This presentation provides an overview of bioterrorism, including: - Defining bioterrorism as the intentional release of viruses, bacteria, or other germs to harm humans, animals or crops. - Categorizing potential bioterrorism agents from Categories A-C based on factors like ease of dissemination and potential impact. Category A includes anthrax, plague, smallpox and viral hemorrhagic fevers. - Discussing the roles of public health in responding to potential bioterrorism through early detection, epidemiological investigation, communication and coordinating medical response including immunization, prophylaxis and treatment.

1. PRESENTATION ON
BIOTERRORISM
BY:--
BIJAY KUMAR MAHATO
BPH 2ND SEMESTER
PADMASHREE SCHOOL OF PUBLIC HEALTH

2. LEARNING OBJECTIVES
INTRODUCTION
BIOTERRORISM AGENTS
HISTORY
IMPACT ON HUMAN
WHY GERMS ARE USED
PUBLIC HEALTH ROLE AND RESPONSE
MEDICAL RESPONSE
TESTING IN PUBLIC HEALTH LABORATORY
PREVENTION
REFERENCE

3. INTRODUCTION
BIOTERRORISM
A biological attack, or bioterrorism, is the intentional release of
viruses, bacteria, or other germs that can sicken or kill people,
livestock, or crops.
• known as "germ warfare," biological weapons involve the use of
toxins or infectious agents that are biological in origin. This can
include bacteria, viruses, or fungi.
• These agents are used to incapacitate or kill humans, animals, or
plants as part of a war effort.

4. WHAT DO WE NEED TO KNOW?
• Understand the risk of bioterrorism
• Recognize a potential bioterrorist event
• Meet immediate care needs of patients
• Notify appropriate authorities
• Participate in coordinated emergency response

5. BIOTERRORISM AGENTS
BIOTERRORISM AGENTS / DISEASES
CATEGORY A
CATEGORY B
CATEGORY C

6. CATEGORY A
• Definition
• The U.S. public health system and primary healthcare providers
must be prepared to address various biological agents,
including pathogens that are rarely seen in the United States.
High-priority agents include organisms that pose a risk to
national security because they
 can be easily disseminated or transmitted from person to
person;
 result in high mortality rates and have the potential for major
public health impact;
 might cause public panic and social disruption; and

7. Cont….
Agents/Diseases
•Anthrax (Bacillus anthracis)
• Botulism (Clostridium botulinum toxin)
•Plague (Yersinia pestis)
•Smallpox (variola major)
•Tularemia (Francisella tularensis)
•Viral hemorrhagic fevers, including
• Filoviruses (Ebola, Marburg)
• Arenaviruses (Lassa, Machupo)

8. CATEGORY B
• Second highest priority agents include those that are:
• moderately easy to disseminate;
• result in moderate morbidity rates and low mortality rates; and
• require specific enhancements of CDC’s diagnostic capacity and
enhanced disease surveillance.

9. CONT…..
Agents/Diseases
•Brucellosis (Brucella species)
•Epsilon toxin of Clostridium perfringens
•Food safety threats (Salmonella species, Escherichia coli , Shigella)
•Psittacosis (Chlamydia psittaci)
•Q fever (Coxiella burnetii)
•Ricin toxin from Ricinus communis
•Staphylococcal enterotoxin B
•Typhus fever (Rickettsia prowazekii)
•Viral encephalitis (alphaviruses, such as eastern equine encephalitis, Venezuelan
encephalitis)
•Water safety threats (Vibrio cholerae, Cryptosporidium parvum)

10. CATEGORY C
• Third highest priority agents include emerging pathogens that
could be engineered for mass dissemination in the future
because of
 availability;
 ease of production and dissemination; and
 potential for high morbidity and mortality rates and major health
impact.
•Agents
 Emerging infectious diseases such as nipah virus and
hantavirus.

11. HISTORY OF BIOTERRORISM
• 1763-------French and Indian war, small pox
• WW 1st ----German program ; anthrax, glanders
• 1925--------Geneva protocol bans biological weapon
• WW 2nd ------Japanese program; anthrax, plegue, shigella
• 1979--------accidental release of B. anthracis spores at weapon
research centre swerdlovsk, USSR
• 1984 ------- Rajneesh cult member contaminate salad bar with salmonella
typhimurium in Oregon
• 2001 --------anthrax releases in FL, DC, NY, NJ

12. IMPACT ON HUMAN HEALTH
 High fever
 Headache
 emotional disturbances such as:
• Emotional numbness
• Horror and disgust at unfamiliar forms of injury
• Anger at authorities for failing to protect them
• Paranoia and xenophobia;
• Loss of trust and increased feelings of vulnerability
• Hopelessness and helplessness
• Survivor guilt

