3 BS PHARMACY | PHARM 33

Universityof SouthernMindanao-Kabacan PUBLIC HEALTH PHARMACY

College of Health Sciences
Department of Pharmacy

TOPIC 1: BIOLOGICAL WARFARE

BIOLOGICAL WARFARE vs. BIOTERRORISM
DEFENITIONS:
BIOLOGICAL WARFARE
Biological Warfare Attack

• Also known as germ warfare.

• Intent is to conquer through incapacitation or lethality
• Use of biological toxins or infectious agents • Little concern about deniability
(bacteria, viruses, fungi). • Likely to involve a delivery device
• Aimed at harming or incapacitating humans, • Dose-response optimized
animals, or plants. • Self-protection is considered
• Considered an act of war by a state or nation.
Terrorist Attack
ENTOMOLOGICAL WARFARE • Attention to a cause
• Fear and disruption
• “Insect warfare”; a type of biological warfare. • Economic impact
• Social and political pressures to change our will and
BIOLOGICAL AGENTS (BIOWEAPONS): society.
Living organisms or viruses that replicate within hosts to
cause harm. HISTORY AND EVOLUTION ANCIENT HISTORY

MID-SPECTRUM AGENTS

Toxins and Psychochemical weapons

• Do not reproduce in host
• Shorter incubation period
• Covered under both biological weapons convention and
chemical weapons conventions

TOXIN
• Non-living
• Poisonous substance produced by many types of
living beings

BIOTERRORISM
• The intentional use of microorganisms or toxins
derived from living organisms to produce death or
disease in humans, animals, or plants

• The deliberate use or threat of use of biological

agents as weapons to cause death or disease with
the aim of spreading panic to achieve ideological,
religious, or political goals by non-state individuals
or groups

• Usually on a smaller scale than warfare

• No concern of epidemicity or controlled spread

• Usually targets humans, rather than animals or

crops
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 3 BS PHARMACY | PHARM 33
Universityof SouthernMindanao-Kabacan PUBLIC HEALTH PHARMACY
College of Health Sciences
Department of Pharmacy
DEFENSIVE OPERATIONS:
● Disease Surveillance Systems:
Early detection of bioweapons
● Identification of Bioweapons:
Diagnosing and mitigating threats.

Identification of Bioweapons:
This involves identifying the specific biological agent that
is being used in an attack.

It's crucial for developing effective treatment and

countermeasures. This process often involves:
○ Security agencies: They gather intelligence on
potential threats.
○ Medical professionals: They diagnose the
disease and identify the agent.
BIOLOGICAL WARFARE OPERATIONS ○ Public health officials: They coordinate the
response to the outbreak.
Biological Warfare: This is using biological agents (like ○ Specific field tools: These are used to perform
bacteria, viruses, or toxins) as weapons to harm or kill on-the-spot analysis of suspect materials.
people, animals, or crops. It's like a weaponized version of Examples include ELISA tests and nanowire-
spreading a disease. based detection systems.

Operations: This refers to the actions and strategies used

to carry out biological warfare. These operations can be:

○ Offensive: Attacking the enemy with biological agents. AGENTS OF BIOLOGICAL WARFARE
○ Defensive: Protecting yourself from biological attacks.
Key Features of Biological Agents used as
OFFENSIVE OPERATIONS: Bioweapon
● High morbidity and mortality
● Potential for person-to-person spread
● Low infective dose and highly infectious
by aerosol
Using biological agents to ● Lack of rapid diagnostic capability
harm or incapacitate human
beings. Think of it as targeting ● Lack of universally available effective
individuals directly. The goal is vaccine
to make them sick or unable
to fight. ● Potential to cause anxiety
● Availability of pathogen and feasibility of
production
● Environmental stability
This targets animals, primarily ● Database of prior research and
livestock, to disrupt food
supplies or cripple agricultural development
production. ● Potential to be “weaponized”

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 3 BS PHARMACY | PHARM 33
Universityof SouthernMindanao-Kabacan PUBLIC HEALTH PHARMACY
College of Health Sciences
Department of Pharmacy
CDC Category A, B and C Agents

CATEGORY A: High priority agents

● Easily disseminated or transmitted from person to
person
● High mortality rates
● Potential for major public health impact
● Might cause public panic and social disruption
● Require special action for public health
preparedness

ANTHRAX EXAMPLE

CATEGORY B: 2nd Highest priority agents PLAGUE

● Moderately easy to disseminate
● Moderate morbidity rates and low mortality rates
● Require specifically enhanced diagnostic capacity

CATEGORY C: Emerging pathogens

● General population lacks immunity
● Could be engineered for mass dissemination in the
feature because of availability
● Ease of production, ease of dissemination
● Potential for high morbidity and mortality
● Major public health impact

ANTHRAX

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 3 BS PHARMACY | PHARM 33
Universityof SouthernMindanao-Kabacan PUBLIC HEALTH PHARMACY
College of Health Sciences
Department of Pharmacy

