DELHI PHARMACEUTICAL SCIENCES AND
RESEARCH UNIVERSITY
ACADEMIC YEAR: 2020-22
COURSE: MASTER of PUBLIC HEALTH
ASSIGNMENT
ON
“BIOTERRORISM”
SUBMITTED TO
Dr. Sheetal Yadav
Associate PROFESSOR
SCHOOL OF ALLIED HEALTH SCIENCES
SUBMITTED BY
NEERU CHAUDHARY
(230/MPH/SAHS/2020)
BIOTERRORISM
INTRODUCTION:
• Bioterrorism is defined as the deliberate release or ultimatum of
release of biologic agents (i.e. viruses, bacteria, fungi or their
toxins) so as to cause disease or death among human population or
food crops and livestock to terrorize a civilian population or
manipulate the government within the present scenario of increased
terrorist activity has become a true possibility.
• The most significant step within the event of a bioterrorist attack is
that the identification of the event.
• Bioterrorist attacks may be covert or announced and caused by virtually any pathogenic
microorganism.
• Bioterrorist agents of major concern are categorized as A, B and C supported the priority of the
agents to pose a risk to the national security and also the ease with which they will be
disseminated.
• A bioterrorism attack during a public place could be a public health emergency. Early detection
and rapid investigation is that the key to contain such attacks.
• The role of public health epidemiologist is critical not only in determining the scope and
magnitude of the attack but also in effective implementation of interventions.
• Bioterrorism and its effects can impose heavy demands on the general public health care
system which can be called upon to handle the results.
• An effective public health care system with strong disease surveillance, rapid epidemiological
and laboratory investigation, efficient medical management, information, education and
communication (IEC) are going to be required to counter any act of covert or overt bioterrorist
attack.
• In India there has been no documented case of bioterrorism to this point. For this very
reason we'd like to grasp and study this kind of terror before it becomes a formidable challenge
to our public health system and also the society.
HISTORICAL PERSPECTIVE:
• The use of biological weapons has been reported as early because the sixth century B.C. when
contamination of water with the fungus fungus (rye ergot) by the Assyrians had been reported.
• The hurling of the dead bodies of plague victims over the walls of town of Kaffa by the Tartar
army in 1346 and therefore the spreading of smallpox via contaminated blankets by land to the
Native American population loyal to the French in 1767 are the foremost frequently cited
episodes of poisoning.
• In the recent past, mycotoxins (fungal toxins) were reported to possess been utilized
in Afghanistan within the type of what's popularly called ‘yellow rain’. The expansion of non
secular cults and extremist political groups also increases the threat of bioterrorism today.
• The most important bioattack within the U. S. (US) was the intentional contamination of
restaurant salad bars with Salmonella by a
non secular cult in Oregon in 1984.
• In September 2001, the American public was
exposed to anthrax spores as a bioweapon
delivered through the US postal system.
• The centre for disease control and prevention
(CDC) identified 22 confirmed or suspected
cases of anthrax during this attack.
• The intentional release or threat of release of
biologic agents (i.e. viruses, bacteria, fungi or their toxins) so as to cause disease or death among
human population or food crops and livestock to terrorize a civilian population or manipulate the
govt. within the present scenario of increased terrorist activity has become a true possibility.
• Bioterrorist attacks can be covert or announced and caused by virtually any pathogenic
microorganism.
• Bioterrorist agents of major concern are categorized as A, B and C supported the priority of the
agents to pose a risk to the national security and therefore the ease with which they'll be
disseminated.
• The role of public health epidemiologist is critical not only in determining the scope and
magnitude of the attack but also in effective implementation of interventions.
IS BIOTERRORISM A LEGITIMATE
THREAT?
• Epidemics of plague in India, avian (H5N1)
influenza in city, Ebola viral haemorrhagic
fever in Central Africa and Nipah virus (NiV)
infection in Malaysia and Singapore required
national and international response.
• During the plague and Ebola investigations, concerns regarding possibility of bioterrorism were
raised, though not supported by subsequent findings.
• The challenges posed by biological weapons are availability of multiple agents and delivery
means, variable incubation periods, high mortality rates and potential for geographic
dispersion of the agent (due to travel) during the period.
• Many of the important prophylactic drugs/vaccines might not be available during a bioterrorist
attack or have limited shelf lives and can't be stockpiled.
• Even today, a minimum of 17 countries are known to possess a biological weapons program.
Bioterrorist attacks may be caused by virtually any pathogenic microorganism.
• However micro organisms (like virus, bacteria, fungi or toxins) to be effective as a bioterrorist
agent should consistently produce a given effect, death or disease, at low concentrations.
