An Introduction to the Threat of Bioterrorism

BNICE 101

The Ohio Center of Excellence for Bioterrorism Preparedness and Response
Bioterrorism Training and Curriculum Development Program PL 107-188, Section 105; 1-T01-HP-00091-01 1071- T01- HP- 000911

Good morning/afternoon. My name is [ ], and I am a member of The Ohio Center of Excellence for Bioterrorism Preparedness and Response. This introductory talk provides an overview of what every health care provider should know about being prepared and responding to bioterrorism, and is a result of funding obtained by the Health Resources and Services Administration.

An Introduction to the Bioterrorist Threat BNICE 101

Purposes of Presentation

• • • •

Background on The Ohio Center of Excellence for Bioterrorism Preparedness and Response Role of Interprofessional Course How you can help us Review the importance of collaboration Discuss Case of the Mysterious Illness • Tularemia - what is it? • Tularemia and bioterrorism
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Dr. Casto asked me to accomplish 6 things in this presentation - given that I have less than 30 minutes to do so, I have a challenge before me. These are the six things he wanted me to cover (go over them). Through this talk I will also emphasize four “essentials” in combating terrorism - those are 1. Early recognition of the event 2. Early management of the event 3. Knowing whom to contact, and 4. Working together as a multidisciplinary team and understanding your role on that team.

11 September 2001 The Attack on the US

Source: www.thaibase.com/news/wtc/images 3

We all remember September 11, 2001, the day when terrorists attacked both the World Trade Center in New York City and the Pentagon in Washington DC. Also, 40 individuals lost their lives when United Airlines Flight 93 crashed into a Pennsylvania field.

explosive. incendiary. which we think of when we hear the word. “bioterrorism. And these weapons are not just biological (point to the letter B in the circle above).” These weapons also involve (point at each letter in the circle above) .nuclear. and cyber terrorism. chemical. .Threat Trends B Cyber N I C E Weapons of Mass Destruction 4 Terrorists such as these are not hesitant to use weapons of mass destruction.

it will come from an attack within our borders from a single individual or group that has access to weapons of mass destruction. 5 Dr.” . including large conventional explosives and nuclear.The greatest threat to the United States and its citizens in the first decade of the 21st century will not come from a military confrontation. Rather. emphasized that. Rather. including large conventional explosives and nuclear. chemical or biological weapons. “The greatest threat to the US and its citizens in the first decade of the 21st century will not come from a military confrontation. chemical or biological weapons. Ed Eitzen. Senior Medical Advisor to the US Assistant Secretary for Public Secretary Health Emergency Preparedness. the Senior Medical Advisor to the US Assistant Secretary for Public Health Emergency Preparedness. it will come from an attack within our borders from a single individual or group that has access to weapons of mass destruction. COL Ed Eitzen.

Terror Is a Weapon Itself “The real force multiplier in bioterrorism is the panic. 6 However. misinformation and paranoia associated with it. Alexandria. Jane’s Chem-Bio Handbook. Remember the run on duct tape as people were sealing their basements. often cutting off their own oxygen supply? It has been documented in prior attacks that for every one person who is injured physically. VA.” Sidell FR. Jane’s Information Group. there are four individuals who are injured emotionally. Dashiell TR. the biggest threat is not the weapons themselves. Recall what our nation went through a few years ago when small towns across the US were trying to prepare for a potential chemical attack. but the terror that is associated with that threat. . 1998. Patrick WC.

7 The major purpose of terrorism is not to kill. . but to create disabling fear and panic.

We can be afraid. .Terrorism forces us to make a choice. U. www. Department of Homeland Security. the Former Director of Homeland Security.S. terrorism forces us to make a choice.gov 8 But as Tom Ridge. points out.ready. Or we can be ready. Tom Ridge. Or we can be ready. We can be afraid.

The Ohio Center of Excellence for Bioterrorism Preparedness and Response • Rationale • A need exists to train healthcare professional students to be prepared to respond to terrorist acts and other public health emergencies 9 Which brings to our Center. to develop The Ohio Center of Excellence for Bioterrorism Preparedness and Response. This center is a collaborative effort of The Ohio State University. Ohio University. thanks to a grant from HRSA. . medicine. Today’s talk has been possible through the efforts of over 50 healthcare providers who have come together. This center was created because a need exists to train healthcare professional students to be prepared to respond to terrorist attacks and other public health emergencies and major natural disasters. nursing. and public health. the University of Cincinnati. and Northeastern Ohio Universities College of Medicine in the disciplines of allied medical professions.

However. And… 4. Nuclear and conventional explosions are easy to detect. 2. 3. what to do with your colleagues. and what to do with your patients. prior to graduation. and the roles of others. Know who to notify if you suspect a terrorist attack. Manage the early events of an attack. knowing your role on the team. and require a heightened sense of awareness and attention to subtle clues. biological and chemical attacks are often less obvious. 4. including what to do personally. will be able to 1.What Every Health Care Provider Should Know 1. Recognize early a potential bioterrorist attack. Early recognition Early management Whom to notify How to work together as a team 10 The Center’s goal is that each health care professional student. 2. This task also includes the management of panic and hysteria that commonly follows the attack. Work together in a multidisciplinary team. 3. .

