Camacho, Aero Gudez, Dominique Elloisa Oracion, Donna Faye Viray, Alexandra
intentional release is to hurt or annihilate military or civilian population. overt (announced) or covert (unannounced) can be spread through air, water or food all pathogenic bacteria or viruses can potentially be utilized by terrorists for biological warfare. It is the unauthorized use of biological weapons by nongovernment groups like religious cults, militants and crazed individuals. utmost concern of all countries is national security. Countries use microbes as a tool of mass murder because of the capabilities and resources.
Advantages of Biological Agents
Potential deadly or incapacitating effect on a susceptible population. self-replicating capacity of some biological agents allows them to proliferate the affected individual and potentially the local population relatively low cost of the production have insidious symptoms like any endemic disease property and physical surroundings makes it easier than conventional or nuclear weapons.
Disadvantages of Biological Agents
danger for the aggressor forces that they may also be affected. big dependence on weather conditions. Temperature, sunlight and desiccation affect survivability of some infectious organism. may not be able to inhabit for long period of time due to environmental persistence. unpredictable morbidity rate limit that may affect their tactical usefulness is their relatively long incubation period for majority of agents.
Agents at high risks easily spread from person to person Category anthrax, botulism, plague, and tularaemia and A viral hemorragic fevers. second highest priority. Categories of Biological moderately easy to spread. Category Coxiella burnetiiand Diseases Agents (Q fever), Brucella B species(brucellosis), ricin toxin. third highest priority. emerging pathogens can be engineered for Category mass distribution in future. C Nipah virus, yellow fever virus, multidrugresistance Mycobacterium tuberculosis.
Characteristics of Biological Weapons
1. They are easy to produce and deliver 2. They are safe for use by the offensive soldiers 2. They are able to incapacitate or kill individuals under attack in reproducible and consistent manner
Agents of Bioterrorism
Agents of Bioterrorism
causes smallpox Family: Poxviridae Subfamily: Chordopoxviridae Genus: Orthopoxvirus Species: Variola Strains: Variola major, Variola Minor 250nm x 250-300nm x 150250150300nm (one of the largest virions) visible with high-quality, highoptical, ultraviolet light microscopes
highly specific to humans; no animal reservoirs infects mostly internal organs; causes fever, malaise, delirium and prostration before movement via bloodstream to the skin fever followed by pink red spots (macules), to pink pimples (papules), and then become a large fluid filled vesicle (variola), pitted scar forms (pocks/scab) Prevention: vaccine; side effects >vaccinia necrosum and/or encephalitis stable in aerosol form
causes Anthrax enzootic disease bacteria: large, gram-positive, facultative gramanaerobic, endospore forming rod with rectangular edge shape 1 m x 3-5 m in size 3endospore forms only under aerobic conditions; not found in tissues or circulating blood acquired by eating infected flesh or inhalation of spores capsule made of polypeptide of glutamic acid no capsule production when outside an organism
Classification of Anthrax
Respiratory Anthrax - aka Woolsorter¶s disease
- fatal regardless of treatment - symptoms are similar to common respiratory infections; mediastinum lymph nodes enlarge and widen - bacteria when inhaled activate the gernimation of spores in alveoli and phagocytized but not killed by macrophages > evade immune system, not killed by WBCs because of capsule and kills the macrophage
Cutaneous Anthrax middle mortality rate when untreated, low mortality rate when supplied with treatment endospores enter epithelial layers of skin, lesions form, become necrotic or eschar
Intestinal Anthrax symptoms: formation of ulcerations along digestive tract similar to food poisioning if bacteria enters blood stream, causes septicemia, leading to meningitis; could also have intestinal hemorrhaging and death