BOTOLINUM TOXIN

SMALLPOX TULEREMIA

CHOLERA

HEMORRHAGIC FEVER VIRUSES

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 3 BS PHARMACY | PHARM 33
Universityof SouthernMindanao-Kabacan PUBLIC HEALTH PHARMACY
College of Health Sciences
Department of Pharmacy

Advantages:

1. Multiple methods for delivery

2. Wide utility : non-discriminating; cause sickness,
death, panic; may disseminate widely; may be persistent
3. Good logistics: cheap to make and store
4. Versatile : can be in small or large quantities
5. Defense may be difficult
6. Cause no damage to infrastructure
7. Easy to conceal
8. "Status" WMD: "poor man's nuclear weapon"

Disadvantages:
1. Slow onset (except for toxins)
2. Indiscriminate
3. Difficult to control distribution (IF contagious)
4. Preventive and/or treatment measures are available
for some
5. Level of technical sophistication is required for
effective delivery
6. International taboo (deterrent to state/nations)

• Spray systems (aerial and aerosol based)

• Non-traditional (food, water supplies, animals, insects)

TREATIES AND CONVENTION

WEAPONIZATION
Early Restrictions (Before the 20th Century)
• It is the process of converting the biological agent into a
usable weapon ● Biological agents were considered “poisons” along
• Delivery Devices: with chemical weapons.
• Bombs ● Various treaties aimed to ban or restrict their use:
• Missiles

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 3 BS PHARMACY | PHARM 33
Universityof SouthernMindanao-Kabacan PUBLIC HEALTH PHARMACY
College of Health Sciences
Department of Pharmacy
Geneva Protocol (1925) USA’S BioWATCH
● Network of detectors across US to detect
bio-agents.
● Also stockpiles vaccines and medicines
for biological threats.

WHO’s Global Outbreak Alert and

Response Network (GOARN)
● Works for both biological warfare agents
as well as other communicable diseases.

World Health Assembly (2001)

Biological Weapons Convention (BWC) – 1972 ● Mandated the Director General to “provide
technical support to Member States for
developing or strengthening preparedness
and response activities against risks posed
by biological agents.

PUBLIC HEALTH IMPORTANCE

● Most bio-agents are communicable diseases

● Usually 1st identification is by public health
professionals and/ or physicians
● Biological weapons have brought together
security/defense establishment and public health
● Biological weapons preparedness adds some
elements to public health.

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 3 BS PHARMACY | PHARM 33
Universityof SouthernMindanao-Kabacan PUBLIC HEALTH PHARMACY
College of Health Sciences
Department of Pharmacy

Examples:
TOPIC 2:DISEASE PREVENTION AND CONTROL
• rehabilitation programs
• counselling and peer support
DISEASE PREVENTION • physical and occupational therapy
➢ Activities designed to protect patients and other
members of the public from actual or potential EARLY DIAGNOSIS
health threats and their harmful consequences. ➢ The identification of a disease or condition as
➢ It aims to reduce the occurrence and impact of soon as the first signs and symptoms appear.
diseases through proactive measures. IT IS NEEDED FOR:
Disease prevention is categorized into differet levels to a. Treatment of patient
address health risks at various stages b. Epidemiological investigation
LEVELS OF PREVENTION
c. Studying the time, place, and person distribution
1. PRIMORDIAL PREVENTION
➢ Focuses on preventing the emergence of risk d. Institution of prevention and control measures
factors associated with diseases.
➢ Focuses on improving social, economic, and NOTIFICATION
environmental conditions to create healthier ➢ Once an infectious disease has been discovered
communities. or suspected, it should be notified to the local
health authority.
Examples:
DISEASES UNDER SURVEILLANCE BY THE WHO:
• Policies on food and nutrition Promoting regular a. Louse borne typhus fever
exercise
b. Paralytic polio
2. PRIMARY PREVENTION
➢ Aims to prevent diseases before they occur. c. Viral influenza A
➢ Involves health education, vaccinations, and
lifestyle changes to reduce risk factors. d. Smallpox
Examples: e. Relapsing fever
• routine immunization programs, anti- smoking f. Malaria
campaigns, and encouraging regular exercise.
g. SARS
3. SECONDARY PREVENTION
➢ defined as “action which halts the progress of a EPIDEMIOLOGICAL INVESTIGATION
disease at its incipient stage and prevent ➢ An investigation that identifies the source and
complications.” factors influencing outbreaks to control and
➢ aims to reduce the impact of a disease or injury prevent disease transmission.
that has already occurred. 1. SOURCE OF INFECTION
Examples: ➢ refers to the origin of an infectious agent from
which individuals contract a disease.
• Regular exams and screening tests (e.g., • Common Source
mammograms) for early disease detection. • Point Source
• Daily, low-dose aspirin and lifestyle changes to • Continuous Source
prevent progression of heart disease or stroke. • Propagated Source
4. TERTIARY PREVENTION
➢ used when the disease process has advanced
beyond its early stages.
➢ aims to enhance quality of life for individuals with
chronic conditions while minimizing the impact of
the disease.