. Associate Dean & Director The National Center for Disaster Preparedness 11 And when we talk about needing to be prepared for a terrorist attack. Irwin Redlener. which occurs in the event of an attack.What do we mean by “prepared”? the “right place” on the continuum between mindless complacency and all consuming paranoia … Mindless Complacency All Consuming Paranoia Dr. we are talking about being at the “right place” on the continuum between mindless complacency. and all consuming paranoia. which can easily occur when it has been a while since the last attack.

. It also includes nuclear.BNICE 101 • • • • • Biological Nuclear Incendiary/fire Chemical Explosive 12 As mentioned earlier. incendiary. for tonight. and one agent in particular. bioterrorism goes beyond just a biological attack. chemical. However. I will focus on the potential biological weapons. and explosive weapons.

. It is highly probable that an astute person in the community.Bioterrorism Defined • • • • Unlawful release of biologic agents or toxins Intent • to intimidate or coerce a government or civilian population to further political or social objectives Targets . animals.” Targets can include humans. will be the first to recognize that a bioterrorist event has occurred. not the traditional first responders such as fire fighters and law enforcement. and plants.humans. plants First recognized by the astute person in the community 13 Bioterrorism is defined as the “unlawful release of biological agents or toxins with the intent to intimidate or coerce a government or civilian population to further political or social objectives. animals.

Biological Agents as WMD • • Relatively easy to obtain Technology easily concealed 14 Terrorist organizations are interested in using biological agents as weapons of mass destruction for a number of reasons. technology used to produce antibiotics. and other industrial and food products can be converted to making biological agents. which can be easily concealed. Second. . clinical specimens and clinical research labs. animals. vaccines. these agents typically can be obtained from soil. water. First.

. and can be concentrated for easier distribution. which can be severe. and cheap to produce • Concentrated for distribution • Adaptable to weapons systems • Name causes fear and panic 15 Those biological agents that are ideally used for bioterrorism have these characteristics. They are easy. and cheap to produce. at low doses. fast. They result in a high rate of morbidity and death. their names cause fear and panic among the public. They are highly infectious. They can be adaptable to weapons systems. They are difficult to diagnose and to treat and are insidious in onset.Characteristics of a “Good” Biological Agent • Pathogenic at low doses • High rate of morbidity & mortality • Highly infectious • Difficult to diagnose and treat • Insidious at onset • Easy. fast. They cause disease. but not always contagious. And.

It also shows up in popular culture: here are nearly two dozen novels that include incidents of the use of biological agents by criminals and terrorists as a central theme. This manifests itself in multiple ways. It shows in the growing press coverage of the threat. . It also shows up in the increasing number of comments about the threat by non-US government experts and by senior US officials.Popular Interest in Bioterrorism 16 It is quite clear that there is growing concern that the people of the United States might be subjected to bioterrorism assaults.

. through the GI tract.Biological Attack Transmission Aerosol Gastrointestinal Transcutaneous • • • 17 The three major ways in which biological agents can be transmitted are through aerosol. and through the skin.

. handkerchief. Explosives are inefficient delivery systems because the heat generated by the explosion will inactivate most of the biological agents. Otherwise. Examples include 2 to 3 layers of cotton such as a T-shirt. cover your mouth and nose with layers of fabric that can filter the air but still allow for breathing. several layers of tissue or paper towels may help. or towel.Aerosol • • • Effectively delivered as an aerosol Protection • Protective mask • 2 to 3 layers of cotton • Several layers of tissue or paper towels Explosives are inefficient delivery systems 18 Many biological agents are effectively delivered as an aerosol. If a protective mask is not readily available.Biological Attack .

.the weight of a paper clip could kill more than one million people.Biological Attack Contamination of Milk • Botulinum toxin 19 Another concern is possibly the contamination of our milk supply with a pathogen such as botulinum toxin. botulinum toxin is the most poisonous natural substance on earth. Easy to find and easy to produce. a single gram . In the hands of a bioterrorist.

only a dozen or so could potentially be used as a biological weapon.Category A Biological Agents • • • High-priority agents HighRisk to national security Characteristics • Easily disseminated or transmitted from person to person • High mortality rates • Major public health impact • Public panic and social disruption • Require special action for public health preparedness 20 Although there are hundreds of thousands of biological agents in this world. the Centers for Disease Control have classified them according to their potential threat. fourth. they require special action for public health preparedness. . Category A agents are those highpriority organisms that have the following characteristics: First. they pose a risk to national security because they can be easily disseminated or transmitted from person to person. And. they cause public panic and social disruption. Of these. they can result in high mortality rates and have the potential for a major public health impact. Second. Third.

Lassa. .g. Plague. Tularemia. Smallpox. Ebola.Category A Biological Agents • • • Anthrax • Bacillus anthracis Smallpox • variola major Botulism • Clostridium botulinum toxin • • • Plague • Yersinia pestis Tularemia • Francisella tularensis Viral hemorrhagic fevers • filoviruses [e..g. Botulism. Marburg] • arenaviruses [e. the most famous of which is probably Ebola virus. Machupo]) 21 The CDC has listed these six agents as Category A… Anthrax.. and Viral hemorrhagic fevers.