-Recovery cannot be determined easily due to false relief > symptoms ease but bacteria can still enter bloodstream leading to septicemia and death - virulence factor : capsule made of glutamic acid > genes that are transmitted from 1st plasmid, and 2nd plasmid which carries exotoxins ~Protective antigen: mediates entry of EF and LF ~Edema factor : combines with protective antigen forming edema toxin > causes swelling, prevents phagocytosis of macrophages ~Lethal factor : binds with protective antigen resulting to lethal toxin > causes macrophages to release tumor necrosis factor and interleukin and other inflammatory cytokines
Diagnosis: culturing blood or examination of smears from cutaneous lesions of patients; serologic DNA susceptible to penicillin; does not inactivate lethal toxins produced by bacteria treated with Ciprofloxacin, antibiotics: Doxycycline, Erythromycin and Chloramphenicol
Yersinia pestis cause of bubonic, septicemic and pneumonic
plague virulent, non-enteric, non-motile, gramnonnongramnegative rod, stains heavily at the poles of the cell (bipolar staining) Transmission: fleas feeding on rats, mice and voles¶ blood that harbor bacteria but don¶t develop disease
> multiplication of bacteria blocks esophagus, starving it and making it jump from host to host in search for blood to feed on. > no person to person transmission
Bubonic plague - blood disease > transfer of bacterial cells from host to host via fleas > bacteria multiply in the bloodstream and stay in the lymph nodes - buboes: hemorrhaging in lymph nodes and swelling - symptoms: blood pressure drops, high fever, malaise, painful buboes progressing to shock thrombosis Pneumonic plague - highly contagious - symptoms: hemoptysis, dyspnea, cyanosis
- Diagnosis: fluorescent antibody tests, stained smears of sputum or fluid from lymph nodes - Treatment: intake of Streptomycin, Gentamycin (intravenously or intramuscularly), tetracycline, chloramphenicol - Untreated cases lead to bacteremia, where there is disseminated intravascular coagulation, subcutaneous hemorrhaging and death of tissues
cause of epidemic typhus, aka louselouseborn typhus small, gram-negative, non-motile, gramnonobligate intracellular parasites which invades the cytoplasm prolific killer of humans endemic in Central and South America and Africa Transmission: scratching bites from body lice of Pediculis humanus
> occurs in crowded, unsanitary living conditions; infection of wound coming from the feces of lice > housed by rodents,
- Symptoms: maculopapular rash visible on body trunk and progress to extremities, intense fever of 40 C, hallucinations and deliriousness - Diagnosis: finding bacterium in tissue samples using fluorescent antibody tests - Treatment: Doxycycline, Erythromycin, Tetracycline, Sulfonamides, Chloramphenicol - Prevention: avoiding and preventing lice infestation, maintenance of good and personal hygiene, vaccination - relapse is possible, where disease remains dormant called Brill-Zinsser disease Brill-
causes Salmonellosis motile, gram-negative, peritrichous grambacilli range from 1 m- 1.2-3 m, has m- 1.22000 known strains pathogen when isolated from food products or humans lack cytochrome oxidase ==> oxidase negative and urease negative can reproduce into millions in a few hours able to conjugate with Serratia and Escherichia for transfer of antibiotic resistance genes
Transmission: ingestion of fecally contaminated water or food harbored in the GI tracts of fowls, rodents and reptiles (animal reservoirs) man as asymptomatic carrier of Salmonella enterica has several serotypes > Choleraesius: swine pathogen > Dublin: acquired from inadequately pasteurized contaminated milk > Paratyphi: cause of enterocolitis or enteric fever > Typhi: causes typhoid
infective dose of Typhi: 1000-10,000 cells 1000> non-motile, non spore-forming, facultatively anaerobic, nonsporegramgram-negative rod > highly resistant to outer environment - Transmission: facilitated by 5Fs: flies, food, fingers, feces and fomites - Symptoms of infection: rose spots covering chest and abdoment wherein blood hemorrhaging of the skin is prominent - Treatment: vaccination with Ty21a vaccine > weakened or attenuated strain of S. Typhi : ViCPS > capsular polysaccharides from S. Typhi
