacillus anthracisBacillus anthracis (anthrax),(anthrax), Yersinia pestisYersinia pestis (plague),(plague), FrancisellaFrancisella
tularensistularensis (tularemia)(tularemia)
ToxinsToxins:: Clostridium botulinumClostridium botulinum toxin (botulism)toxin (botulism)
15. CENTERS FOR DISEASE CONTROLCENTERS FOR DISEASE CONTROL
BIOTERRORIST AGENTS: CATEGORY BBIOTERRORIST AGENTS: CATEGORY B
Moderately easy to disseminateModerately easy to disseminate
Moderate morbidity and low mortalityModerate morbidity and low mortality
Require improved diagnostic capacity & enhanced surveillance .Require improved diagnostic capacity & enhanced surveillance .
VirusesViruses: Alphaviruses (VEE, EEE, WEE): Alphaviruses (VEE, EEE, WEE)
BacteriaBacteria:: Coxiella burnetiiCoxiella burnetii (Q fever),(Q fever), Brucella sppBrucella spp. (brucellosis),. (brucellosis), BurkholderiaBurkholderia
malleimallei (glanders)(glanders)
Toxins:Toxins: Rinus communisRinus communis (caster beans) ricin toxin,(caster beans) ricin toxin, Clostridium perfringensClostridium perfringens
episolon toxin,episolon toxin, StaphylococcusStaphylococcus enterotoxin Benterotoxin B
Food/waterborne pathogensFood/waterborne pathogens:: Salmonella sppSalmonella spp.,., Vibrio choleraeVibrio cholerae,, ShigellaShigella
dyseneriaedyseneriae,, E. coliE. coli O157:H7,O157:H7, Cryptosporidium parvumCryptosporidium parvum, etc., etc.
16. CENTERS FOR DISEASE CONTROLCENTERS FOR DISEASE CONTROL
BIOTERRORIST AGENTS: CATEGORY CBIOTERRORIST AGENTS: CATEGORY C
AvailabilityAvailability
Ease of production and disseminationEase of production and dissemination
Potential for high morbidity and mortality and major publicPotential for high morbidity and mortality and major public
healthhealth impactimpact
Viruses:Viruses: Nipah, hantaviruses, tick borne hemorrhagic feverNipah, hantaviruses, tick borne hemorrhagic fever
viruses, tick borne encephalitis viruses, yellow feverviruses, tick borne encephalitis viruses, yellow fever
BacteriaBacteria: Multi-drug resistant: Multi-drug resistant Mycobacterium tuberculosisMycobacterium tuberculosis
17. CHARACTERISTICS* OF PRIORITY AGENTSCHARACTERISTICS* OF PRIORITY AGENTS
Infectious via aerosolInfectious via aerosol
Organisms fairly stable in aerosolOrganisms fairly stable in aerosol
Susceptible civilian populationsSusceptible civilian populations
High morbidity and mortalityHigh morbidity and mortality
Person-to-person transmissionPerson-to-person transmission
Difficult to diagnose and/or treatDifficult to diagnose and/or treat
Previous development for BWPrevious development for BW
** * Priority agents may exhibit all or some of the above characteristics* Priority agents may exhibit all or some of the above characteristics
18. SOURCES OF BIOTERRORISMSOURCES OF BIOTERRORISM
Biological warfareBiological warfare
State sponsored terrorismState sponsored terrorism
International terrorist groupsInternational terrorist groups
National cultsNational cults
The deranged “loner”The deranged “loner”
20. The terrorists have an option to use exotic
organisms to spread disease in animals and plants.
Imagine somebody spread Foot and Mouth disease,
Glanders, VEE, Rinderpest, Brucellosis, Swine fever, Fowl
plague, Rabies and so on.
THREAT TO ECONOMYTHREAT TO ECONOMY
21. Similarly Rice blast, Stem Rust, Late blight of potato, Black Rust
and Maize Rust and so on would destroy all the crops and shatter
the economy of the country.
Eg:-Irish Potato Famine in 1940 due to Potato Blast
Half a million people died of starvation and half a million people
migrated. It took one century for the country’s economy to
recover.
22. BIOLOGICAL WARFARE: IMPACTBIOLOGICAL WARFARE: IMPACT
[[release of 50 kg agent by aircraft along a 2 km line upwind of arelease of 50 kg agent by aircraft along a 2 km line upwind of a
population center of 500,000 – Christopher et al., JAMA 278;1997:412population center of 500,000 – Christopher et al., JAMA 278;1997:412
AgentAgent Downwind No. deadDownwind No. dead No.No.
