This document discusses bioterrorism and countermeasures against it. It defines bioterrorism and describes ideal biological agents for bioweapons. It outlines the categories of biological agents that pose threats from categories A to C. It discusses the history of bioweapons use from ancient times to the 21st century. It also describes India's defenses against bioterrorism, including surveillance programs, laboratories, and medical preparedness. Key response measures involve deterring attacks, preventing access to pathogens, rapidly diagnosing outbreaks, and treating affected populations.

1. BIOTERRORISM
DR.SHRUTIKIRTI
CONSULTANT MICROBIOLOGIST

2. Bioterrorism
Definition
 Biological agents—Categories ideal biological agents,
routes of administration
History – World and Indian perspective
 Countermeasure against bioterrorism
Laboratory response Network
Laboratory diagnosis

3. Bioterrorism –
intentional use of biological agents
 not related to any prophylactic, protective or other peaceful
purposes
 inflict disease and death of human, animals or plants.
Biological weapons –
Microbial agents (bacteria, virus, fungi, protozoan)
Biologically derived bioactive substance eg; toxins and
poisons
Artificially designed biological –mimicking substances

4. Source
• Natural environment
• Microbiology laboratory (ATCC) – creating and storing such
agents

5. Mode of Delivering biological weapons
• scud missiles
• motor vehicle with spray
• hand pump sprayer
• humans ,books, letter guns
• remote control, robotic delivery

6. Ideal Biological Agents
Stable and resistant to environmental conditions
Inexpensive, grown and produced in large quantities
Easily disseminated
Small amount should produce devastating impact with
Impact multipling with time
Difficult to detect
Difficult eradicate or resistant to antibiotics

7. WHY TO WORRY ?
FACTORS
EASY DELIVARY
LOW VISIBILITY
INTERNET
AVAILABILITY
HIGH POTENCY
USE OF LOW
TECHNOLOGICAL
METHOD TO
;PRODUCE
CONCEALMENT
TRANSPORTATION
AND
DISSEMINATION IS
EASY

8. Types of agents
ANTI PLANT ANTI ANIMAL
ANTI
PERSONAL
ANTI
MATERIAL

9. Biowarfare
pathogen
Contagious
Lethal
Mass killing
Non lethal
Economic
destruction
Non
contagious
Lethal
Area denial
Non lethal
Incapcitation

10. CATEGORIES OF BIOTERRORISM AGENTS
Category A
easily disseminated or transmitted easily
high mortality and greatly impact public health.
potential to create public panic
lead to disruption of daily lives.

special action for public health preparedness.
Category B -
less easy to disseminate
moderate morbidity and low mortality.
Category C
 emerging pathogens
 potential for mass dissemination.
.

11. Category A
Anthrax (Bacillus anthracis)
Botulism (Clostridium botulinum toxin)
Plague (Yersinia pestis)
Smallpox (variola major)
Tularemia (Francisella tularensis)
Viral hemorrhagic fevers (e.g., Ebola, Marburg, Lassa, Machupo])

12. Category B
Brucellosis (Brucella species)
Epsilon toxin of Clostridium perfringens
Food safety threats (e.g., Salmonella species, Escherichia coli O157:H7,
Shigella)
Glanders (Burkholderia mallei)
Melioidosis (Burkholderia pseudomallei)
Psittacosis (Chlamydia psittaci)
Q fever (Coxiella burnetii)
Ricin toxin from Ricinus communis (castor beans)
Staphylococcal enterotoxin B
Typhus fever (Rickettsia prowazekii)
Viral encephalitis (alphaviruses [e.g., Venezuelan equine encephalitis,
eastern equine encephalitis, western equine encephalitis])
Water safety threats (e.g., Vibrio cholerae, Cryptosporidium parvum)

13. Category C
Nipah virus
Hanta virus
 MDR tuberculosis
Corona virus <recent pandemic>

14. TARGET??
METROPOLITAN CITIES, URBAN
CONGLOMERATION, DISTRICT WITH
INTERNATIONAL BORDER

15. MODE OF SPREAD--
Depends on type of agent used
Aerosol mechanism in closed , confined areas
Contamination of food and water
Deliberate infiltration of infected animals, pests, vectors via border