Symptoms of Salmonellosis: non-bloody diarrhea, nausea, nonvomiting, muscle pain, headache, abdominal cramps, and fever caused by endotoxins > toxins released when cell undergoes lysis *caused by movement of bacteria into small intestine and attachment to the intestine¶s epithelial cell lining; bacteria triggers endocytosis and multiplies within food vesicle; kills host cell inducing fever, cramps and diarrhea - bacteremia caused by movement of bacteria to bloodstream - gastroenteritis and abdominal pain due to reproduction of bacteria in gallbladder and release for reinfection of intestines - ulceration and perforation of intestinal wall allows bacteria to enter abdominal cavity and cause peritronitis
Treatment: fluid and electrolyte replacement; typhoid treatment: antimicrobial drugs e.g. Ampicillin or Ciprofloxacin; removal of gallbladder for complete treatment; no known vaccine for enterocolitis; oral typhoid vaccine is available; no antibiotics > induce carrier states and antibiotic resistant strains of Salmonella - Prevention: proper personal hygiene, treatment of sewage environment, proper food pasteurization
Serratia marcescens gramgram-negative, motile,
facultatively anaerobic bacillus 16 m non pathogenic in the past cause of respiratory disease to immunocompromised patients, urinary and respiratory tract infections, non-socomial blood noninfection, endocarditis, osteomyelitis (for heroin addicts), septicemia, wound infections, eye infections, and meningitis resistant to antibiotics due to conjugation with Salmonella
Transmission: direct contact, droplets, growth on catheters in hospitals and saline irrigation solutions Treatment: Cephalosporins, Gentamicin, Amikacine most strains are resistant to antibiotics because of R-factors on Rplasmids
NonNon-motile, obligate aerobic, encapsulated, gram-negative gramcoccobacillus cause of Tularemia lives in water as intracellular parasite of animals and amoeba Transmission: through arthropods from fur of animals or consumption of infected rabbit meat, drinking contaminated water, ticks, sick or dead animals, or airborne incorporated in eggs of ticks highly virulent, highly infectious, live intracellularly in macrophages where degradation is resisted
acquired by entry through skin or ulceroglandular Symptoms: high fever with chills and shaking, headache, buboes and ulcer formation at site of entry Typhoidal tularemia causes bacteremia from lesions, septicemia that resembles typhoid fever from inhalation from aerosols during skinning of infected animals, spread from blood and bronchopneumonia Symptoms: patchy bronchial pneumonia leading to tissue necrosis Diagnosis: nasal swab and respiratory culture, lymph node FA, blood culture, serology-agglutination of bacterium serologyTreatment: Streptomycin, Gentamicin Prevention: IND-live attenuated vaccine readministered INDevery 3-5 years (dose can cause scarring); avoiding ticks from 3biting, sick or dead animals
cause of Botulism: neuroparalytic disease 8 serological types (A-G) (Aneurotoxin sporespore-forming, obligate anaerobe, gramgram-positive bacillus releases potent exotoxin or neurotoxin that binds irreversibly to neuronal cytoplasmic membranes, prevents fusion of vesicles and release of acetylcholine Types A, G, E: causative agent for disease in humans; type E is transmitted through food organism do not cause disease by infecting tissues but by intoxication
TYPES OF BOTULISM 1. Foodborne Botulism- caused by ingestion of Botulismtoxin from improperly home-canned nonacid homefoods 2. Infant Botulism- infection and intoxication; Botulismorganisms grow in tissues and produce toxins in gastrointestinal tracts of babies 3. Wound Botulism- tissue is damaged where Botulismcirculation is impaired creating an anaerobic condition where endospores germinate, multiply and produce toxin
Transmission: contaminated canned food, contaminated wounds, consumption of spores endospores more heat-resistant (freezing and heatirradiation is ineffective) viable for long periods of time and enables organism to withstand aerobic conditions form of toxin depends on infection with a bacteriophage that carries information for botulinum toxin production
Symptoms: respiratory paralysis, double vision, cranial nerve palsyptosis, dry mouth, dysphagia, dysphonia, descending flaccid paralysis with weakness, respiratory failure, dilated pupils, constipation and abdominal pain Diagnosis: nasal swab, serum toxin assays, blood and stool cultures Treatment: desperciated antitoxin for serotypes A-G, Apolyvalent antitoxin, passive immunotherapy with performed antibodies against the toxin; antibodies or antitoxins for neutralization of toxin in blood before binding to neurons; repeated washing to intestinal tract to remove clostridium Penicillin for infant and wound botulism Prevention: destruction of endospores by proper canning, prevention of germination; acidic environment to inhibit bacterial growth