• The agent should be highly contagious, have a brief and predictable period of time.
CLASSIFICATION OF AGENTS OF BIOTERRORISM:
CATEGORY A CATEGORY B CATEGORY C
High priority agents include Second highest priority agents Third highest priority agents
organisms that pose a risk to include those that are: include emerging pathogens:
national security because they
are:
Easily disseminated Moderately easy to That could be engineered
Cause high mortality disseminate for mass dissemination in
Cause public panic and Cause moderate morbidity the future.
social disruption Require enhanced disease Have potential for high
Require special action for surveillance and public morbidity mortality and
public health preparedness. health diagnostic capacity major health impact.
AGENTS OF BIOTERRORISM:
CATEGORY A AGENTS CATEGORY B AGENTS CATEGORY C AGENTS
Bacillus anthracis (anthrax) Alpha viruses Hanta viruses
Clostridium botulinum toxin Eastern and western equine Multidrug-resistant tuberculosis
(botulism) encephalomyelitis viruses Nipah virus
Francisella tularensis (EEE, WEE) Tickborne encephalitis viruses
(tularemia) Venezuelan equine Tickborne haemorrhagic fever
Variola major (smallpox) encephalomyelitis virus (VEE) viruses
Yersinia pestis (plague) Brucella species (brucellosis) Yellow fever
Filo viruses Burkholderia mallei (glanders)
Ebola virus (Ebola hemorrhagic Coxiella burnetii (Q fever)
fever)
Arena viruses
CLINICAL SYNDROMES CAUSED BY BIOTERRORISM AGENTS:
Acute respiratory distress with Acute rash with fever Neurologic syndromes Influenza like illness
fever
i. Inhalational Anthrax. i. Small Pox i. Botulism i. Brucellosis
Abrupt fever, distress, chest Fever with papular rash Acute bilateral Irregular fever, chills,
pain. Widened mediastinum that begins on the face descending flaccid malaise, headache and
Gram +ve bacilli in sputum. and extremities and paralysis beginning pleuritic chest pain.
Treatment is with Ciproflox uniformly progresses to with cranial nerve Gram-ve coccobacilli
500 mg 12 hourly or vesicles and pustules; palsies. in blood / bone marrow
Doxycycline 100 mg 12 hourly Clinical with laboratory Electromyography culture.
or Clindamycin 900 mg thrice confirmation; (EMG): augmented Serologic testing and
daily for 60 days Treatment: Supportive. muscle action potential culture available.
Prophylaxis post exposure: Prophylaxis: Vaccine toxin assays of serum, Treatment:
Ciproflox 500 mg 12 hourly or immunization. faeces or gastric Intramuscular
Doxycycline 100 mg 12 for 60 aspirate can be done. Streptomycin 750 mg
days Anthrax vaccine Treatment: Supportive, to 1 g daily for 14 to
Equine antitoxin. 21 days with
Prophylaxis: Doxycycline 100 mg
Administration of 12 hourly for 6 weeks.
antitoxin. Prophylaxis: Vaccines
based on live
attenuated B. abortus
strain are of uncertain
value.
PUBLIC HEALTH EMERGENCY PREPAREDNESS AND RESPONSE TO
BIOTERRORIST ATTACK:
• The public health agencies are answerable for surveillance of infectious diseases, detection and
investigation of outbreaks, identification of etiologic agents and also their modes of transmission
and the development of prevention and control strategies.
• Maintaining effective disease surveillance and communication systems are fundamental
components of an adequate public health infrastructure.
• The public health approach to bioterrorism must begin with the event of local and state-level
plans.
• Close collaboration between the clinical and public health communities is additionally critical.
• Completion of the subsequent five phases of activities before an occasion are essential for
successful response to a bioterrorist attack:
a) Preparedness phase: This phase includes actions to be taken by different agencies to
confirm required state of preparedness.
b) Early Warning Phase: the first warning within the closed-circuit television includes
activities like case definitions, notification, compilation and interpretation of
epidemiological data.
• Early detection and rapid investigation by public health epidemiologist is critical in
determining the scope and magnitude of the attack and to implement effective
interventions.
c) Notification Phase: it's mandatory to report any unusual syndrome or usual syndromes
in unusual numbers to appropriate authorities.
• The activities during this phase include rapid epidemiological investigations, quick
laboratory support for confirmation of diagnosis, quarantine, isolation, keeping health
care facilities geared for impending casualty management and evolving public health
facilities for control.
d) Response Phase: during this phase the activities include rapid epidemiological
investigation, quick laboratory support, mass casualty management and initiation of
preventive, curative and specific control measures for holding the further spread of the
disease.
