Weaponized Bioagents

YSU – Agents of Mass Casualty

Agent Classification

• Military– Foundations may be foreign– May have practical roots

• Civilian– CDC Classification

Military “C”

• “C” = Class

• Chemical Classes– C01 to C24

• Biological Classes– C25 to C29

Chemical Agents

• Sub-Codes – Examples C01– GA– GB– GD– GF

Military Classes - Bioagents

• C24 – Anti-Personnel

• C25 – Anti-Personnel/Vector

• C26 – Anti-Personnel/Ingestion

• C27 – Anti-Animal

• C28 – Anti-Plant

• C29 - Simulants

CDC & EM Classification

• Category A – Weaponized or Available– Variola virus– Bacillus anthracis– Yersinia pestis– Botulinum toxin– Francisella tularensis– Filoviruses & Arenaviruses

CDC & EM Classification

• Category B – Lower Virulence/Possible Agents– Coxiella burnetii– Brucellae– Burkholderia mallei– Alphaviruses– Ricin– SEB– Foods Agents – E. coli 0157:H7, Salmonellae– Water Threat – Vibrio cholera, Cryptosporidium

CDC & EM Classification

• Category C– Any other emerging pathogen or biological

toxin that might be a threat.

Anthrax – B. anthracis

• 12 hrs-5 days (except delay)

• Inhalation – flu-like, fluid in lungs, severe difficulty breathing, broadening mediastinum

• Not Contagious – Aerosol or powder

• Treat With Antibiotics

• Military Vaccine

• 30% Mortality (untreated may be higher)

Botulinum Toxin

• Affects in 12 hours to 3 days

• Flu-like symptoms, difficulty speaking, swallowing, drooping eyelids, paralysis

• Antitoxin available (not reversible damage)

• No commercial vaccine

• Probably disseminated in liquid droplets or on food.

Cholera – V. cholera

• 12 hours to 5 days

• Severe diarrhea, vomiting and weakness, leg cramps and fluid loss.

• Not contagious – disseminated in food or water.

• Treatable with antibiotics – high fluids

• Newer vaccines not available in U.S. Old vaccine low effectiveness, short-lived

Glanders – B. mallei

• 1-14 days• Fever and headache, muscle

tightness, chest pain, tearing and light sensitivity

• Not highly contagious – aerosol diss.• Treatable with antibiotics• Very few historical cases, up to 50%

mortality possible.• No vaccine

Plague – Y. pestis

• 1-6 days

• Flu-like, lymph node pain (buboes), blood-streaked sputum, septic shock

• Aerosol or food – pneumonic transmissible

• Treatable with antibiotics – time is critical

• Vaccine, once available did not prevent pneumonic form. Discontinued in 1999.

Q-Fever – C. burnetii

• 2-3 weeks

• High fever, throbbing headache, sweating, auditory and visual hallucinations, hepatitis

• Aerosol or food dissemination, not very transmissible

• Low mortality, most recover without treatment.

• Vaccine not available to general public

Smallpox – V. major

• 10-14 days

• High fever, aches, rash starts in face and arms (then trunk – unlike chickenpox)

• Aerosol or person-to-person. Contagious stage comes with symptoms.

• Vaccination 3-5 days after exposure may avoid or lessen disease.

• No treatment (supportive therapy only)

Tularemia – F. tularensis

• 1-14 days in nature (3-5 in a deliberate act)

• Flu-like + lethargy. Swollen lymph nodes in systemic infections, red, sore eyes, pneumonia

• Disseminated as aerosol or on food – no human to human

• Antibiotics. Some weaponized strains may be abx. resistant.

Mortality

• 1970 World Health Organization

• Assumed 50 kg of dried agent

• Disseminated on a 2 km line

• Upwind of a population of 500,000

Results

Agent Distance Carried (km)

Fatalities Casualties

(Total)

VEE 1 400 35,000

Typhus 5 9,500 35,000

Brucellosis 10 19,000 85,000

Plague 10 500 100,000

Q-Fever >20 150 125,000

Tularemia >20 30,000 125,000

Anthrax >>20 95,000 125,000

Other Concerns

• Residential backflow protectors

• Food QC

• Availability of viral hemorrhagic fevers

• Soviet brain drain

Soviet Bioweapons - Rating

• Smallpox

• Plague

• Anthrax

• VEE

• Tularemia

• Q-Fever

• Marburg virus

Others include the flu virus, glanders and epidemic typhus.

Detection

• Rapid Dx Assays– Military

• Botulinum, SEB, SEA-C-D• Dengue Fever, Q-Fever, Plague,

Tularemia, Typhus, West Nile

– Civilian• SMART Tickets• DNA Techniques

Decon

                               

ER + Decon

• Isolate small areas to 100 ft or more

• Note weather, population, density and time of day

• For airborne cloud – shelter-in-place

• Field Detection – Not Recommended

• PPE– General rule – Level A – Latex may not be

fully protective

ER + Decon

• Remove clothing (aerosol or powder)

• Double bag

• Wash w/soap + water

• 10% bleach wash (10-15 minutes)

• Rinse solutions should be retained if possible

ER + Decon

• Careful of reaerosolization

• Treat all items as Haz-Waste

• Note airflow around patients (bioaerosols)

• Always try to decon at site if possible

NPS or SNS• Future module will address

• Located at secret locations around the nation (12 hour deployment on gov. req.)

• Enough to treat, perhaps hundreds of thousands (depending on disease)

Antibiotics

• May be classified:– By spectrum– Method of administration– Activity (bacteriacide vs. bacteriastat)– Chemical structure

• Useful because those in the same class will show similar side-effects, action, toxicity etc.

Antibiotics

• Penicillins

• Cephalosporins

• Fluoroquinolones

• Tetracyclines

• Aminoglycosides

Antibiotics

• Penicillins– Oldest– Similar in chemistry to cephalosporins– Bacteriacidal– Natural penicillins (“G”) (methycillin)– Aminopenicillins (Amoxil) – broader may

require penicillinase inhibitor

Antibiotics

• Cephalosporins– Bacteriacidal– May show similar allergic problems to pen.– 1st, 2nd and 3rd generation– 3rd generation cross blood-brain barrier– Work on anaerobes

Antibiotics

• Fluoroquinolones– Synthetic– Reach deep tissues– Bacteriacidal– Cipro, Penetrex, Floxin, Trovan

Antibiotics

• Tetracyclines– Derrived from strep bacteria– Bacteriostatic– Effective against rickettsia + parasites

• Macrolides– Emycin, Z-pak, Clarithromycin– Effective to penetrate lung tissue– Spectrum similar to penicillins