unencapsulated, gram-negative, gramoxidaseoxidase-negative, urease-negative, ureasenonmotile pathogen family: Enterobacteriaceae phylum: Proteobacteria genus: Shigella produces enterotoxin, cause of Shigellosis or bacillary dysentery binds with Escherichia for exchange of antibioticantibiotic-resistant genes Transmission: contaminated food; salad, milk, dairy products, eggs, vegetables, shellfish, fecal-oral transmission, fingers, fecalflies, feces, fomites, playing, bathing, washing, clothes in contaminated water and poor handwashing
tolerates acidity of stomach and pass through the small intestine and attach to epithelial cell of the colon; triggers endocytosis and multiplies in cytosol invades neighboring epithelial cells, avoiding immune defenses; abscess forms as epithelial cells are killed by infection bacteria that enters blood is quickly phagocytized and destroyed Symptoms: abdominal cramps, fever, profuse diarrhea with blood and mucus, convulsions, coma, ulceration, bleeding of intestinal lining and deeper intestinal layers, causes dehydration and fluid and electrolyte imbalances leading to neurological damage neurotoxin: Shiga, stops protein synthesis in host¶s cells that causes neurological damage
Diagnosis: fecal specimens maintained in a buffered transport medium, viable specimens obtained by bowel lesion swabbing during internal examination of bowel, stool specimens inoculated into selective media Treatment: restoration of fluid and electrolytes (salt tablets, oral solutions, intravenous injections of salt solutions), hydration fluids with or without antibiotics > Fluoroquinolones, Trimetroprim or Sulfamethoxazole, Ciprofloxacin, Sulfonamides and Penicillin Prevention: oral vaccines with strains of Shigella flexneri and Shigella sonnei
Bioterrorism can be described as the use, or threatened use, of biological agents to promote or spread fear or intimidation upon an individual, a specific group, or the population as a whole for religious, political, ideological, financial, or personal purposes. These biological agents, with the exception of smallpox virus, are typically found in nature in various parts of the world.
6th century ± late 17th century The milestones 1860 ± 1924 The Germans
1925-1941,1945 The Japanese
1941-2001 The Cold War and The Allied Forces
6th Century B.C. Assyrians poison the wells of their enemies with rye ergot. 6th Century B.C. Solon of Athens poisons the water supply with false hellebore ,an herb purgative, during the siege of Krissa.
Ergot and False Hellebore
15th C It has been said that during Pizarro's conquest of South America, he improved his chances of victory by presenting to the natives, as gifts, clothing laden with the variola virus. 1763 Captain Ecuyer of the Royal Americans, under the guise of friendship, presents to the native Americans two blankets and a handkerchief contaminated with smallpox. 1767 During the French and Indian War, the English general, Sir Jeffrey Amherst, gives blankets laced with smallpox to Indians loyal to the French. The epidemic decimates the tribes, arguably, resulting in a successful British attack on Ft. Carillon.
1346 During the siege of Kaffa, the Tartar army hurls its bubonic plague-ridden dead (infected by a gram negative bacteria called Yersinia pestis) over the walls of the city. The defenders are forced to surrender. 1422 At the battle of Carolstein, bodies of plague-stricken soldiers plus 2000 cartloads of excrement are hurled into the ranks of enemy troops. 1710 Russian troops hurl the corpses of plague victims over the city walls of Reval during Russia's war with Sweden. 1797 Napoleon attempts to force the surrender of Mantua by infecting the citizens with swamp fever. Yersinia pestis
Is the inflammation of the gastrointestinal tract, involving both the stomach and the small intestine and resulting in acute diarrhea. It can be transferred by contact with contaminated food and water.
1914-1917 Allegations are made against the Germans that during WWI they attempted to spread cholera in Italy, plague in St. Petersburg, and biological bombs over Britain.
