Biologic Agents of Warfare

1. Biological Agents of Warfare

2. Categories
Prioritized by the CDC
Category A
– Higher potential for weaponizing
– More history-based risk
– Higher risk of transmission
Category B
Category C

3. BW Category A
 Small pox*
 Anthrax*
 Plague*
 Botulism
 Tularemia
 Viral hemorrhagic
fever
 Variola major
 Bacillus anthracis
 Yersinia pestis
 Clostridium botulinum
toxin
 Ebola,marburg, lassa

4. Small Pox Victim

5. Small Pox History
 1754-67 British BW during French-Indian wars
in North America.
– Infected blankets intentionally given to American
Indians resulting in >50% mortality.
 1977 WHO eradicated small pox
 1978/80s stopped vaccinations in USA &
worldwide
– Soviet Union secretly weaponized
 WHO approved repositories of variola in CDC
and Institute for Viral Preparations (Moscow)

6. Small Pox Vaccine Impact on
Mortality
 Never vaccinated
 Post exposure vax
 < 10 years ago
 11-20 years ago
 >20 years ago
 52% case fatality
 29%
 1.4%
 7%
 11%

7. Similar Conditions Confused
with Small Pox
 Varicella
 Scabies
 Erythema multiforme
 Herpes zoster/simplex
 Impetigo
 Drug reactions
(eruptions)
 Contact dermatitis
 Case
 Contacts of case
 Contacts of contacts

8. Lesions progress from macules to papules to vesicles to
pustules to crusting & finally separation of crusts

9. Anthrax
Bacillus anthracis lives in certain soils
Hardy forms (spores) survive in soil or
objects for years
Animals are infected when they ingest
spores while grazing, breathe in spores or
eat infected animals
Once inside the host the bacteria multipy

11. Anthrax Types & Symptoms
Cutaneous
Intestinal
Inhalation
– Most dangerous form, spreads quickly from
lungs to bloodstream
Symptoms
– Resemble Flu
– Fever, sweating, labored breathing

12. Bioterrorism Threat
Easy to manufacture
Small amount can lead to widespread
danger, fear, disruption, destabilizing chaos
and death.
October 2001 USA
– Via US Mail to a tabloid publishing company
in Boca Raton, Florida & NBC studios, NY
– Spore filled letters indirectly affected thousands
of people
– 11 with inhalation, killing 5

13. Anthrax Post-exp
prophylaxis
 1991 Iraq
acknowledged
weaponizing wet
anthrax
 1995 Aum Shinrikyo
terrorist group
unsuccessfully
attempted release in
Tokyo subway before
using sarin
 Vax + cipro x 30 days
 Ciprofloxacin 60 days
 Doxycycline 60 days
 Amoxicillin 60 days
 If symptoms Hospital
IV and po meds

14. Anthrax Vaccine?
1880 development began in animals
1930 live spore vax for livestock
WWII work began on inactivated vax
against bacteria
1970 licensed Anthrax Vaccine Adsorbed
– Primarily used to protect troops

15. Does is Work?
CDC Study of mill workers at risk for
cutaneous anthrax
5 unvaccinated workers developed
inhalation anthrax, 4 of whom died
None of the vaccinated workers became ill
90% of vaccinated animals survive lethal
doses of inhalation anthrax
www.anthrax.osd.mil/vaccine/project2.asp

16. Side Effects
Redness, pain, swelling, burning, itching at
injection site
Lump forms under skin subsides in a few
days
Serious adverse event 1 in 100,000
Since 1940 vax lab workers followed- so far
no long term health problems have arisen

18. A Study in Black
Acute infection primarily in rats & rodents
who have been bitten by infected fleas
Types
– Bubonic plague (swollen lymph glands)
– Pneumonic plague (respiratory distress)
– Septicemic plague (severe, rapid systemic dz)
Spreads
– Contact with infected fleas
• trapping & hunting animals
• Rats living in close proximity to humans

19. Yersinia pestis (Plague)
 Environmental Cycle:
– Flea bite Bubonic Plague Septicemia
Pneumonic Plague Contagious Respiratory droplets
 Treatment:
– Infected in natural setting
• Streptomycin or gentamycin
– Mass exposure
• Doxycycline, ciprofloxacin, chloramphenicol
– Vaccine discontinued 1999

20. Plague as a Bioweapon
1346 Tartar army hurled infected corpses
into Kaffa
– Possible start of Europe’s “Black Death”
WWII Japanese army dropped plague
infected fleas in China
Post war USA & USSR aerosolized plague

21. Plague in History
First Pandemic
– Plague of Justinian 6th
century- recurring
periodically every 200 years
Second Pandemic
– Black Death/Great Plague 14th
-17th
century-
recurring every 17-25 yrs from 1348-1750
Third Pandemic
– 19th
-20th
century (1890-1930)

22. Early Theories
Corruption of atmosphere
– Move to country, block windows, use of
homeopathic remedies
Will of God or astrological influences
– Resulting in death & persecution of religious
and social minorities (Jews, prostitutes and
homosexuals)
Contagion through the air
– Isolation, quarantine, blindfolded (to keep the
spirit of the infected from entering your eyes)

23. Medieval Infection Control
1500 AD
 The Plague Doctor
 Beaked Mask
– Filter air stuffed with
herbs
– Feverfew, chamomile,
hemp
– Glass over eyeholes
– Precursor to gas mask
 Stick in hand
 Cloak of sealed canvas
 Frighten spirits not
microbes