BIOLOGICAL WARFARE

PRESENTED BY: DR. TIMIRESH KUMAR DAS

MODERATOR: DR. ANITA VERMA

ASSOCIATE PROFESSOR
DEPT. OF COMMUNITY MEDICINE
DEFINITIONS:
 Biological warfare (also known as germ warfare)
is the use of biological toxins or infectious agents
such as bacteria, viruses, and fungi with intent to
kill or incapacitate humans, animals or plants as
an act of war by a state or nation.1

 Entomological (insect) warfare is also

considered a type of biological warfare.
DEFINITIONS:
 Biological agents ("bio-weapons") are living
organisms or replicating entities (viruses) that
reproduce or replicate within their host to cause
harm.2

 They are microorganisms such as viruses,

bacteria or fungi that infect humans, livestock or
crops and cause an incapacitating or fatal
disease. Symptoms of illness do not appear
immediately but only after a delay, or
‘incubation period’, that may last for days or
weeks.3
DEFINITIONS:
 Mid-spectrum agents: Toxins and
Psychochemical weapons.
 Do not reproduce in host,
 Shorter incubation period.
 Covered under both Biological weapons convention
and Chemical weapons convention.

 Toxin : Non-living, poisonous substance

produced by many types of living beings,
including animals, plants and bacteria.2
DEFINITIONS:
 Bioterrorism: The intentional use of
microorganisms, or toxins, derived from living
organisms, to produce death or disease in
humans, animals or plants.3
 The deliberate use or threat of use of biological
agents as weapons to cause death or disease
with the aim of spreading panic order to achieve
ideological, religious or political goals by non
state individuals or groups.4
 Usually on a smaller scale than warfare.
 No concern of epidemicity or controlled spread.
 Usually target humans, rather than animals or crops.
Biological warfare vs Bioterrorism

 Biological warfare attack:

 Intent is to conquer through incapacitation or
lethality
 Little concern about deniability
 Likely to involve a delivery device
 Dose-response optimized
 Self-protection is considered
Biological warfare vs Bioterrorism
 Terrorist attacks are about:
 Attention to a cause
 Fear and Disruption
 Economic impact
 Social and political pressures to change our
will and society
HISTORY AND EVOLUTION
 Ancient history:
 6th century BC – Assyrians poisoned wells with
decomposing rye ergot (Claviceps purpura)
 400 BC – Scythian archers dipped arrows in
decomposing bodies and faecal matter.
 300 BC – Greeks and Romans – dead animals in wells.

 190 BC – Battle of Eurymedon – Snakes in

earthenware pots fired on ships by Hannibal.
HISTORY AND EVOLUTION
 Medieval period:
 1155 – Battle of Tortona, Italy – Barbarossa put human
corpses in enemy water supply.

1346 – Battle of
Kaffa – Plague
outbreak in Tartar
army – corpses of
infected soldiers
hurled back –>
epidemic 
Christian Genoese
sailors fled to Italy
Resulted in the
European Plague of
Black Death.
HISTORY AND EVOLUTION
 1767 - French and Indian War
 Indians greatly outnumbered the British and were
suspected of being on the side of the French
 Sir Jeffrey Amherst, Commander of British Forces,
directs that small-pox bearing blankets be given
to Indians in the Ohio River Valley.
 Smallpox decimated the Indians
HISTORY AND EVOLUTION
 World War 1:
 Germany
 Developed anthrax, glanders, cholera and wheat
fungus.
 Attempted to spread Cholera in Italy and Plague in
St. Petersburg.
 Infected horses in US ( Baltimore) with anthrax
developed by Dr. Anton Dilger.
 France
 Planned biological sabotage programme against
German livestock – pigs and cattle.
HISTORY AND EVOLUTION
 World War 2:
 Japan –
 Unit 731 in Manchuria, China. Dr. Ishii Shiro.
 Human experiments.
 Used typhoid warheads against Russians in 1939.
 Contaminated wells with typhoid in Harbin, China
(1939-40)
 Caused cholera outbreak in Changchun (1940).
 Used plague infested rats in Nanking (1941).
 Operation Sei-Go (Scorched Earth) (1942).
Unit 731 headquarters: The square building.
HISTORY AND EVOLUTION
 World War 2:
 Germany –
 Suspected of producing and using biological agents
 Not proved.
 Hitler persuaded by microbiologists and doctors not
to use?