reach, kmreach, km incapacitatedincapacitated
Rift Valley feverRift Valley fever 11 400400 35,00035,000
Tick-borne encephalitisTick-borne encephalitis 11 9,5009,500 35,00035,000
TyphusTyphus 55 19,000 85,00019,000 85,000
BrucellosisBrucellosis 1010 500500 125,000125,000
Q feverQ fever >20>20 150150 125,000125,000
TularemiaTularemia >20>20 30,00030,000 125,000125,000
AnthraxAnthrax >20>20 95,00095,000 125,000125,000
23. Biological Delivery Methods
• Food / Water
• Aircraft sprayers
• Vehicle sprayers
• Hand sprayers
• Mail
• Air handling
systems
• Human Vector
• Animal Vector
24. CHARACTERISTICS OF BIOWARFARE
Potential for massive numbers of casualties
Ability to produce lengthy illnesses requiring prolonged and intensive care
Ability of certain agents to spread via contagion
Paucity of adequate detection systems
Presence of an incubation period, enabling victims to disperse widely
Ability to produce non-specific symptoms, complicating diagnosis
Ability to mimic endemic infectious diseases, further complicating diagnosis
25. FOMITE ACQUISITIONFOMITE ACQUISITION
Agents acquired from contaminated clothesAgents acquired from contaminated clothes
Variola major (smallpox)Variola major (smallpox)
• Bacillus anthracisBacillus anthracis (anthrax)(anthrax)
• Coxiella burnetiiCoxiella burnetii (Q fever)(Q fever)
• Yersinia pestisYersinia pestis (plague)(plague)
ManagementManagement
•Remove clothing, have patient showerRemove clothing, have patient shower
•Place contaminated clothes in impervious bag, wear PPEPlace contaminated clothes in impervious bag, wear PPE
•Decontaminate environmental surfaces with EPA approvedDecontaminate environmental surfaces with EPA approved
germicidal agent or 0.5% bleach (1:10 dilution)germicidal agent or 0.5% bleach (1:10 dilution)
27. ANTHRAX IN THE US, 2001ANTHRAX IN THE US, 2001
Locations: FL, NY, DC, NJ, CT, VALocations: FL, NY, DC, NJ, CT, VA
Mechanism: Via the mail (4 letters positive)Mechanism: Via the mail (4 letters positive)
Infections: 22 casesInfections: 22 cases
Cutaneous anthrax: 11 (fatality rate = 0)Cutaneous anthrax: 11 (fatality rate = 0)
Inhalation anthrax: 11 (fatality rate = 45%)Inhalation anthrax: 11 (fatality rate = 45%)
ProphylaxisProphylaxis
Initiated: ~32,000Initiated: ~32,000
60 day course recommended: ~5,00060 day course recommended: ~5,000
28. UNEXPECTED FEATURES OFUNEXPECTED FEATURES OF
ATTACKATTACK
Targets (news media)Targets (news media)
Vehicle (US mail)Vehicle (US mail)
Source of strain (US, probably weaponized)Source of strain (US, probably weaponized)
Translocation of spore through envelopeTranslocation of spore through envelope
Airborne acquisition in mail facilitiesAirborne acquisition in mail facilities
Wide spread contamination in mail facilitiesWide spread contamination in mail facilities
Transmission via mail-to-mail contaminationTransmission via mail-to-mail contamination
No person or group has claimed responsibilityNo person or group has claimed responsibility
29. ANTHRAX: EPIDEMIOLOGYANTHRAX: EPIDEMIOLOGY
Agent:Agent: Bacillus anthracisBacillus anthracis, a Gram-positive,, a Gram-positive,
spore forming non-motile bacillusspore forming non-motile bacillus
(straightforward lab identification)(straightforward lab identification)
ReservoirReservoir: Herbivores (cattle, goats,: Herbivores (cattle, goats,
sheep),sheep),
capable of surviving in the environment forcapable of surviving in the environment for
prolonged periodsprolonged periods
TransmissionTransmission
Contact, ingestion, orContact, ingestion, or inhalation of infectiveinhalation of infective
sporesspores
Sources of infection: Contaminated hides,Sources of infection: Contaminated hides,
wool, hair, bone, meat, or other animalwool, hair, bone, meat, or other animal
productsproducts
30. SVERDLOVSK ANTHRAX OUTBREAKSVERDLOVSK ANTHRAX OUTBREAK
Site: Sverdlovsk, USSRSite: Sverdlovsk, USSR
Year: 1979Year: 1979
Cause: Accidental release fromCause: Accidental release from
military microbiologic facility –military microbiologic facility –
Military report noted: “FilterMilitary report noted: “Filter
clogged so I’ve removed it.clogged so I’ve removed it.