16. Route of administration –Biological agents
oro -gastric route
Percutaneous administration- Toxins
Airborne route-Aerosols, droplets infection
 fomite-(contact)

17. HISTORY
 Pre 20th century
 600 B.C. – crude filth, cadaver animal carcasses , animal bodies
1155 - Emperor Barbarossa poisons water wells with human
bodies in Tortona, Italy
 1346 AD- epidemic plague converted to black
death(pandemic plague) covering Europe , east and north Africa
1495 Spanish mix wine with blood of leprosy patients to sell to their
French foes in Italy

18. 1675 German and French forces agree to not use “poisones bullets”
1710 Russian troops catapult human bodies of plague victims into
Swedish cities
1763 British distribute blankets from smallpox patients to Native
Americans
1797 Napoleon floods the plains around Mantua, Italy, to enhance
the spread of malaria
 1863 Confederates sell clothing from yellow fever and smallpox
patients to Union troops during the US Civil War

19. World War I German and French agents use glanders and anthrax
World War II Japan uses plague, anthrax, and other diseases;
several other countries experiment with and develop biological
weapons programs
 Early to mid 20th century-

20.  Late 20th century
1980–1988 Iraq uses mustard gas, sarin, and tabun against Iran and
ethnic groups inside Iraq during the Persian Gulf War
 1995 Aum Shinrikyo uses sarin gas in the Tokyo subway system

21.  Early 21st century
2001- Bacillus anthracis was used against civillians via sevral letters
laced with spores in U.S.
Events in India (??)
1994-Plague episodes in Surat
1996—Dengue outbreak in Delhi
2001– Eastern India (Siliguri) suffered from encephalitis

22. Counter measure for Bioterrorism
 Deterrence – state actor and non state actor
 Prevention
 surveillance
 Lab investigation and research
 Medical management
 Dissemination of public safety

23. DETERRANCE
Geneva protocol –
world war 1 1925
prohibit 1st use of asphyxiating, poisonous, and other
bacteriological method in war
 ratified in 2013 signed by 137 country
prohibit the use & possession, production of biological warfare
Other programs
National security decision memorandum 35 – 1969
Toxin weapon programs 1970
Biological weapon convention-1975 (169 countries)

24. 18 research laboratories and centre
 60 000 staff
 research over biological weapons of
VECTOR, ISBM
at present Russian federation ministry of defense microbiology
scientific research institute
collection of dangerous pathogen like Ebola Marburg Lassa virus
UNESCOM- U.N. special commission
 site inspection of Iraq’s biological , chemical, missile capabilities
 Iraq Russia and china were also investigated

25. Non state actors
1990-1999 -185 documented biological weapons
27 cases-terrorist
56 –criminals
 97 were uncertain
Sep 1984 religious cult contaminated salad bars along Oregon
interstate highway with salmonella typhimurium
UNESCOM resolution
Require all country to set laws to prevent biological attacks by
preventing production delivery and dissemination

26. Indian perspective
India have defensive biological weapon capabilities
conducted research on diseases like plague, brucellosis, and
smallpox.
Biological and Toxin Weapons Convention (BWC)
July 15, 1974
India has improved its capabilities in biotechnology & other
peaceful capacity.

27. Defense Research and Development Establishment (DRDE) at
Gwalior
Centers for countering disease threats such as anthrax, brucellosis,
cholera, plague, smallpox, viral hemorrhage fever, and botulism
 Central Industrial Security Force (CISF)
Prepare group of specially-trained first responders for nuclear or
biological attack.

28. Prevention
Global conference- 2004
launches $ 1 million grant for preventing bioterrorism
examine risk of bioterror, case studies, attack prevention, law
enforcement and legal political frame work
National Disaster Management Authority (NDMA)
eight battalions -1000 trained personal
Training of existing existing force to deal with chemical,
biological, radiological, and nuclear (CBRN) threats

29. Under NDMA India enforce revised international health
regulation in June 2007
 deal with outbreaks and other emergencies related to national
and international concern

30. Survillence and asssessment
System must be timely , sensitive, specific, and practical,
Key elements---
Harnessing information<epidemiological clues of bioterror attack
Verification and confirmation of cases
Initiation of appropriate prevention and control measures