 Soviet Union –
 Weaponised Bacillus anthracis,Clostridium
botulinum , Yersinia pestis and foot-and-mouth
disease virus.
 Developed missiles with biological warheads.
 Did not use during war.
HISTORY AND EVOLUTION
 World War 2:
 United Kingdom –
 Paul Fildes headed Bacteriological Warfare
Subcommittee.
 Developed cattle cakes with Anthrax.
 Aerosolised anti-personel agents developed.
 Gruinard island used for testing of Anthrax bombs.
Decontaminated in 1987.

 US & Canada –
 Mostly anti animal and plant agents.
 Developed Anthrax and Botulinum toxin bombs.
 Also developed vaccines against rinderpest and botulin
toxin.
Gruinard Island, Scotland
The Black Maria was the first laboratory facility built to
accommodate top secret research in US. Ft. Detrick, Maryland.
HISTORY AND EVOLUTION
 Recent times:
 Biological warfare to bioterrorism
 1979 – Accidental leak of Anthrax spores in Sverdlosk,
USSR  66 people dead.
 Iraq (1985 – 1995) – Developed bombs, rockets and
missiles armed with botulin, anthrax and aflatoxin.
 South Africa (1981-1994) – Developed toxins for political
assassinations . Anti fertility vaccine against blacks.
 1984 – 751 people infected with Salmonella by followers
of Bhagwan Rajneesh in salad bars in Oregon, USA.
 2001 – Anthrax spores through mail in US. 22 cases, 5
deaths.
BIOLOGICAL WARFARE OPERATIONS
 Offensive:
 Anti-personnel:
 high infectivity, high virulence, non-availability of
vaccines, availability of an effective and efficient
delivery system and stability of the weaponized
agent.
 Bacteria such as B. anthracis, Brucella spp., V.
cholerae, Y. pestis, etc.
 Viral agents such as Variola virus, JE virus, Ebola
virus, Marburg virus, and Yellow fever
 Fungal agents like Coccidioides spp.
 Toxins like ricin, staphylococcal enterotoxin B,
botulinum toxin.
BIOLOGICAL WARFARE OPERATIONS
 Offensive:
 Anti livestock
 Foot-and-mouth disease and rinderpest against
cows,
 African swine fever for pigs
 Psittacosis to kill chicken.
 Anthrax against cattle and draught animals
 Glanders in horses.
 Anti crop/ anti vegetation
 Bioherbicides (used by British & US in Vietnam)
 Wheat blast & Rice blast were weaponised by US &
USSR
BIOLOGICAL WARFARE OPERATIONS
 Offensive:
 Entomological warfare
 Uses insects to attack the enemy
 Infecting insects with a pathogen and then
dispersing the insects over target areas
(cholera, plague)
 Direct insect attack against crops
 Uninfected insects, such as bees, to directly
attack the enemy.
BIOLOGICAL WARFARE OPERATIONS
 Defensive:
 Disease surveillance systems
 Most biological warfare agents are primarily animal
pathogens  animals affected earlier.
 Surveillance systems include public health
specialists and veterinarians.
 Early warning helps reduce morbidity & mortality.
 E.g. In Anthrax infections almost 80% of exposed
persons can be given antibiotics before
development of symptoms if the surveillance and
early warning systems are good.
BIOLOGICAL WARFARE OPERATIONS
 Defensive:
 Identification of bioweapons (Diagnosis)
 integrate the sustained efforts of the security agencies,