1915 Allegedly, a German-American, Dr. Anton Dilger, grows cultures of Bacillus anthracis and Pseudomonas mallei (Glanders), supplied by the German government, in his Washington D.C. home. The agents and an inoculation device are given to sympathetic dockworkers in Baltimore to infect 3000 head of horses, mules, and cattle, destined for the Allied troops in Europe. It is also alleged that several hundred troops are additionally affected.
Bacillus anthracis and Glanders
1925 The Geneva Protocol bans biological weapons on June 17. It is the first multilateral agreement that extends the prohibition of chemical agents to biological agents. Japan refuses to approve the ban. 1931 In 1994, according to Prince Mikasa of Japan, Japanese military officials attempted to poison the League of Nations investigatory commission who was investigating Japan's siege of Manchuria. They poisoned the fruit with cholera. No one fell ill, however.
1932 As Japanese troops invade Manchuria, Shiro Ishii, a physician & army officer, begins experiments on biological warfare. 1936 Unit 731 is formed. An actual bio-warfare unit masquerading as a waterpurification unit. Ishii constructs a 150 building complex just outside of Harbin, Manchuria for experimental purposes. Over 9000 test cases eventually die there. Another biological warfare site was also developed near Changchun named Unit 100. Ishii field-tests biological warfare on the Chinese, soldiers and civilians alike. Tens of thousands die as a result of plague, cholera, anthrax, etc. One method was overflying Manchuria and China. Infected fleas would be dropped with grain. The grain attracted rats. The rats became infected from the fleas (they can regurgitate up to 24,000 organisms in a single feeding) and brought the disease deeper into the human population.
Lieutenant General Shiro Ishii
Ishii was a covert biological and chemical warfare research and development unit of the Imperial Japanese Army that undertook lethal human experimentation during the Second SinoJapanese War (1937±1945) and World War II. It was responsible for some of the most notorious war crimes carried out by Japanese personnel. Anthrax, plague-carrier fleas, typhoid, dysentery, cholera was primarily used by him.
Relentless Japanese attacks
1940 On October 4, the Japanese releases plague bacteria at Chuhsien resulting n the deaths of 21 people. 1940 On October 29, plague is dropped by Japanese planes at Ninpo, causing 99 deaths. 1940 On November 28, Japanese planes drop biological bombs at Chinhua, but there are no deaths. 1941 In January, plague is introduced by the Japanese in Suiyuan and Ninghsia provinces. A serious epidemic follows.
1941 The British are experimenting with anthrax off the Scottish coast using sheep as the test subjects. 1941-1943 US launches its own studies surrounding the use of and defense from biological agents. The Army (Chemical Warfare Service) develops Camp Detrick, Frederick, MD into a site for biological R&D.
Anthrax tests on sheep and Camp Detrick
Facilities of the Cold War
1943 Camp Detrick in Maryland becomes operational. Field-testing is established in Mississippi. 1944 Dugway Proving Grounds in Utah replaces Mississippi's testing facilities. 1945-1949 The US Bio-program devolves to research capabilities only. 1946 US announces its involvement in BW research to the world.
Facilities of the Cold War
1950 The US BW program gears up during the Korean War. 1951 A BW bacterial production facility is started at the Pine Bluff Arsenal in Arkansas 1954 Pine Bluff Arsenal provides Brucella suis for antipersonnel BW cluster bombs. 1955 Pine Bluff Arsenal begins the production of large quantities of Francisella tularemia. 1956M USAMRIID (known then as the Army Medical Unit) becomes operational.
Brucella suis infected pigs and Francisella tularemia.
1960s The Vietcong use fecally contaminated spear traps during the Vietnam war. 1966 A simulated covert BW attack, with a benign agent, in the subway system of NYC reveals that large numbers of Americans can be exposed with just one release. 1971 From May 10 to May 1, 1972, there is the total destruction of antipersonnel BW agent supplies and munitions in the US.
1969 On November 25, President Nixon renounces BW and limits future research to defensive measures only. Toxins are not expressly mentioned. 1970 On February 14, President Nixon closes a loophole when he prohibits the weaponization of toxins and limits its research to defensive purposes only.
