DR.
ARISHAH JAWED
DEPARTMENT OF COMMUNITY
HEALTH SCIENCES
DEFINITION:
Bioterrorism is the unlawful use of microorganisms or
toxins derived from living organisms to produce death
or disease in humans, animals, or plants.
The act is intended to create fear, inflict injury and/or
death, and to intimidate governments or societies in
the pursuit of political, religious or ideological goals.
Why Biological Agents Are Preferred
For Terrorism?
Biological agents are likely to be used by
terrorists as weapons because:
• They are capable of damaging
populations, economies, and food supplies.
• They cause fear, panic and social disruption.
• They are inexpensive / relatively easy to produce
• Cost: (1970 Study - Cost of 50% casualties over a one
sq/km area)
• Conventional weapons - $2,000
• Nuclear - $800
• Chemical - $600
• Anthrax - $1
Characteristics of biological agents that could
be used as bioterrorist agents
• They have a wide range of effects
• They are easily made by relatively unsophisticated
methods
• They are invisible to the senses
• Their effects may be delayed
• They can produce mass casualties
Routes Of Entry Into The Human Body
•Ingestion
•Dermal penetration
•Inhalation
Delivery Mechanisms
❖ Aerosol route
• Easy to disperse
• High number of people exposed
• Most infectious
• Undetectable to humans
❖ Food / Waterborne less likely
• Larger volumes required
• More technically difficult
Era of Modern Microbiology
• 1915-18 –World War I – German BW Program:
• Developed anthrax, glanders, cholera, and
wheat fungus as weapons .
• 1932-1945 – World War II – Japanese BW Program:
• Operated a secret facility (Unit 731) testing BW
agents on Chinese prisoners
2001- Anthrax via Mail
• A week following the attacks of Sept. 11, letters laced with anthrax
arrive via mail at the offices of NBC News and the New York Post in
New York and Washington, D.C. By year’s end, 18 people had
tested positive for anthrax and five had died of anthrax inhalation.
Bioterrorism Agent Categories
Category A
These agents include organisms or toxins that pose the
highest risk to the public and national security because:
• They can be easily spread or transmitted from person to
person
• They result in high death rates
• They require special action for public health preparedness
• Example: Anthrax, Botulism, Smallpox etc
Category B
These agents are the second highest priority because:
• They are moderately easy to spread
• They result in moderate illness rates and low death rates
• They require enhanced disease monitoring
• Example: Calcivirus, Hepititis A, [Link] etc
Category C
These third highest priority agents include emerging
pathogens that could be engineered for mass spread in the
future because:
• They are easily available
• They are easily produced and spread
• They have potential for high morbidity and mortality rates
and major health impact.
• Example: Influenza, MDR-TB, SARS etc
Common Agents for Bioterrorism-
Anthrax
2.2 KG’S OF ANTHRAX SPRINKLED FROM A 20TH
FLOOR HIGH RISE IN NEW YORK CITY WOULD KILL /
INFECT OVER 120,000 PEOPLE
Cause
Bacillus anthracis, encapsulated, aerobic, gram-
positive, spore-forming, rod-shaped (bacillus)
bacterium
System Affected
•Skin or Cutaneous (most common)
•Respiratory tract or Inhalational (rare)
•Gastrointestinal tract (rare)
•Oropharyngeal form (least common)
Transmission
• Skin: direct skin contact with spores; in nature, contact with
infected animals or animal products (usually related to
occupational exposure)
• Respiratory tract: inhalation of aerosolized spores
• GI: consumption of undercooked or raw meat products or
dairy products from infected animals
• NO person-to-person transmission of inhalation or GI
anthrax
Common Agents for Bioterrorism-
Botulism
Agent
•Toxin produced by Clostridium botulinum, an
encapsulated, anaerobe, gram-positive, spore-
forming, rod-shaped (bacillus) bacterium.