medical, public health, intelligence, diplomatic, and law
enforcement communities.
 Doctors & public health officers - 1st line of defence.
 First Gulf War - United Nations activated a biological and
chemical response team, Task Force Scorpio.
 Specific field tools that perform on-the-spot analysis and
identification of encountered suspect materials.
 Multiple sandwich ELISA using gold & silver nanowires.
 BiosparQ developed by TNO Labs, Netherlands.
 BioPen by Ben Guiron Labs, Israel.
AGENTS OF BIOLOGICAL WARFARE
Key Features of Biologic Agents Used as Bioweapons
1. High morbidity and mortality
2. Potential for person-to-person spread
3. Low infective dose and highly infectious by aerosol
4. Lack of rapid diagnostic capability
5. Lack of universally available effective vaccine
6. Potential to cause anxiety
7. Availability of pathogen and feasibility of
production
8. Environmental stability
9. Database of prior research and development
10. Potential to be "weaponized"
AGENTS OF BIOLOGICAL WARFARE
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
 Category B: 2nd highest priority
 moderately easy to disseminate,
 moderate morbidity rates and low mortality rates
 require specifically enhanced diagnostic capacity
AGENTS OF BIOLOGICAL WARFARE
CDC Category A, B, and C Agents
 Category C: emerging pathogens
 general population lacks immunity,
 could be engineered for mass dissemination in the future
because of availability,
 ease of production, ease of dissemination,
 potential for high morbidity and mortality, and
 major public health impact.
CATEGORY A
Anthrax (Bacillus anthracis)
Botulism (Cl. botulinum toxin)
Plague (Yersinia pestis)
Smallpox (Variola major)
Tularemia (Francisella tularensis)
Viral hemorrhagic fevers: Lassa,
New World (Machupo, Junin,
Guanarito,Sabia), Crimean Congo,
Rift Valley, Ebola, Marburg
CATEGORY B CATEGORY C
Psittacosis (Ch. psittaci) (Emerging
infections)
Epsilon toxin of Cl. Perfringens Hantavirus
Melioidosis (B. pseudomallei) SARS coronavirus,
Glanders (Burkholderia mallei) Pandemic influenza
Food safety threats (e.g., Nipah
Salmonella spp., E.coli O157:H7,
Shigella)
Viral encephalitis [alphaviruses
(e.g., Venezuelan, eastern, and
western equine encephalitis)]
Brucellosis (Brucella spp.)
Q fever (Coxiella burnetii)
Ricin toxin from Ricinus communis
(castor beans)
Staphylococcal enterotoxin B
Water safety threats (e.g., V.
cholerae, Cr. parvum)
Anthrax (Bacillus anthracis)
 Infection – By cutaneous and inhalational route
 Signs/Symptoms-
Cutaneous Pulmonary
95% cases 5% cases
1-5 days 1-6 days (60 days)
Fever, tiredness, headache Fever, Headache, Cough
Pustules, eschar Dyspnea, Chest pain

 Diagnosis :
 Skin biopsy for cutaneous
 Blood culture
 ELISA, PCR
Day 5 Day 12

2 months
 Hilar prominence and
right perihilar infiltrate

widened mediastinum,
perihilar infiltrates,
peribronchial cuffing,
air bronchograms.
Anthrax (Bacillus anthracis)
 Treatment :
 Ciprofloxacin, Penicillin, Doxycycline.
 Treated for 60 days.

 Prevention:
 Vaccination – 6 doses over 18 months, booster anually.
 Chemoprophylaxis – Cipro/ Doxy 4 weeks before
exposure.