Replacement necessary”Replacement necessary”
Transmission: AirborneTransmission: Airborne
Impact: 68 human deaths, 79Impact: 68 human deaths, 79
human cases, multiple animalhuman cases, multiple animal
deaths (sheep, cowsdeaths (sheep, cows))
31. ANTHRAX: CLINICAL FEATURESANTHRAX: CLINICAL FEATURES
Incubation period:Incubation period: 1-7 days1-7 days (1-60 days)(1-60 days)
Clinical syndrome(s): Cutaneous ulcer,Clinical syndrome(s): Cutaneous ulcer, respiratoryrespiratory, gastrointestinal,, gastrointestinal,
oropharyngealoropharyngeal
Inhalation anthrax = main threatInhalation anthrax = main threat
Spores may germinate up to 60 days after exposureSpores may germinate up to 60 days after exposure
LDLD5050 (human): 2,500 to 55,000 spores(human): 2,500 to 55,000 spores
Bronchopneumonia not a component (hemorrhagic lymphadenitis andBronchopneumonia not a component (hemorrhagic lymphadenitis and
mediastinitis)mediastinitis)
Early diagnosis difficultEarly diagnosis difficult
39. INHALATION ANTHRAX: DIAGNOSISINHALATION ANTHRAX: DIAGNOSIS
EpidemiologyEpidemiology
Sudden appearance of multiple cases of severe flu illness with fulminantSudden appearance of multiple cases of severe flu illness with fulminant
course and high mortalitycourse and high mortality
Clinical symptomsClinical symptoms
Non-specific prodrome of flu-like symptomsNon-specific prodrome of flu-like symptoms
Possible brief interim improvementPossible brief interim improvement
Abrupt onset of respiratory failure and hemodynamic collapse 2-4 days afterAbrupt onset of respiratory failure and hemodynamic collapse 2-4 days after
initial symptoms, possibly accompanied by thoracic edema and a widenedinitial symptoms, possibly accompanied by thoracic edema and a widened
mediastinum on CxRmediastinum on CxR
40. INHALATION ANTHRAX: DIAGNOSISINHALATION ANTHRAX: DIAGNOSIS
Diagnostic studiesDiagnostic studies
Chest radiograph with widened mediastinumChest radiograph with widened mediastinum
Peripheral blood smear with gram (+) bacilli onPeripheral blood smear with gram (+) bacilli on
unspun smearunspun smear
MicrobiologyMicrobiology
Blood culture growth of large gram (+) bacilliBlood culture growth of large gram (+) bacilli
with preliminary identification ofwith preliminary identification of Bacillus sppBacillus spp..
PLET mediumPLET medium
PathologyPathology
Hemorrhagic mediastinitis, hemorrhagicHemorrhagic mediastinitis, hemorrhagic
thoracic lymphadenitis, hemorrhagic meningitisthoracic lymphadenitis, hemorrhagic meningitis
INHALATION ANTHRAX: CxRINHALATION ANTHRAX: CxR
Inhalational anthrax: CT scan
41. INHALATION ANTHRAX, US
Prominent superior mediastinum,
?small left pleural effusion
B. ANTHRACISB. ANTHRACIS: PERIPHERAL: PERIPHERAL
BLOOD SMEARBLOOD SMEAR
42. Cutaneous Anthrax, USCutaneous Anthrax, US
7 mo male infant hospitalized with 2 day7 mo male infant hospitalized with 2 day
history of swelling left arm and weepinghistory of swelling left arm and weeping
lesion at left elbow. Patient had been atlesion at left elbow. Patient had been at
his mother’s office at a TV network.his mother’s office at a TV network.
Biopsies yieldedBiopsies yielded B. anthracis.B. anthracis.
44. IntroductionIntroduction
Due to infection with theDue to infection with the
bacteriumbacterium
Yersinia pestisYersinia pestis
Several forms:Several forms:
––BubonicBubonic
––Primary septicemia/Primary septicemia/
secondarysecondary
pneumonicpneumonic
––Primary pneumonicPrimary pneumonic
PERIPHERAL BLOOD SMEARPERIPHERAL BLOOD SMEAR
45.
46.
47. Public Health FeaturesPublic Health Features
Most cases in U.S. occur in southwestMost cases in U.S. occur in southwest
Pneumonic plague can be transmittedPneumonic plague can be transmitted person toperson to
person via respiratory dropletsperson via respiratory droplets
48. PLAGUE: CLINICAL FEATURESPLAGUE: CLINICAL FEATURES
Incubation period: 1-4 days (pneumonia), 1-7 days (bubonic orIncubation period: 1-4 days (pneumonia), 1-7 days (bubonic or
septicaemic)septicaemic)
Clinical syndrome(s)Clinical syndrome(s)
Bubonic, septicemic, pneumonic, cutaneous, meningitisBubonic, septicemic, pneumonic, cutaneous, meningitis
Epidemiology and symptomsEpidemiology and symptoms
Sudden onset fever, shortness of breath, hemoptysis, chest painSudden onset fever, shortness of breath, hemoptysis, chest pain
Gastrointestinal symptoms common (N, V, diarrhea)Gastrointestinal symptoms common (N, V, diarrhea)
Fulminant course and high mortalityFulminant course and high mortality
53. PLAGUE: CONTROLPLAGUE: CONTROL
Laboratory precautions: BSL 2 (potentially infective clinical material), BSLLaboratory precautions: BSL 2 (potentially infective clinical material), BSL
3 (activities with high potential for droplet or aerosol production)3 (activities with high potential for droplet or aerosol production)
Prophylaxis:Prophylaxis:
Post-exposure: Doxycycline (alternatives ciprofloxacin or TMP-SMX)Post-exposure: Doxycycline (alternatives ciprofloxacin or TMP-SMX)
CDC isolation guidelinesCDC isolation guidelines
Bubonic: StandardBubonic: Standard