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 3 BS PHARMACY | PHARM 33
Universityof SouthernMindanao-Kabacan PUBLIC HEALTH PHARMACY
College of Health Sciences
Department of Pharmacy

2. FACTORS INFLUENCING SPREAD INTERRUPTION OF TRANSMISSION

• Geographical situations ➢ refers to the measures taken to break the chain
• Climatic condition, Social and Behavioral of infection and prevent a disease from
Patterns spreading.
• Agent & Transmission - pathogen, Examples:
reservoirs, vectors
• Isolation, Vaccination,Vector
ISOLATION control,Personal hygiene, Public health education
➢ Isolation is the separation of infected persons or
animals during the communicable period to ACTIVE & PASSIVE IMMUNIZATION
prevent the spread of infection. ACTIVE IMMUNIZATION
➢ stimulates the immune system to produce long-
PURPOSE: term immunity
➢ Limits direct or indirect transmission to ➢ induced by vaccines containing antigens
susceptible individuals. (weakened, inactivated, or parts of pathogens)
DURATION: Examples:
Varies based on disease communicability and
treatment effects. • Live attenuated vaccines (e.g., MMR,
Varicella)
Examples: • Inactivated vaccines (e.g., Hepatitis A,
Influenza)
a. Chickenpox - isolation lasts until all lesions are
• Toxoid vaccines (e.g., Tetanus, Diphtheria)
crusted, usually around 6 days after rash onset.
b. Measles - Isolate for 4 days after rash onset PASSIVE IMMUNIZATION
(airborne transmission). ➢ provides immediate but short-term immunity
using preformed antibodies.
TREATMENT ➢ given when immediate protection is needed
OBJECTIVES:
1. To kill the infectious agent when it is still in the Examples:
reservoir before it is disseminated.
2. Reduce the communicability of disease. • Maternal antibodies (passed through
placenta or breast milk)
3. Cut short the duration of illness and
• Monoclonal antibodies (e.g., Palivizumab for
4. Prevent development of secondary cases. RSV)
QUARANTINE • Immune globulin injections (e.g., Rabies,
➢ the separation and restriction of movement of Hepatitis B post-exposure prophylaxis)
individuals who have been exposed to a (Active immunization lasts longer but takes time to
contagious disease but are not yet ill. develop; passive immunization is immediate but
TYPES OF QUARANTINE: temporary)
1. ABSOLUTE
➢ The strictest form of quarantine.
➢ For highly contagious diseases.
2. MODIFIED

➢ allows limited interaction with others (e.g. family,

caregiver)
➢ Restricting potential exposure to the wider
community.
3. SEGREGATION
➢ separating individuals. who are susceptible to a
disease but not yet infected from those who are
already ill.

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 3 BS PHARMACY | PHARM 33
Universityof SouthernMindanao-Kabacan PUBLIC HEALTH PHARMACY
College of Health Sciences
Department of Pharmacy

CHEMOPROPHYLAXIS SURVEILLANCE
➢ Chemoprophylaxis is the use of drugs to ➢ It is the continuous scrutiny of all aspects of
prevent infections or diseases before exposure or occurrence and spread of disease that are
in early stages. It is commonly used in infectious pertinent to effective control. The ultimate
disease control and high- risk situations. objective of surveillance is “PREVENTION”
Surveillance must follow control measures.
TYPES OF CHEMOPROPHYLAXIS:
4 TYPES OF SURVEILLANCE
PRE-EXPOSURE PROPHYLAXIS (PREP):
INDIVIDUAL SURVEILLANCE
➢ Taken before potential exposure to prevent
infection ➢ monitoring infected person until they are no longer
Example: a significant risk to other individual.
• PrEP for HIV prevention
(Tenofovir/Emtricitabine) LOCAL POPULATION SURVEILLANCE

POST-EXPOSURE PROPHYLAXIS (PEP): ➢ monitoring diseases at a community or city.

➢ Taken after potential exposure to prevent
NATIONAL POPULATION SURVEILLANCE
disease development
➢ monitoring diseases at a country, especially those
Example:
that have been eliminated but need to be
• Rabies vaccine after an animal bite watched for potential re-emergence.
ROUTINE PROPHYLAXIS: INTERNATIONAL SURVEILLANCE –
➢ Used for continuous prevention in individuals
who are at ongoing risk of infection due to ➢ The World Health Organization (WHO) and other
medical conditions, environment, or occupational global agencies track diseases worldwide.
exposure
Example:

• Atovaquone-proguanil (Malarone) taken taken

before, during, and after travel to malaria-
endemic regions
PERIOPERATIVE PROPHYLAXIS:
➢ Antibiotics given before surgery to prevent
infections
Example:

• Cefazolin before major surgeries

NON-SPECIFIC MEASURES
➢ These are general public health interventions that
help control and prevent the spread of diseases
but do not target specific pathogens.
• Interrupt pathways of transmission
• Improvements on the quality of life
• Formulation of legislative measures and
integrated programs
• Have played a dominant role in decline of
diseases like TB, Cholera, Leprosy and Child
Mortality

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