 Infectious form: Spores

 Hardy, resistant to environmental conditions.
 Relatively easy to weaponise.
Anthrax (Bacillus anthracis)
 Example:
 September 2001, Anthrax used as bioweapon
through US Postal system.
 22 cases (18 confirmed) – 11 inhalational + 11 cut. (7 + 4)
 5 deaths ( all among inhalational)
 Ames strain used. (beta lactamase + cephalosporinase);
but luckily susceptible to antibiotics.
 Maximum amount of spore in a letter – 2g (100 billion to
1 trillion spores) [ LD 50 = 10000]
Geographic location, clinical manifestation, and outcome of
the 11 cases of confirmed inhalational and 11 cases of
confirmed cutaneous anthrax.
Epidemic curve for 18 confirmed cases of inhalational and
cutaneous anthrax and additional 4 cases of suspected
cutaneous anthrax.
Letter sent to NBC anchor Tom Brokaw with cutaneous
anthrax. Infected Brokaw's assistant, Erin O'Connor.
Plague (Yersinia pestis)
 Highly contagious.
 Pneumonic plague is most severe.
 Signs/ Symptoms:
Bubonic Septicemic Pneumonic
Due to infection Usually from Due to
through skin bubonic plague inhalational
exposure
Fever, Chills, Fever, Chills, 24 hours
Nausea, Vomiting Nausea, Vomiting

Buboes (1-8 days) Bleeding in skin, Cough with blood

Ischemia in limbs tinged sputum.
Bubo

Ulcer
Plague (Yersinia pestis)
 Diagnosis:
 Clinical features
 Microscopic examination of bubo fluid/ sputum
 Cultures
 PCR/ DFA
 Treatment:
 Gentamicin, Streptomycin, Doxycycline
 Prevention:
 Formalin fixed vaccine
 Flea control measures
Plague (Yersinia pestis)
 Spread:
 Through bite of infected fleas.
 Through droplet spread from pneumonic plague patients.
 Through direct contact with non intact skin.

 Weapon potential:
 Labile in environment ( 1 hour)
 Highly contagious, person to person spread.
 Can be weaponised as aerosols. (10 km)
Smallpox (Variola)
 By 1980, close to whole world population was
immune  not important as bioweapon then.
 Now susceptible population (50%).
 High infectivity, can spread at a factor of 10-20.
 10-30% mortality in untreated.
 Signs/ Symptoms:
 Incubation period = 7 – 17 days (12-14)
 Fever, malaise, headache, backache, emesis
 Maculopapular to vesicular to pustular skin lesions
 Centrifugal, same stage of development
 Hemorrhagic & malignant forms (5- 10%)
Smallpox (Variola)
 Diagnosis:
 Culture, PCR, Electron Microscopy
 Treatment:
 Supportive treatment.
 Cidofovir, Antivaccinia immunoglobulin
 Prevention:
 Vaccinia immunisation
 Weaponisation:
 Infected fomites (historical use)
 Aerosol sprays
Tularemia (F. tularensis)
 Extremely infectious. (10-50 by inhalation)
 Infection through non intact skin, mucous
membrane, GI tract, Respiratory tract.
 Rabbits, ticks, water rats, deer.
 Signs/ Symptoms:
 1-14 days
 Ulceroglandular (75%) & Typhoidal (25%)
 Fever, chills, malaise, myalgia, headache
 Chest discomfort, dyspnea,,
 Skin rash, Pharyngitis, conjunctivitis
 Hilar adenopathy on chest x-ray
Tularemia (F. tularensis)
 Diagnosis:
 Gram stain, culture (blood, ulcer discharge, sputum)
 Immunohistochemistry, PCR
 Treatment:
 Streptomycin, Gentamycin, Doxycycline, Ciprofloxacin
 Prevention:
 Chemoprophylaxis - Doxycycline, 100 mg PO bid x 14 d
or Ciprofloxacin, 500 mg PO bid x 14 days
 Weaponisation:
 Aerosol sprays.
Hemorrhagic Fever Viruses
 Includes:
 Arenaviridae: Lassa, New World (Machupo, Junin,
Guanarito, and Sabia)
 Bunyaviridae: Crimean Congo, Rift Valley
 Filoviridae: Ebola, Marburg