Pneumonic: Droplet (until patient treated for 3 days)Pneumonic: Droplet (until patient treated for 3 days)
54. SMALLPOX: HISTORYSMALLPOX: HISTORY
1754-67: Biological weapon French and Indian wars1754-67: Biological weapon French and Indian wars
1796: Edward Jenner uses vaccinia for immunization1796: Edward Jenner uses vaccinia for immunization
1967: WHO global eradication campaign1967: WHO global eradication campaign
1972: US ceases routine vaccination1972: US ceases routine vaccination
1977: Last case endemic smallpox (Somalia)1977: Last case endemic smallpox (Somalia)
1978: Last laboratory acquired case (England)1978: Last laboratory acquired case (England)
1982: Worldwide cessation of vaccination1982: Worldwide cessation of vaccination
55. SMALLPOX: VIROLOGYSMALLPOX: VIROLOGY
Agent: Variola (family poxviridae)Agent: Variola (family poxviridae)
8 genera in family8 genera in family
Human infectious agentsHuman infectious agents
Orthopoxviruses: Variola, varicella (chickenpox)Orthopoxviruses: Variola, varicella (chickenpox)
Mullucipoxvirus: Mulluscum contagiosum virusMullucipoxvirus: Mulluscum contagiosum virus
Nonhuman orthopoxviruses: Monkeypox, cowpox,Nonhuman orthopoxviruses: Monkeypox, cowpox,
canarypox, rabbitpox, etc.canarypox, rabbitpox, etc.
56. VARIOLA (SMALLPOX)VARIOLA (SMALLPOX)
Large DNA VirusLarge DNA Virus
Dumb bell shaped virusDumb bell shaped virus
Complex membranesComplex membranes
57.
58. SMALLPOX: EPIDEMIOLOGYSMALLPOX: EPIDEMIOLOGY
Agent: Variola virusAgent: Variola virus
Reservoir: HumansReservoir: Humans
TransmissionTransmission
Contact, droplet, and airborneContact, droplet, and airborne
Transmission does not occur until the onset rashTransmission does not occur until the onset rash
Maximum infectiousness, days 7-10 of rashMaximum infectiousness, days 7-10 of rash
Increased infectiousness if patient coughing or has a hemorrhagicIncreased infectiousness if patient coughing or has a hemorrhagic
form of smallpoxform of smallpox
59. SMALLPOX: CLINICAL FEATURESSMALLPOX: CLINICAL FEATURES
Incubation period: 12 days (7-17 days)Incubation period: 12 days (7-17 days)
Clinical featuresClinical features
Non-specific prodrome (2-4 days) of fever, mylagiasNon-specific prodrome (2-4 days) of fever, mylagias
Rash most prominent on face and extremities (including palms andRash most prominent on face and extremities (including palms and
soles) in contrast to truncal distribution of varicellasoles) in contrast to truncal distribution of varicella
Rash scabs over in 1-2 weeksRash scabs over in 1-2 weeks
Variola rash has a synchronous onset (in contrast to the rash ofVariola rash has a synchronous onset (in contrast to the rash of
varicella which arises in crops)varicella which arises in crops)
61. Classic Centrifugal Rash of Smallpox Involving Face
and Extremities. Photo courtesy of National
Archives
62. Smallpox in an adult
Nigeria, 1970
27 yo female
Lesions have a
peripheral distribution,
Facial edema, and
Uniform in terms of
Stage of development
63. SMALLPOX: DIAGNOSISSMALLPOX: DIAGNOSIS
Appearance of rashAppearance of rash
Hemorrhagic smallpox may be mistaken for meningococcemia orHemorrhagic smallpox may be mistaken for meningococcemia or
severe acute leukemiasevere acute leukemia
Culture of lesionsCulture of lesions
Should be obtained by immunized person; place specimen inShould be obtained by immunized person; place specimen in
vacutainer tube, tape juncture of stopper and tube, place in secondvacutainer tube, tape juncture of stopper and tube, place in second
durable, watertight containerdurable, watertight container
Alert labAlert lab
64. SMALLPOX: CONTROLSMALLPOX: CONTROL
Laboratory precautions: BSL 4Laboratory precautions: BSL 4
Clothing/fomites: DecontaminateClothing/fomites: Decontaminate
ProphylaxisProphylaxis
Pre-exposure: VaccinePre-exposure: Vaccine
Post-exposure: Vaccine (within 4 days) or vaccine plus VIG (>4Post-exposure: Vaccine (within 4 days) or vaccine plus VIG (>4
days); potential role for cidofovirdays); potential role for cidofovir
Isolation: Contact plus airborneIsolation: Contact plus airborne
68. Photo courtesy of CDC
Fatal case of Vaccinia necrosum
at inoculation site Accidental auto-inoculation of theAccidental auto-inoculation of the
eye witheye with VacciniaVaccinia virusvirus
69. VACCINIA VACCINE:VACCINIA VACCINE:
PRECAUTONS AND CONTRAINDICATIONSPRECAUTONS AND CONTRAINDICATIONS
Severe allergic reaction to prior dose of vaccineSevere allergic reaction to prior dose of vaccine
History or presence of eczema, other skin conditionsHistory or presence of eczema, other skin conditions
Pregnancy (children in the household is not a contraindication)Pregnancy (children in the household is not a contraindication)
Altered immocompetenceAltered immocompetence
HIV, Leukemia, lymphoma, generalized malignancyHIV, Leukemia, lymphoma, generalized malignancy
Solid organ transplant, BMTSolid organ transplant, BMT
Corticosteroids, alkylating agents, antimetabolites, radiationCorticosteroids, alkylating agents, antimetabolites, radiation
Cardiac diseaseCardiac disease
AllergiesAllergies