31. When to suspect??????
similar disease or syndrome, in a discrete population .
 unexplained diseases or deaths
severe disease than expected
 Unusual routes of exposure to pathogen e.g. inhalational route for
diseases that occur through other exposures
disease unusual in geographic area or season
Disease normally transmitted by a vector that is not present in the
local area

32. Simultaneous or serial epidemics in same population
single case of disease by an uncommon agent
Unusual strains or variants of organisms,
Higher attack rates in certain areas
 Disease outbreaks of the same illness occurring in non-contiguous
areas
Intelligence report showing suspect of a potential attack

33. India-------
Integrated Disease Surveillance Project (IDSP)
Decentralized and state-based surveillance program, November 2004
Integrates the public sector, private sector, rural and urban health
system, Health Agencies (WHO, CDC, NIC, etc.)
Regulate surveillance activities
Strengthening of public health laboratories,
Human resource development
Use of information technology for collection,compilation, analysis,
and dissemination of data

34. Lab investigation– role of clinical
microbiology LABORATORY REFERENCE NETWORK
1999, collaboration of CDC, APHL
AND FBI
Integration of National &
International network of laboratories
that are fully equipped to respond
quickly to acts of chemical or
biological terrorism, emerging
infectious diseases, and other public
health threats and emergencies

35. Sentinel laboratory
• Capable of analysing or referring samples containing infectious agent
• Able to perform all complex testing as per ASM 1988 guideline and Clinical
Laboratory Improvement Amendments of 1988
• Packing and shipping of infectious agents according to standard protocol
• Maintain testing protocol in accordance to ASM guidelines and participate
in proficiency test
• Biosafety level II
• Not required to register with Select Agent rules, but must be familiar

36. Confirmatory reference laboratory
Typically public health laboratories, which represent states, countries, in large
metropolitan areas.
160 reference laboratories,
To confirm or rule out suspected bioterrorism agents
 responsibility to produce high-confidence test results for threat analysis
National laboratories
Definative characterisation OF samples
CDC and U.S. Army Medical Research Institute for Infectious Diseases
(USAMRIID)
Biosafety level IV (BSL-4) facilities.

37. List of some laboratories in india linked to NACD
NACD, New Delhi; National Institute of Cholera and Enteric Diseases
 Department of Microbiology, AIIMS (Virology)
 National Institute of Virology, Pune
Enterovirus Research Centre, Mumbai (polio)
 Vector Control Research Centre, Pondicherry (vectors, filariasis)
 Centre for Research in Medical Entomology, Madurai (vectors and
other vector-borne diseases);
 Defense Research Development Establishment, Gwalior.

38. SELECT AGENTS
 agents derived from biological sources
 cause significant harm to public health and safety.
 Listed by U.S. Department of Health and Human Services (HHS) humans) & the U.S.
Department of Agriculture (USDA)
 Updated in October2012,
 13 tier1 agents were identified.
 The criteria for a tier1 agents
 mass casualty and economic devastation
 communicability
 low infectious dose,
 history of interest in weaponization.
The 2012 update also added the SARS-associated coronavirus and Chapare and Lujo
viruses (Arena viridae) to the list

39. Ebola virus Ebola hemorrhagic fever
Francisella tularensis Tularemia
Marburg virus Marburg hemorrhagic fever
Variola major virus Smallpox
Variola minor virus Smallpox
Yersinia pestis Plague
Botulinum neurotoxin Botulism
Botulinum neurotoxin producing species
of Clostridium
Botulism
Bacillus anthracis Anthrax
Bacillus cereus Biovar anthracis Anthrax
Burkholderia mallei Glanders
Burkholderia pseudomallei Melioidosis
Foot and Mouth Disease virus FMDV
Rinderpest virus Cattle plague
SELECT AGENT DISEASE

41. MEDICAL MANAGEMENT -PREVENTIVE PROMOTIVE AND
CURATIVE SERVICE
Biothreat may disrupt health care delivery even in well-resourced health system
Increase resilience, HHS - the National Bioterrorism Hospital Preparedness
Program (NBHPP),2002
Funding and guidance to hospitals
Provided more than $2 billion to states, territories, and eligible municipalities
Administered by the Health Resources and Services Administration (HRSA)
until 2006,
At present by ASPR
renamed as hospital preparedness programe(HPP)
All hazards – biowarfare or any health outbreak