 Person to person transmission through direct

contact with body fluids. (Lassa, Ebola, Marburg).
 Aerosol sprays infectious (animal studies).
 Upto 90% mortality.
Hemorrhagic Fever Viruses
 Signs/ Symptoms:
 Fever, myalgia, prostration, and DIC with
thrombocytopenia and capillary hemorrhage
 Maculopapular or erythematous rashes
 Leukopenia, temperature-pulse dissociation, renal
failure, and seizures
 Diagnosis should be suspected in anyone with
temperature >38.3°C for <3 weeks who also exhibits
at least two of the following: hemorrhagic or purpuric
rash, epistaxis, hematemesis, hemoptysis, or
hematochezia in the absence of any other
identifiable cause.
Hemorrhagic Fever Viruses
 Diagnosis:
 RT-PCR
 Antigen isolation
 Treatment:
 Supportive therapy
 Ribavirin, IF , Hyperimmune Ig
 Prevention:
 No known chemoprophylaxis
 No vaccines
 Strict isolation and PPE ( N95 mask or PAPR)
Botulinum toxin (Cl. Botulinum)
 One of the most potent toxins.
 Produced by Cl. Botulinum.
 Toxin is labile in atmosphere (1% per min),
Organism is easily destroyed (chlorine, heat)

 Botulism can occur:

 infection in a wound or the intestine,
 the ingestion of contaminated food, or
 the inhalation of aerosolized toxin.
Botulinum toxin (Cl. Botulinum)
 Signs/ Symptoms:
 12 – 72 hours
 Dry mouth, blurred vision, ptosis,
 weakness, dysarthria, dysphagia, dizziness,
 respiratory failure, progressive paralysis, dilated pupils

 Diagnosis:
 Mouse bioassay
 Toxin immunoassay
Botulinum toxin (Cl. Botulinum)
 Treatment:
 Supportive ( Intubation, Mechanical ventilation, TPN)
 Equine antitoxin (only against A &B)

 Prevention:
 Botulinum toxoid is available for high risk workers
 Lab workers, military personnel
Botulinum toxin (Cl. Botulinum)
 Examples of use:
 Botulinum toxin was the primary focus of the pre-1991
Iraqi bioweapons program. (19000 l conc. toxin.)
 Aum Shrinrikyo cult unsuccessfully attempted on a least
three occasions to disperse botulism toxin into the
civilian population of Tokyo.
 1990 - Outfitted a car to disperse botulinum toxin through
an exhaust system and drove the car around Parliament.
 1993 - Attempted to disrupt the wedding of Prince
Naruhito by spreading botulinum in Tokyo via car.
 1995 - Planted 3 briefcases designed to release botulinum
in a Tokyo subway.
Cholera (Vibrio cholera)
 Causes acute, potentially severe gastroenteritis.
 Spread through contaminated drinking water.
 Signs/ Symptoms:
 Begins in 12-72 hrs.
 Watery rice water diarrhoea.
 Abdominal pain, cramps.
 Dehydration, Electrolyte imbalance
 Seizures and Cardiovascular collapsein children

 Diagnosis:
 Stool microscopy – dark field
Cholera (Vibrio cholera)
 Treatment:
 Fluid & electrolyte replacement
 Antibiotics – Doxycycline, Ciprofloxacin, Erythromycin.

 Prevention:
 Live vaccine – 50% efficacy, 2 doses + booster.
 Inactivated vaccine – rapid protection, 2 doses, 85%
efficacy, 2-3 years.

 Spread:
 By contamination of drinking water supply.
 Easily destroyed by heat, boiling, chemical disinfectants.
SAMPLES TO BE COLLECTED
WEAPONISATION
 It is the process of converting the biological agent
into a usable weapon.