Neomycin, polymyxin b, tetracyclines, streptomycinNeomycin, polymyxin b, tetracyclines, streptomycin
70. VACCINIA VACCINE:VACCINIA VACCINE:
PREVENTION OF CONTACT TRANSMISSIONPREVENTION OF CONTACT TRANSMISSION
Vaccinia virus can be cultured from primary vaccination site beginning at theVaccinia virus can be cultured from primary vaccination site beginning at the
time of development papule (2-5d after vaccination)time of development papule (2-5d after vaccination)
Transmission via direct skin contact may occurTransmission via direct skin contact may occur
Vaccination site should be covered with a porous bandage until scab hasVaccination site should be covered with a porous bandage until scab has
separated and underlying skin has healed (do not use an occlusive dressing)separated and underlying skin has healed (do not use an occlusive dressing)
Use impermeable bandage when bathingUse impermeable bandage when bathing
Vaccinated HCWs may continue to work (vaccination site covered withVaccinated HCWs may continue to work (vaccination site covered with
sterile gauze and semipermeable dressing, and practice of goodsterile gauze and semipermeable dressing, and practice of good
handwashing)handwashing)
71.
72. Botulism ToxinBotulism Toxin
A major bioweapons threat because ofA major bioweapons threat because of
its extreme potency and lethalityits extreme potency and lethality
• The single most poisonous substance known.The single most poisonous substance known.
Easy to produce, transport and misuseEasy to produce, transport and misuse
The average incubation period is 12-72 hours afterThe average incubation period is 12-72 hours after
ingestion.ingestion.
Neurotoxin produced by
Clostridium botulinum
Most lethal substance known
73. Modes of transmissionModes of transmission
No person-to-person transmissionNo person-to-person transmission
Exposure typesExposure types
Foodborne - Ingestion of toxinFoodborne - Ingestion of toxin
Infant – Ingestion ofInfant – Ingestion of C. botulinumC. botulinum
Wound – Infection withWound – Infection with C. botulinumC. botulinum
Inhalation of aerosolized toxinInhalation of aerosolized toxin
As BT agent may be aerosolized or added toAs BT agent may be aerosolized or added to
food or waterfood or water
74. • Patients with botulism typicallyPatients with botulism typically
present with difficulty speaking,present with difficulty speaking,
seeing and/or swallowing.seeing and/or swallowing.
Prominent neurologic findings includeProminent neurologic findings include
ptsosis, diplopia, blurred vision,ptsosis, diplopia, blurred vision,
dysarthria and dysphagia.dysarthria and dysphagia.
Patients typically are afebrile and doPatients typically are afebrile and do
not have an altered level ofnot have an altered level of
consciousness.consciousness.
Patients may initially presentPatients may initially present withwith
gastrointestinal distress,gastrointestinal distress,
nausea, and vomiting preceding neurologicalnausea, and vomiting preceding neurological
symptoms.symptoms.
Six-week old infant with
botulism.
76. BotulismBotulism
Symptoms:Symptoms:
Acute, afebrile, symmetric, decending paralysis of facialAcute, afebrile, symmetric, decending paralysis of facial
musculature, multiple cranial nerve palsiesmusculature, multiple cranial nerve palsies
Onset and severity dependent on amount of toxin absorbedOnset and severity dependent on amount of toxin absorbed
Incubation variable 2 hrs to 8 days after ingestionIncubation variable 2 hrs to 8 days after ingestion
Neurologic symptoms:Neurologic symptoms:
Ptosis, diplopia, blurred vision, loss of head controlPtosis, diplopia, blurred vision, loss of head control
Deep tendon reflexes diminishDeep tendon reflexes diminish
Death results from airway obstruction;Death results from airway obstruction;
Respiratory and diaphragmatic muscle paralysisRespiratory and diaphragmatic muscle paralysis
Diagnosis:Diagnosis:
Index of suspicion for botulism; clusters of casesIndex of suspicion for botulism; clusters of cases
Treatment:Treatment:
Supportive care and administration of passive equine antitoxinSupportive care and administration of passive equine antitoxin
77. Botulinum Toxin as a BioweaponBotulinum Toxin as a Bioweapon
Aum Shinrikyo 1990, 1993, 1995: attempted aerosol dispersionAum Shinrikyo 1990, 1993, 1995: attempted aerosol dispersion
in Japanin Japan
Japan WW II (Unit 731): fed cultures to prisoners in ChinaJapan WW II (Unit 731): fed cultures to prisoners in China
US bioweapons programUS bioweapons program
Soviet Union program: gene splicingSoviet Union program: gene splicing
Iraq 19,000 liters weaponizedIraq 19,000 liters weaponized
? Iran, North Korea, Syria? Iran, North Korea, Syria
79. Ebola and Marburg –Ebola and Marburg –
Etiologic agentsEtiologic agents
FlioviridaeFlioviridae family virusesfamily viruses
Among the most virulent viruses (25-90%Among the most virulent viruses (25-90%
case fatality depending on strain)case fatality depending on strain)
ZoonoticZoonotic
Humans are incidental hostsHumans are incidental hosts Marburg
Ebola
80.