Disease
Botulism is a neuroparalytic (muscle-paralyzing)
disease. There are four forms of naturally occurring botulism:
• Food borne botulism
Caused by ingestion of pre-formed toxin
• Infant botulism
Caused by ingestion of C. botulinum which produces toxin in
the intestinal tract
• Wound botulism
Caused by wound infection with C. botulinum that secretes the
toxin
• Adult intestinal colonization
Rare, caused when C. botulinum colonizes the intestinal tract
of children or adults, usually with gastrointestinal
abnormalities
Botulinum Toxin as a Biological
Weapon
Aerosolized botulinum toxin is a possible mechanism
for a bioterrorism attack
• Botulism is not transferred from person to person
• Indications of intentional release of a biologic agent may
include:
• An unusual geographic clustering of illness
(e.g., persons who attended the same public
event or gathering)
• A large number of cases of acute flaccid paralysis with
prominent bulbar palsies, especially if occurring in
otherwise healthy persons
Sign & Symptoms
• Difficulty swallowing or speaking, dry mouth
• Diplopia (double vision), blurred vision, dilated or non-
reactive pupils, ptosis (drooping eyelids)
• Symmetric descending weakness
• respiratory dysfunction (requiring
mechanical ventilation)
• Descending flaccid paralysis
• Intact mental state
• No sensory dysfunction
• No fever
• Constipation more common in infant botulism
Diagnosis & Lab Reporting
• Diagnosis: history and clinical exam
• Laboratory confirmation:
• Demonstrating the presence of toxin in serum,
stool, or food
• Culturing C. botulinum from stool, wound or food
Treatment
• Prompt diagnosis is essential
• Antitoxin is effective in reducing the severity of
symptoms, if administered early
• Supportive care as needed, including mechanical
ventilation
Control Measures
• When inhalational exposure is anticipated, some
protection may be conferred by covering the mouth
and nose
• After exposure to botulinum toxin, clothing and skin
should be washed with soap and water
• Contaminated objects or surfaces should be cleaned
with 0.1% hypochlorite bleach solution
Clinical Presentations and Syndromic Diflerential Diagnoses of Selected Agents of Bioterror ism
Few doye of non epecifi c “flu Iike” eympt orrie with Inhslotiono I onth mx B octeriol medisstî nitic, tulororri io, ri p6u red oortic sneurysm , S‘.’C
nausea, emesis, cou gh +/- chest dTcomfort, out syndro rne, hTtoglasmosis, to tcidioido rrrycosis, Q fever,
coryziz or rhino rrhea—+ Erupt onset of psittctosis, Legionna ires' dioease, influeriza,
respirmory distress +/- shock +/- mental sarco idos s
status changes, with CXR abnormalities
(wide mediastinum, infiltrates,
tluse sple er oite, atygiM Lyme disease, stap
papuIe—+yesicJ@s)—+uIcer—+edematous black nyloco tcizl lesion, Or, glu ders, tularemia, rm-bite
eschew fever, e cthyma
-w’ mocoiue edema and regions I oden-apathy, +/
g on grenosu m , pl ogue , ri ckettsillpot, stygic sJ
Meyer, evolving over 3-7 days
mycobact*ria, diphtheria
Cough, fever, d yspnea, hemogtysis, lung Pneumonic plague Severe kccterial or viml pneumonia, inhalation al uthrax,
c oneolf do6on +/ ehock puImo nsry Infor eg puImo nsry he rnorrhoge
Sepsis, DIC, purgum, acrrd gangrene Primary septicemic plague ktenirtg ocotcemia; Gmm-negative, streptococcal,
prteumo toctaI or hy1ococcal bcctere mia with sh
ock; overwhel mi n-g port eplenectomy eegeie. ocwte Ieukemis
Synchronous, progressN'e 5mallpox Atygicrd varicella, drug eruption, Stevens—Johnson
popular—+ve cular—+pustular msh on late, syndrome, apical measles, setondcry syqnilrs,
extremities.•.•trunk—+generaIization +/-
erytnema multiforme, meningotc•ccemia, monkeypax
(with African
hemorrhagit trsvel histcry )
compo n-cnt, with systcmic toñciry
Atute febrile illness wah pleuroprieumonitÌs, Inhalations I tularemia Inhalational anthmx, influenza, mycoplusma
brorichiolitÌs +/- hilar lymphadenogathy, pneumonia, Legionnaire's disease, Q lever, plague
varia bIe progmooion to mopirotory foflum
Atute onset of aleb rile, symmetric, desce nding Brain stem C‘/A, polio, mycsthenia gmvis, G
IIactid paraly s that begins in bulbar muscles, villain-Barre syildrome titk pamlysis, the micizl
dflotod pupiIo, dry m u co os membrane o with n-ormal intoxlciztion
mental status and absen ce of sen so n/ chan
ges
Response to Bioterrorism
The response to bioterrorism may involve:
• Surveillance and contact tracing
• Isolation or quarantine of persons
• Crowd control
• Safe disposal of corpses and infectious wastes
• Preventing contamination of food and water
• Providing information to the public and answering their questions
• Providing mental health support
Events Suggesting the Release of a
Bio weapon
▪ Multiple people ill at the same time (epidemic)
▪ Previously healthy persons affected
▪ High morbidity and mortality among affected
individuals
▪ Identification of diseases and pathogens unusual to a
particular region
▪ Recent terrorist claims or activity
Roles of Primary
Roles of Clinicians
Health Workers
•For specific Bioterrorism (BT) diseases
• Recognize typical BT disease syndromes
• Perform appropriate diagnostic testing
• Initiate appropriate treatment/prophylaxis
• Report suspected cases to proper authorities
Thank you