Bioterrorism Basics (Biodefense) September 8, 2002 ASPH Conference

1. Bioterrorism Basics(Biodefense)September 8, 2002ASPH Conference

3. History, origins, motivations, threats • Differentials • How conducted, launched, done • Purpose – Motivation • Clinical effects • Teaching, Research, Planning and Preparedness differentials • Detection • Response & Treatment • Containment

4. Violence Against Humans

5. Examples of Terrorism • Hostage-taking • Aircraft piracy or sabotage • Assassinations and kidnappings • Threats and hoaxes • Indiscriminate bombings • Shootings • High Explosives • Weapons of Mass Destruction (WMD) vs. Weapons of Mass Casualties (WMC) • Chemical, biological, radiological, nuclear, and explosives (CBRNE)

6. Scale of Attack and Response (Small) (Medium) (Large)

7. Biological Warfare & Terrorism • Pre-Modern warfare - use of carcasses • Early American colonial period • WWI - Glanders • WWII • Japanese Unit 731 • UK - US fear of Nazis • Cold War - USSR; UK; US; France; PRC • “Third World” - Iran; Iraq; North Korea; Libya; Syria; … • The Dalles, Oregon - 1984 • Iran-Iraq War - 1980s • Aum Shin Rykio - 1990s • Anthrax – 2001

8. BioWar Stereotypical attack scenarios Cold War Big attacks 100,000s BioTerror Unconventional attack scenarios Creative terrorism “New” “War” Small attacks 10 – 100 A Paradigm: Biowar -- Bioterror • Change: move away from big bio war to small bioterrorism, creative terrorism • Implications for detection, response and containment

9. TERRORISM • CREATES CASUALTIES • TRAUMATIZES POPULATION • PRESSURES LEADERS • ATEMPTS TO TEAR CIVIL SOCIETY AND DEMORALIZE IT • INSPIRES TERRORIST AND THEIR BASE Courtesy: Ken Thompson, M.D.

10. Terrorism • Easier to describe than define • One definition: Unlawful [criminal] use or threat of violence against persons or property to further political or social objectives • Intent is to intimidate or coerce a government, individuals or groups to modify their behavior or policies (VP Bush, Terrorism Task Force Report, February 1986) • Unexpected attack against unwarned, unprotected civilians to cause death or provoke fear and panic (not just against U.S. persons)

11. Sources of Terrorist Attacks • U.S. persons (OKC, Rashneesh, Anthrax) • Self-supported (home grown, racist, identity, environmental, Aryan Nation, Neo-Nazis, millennial, disaffected, ....) • Non-U.S. persons (Aum Shinrikyo) • Trans-national (religious, ethnic, tribal, “nucs on the loose,” ....) • Foreign government or organizations hostile to U.S. (World Trade Center) • State-sponsored (Iraq, Sudan, Libya, ....) • Foreign government in support of an armed conflict with the U.S. • Theft from industry or research • Sources: foreign and domestic

12. Who is the Bioterrorist? • Ability • Intent • Opportunity • Benefit • Not just the kid next door

13. Important Points • Terrorists becoming increasingly violent and indiscriminate; religious and cultural reasons • Not big leap from big bomb mass casualties to biological agents • Bioterrorism: attacks on non-combatants • Purpose: panic, fear, traumatize public, pressure leaders • Sources: foreign and domestic • Coordination and collaboration among government and academia needed

14. A Date to RememberAn Attack in America October 5, 2001 • First U.S. death from anthrax caused by terrorism; a date to remember

15. CBRNE • They’re not all the same!

16. Got to Rethink • Detection: release, illness, clinician, laboratory, autopsy • Response: local and State, then Federal support • Containment: isolation, decon, respiratory support • What are the implications? • Research • Education • Clinical (Practice and Service) • Application

17. Bioterror Preparedness and Response Functions • Planning • Detection • Response • Containment • Follow-up

18. Bioterror Planning Needs • Understand Threats • Policy • Hospital and Clinic Capacity, Cost and Impact Modeling • Mutual Aid Agreements • Health and Emergency Services Departments • Metropolitan Medical Response System (MMRS) • Education and Training • Stockpiling • Research • Legal and Law Enforcement • Public Information

19. Bioterror Detection Needs • Symptom and Patient Surveillance • Pattern Recognition • Laboratory Capabilities • Education and Re-Education of Clinicians • Sensors and Diagnostics • Computer-Based Surveillance • Autopsy Results

20. Detection Law Enforcement +Intelligence Laboratory workup Illness Autopsy Agent release Clinical visit • Law Enforcement and Intelligence: Foreign and domestic intelligence; law enforcement; pathogen registration and controls • Agent release: Air-breathing samplers; mail sorting • Illness: Work and school absences; purchases; prescriptions • Clinical visit: Doctor and nurse education and recognition input to a Realtime Outbreak Disease Surveillance System (RODS); • Laboratory workup: Good microbiology; suspicion; technology available • Autopsy: Suspicion; not natural; age; history;

21. Detect agent release Air-breathing sensors Many sensors Networked solution Wide geographic area Logistically complicated Detect illness Emergency rooms Diagnostic skills One out of many Proper recording Syndromic surveillance How Do We Know We’ve Been Attacked? • Who to warn and treat? • How to warn? • How to protect?

22. Bioterror Response Needs • Case Treatment and Protocols • Epidemiological Investigations • Hospital Care • Non-Medical Facility Care • Long-Term Care • Psychiatric and Risk Communications • Non-UPMC-HS Relations • Local and mutual aid planning • Relations with State and Federal assisters • Health and Emergency Services Departments • Mortuary

23. Bioterror Containment Needs • Identify Population at Risk • Infection Control • Contagious Disease Control • Decontaminate • Public Health Education • Medical Research

24. Bioterror Follow-up Needs • Investigations • Legal • Apprehension • Prosecution • Financial and Health Economics

25. Clinician: What is your diagnosis? • Contact dermatitis? • Teen-age acne? • Smallpox (Variola)? • Herpes? • Measles? • Chickenpox? Courtesy: Dr. Michael Allswede

26. Diagnosis -- Smallpox (Variola) Courtesy: Dr. Michael Allswede

27. At any given time, about 60% of the world’s population is awake. Some of them are up to no good. Courtesy: Dr. Michael Allswede

28. Definitely a Date to Remember: October 5, 2001 • Changed the way we look at threats to health and security • A new multi-faceted integrated approach needed for preparedness and response against terrorists using biological pathogens B. anthracis, gram stained spores

29. In Pittsburgh we’ve tackled bioterrorism • Education -- developing curricula in MPH program; teaching, resource; community groups; students; outreach; lecture program; Certificate in Public Health Preparedness and Disaster Management • Research -- in terrorism preparedness and response • Service / Practice -- to the Pittsburgh community in mass casualty response planning; MMRS; education; resource to local planners, elected officials and local and State Health Departments; hospital preparedness • Create a catalyst and create synergy for the region and nation

30. President’s Visit to the University of Pittsburgh – February 5, 2002 Dr. William Pasculle and Ms. Liz Forster– UPMC Microbiology Laboratory

31. Contact Information: Samuel J. Watson 412-383-7985 / 7475 412-624-3040 (fax) watsons@pitt.edu c/o University of Pittsburgh 130 DeSoto Street Room A730 Crabtree Hall Pittsburgh, Pennsylvania 15261 USA