81. Clinical features - VHFClinical features - VHF
Severe multisystem syndromeSevere multisystem syndrome
Overall vascular system damageOverall vascular system damage
Body’s ability to regulate itself is impairedBody’s ability to regulate itself is impaired
Often accompanied by hemorrhagic (in itself notOften accompanied by hemorrhagic (in itself not
usually life threatening)usually life threatening)
82. Ebola & Marburg Viruses -Ebola & Marburg Viruses -
clinical courseclinical course
Sudden onset of flu-like illnessSudden onset of flu-like illness
May progress to nausea, vomiting, diarrhea,May progress to nausea, vomiting, diarrhea,
abdominal pain, photophobia, maculopapularabdominal pain, photophobia, maculopapular
rash, DIC, internal and external hemorrhage,rash, DIC, internal and external hemorrhage,
multiorgan failure with jaundice and renalmultiorgan failure with jaundice and renal
insufficiencyinsufficiency
83. Atlanta, Georgia: Electron Micrograph: Ebola virus causing African
Hemorrhagic Fever. (Courtesy of the National Archives, 82-424)
84. Marburg & Ebola –Marburg & Ebola –
OccurrenceOccurrence
Naturally occurring sporadic outbreaks in AfricaNaturally occurring sporadic outbreaks in Africa
Cases have occurred in West as a result of exposure toCases have occurred in West as a result of exposure to
animal reservoirsanimal reservoirs
BT potentialBT potential
Russian biowarfare programRussian biowarfare program
Iraq is believe to have triedIraq is believe to have tried
85. Ebola and Marburg - transmissionEbola and Marburg - transmission
Direct contact with infected tissue and bodyDirect contact with infected tissue and body
fluids or contaminated objectsfluids or contaminated objects
Probably aerosol inhalationProbably aerosol inhalation
86. Borio, et al JAMA consensus statement 2002
Maculopapular Rash in Marburg Disease
Ocular Manifestations in Bolivian Hemorrhagic Fever
87. Psychological and Social FactorsPsychological and Social Factors
during bioterrorismduring bioterrorism
1.1. HorrorHorror
2.2. AngerAnger
3.3. PanicPanic
4.4. Magical thinking about microbesMagical thinking about microbes
5.5. Fear of invisible agents Fear of contagionFear of invisible agents Fear of contagion
6.6. Anger at Terrorist/GovernmentAnger at Terrorist/Government
7.7. ScapegoatScapegoat
8.8. ParanoiaParanoia
9.9. Social isolationSocial isolation
10. Demoralization10. Demoralization
11. Loss of faith in social institutions11. Loss of faith in social institutions
12. Attribution of arousal symptoms to infection12. Attribution of arousal symptoms to infection
88. MANAGEMENT OF PEOPLE WITHMANAGEMENT OF PEOPLE WITH
PSYCHOLOGICAL PROBLEMSPSYCHOLOGICAL PROBLEMS
1.1. care of health workerscare of health workers
2.2. Critical incidence stress management (CISM) for rescue workersCritical incidence stress management (CISM) for rescue workers
3.3. Prevention of public fleeingPrevention of public fleeing
4.4. Confidence building by the medical workersConfidence building by the medical workers
5.5. Dealing with emotional and psychological problems while dealing with theDealing with emotional and psychological problems while dealing with the
dead.dead.