Tularemia Francisella tularensis Gram-negative bacteria Found in rodents One of the most infectious agents known • Few organisms can cause disease • • • 22 Up to 95% of naturally occurring anthrax infections develop when the bacterium enters a cut or abrasion of the skin. In this slide we see Berlin electoral workers equipped with protective masks and gloves as they open mailed votes during the regional elections in October 2001. The protection is used as a precaution against a possible anthrax threat. especially goat hair. . leather or hair products. of infected animals. hides. such as when handling contaminated wool.

. In this slide we see Berlin electoral workers equipped with protective masks and gloves as they open mailed votes during the regional elections in October 2001. hides. especially goat hair. of infected animals. “flu-like” Non“flusymptoms • Fever. leather or hair products.Tularemia Francisella tularensis • • • Non-specific. such as when handling contaminated wool. The protection is used as a precaution against a possible anthrax threat. chills • Headache • Muscle aches • Non-productive cough NonDeadly if not treated! Diagnosed by index of suspicion and confirmed by laboratory 23 Up to 95% of naturally occurring anthrax infections develop when the bacterium enters a cut or abrasion of the skin.

. The state and local public health departments play an extremely important role in all-hazards emergency preparedness and response.Whom to Contact for Suspected Biological Threat? Your Local Health Department! If you suspect a biological threat. Public health professionals within these departments have immediate access to guidance and information that will assist them in rapidly establishing priorities and undertaking necessary actions during the response to an emergency or disaster. the best resource to contact immediately is your local health department.

such as what we have talked about today. Health Care Providers include physicians. allied health such as lab.It is also important to know that most disaster plans call for an Incident Commander. First Responders include members of the fire and police department. EMT FBI 25 Regardless of the cause of the disaster. . Homeland Security. whether it be natural. such as a tornado or flood. depending upon the disaster. a critical skill that health care providers need to have is the ability to work together in a multi-disciplinary team. veterinarians.The team consists of these three major groups. who is responsible for coordinating the effort of all three groups. the FBI. and. while the Fire Chief would oversee the other events. dentists and psychologists. It is important that you know what your role would be in this team. nurses. Police. or whether it be man-made. Public Health Officials include the local and state health departments and the Centers for Disease Control. emergency personnel. Click to bring forth next image . The Incident Commander is determined by the agent and delivery mechanisms.Working Together as a Team Public Health Officials Health Care Providers Incident Commander First Responders Fire. Typically. Each have an important role and must work together. respiratory and x-ray technicians. the Public Health Commissioner would be the Incident Commander for biological events. and the Federal Emergency Management Agency. Click to bring forth next image .

review the Ohio Department of Health Disaster Preparedness and Response Plan. review your local Disaster and Bioterrorism Safety Plan. Also. .asp 26 To be prepared.odh. which can be found at this website.Be Prepared • • Review your local Disaster/Bioterrorism Safety Plan Review the Ohio Department of Health Disaster Preparedness & Response Plan • http://www.state.us/alerts/alertmain.oh.

org/services/disaster/beprepared/hsas.ready.cdc. the CDC is a wonderful. rich resource for health care providers. Both Homeland Security and the American Red Cross have excellent web sites that provide advice on personal and family safety during a disaster. I would recommend that you become familiar with all three sites.Be Prepared http://www.gov http://www.gov/ http://www. Almost everything you wanted to know about what we have touched on today is found at this site. First. .html 27 Three great websites that will help you to get prepared are presented here.redcross.

it is essential that we as health care providers be prepared for a new generation of potential threats to our health. Be ready to manage not only the physical but also the mental health casualties. And finally. Develop skills on how to work together in a multidisciplinary team during a disaster. know the web sites where you can go to quickly to learn more about what we discussed today.How You Can Help • • Be prepared Help us with this case • Working together as a team The Ohio Center of Excellence for Bioterrorism Preparedness and Response 28 So. Be alert for subtle warning signs that may be due to a terrorist event. in summary. and know your role on that team. Become familiar with your local public health department. . and know how to contact them quickly.

and know your role on that team. know the web sites where you can go to quickly to learn more about what we discussed today. it is essential that we as health care providers be prepared for a new generation of potential threats to our health. Be ready to manage not only the physical but also the mental health casualties. and know how to contact them quickly. And finally. . Become familiar with your local public health department. Develop skills on how to work together in a multidisciplinary team during a disaster.Summary • • • • • • Be prepared Be alert Manage initial casualties Know whom to contact Know your team role Have ready references The Ohio Center of Excellence for Bioterrorism Preparedness and Response 29 So. Be alert for subtle warning signs that may be due to a terrorist event. in summary.

If you have any questions. . I will be able to answer them once your evaluations are completed.Thank You! Questions? The Ohio Center of Excellence for Bioterrorism Preparedness and Response 30 Thank you for your attention. Please take a few minutes to complete the evaluation.

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