1975-1983 The countries of Laos and Kampuchea come under attack by planes and helicopters that deliver multi-colored aerosols ("Yellow Rain") over the population. Both man and animal are affected and some die. There is no definitive evidence that these aerosol attacks were examples of biological warfare, but there is a belief among many that, at least some of these attacks, involved T-2 mycotoxins.
Yellow rain and T-2 mycotoxin infection
1979 In April, in the city of Sverdlovsk, USSR, an explosion from Military Compound 19 results in a toxic release. Over the next several days, citizens downwind are stricken with high fevers, difficulty breathing, and death. There are over 40 fatalities. Some believe the estimated death toll approaches 1000. While local doctors announce an outbreak of inhalational anthrax, the government blames the situation on anthrax-contaminated beef. The military takes over a hospital to attend to these victims exclusively. The official cause is made known by President Boris Yeltsin in 1992 when he states that it was an accidental release of anthrax spores in a BW program.
1991 It is alleged that members of the Minnesota Patriots Council attempt to harm an IRS official, local law enforcement, & a US deputy marshal with ricin. They extracted the toxin from castor beans they received from a mail order house. The plan is to deliver the ricin through the skin with DMSO & aloe vera and by aerosol. Four members are arrested when the group is infiltrated by the FBI. 1999 On November 5, James Kenneth Gluck is arrested for threatening to poison 2 Colorado judges with ricin. The raw materials for making the toxin are found in his Tampa home.
The Toxic Castor Beans (Ricin)
1981 Dark Harvest spreads dirt contaminated with anthrax. 1984 In September, the Rajneeshee cult, an Indian religious cult, contaminates salad bars of The Dalles, OR & Wasco County, OR with Salmonella typhimurium. Over 750 are poisoned and 40 hospitalized. The purpose is to influence the outcome of a local election. It is only discovered a year later when members of the cult turned informants.
1992 In October, Soko Asahra, head of the Aum Shinrikyo cult, with 40 followers, travels to Zaire in order to assist victims of the Ebola virus. According to an October 31, 1995 report by the US Senate's Permanent Sub committee on Investigations, the cult's real motive was to obtain virus samples to be used for biological attacks. 1995 It is reported that on at least 10 occasions Aum Shinrikyo attempted to disperse anthrax, botulinum toxin, Q fever, & Ebola against the mass population and authority figures in Japan. No reported infections occur.
1990 Outfitted car to disperse botulinum toxin through an exhaust system and drove car around parliament building. 1993 Attempted to disrupt the wedding of Prince Naruhito by spreading botulinum in downtown Tokyo via an auto. 1993 Spread anthrax in Tokyo via a sprayer system from the roof of a building. Done over 4 days. 1995 Planted 3 briefcases designed to release botulinum in a Tokyo subway. The attack was averted when a cult member substituted a non-toxic agent instead.
1998 On February 18, Larry Wayne Harris, a microbiologist said to have been linked to white-supremacist groups, is arrested after he, allegedly, threatened to release anthrax in Las Vegas. The strain in his possession is a harmless veterinary vaccine strain.
1999 It has been reported that Osama bin Laden has attempted to acquire biological weapons in Sudan and Afghanistan. 1999 In Nakhon Nayok, China, a widow of a man who died of AIDS tries to infect 20 policemen and several politicians with HIV. 1999 On January 6, a perpetrator tries to rob a currency exchange office in Zadar, Croatia using a syringe allegedly containing HIV as a weapon. 1999 On August 24, a man, armed with a syringe claimed to be filled with HIV-infected blood, attempts to hold up 3 people.
2001 A 38 year old assistant to NBC anchorman, Tom Brokaw, handles a letter containing powder which was postmarked on this date. On 9/25 she notices a raised skin lesion on her chest and over the next three days there is progressive erythema and edema. On 9/29, she develops malaise and a headache. By 10/1, the lesion has developed into a 5cm oval with raised borders and satellite vesicles. There is left cervical lymphadenopathy and a black eschar soon develops. This turns out to be the first case of cutaneous anthrax. The patient recovers with antibiotics.