 Delivery device-
 Bombs
 Missiles
 Spray systems – Aerial, Aerosol based.
 Non traditional – food, water supplies, animals, insects.
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. Defence 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 toxins)
2. Indiscriminate
3. Difficult to control distribution ( IF contagious)
4. Preventive and/or Treatment measures
available for some.
5. Level of technical sophistication required for
effective delivery.
6. International taboo (deterrent to state/
nations)
TREATIES AND CONVENTIONS

 Before the 20th century, biological agents were

clubbed with chemicals as ‘poisons’.
 Various treaties have tried to restrict or ban the use
of such ‘poisons’ and asphyxiants.
 The Brussels convention on laws and customs of war,
1874.
 The Hague Declaration concerning asphyxiating
gases, 1899
 The Treaty of Versailles, 1919
TREATIES AND CONVENTIONS
 Geneva Protocol, 1925
 League of Nations, the “Conference for the Supervision
of the International Trade in Arms and Ammunition and
in Implements of War” - May 1925.
 Appeal by International Red Cross & Poland.
 “Protocol for the Prohibition of the Use of Asphyxiating,
Poisonous or Other Gases, and of Bacteriological
Methods of Warfare” was adopted by the
international community in Geneva on 17th June 1925.
 Customary international law.
 A no-first-use agreement only.
TREATIES AND CONVENTIONS
 Biological Weapons Convention (BWC), 1972
 Eighteen-Nation Disarmament Committee in 1969.
 Convention on the Prohibition of the Development,
Production and Stockpiling of Bacteriological
(Biological) and Toxin Weapons and on Their
Destruction was signed on 10th April, 1972.
 Entered into force on 26 March, 1975.
 First treaty to ban an entire class of weapons.
 Prohibits development, production, stockpiling and
acquisition of biological weapons.
 Does not obstruct non-hostile use of biological
agents but still covers future weaponisation of
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 weapon preparedness adds some

elements to public health.
PUBLIC HEALTH IMPORTANCE
PUBLIC HEALTH IMPORTANCE
 USA’s BioWatch:
 Network of detectors across US to detect bio-agents.
 Also stockpiles vaccines & 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):
 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”.
INDIAN SCENARIO
 Geneva protocol, 1925:
 Signed – 17th June, 1925
 Ratified – 9th April, 1930

 BWC, 1972:
 Signed – 15th January, 1973
 Ratified – 15th July, 1974

 Nodal agencies – DRDO (MoD), NDMA, MoHA,

MoHFW.
 Indian Biodefence Program – started in 1973
INDIAN SCENARIO

MoHFW

MoA NDMA MoHA

NCMC

NDRF MoD
INDIAN SCENARIO
 National Disaster Management Authority:
 Coordinating & mandating government policies for
disaster reduction/ mitigation
 Devising plans to counter the threat of biological
disaster, both natural and man-made (bioterrorism).
 Ensuring preparedness at all levels

 Coordination of response to disaster and post

disaster relief & rehabilitation.
 Conducts civilian biodefence and disaster
management activities and drills.
INDIAN SCENARIO

BW MoD

BT MoHA

Outbreak MoHFW
INDIAN SCENARIO
 Ministry of Defence:
 Evacuation, Logistics, Control & Coordination, Clinical
 First responders

 DRDO:
 R&D
 Equipment & Materials
 AFMS:
 Command and direction
 Stockpiling of vaccines/ medicines
 Exercises and drills
 Immunisation of 1st responders
 25 hospitals for biological disaster management
INDIAN SCENARIO
 Indian biodefence establishments under DRDO:
Defence Research and
Development
Establishment (DRDE), Gwalior
Defence Materials and Stores
Research and Development
Establishment (DMSRDE) ,
Kanpur
Defense Bioengineering and
Electromedical Laboratory
(DEBEL), Bangalore
Defence Food Research
Laboratory (DFRL), Mysore
Toxicology, Immunology, Biochemical
Pharmacology, Development of diagnostic
kits, Decontamination equipment.
NBC sensors & shelters.
Personal Protective Equipment
development & Manufacture,
Gloves, Boots, Protective suits,
Self contained biological suit (u/d)
Canisters, Face Masks, Respirators,
NBC filter fitted evacuation bags
Food supply systems for armed forces
“Anthra-check Sand-E kit” detects Anthrax
INDIAN SCENARIO
 Ministry of Health & Family Welfare:
 Outbreaks & epidemics
 Training & deployment of RRTs
 EMR department:
 Primary 1st responder in case of human affliction
 Formulation of policies & plans to handle medical problems
 NCDC:
 Investigation of outbreaks
 Training
 R&D
 ICMR:
 R&D
 Training
INDIAN SCENARIO
 Ministry of Home Affairs:
 Nodal agency in bioterrorist attacks.