42. Activation of National Disaster Medical System (NDMS)
 the Medical Reserve Corps (MRC)- groups of health care volunteers
Disaster medical assistance teams (DMATs) - to aid medical facility
 U.S. - >300 units of MRC

43. MEDICAL COUNTERMEASURES
Easy availability of Diagnostic tests, drugs, vaccines and other
equipment and supplies needed to respond emergency.
Formation of medical teams for easy and efficient delivery of
services
 migration of health professional at effected site
Applying Triage
Public Health Emergency Medical Countermeasures Enterprise
(PHEMCE), mitigate the adverse health consequences associated
with biological threats

44. ANTHRAX
 Zoonotic disease,
 Aerosol and Inhalational- pulmonary anthrax (hemorrhagic
pneumonia) most common
 Orogastric route causing bloody diarrhoea
 High fatality rate
 Easily extracted from soil (spores) around the world.
 It’s cheap and can be grown in large quantities.
 Anthrax as war weapon has been explored by many times over a
century
 dipicolinic acid – stability and germinatiion

45. Diagnosis (cdc, 2001)
Presumptive diagnosis(SLN)- any large gram positive bacilli with
cultural properties similar to B. anthracis
Confirmatory test(CLN & NLN)-
Initial – gamma phage lysis (PHAGE W)
-- direct immunofluroscence test
Final- PCR (primer – BA pX01 & BA pX02)

46. • Bio Thrax- Antitoxin
• Raxibacumab
PRE-EXPOSURE
PROPHYLAXIS
• Ciprofloxacin+ Doxycycline/Amoxicillin – 60
Day
POST EXPOSURE
PROPHYLAXIS
•Ciprofloxacin/Doxycycline +
Clindamycin &/Or Rifampicin – 60 Day
TREATMENT
MANAGEMENT
PREVENTION
Decontamination
of animal products
Proper handling of
infected materials
As well as following
proper hygiene
Disposal of animal
carcasses
Decontamination
of animal products
Disposal of animal
carcasses

47. Extra-
MDR Bacillus
Functional hybrid nickel nanostructures as recyclable
SERS substrates

48. Small pox
DNA virus- orthopoxvirus – variola(major and minor)
- vaccina
Exclusive reservoir – human
Eradicated 8may 1980
Accidental laboratory spread 1978
Only two laboratories hold stocks-
Institute of Virus Preparations in Moscow, Russia
 CDC in Atlanta, USA

49. Potentioal biowarfare-
No vaccination after 1980
Highly contagious and aerosole
No subclinical stage or carrier state
High case fatality rate
Severe complication- hemorrhagic small pox

50. Lab diagnosis
collected by someone recently vaccinated with all PPE
 pustular fluid or scabs
 BSL-4
Presumptive diagnosis
electron microscopy rapid method
Serological- immunofluorescent assay, enzyme immunoassay
Immunoglobulin M capture
Immunoglobulin G enzyme-linked immunosorbent assay
Definative method
Viral culture
polymerase chain reaction (PCR) E9L, A25R, HA, HTI, crmB

51. Yersinia pestis aka pasteurella pestis .
Vector- rat flea (Xenopsylla cheopis ,X.astia)
Incubation period- 1-7 days
Plague

52. TOXINS

53. Summary of characteristics of selected bioterrorism agents
Agent
Incubation
period
Person-to-
person spread
Morbidiity/mor
tality if
untreated
Diagnosisa
B. anthracis 1-5 days Cutaneous High/high Culture,
serology
Y. pestis 2-3 days Yes High/high Culture,
serology
F. tularensis 2-10 days
Skin lesion
High/low Culture,
serology
Brucella spp. 5 days-2
months
No High/low Culture,
serology
Botulinum
toxins
1-5 days No High/high ELISA or mouse
inoculation for
toxin
detection
Variola virus 7-17 days Yes High/high Detection via
ELISA, PCR, or

54. Developing technologies
• Antibody fragments
• Aptamers and peptide ligands
• Biochips
• Evanescent wave biosensor
• Cantilever
• Microarray