6.6. Care of emergency workers, medical and paramedical workersCare of emergency workers, medical and paramedical workers
7.7. Critical incidence of stress debriefing(CSID)Critical incidence of stress debriefing(CSID)
89. 8.Prevention of group panic8.Prevention of group panic
9. Avoidance of emotion based responses (Knee jerk9. Avoidance of emotion based responses (Knee jerk
quarantine)quarantine)
10. Effective risk communication10. Effective risk communication
11. Control of symptoms secondary to hyper arousal11. Control of symptoms secondary to hyper arousal
12. Reassurance12. Reassurance
13. Management of anger fear (Diazepam and other13. Management of anger fear (Diazepam and other
anxiolytic drugs)anxiolytic drugs)
14. Provision of respite as required14. Provision of respite as required
15. Social support of the community15. Social support of the community
90. Role of CliniciansRole of Clinicians
Be prepared to diagnose and treat BTBe prepared to diagnose and treat BT
diseasesdiseases
Keep alert to unusual disease patternsKeep alert to unusual disease patterns
Use reportable disease system toUse reportable disease system to
alert public health officials of aalert public health officials of a
potential problempotential problem
Get involved in disaster planningGet involved in disaster planning
processprocess
91. Clusters of patients with the sameClusters of patients with the same
disease or syndromedisease or syndrome
Especially when:Especially when:
there is more cases than would be expectedthere is more cases than would be expected
cases are geographically or temporally clusteredcases are geographically or temporally clustered
the illness is unexplainedthe illness is unexplained
there are multiple atypical presentations of the diseasethere are multiple atypical presentations of the disease
the mortality or morbidity is higher than expectedthe mortality or morbidity is higher than expected
92. Even a single case may be a signalEven a single case may be a signal
Caused by an uncommon agentCaused by an uncommon agent
Unusual for region, age group or seasonUnusual for region, age group or season
Fulminant disease in otherwise healthy patientFulminant disease in otherwise healthy patient
Atypical presentationAtypical presentation
93. Other cluesOther clues
Similar genetic type of agent from distinctSimilar genetic type of agent from distinct
sourcessources
Unusual, atypical, genetically engineered, orUnusual, atypical, genetically engineered, or
antiquated strainantiquated strain
Atypical aerosol, food, or water transmissionAtypical aerosol, food, or water transmission
Concurrent animal diseaseConcurrent animal disease
94. DETECTION OFDETECTION OF
OUTBREAKSOUTBREAKS
RecognitionRecognition
• Syndrome criteriaSyndrome criteria
• Epidemiological featuresEpidemiological features
CommunicationCommunication
MedicalMedical
•Triage, psychological aspects, lab support, public informationTriage, psychological aspects, lab support, public information
•Patient isolation (Follow CDC guidelines), decontaminationPatient isolation (Follow CDC guidelines), decontamination
•Post-exposure prophylaxis, treatment of infected personsPost-exposure prophylaxis, treatment of infected persons
95. DETECTION OFDETECTION OF
OUTBREAKSOUTBREAKS
Epidemiologic featuresEpidemiologic features
A rapidly increasing disease incidenceA rapidly increasing disease incidence
An unusual increase in the number of people seeking care, esp. withAn unusual increase in the number of people seeking care, esp. with
fever, respiratory, or gastrointestinal symptomsfever, respiratory, or gastrointestinal symptoms
An endemic disease rapidly emerging at an uncharacteristic time or inAn endemic disease rapidly emerging at an uncharacteristic time or in
an usual patternan usual pattern
Lower attack rate among persons who had been indoorsLower attack rate among persons who had been indoors
Clusters of patients arriving from a single localClusters of patients arriving from a single local
Large numbers of rapidly fatal casesLarge numbers of rapidly fatal cases
Any patient presenting with a disease that is relatively uncommon andAny patient presenting with a disease that is relatively uncommon and
has bioterrorism potentialhas bioterrorism potential
96. DETECTION AND IDENTIFICATIONDETECTION AND IDENTIFICATION
OF BIOWEAPON AGENTOF BIOWEAPON AGENT
1.1. The conventional microbiological methods viz., culture,The conventional microbiological methods viz., culture,
immunodetection, serology, molecular identification take longimmunodetection, serology, molecular identification take long
time (hours to days)time (hours to days)
2.2. Several biodetectors (bioluminometer) based on the principlesSeveral biodetectors (bioluminometer) based on the principles
of bioluminescence and biofluorescence are being developedof bioluminescence and biofluorescence are being developed
__ Fire fly luciferage geneFire fly luciferage gene..
3.3. There are various types ofThere are various types of biosensors such as immunosensors,biosensors such as immunosensors,
nucleic acid sensors, tissue based sensors and laser sensorsnucleic acid sensors, tissue based sensors and laser sensors
97. EMERGINGEMERGING INFECTIONS ANDINFECTIONS AND
BIOTERRORISMBIOTERRORISM
New diseases have also appeared within the developed nations includingNew diseases have also appeared within the developed nations including
United States. Some of these include:United States. Some of these include:
Lyme diseaseLyme disease
Legionnaires’ diseaseLegionnaires’ disease
New variant of Creutzfeldt -Jakob diseaseNew variant of Creutzfeldt -Jakob disease
West-Nile virus diseaseWest-Nile virus disease
Hantavirus pulmonary syndrome (HPS)Hantavirus pulmonary syndrome (HPS)
Multi-drug resistant TB,Multi-drug resistant TB,
Antibiotic resistant staphylococcal, enterococcal and pneumococcalAntibiotic resistant staphylococcal, enterococcal and pneumococcal
infectionsinfections
Diarrhoeal diseases caused by the parasiteDiarrhoeal diseases caused by the parasite Cryptosporidium parvumCryptosporidium parvum andand
then certain strains ofthen certain strains of Escherichia coliEscherichia coli bacteria.bacteria.