13. Cont…
• Many infectious diseases
Bacterial diseases
 eg. Anthrax, plague, botulism, typhoid, Q-fever, brucellosis and many
more….
 viral diseases
 eg. small pox , viral encephalitis and many more…

14. EPIDEMIOLOGICAL CLUES
• Unusual disease / symptoms (exotic disease)
• Epidemic numbers with similar syndromes
• Tight geographic cluster
• Unusual timing for endemic disease
• Rapidly increasing disease incidence in a healthy
population
• Multiple diseases in one patient
• Dead animals (especially multiple species)
• History of visible cloud
• Claims by aggressors
• Fulminant disease presentations

15. WHY GERMS ARE USED?
 Agents easy to manufacture
 Possible to attack covertly
 Psychological impact
 Potential economic impact
• Mainly inhaled - may be ingested or absorbed
• Particles may remain suspended for hours
• May be released silently with no immediate effect
• Person-to-person spread happens for some agents
• Long incubation periods mean "first responders
may be primary health care providers
• Agents may be lethal or incapacitating
• Vaccines antitoxins exist for some agents
•

16. CONT….
• Undetectable by our 5 senses
• Relatively inexpensive lt600X less Chem,lt800X
Nuc
• Relatively low-tech to make deliver
• Small amounts hard to trace Undetectable by our 5 senses
• Relatively inexpensive lt600X less Chem,lt800X
Nuc
• Relatively low-tech to make deliver
• Small amounts hard to trace
• Delay in symptoms anonymity
• Chance of mass casualties

17. PUBLIC HEALTH ROLE AND RESPONSE
Public Health Role
• Early Detection
• Mass Patient Care
• Mass Immunization/Prophylaxis
• Epidemiologic investigation
• Communication
• Command and Control
• Mass Fatality Management
• Evacuations/sheltering (humans and animals)
• Environmental Surety
•

18. MEDICAL RESPONSE
• active and passive immunization
• Prophylaxis.
• identification of threat/use.
• Incubation period.
• Diagnosis.
• antimicrobial or supportive therapy.
• Overt disease.
• Diagnosis.
• Treatment.
• direct patient care will predominate.

19. PUBLIC HEALTH ACTION
 Promptly investigate original case
 Confirm laboratory results
 Identify interview case contacts as needed
 Initiate active surveillance for additional cases
 Take immediate public health prevention action as
needed
 Alert local medical community/public
 Determine need for Rx of contacts/health
professionals
 Mobilize needed assets at local, provincial,
federal level
 Maintain contact with case family reporting MD

20. STRATEGIES
• Strategies
• Plans should be implemented for educating and reminding health-
care providers about how to recognize unusual illnesses that might
indicate intentional release of a biologic agent. Strategies for
responding to potential bioterrorism could include [7]
1. Providing information to health-care providers and clinical
laboratories about how to report events through the appropriate
fastest channel.
2. Reporting immediately to higher HQ if the results of an
investigation suggest release of a biologic agent. Implementing a
sustained capacity to receive and act on any positive report of
events that suggest intentional release of a biologic agent.

21. Cont…
3. Investigating immediately any report of a cluster of illnesses or other
event that suggests an intentional release of a biologic agent and
requesting assistance of a Preventive Medicine specialist when
necessary.
4. Implementing a plan, to collect and transport specimens and to
store them appropriately before analysis at designated laboratories.
5. Reporting immediately to higher HQ if the results of an investigation
suggest release of a biologic agent.

22. DIAGNOSIS IN PUBLIC HEALTH
LABORATORY
• Open and examine package in a negative pressure
containment lab using level 3 protection.
• Gram stain, /- spore stains for bacteria on any
material (powder, etc.) present.
• Cultures, motility, biochemicals as required.
• Testing performed while maintaining chain of
custody procedures and evidence documentation.
• preserve DNA, fingerprints, handwriting

23. PREVENTION
• EDUCATION
• Awareness
• Development of Contingency Plans
• Focus on Class A Agents
• Avoidance of High Risk Areas
• Use of mass inoculations
• Rapid delivery of pharmaceuticals

24. How can you protect yourself from
bioterrorism?
• Depending on the situation, wear a face mask to reduce
inhaling or spreading germs. If you have been exposed to a
biological agent, remove and bag your clothes and personal
items. Follow official instructions for disposal of contaminated
items. Wash yourself with soap and water and put on clean
clothes.
•

25. REFRENCE
www.cdc.gov.in
www.medicine.in

26. THANKS
FOR YOUR ATTENTION