 Threat perception & analysis

 Threat mitigation
 Policy development
 Law enforcement

 Technical support from MoHFW & MoD

INDIAN SCENARIO
 Stockpile maintenance:

 Vaccines – NIV,
 Medicines – With states, Pharmaceutical
manufacturers
 PPE – State RRTs, Central RRT, DMSRDE
 Containment equipment – DMSRDE, DRDE
INDIAN SCENARIO
 Patient isolation precautions:
 Standard precautions
 Wash hands before and after patient contact
 Wear gloves, Wear masks/ face covers
 Proper handling of equipment & Linen
 Airborne precautions (Smallpox, Plague, Anthrax)
 private room with negative air pressure, a 6 air changes per
hour, and appropriate filtration of air.
 Wear respiratory protection when dealing with patient
 Droplet precautions
 private room or group with same patients
 Wear mask and also use mask on patient during movt.
INDIAN SCENARIO
 Patient isolation procedure:
 Contact precautions (VHFs)
 Private room/ group patients together
 Gloves. Change gloves after contact.
 Wear gowns.
 Use shoe covers
 Dedicate non-critical equipment that requires contact
(stethoscope)
INDIAN SCENARIO
 Sample collection guidelines:
 Early post-exposure: when it is known that an individual
has been exposed to a bioagent aerosol, aggressively
attempt to obtain samples as indicated.
 Clinical: samples from those individuals presenting with
clinical symptoms.
 Convalescent/Terminal/Postmortem: samples taken
during convalescence, the terminal stages of infection or
toxicosis or postmortem during autopsy.
INDIAN SCENARIO
 Sample collection guidelines:
 Clean line and exit and entry strategy
 3 person team is recommended, with 1 clean and 2 dirty.
 Personnel protective equipment
 Waterproof disposable cameras and waterproof notepads
 What to collect –
 Aerosol – aerosol collector required
 Swabs/ paper – from any contaminated site
 Dead animals or humans or parts
 Packed in double ziploc bags (Inner bag decontaminated
with bleach before putting outer bag)
REFERENCES:
1. U.S. Army report to the Senate Committee on Human
Resources, 1977.
2. United Nations definition. Report of the secretary
general titled “Chemical and Bacteriological
(Biological) Weapons and the Effects of Their Possible
Use,” 1969.
3. National Disaster Management Guidelines—
Management of Biological Disasters, 2008. A
publication of National Disaster Management
Authority, Government of India. July 2008, New Delhi.
4. McLaughlin K., Nixdorf K.; BWPP Biological Weapons
Reader: Geneva, 2009.
5. Harrison’s Principles of Internal Medicine; 18th ed:
2011. Edited by Fauci AS, Kasper DL, Longo DL.
REFERENCES:
6. http://www.cdc.org . Website of the Centre for Disease
Control and Prevention, Dept. of Health and Human
Services, USA.
7. Hunger I. Bioweapons Monitor 2011, 1st ed: 2011.
8. National Strategy for Countering Biological Threats;
National Security Council of USA, 2009.
9. http://www.emedicinehealth.com/script/main/art.asp?
articlekey=58836
10. www.mapw.org.au ; website of the Medical
Association for Prevention of War Australia
(MAPW).
11.http://www.proliferationnews.org ; website of
the Carnegie Endowment for International
Peace.