98. Factors contribute to the emergence and re-Factors contribute to the emergence and re-
emergence of infectious diseasesemergence of infectious diseases
1. Unprecedented worldwide population growth draining the natu1. Unprecedented worldwide population growth draining the naturalral
resourcesresources
2. Overcrowding in cities with poor sanitation2. Overcrowding in cities with poor sanitation
3. Rapid and increased international travel3. Rapid and increased international travel
4. Increased international trade in animals and food products4. Increased international trade in animals and food products
5. Mass distribution of food and unhygienic food preparation5. Mass distribution of food and unhygienic food preparation practicespractices
6. Increased exposure of humans to disease vectors and reservoirs in nature6. Increased exposure of humans to disease vectors and reservoirs in nature
7. Man-made changes to the environment and climatic changes which have7. Man-made changes to the environment and climatic changes which have
a direct impact on the population of insect vectors and animala direct impact on the population of insect vectors and animal
reservoirs.reservoirs.
7. Misuse of antibiotics leading to the evolution of resistant microbes.7. Misuse of antibiotics leading to the evolution of resistant microbes.
99. Impact of biological agents on nationalImpact of biological agents on national
economieseconomies
Highly pathogenic avian influenza, Hong KongHighly pathogenic avian influenza, Hong Kong
The outbreak of highly pathogenic avian influenzaThe outbreak of highly pathogenic avian influenza
(HPAI) type A (H5N1) in live market chickens in Hong(HPAI) type A (H5N1) in live market chickens in Hong
Kong resulted in 6 million deaths and killing of 1.4Kong resulted in 6 million deaths and killing of 1.4
million birds.million birds.
100. Nipah virus, MalaysiaNipah virus, Malaysia
Nipah virus, a previously un known virus wasNipah virus, a previously un known virus was
identified in 1998, primarily inidentified in 1998, primarily in pigs and in humanspigs and in humans inin
Malaysia.Malaysia.
The virus caused over 250 human cases resulting in 100The virus caused over 250 human cases resulting in 100
deaths. Approximately 1 million pigs were killed. Otherdeaths. Approximately 1 million pigs were killed. Other
countries in the region banned he importation of porkcountries in the region banned he importation of pork
products.products.
Malaysia authorities blamed the disease on a deliberateMalaysia authorities blamed the disease on a deliberate
attack by rival Asian countries trying to slowdownattack by rival Asian countries trying to slowdown
Malaysia’s recovery from the Asian Economic Crisis ofMalaysia’s recovery from the Asian Economic Crisis of
the 1997.the 1997.
101. Foot and Mouth disease, TaiwanFoot and Mouth disease, Taiwan
The 1997 Foot and mouth disease outbreak in Taiwan had aThe 1997 Foot and mouth disease outbreak in Taiwan had a
devasting effect on export oriented pork industry.devasting effect on export oriented pork industry.
The virus is believed to have been brought into TaiwanThe virus is believed to have been brought into Taiwan
through smuggled animals, meat products or illegalthrough smuggled animals, meat products or illegal
immigrants from mainland China.immigrants from mainland China.
The epizootic resulted in the depopulation of 3.8 million pigs.The epizootic resulted in the depopulation of 3.8 million pigs.
At one point the outbreak it was blamed asAt one point the outbreak it was blamed as deliberate introduction ofdeliberate introduction of
FMD into Taiwan by mainland China. The economic impact on TaiwanFMD into Taiwan by mainland China. The economic impact on Taiwan
has been estimated in the billions of dollars.has been estimated in the billions of dollars.
102.
103. ConclusionsConclusions
Less developed nations can produce biological weapons that are as lethal asLess developed nations can produce biological weapons that are as lethal as
nuclear weapons include: Iran, Iraq, Israel, North Korea, China, Libya, Syrianuclear weapons include: Iran, Iraq, Israel, North Korea, China, Libya, Syria
and Taiwan.and Taiwan.
Recent terrorist activities in India underscores it’s vulnerability toRecent terrorist activities in India underscores it’s vulnerability to
bioterrorism and the need for a comprehensive plan to defend against anbioterrorism and the need for a comprehensive plan to defend against an
attack.attack.
Currently, it does not have the infrastructure to quickly detect and identifyCurrently, it does not have the infrastructure to quickly detect and identify
many pests and pathogens nor is the country able to respond to even small-many pests and pathogens nor is the country able to respond to even small-
scale attack.scale attack.
Ocular manifestations associated with hemorrhagic fever viruses range from conjunctival injection to subconjunctival hemorrhage, as seen in this patient. Reprinted with permission from Current Science/Current Medicine
A nonpruritic maculopapular rash (resembling the rash of measles) may occur in up to 50% of patients infected with the Ebola or Marburg viruses within the first week of illness. The rash is more common in light-colored skin and desquamates on resolution. Reprinted with permission from Thieme (Martini GA, Knauff HG, Schmidt HA, et al. A hitherto unknown infectious disease contracted from monkeys. Ger Med Mon. 1968;13:457-470).