2001 Robert Stevens, 63, is admitted to a Lake Worth hospital gravely ill with the presumptive diagnosis of meningitis. The diagnosis of inhalational anthrax was made after further testing. Initial reports from HHS discount the possibility of terrorism. A co-worker, Ernest Blanco is admitted to a Miami hospital with the diagnosis of pneumonia which over the course of time is diagnosed as inhalational anthrax. He eventually recovers.
Accounts on Bioterrorism
October 2, 2001, a 63-year old Florida man who
worked as a photo editor in a media publishing company.
another case occurred in a 73 year old man
who worked at the same Florida media publishing company and delivered mail to the first man. Health officials theorized that a letter contaminated with deadly finely milled anthrax spores was the source of the disease. health officials closed the media publishing company and treated over 1100 employees with antibiotics.
On October 9, a letter addressed to
Senator Dashle with a powder of anthrax spreading in the entire building. ultimately only 11 cases of inhalational anthrax nationwide in 2001. U.S outbreak, includes 5 deaths, over 10,000 persons were treated with antibiotics to prevent disease.
A model that can be developed on how
many cases of anthrax were prevented by antibiotics. *cases that are symptomatic and come to public attention. *potential cases that are also infected but their disease is still incubating are the silent cases that have not yet become symptomatic.
Cases still incubating
The cases of disease that initially occur
when an outbreak begins to unfold are the cases with the shorter incubation periods.
central idea underlying the iceberg effect
is that there is variability in incubation periods and that incubation periods follow a probability distribution.
Incubation Period of Anthrax
Sverdlosvk, Russia - largest human outbreak of anthrax
A histogram of the incubation periods of 70 cases from
the Sverdlosvk outbreak shows a long tail with incubation periods as long as 40 days.
only persons with potential incubation periods greater
than two weeks would have had an opportunity to obtain antibiotics and perhaps have their disease prevented.
Statisticians call this phenomenon right
truncation, a form of selection bias that occurs when larger observations may be less likely to be included in the data set.
Sartwell (1950) pioneered the use of the
lognormal distribution for the incubation distribution of infectious diseases.
distribution is lognormal if the logarithm of the
incubation period follows a normal distribution logarithmic transformation produces the familiar bellshaped curve.
Statistical Model for the 2001 U. S. Anthrax Outbreak
used to describe the number of cases that occurred in each cluster is the binomial distribution. parameters of the statistical model were estimated using maximum likelihood methods
Epidemics of plague in humans usually involve house rats and their fleas. Between outbreaks, the plague bacterium is believed to circulate within populations of certain species of rodents without causing excessive mortality.
Geographic Distribution of Plague
during the 1980s plague cases averaged about 18 per year. y Most of the cases occurred in persons under 20 years of age. y Worldwide, there are 1,000 to 2,000 cases each year. y During the 1980s epidemic plague occurred each year in Africa, Asia, or South America.
Plague is transmitted from animal to animal and from animal to human by the bites of infective fleas. Transmission of plague from person to person is uncommon and has not been observed.
y y y
The last natural outbreak of smallpox in the U.S. occurred in 1949. Today, the smallpox virus is kept in two approved laboratories in the U.S. and Russia. CDC has a detailed plan to protect Americans against the use of smallpox as a biological weapon. plan includes the creation and use of special teams of health care and public health workers.
Response to Bioterrorism
A. Coping with Danger in Microbial World
1.Sanitation 2.Vaccination 3.Antimicrobial Drugs
1. Biological Weapons Act, 1989.
B. Government Laws and Regulations
2. Chemical and Biological Weapons Control and Warfare Elimination, 1991 3. Presidential Decision Directive 39, 1995 4. Anti-Terrorism and Effective Death Penalty, 1996 5. CDC charged with regulation and transfer of biological agents, 1997 6. USA PATRIOT of 2001
C. Laboratory Response Networks
Role of Sentinel Laboratories
Raise suspicion 1.Must have Class II Biological cabinets 2.Must know proper packaging; shipping is critical 2. do NOT determine a Bioterrorism attack