WELCOME

BIOLOGICAL DISASTERS PREVENTION AND

MITIGATION

BY MENAKA KANNAIYAN

TAM-14-012

BIOLOGICAL DISASTERS

• A biological disaster may have a considerable impact in terms of human life, disability, quarantine, treatment costs and disposal of deceased persons in addition to long term environmental and economic consequences.

• It is important to recognise that biological disasters may be naturally occurring events (e.g. an influenza pandemic) or a deliberate event (biological terrorism).

• Biological disasters of natural origin are largely the result of the entry of a virulent organism into a congregation of susceptible people living in a manner suited to the spread of the infection.

• Anthrax- spore dispersal in the air.

• Small pox-aerosols.

• Typhus and plague-lice, fleas, rodents etc.

• Epidemic spreads locally and dies down if the contagion is localized.

• Diseases have spread widely, even across national boundaries

• Disasters occurred-environmental factors conducive

• Black death occurred- increase in number of rats.

• Cholera attained a pandemic form-causative agent entered urban areas which had inadequate sanitation facilities

BIOLOGICAL AGENTS AS CAUSES OF MASS DESTRUCTION

• Highly virulent agents have the potential of infecting large numbers- infectious chains.

• The potential of some infectious agents is nearly as great as that of nuclear weapons.

• Weapon of mass destruction(WMD): Nuclear ,Biological and Chemical.

TRENDS FAVOURING BIOLOGICAL WEAPONS• Low cost and wide spread availability .

• More efficient in terms of coverage/ kg of payload.

• Advances in biotechnology have made production easy.

• Agents are largely natural pathogens and simulate existing diseases.

• Have an unmatched destructive potential.

• Technology for dispersing biological agents- sophisticated.

• The lag time between infection and appearance of symptoms is longer than with chemical exposures.

• Lethal biological agents can be produced easily and cheaply.

SOURCES OF BIOLOGICAL AGENTS:

• Any human, animal or plant pathogen can cause a epidemic or biological weapon.

• The deliberate intention or action to cause harm or biological attack.

• Incident in USA where members of a religious cult caused gastroenteritis by the use of Salmonella typhimurium (common natural pathogen).

METHODS OF DESSIMINATION OR DELIVERY

• Aerosols-biological agents are dispersed into the air forming a fine mist that may drift for miles.

• Animals-fleas, mice, flies , mosquitoes and livestock.

• Food and water contamination-some pathogenic organisms and toxins may persist in food and water supplies.

• Person to person-Small pox , Plague and the Lassa viruses.

TYPES OF BIOLOGICAL AGENTS• There are 3 categories of biological agents potential enough to

cause mass casualties( centre for disease control and prevention)• Category A, B and C.• Those in category A have greatest potential for fear and disruption

and most significant public health impacts.

CATEGORY A:

Easily disseminated or transmitted from person to person.

High mortality.

Requires special action for public health preparedness.

Viruses: Variola major(small pox), Filo viruses(Ebola, Marburg), Arena viruses(Lassa, Junin).

Bacteria: Bacillus anthracis(anthrax), Yersinia pestis(plague), Francicella tularensis(tularemia).

Toxins : Clostridium botulinum toxin(botulism)

CATEGORY B:

Moderately easy to disseminate. Moderate to low mortality. Require improved diagnostic capacity and enhanced surveillance. Viruses: Alpha viruses Bacteria: Coxiella burnetti (Q fever), Brucella species

(brucellosis). Toxins: Ricinus communis( caster beans) ricin toxin,

staphylococcus entero toxin B. Food and water borne pathogens: Salmonella spp., Vibrio

cholerae.

CATEGORY C:

• Viruses: Nipah, hanta viruses, tick borne hemorrhagic fever viruses, tick borne encephalitis viruses, yellow fever.

• Bacteria: Multi drug resistant Mycobacterium tuberculosis.

ANTHRAX DISEASE

• The disease anthrax is caused by non motile, gram positive Bacillus anthracis.

• It has been a scourge of cattle and other herbivores for centuries.

• During the industrial revolution , the inhalation form was first recognized as an occupational pulmonary disease in workers in the wool industries of Europe.

• Anthrax makes an ideal biological weapon.• The inhalation form of disease is highly lethal.• The spores can maintain for decades they can be milled into

ideal particle size for optimum infection of human respiratory tract.

SMALL POX DISEASE

• If used as a biological weapon, smallpox represents a serious threat to civilian population because of its case fatality rate of 30% or more among unvaccinated persons and the absence of specific therapy.

• Small pox has long been considered as the most devastating of all infectious diseases and today its potential for devastation is far greater than at any previous time

Smallpox virus is a member of genus Orthopox virus, and it is closely related to the viruses causing cowpox vaccinia and monkey pox.

It is one of the largest DNA viruses known and it has a brick like appearance on electron microscopy.

Transmission risk increases if the patient is coughing or sneezing or if he or she has hemorrhagic disease.

• Typically, the virus enters the respiratory mucosa and then travels to regional lymph nodes where it replicates.

• The incubation period from infection to onset of rash ranges from 7 to 17 days. Small pox scabs remain infectious until they fall off, whereas chicken pox is no longer infectious once the lesions are crusted.

PLAGUE DISEASE• The mere mention of the world plague conjures up many images

because has already demonstrated a historical potential to kill millions of people across the globe .

• It is a disease that results from infection by non- motile gram negative coccobacillus Yersinia pestis.

Following the bite of an infected flea, plague bacilli are carried via the lymphatic to the regional lymph nodes where they multiply exponentially.

This is the only weapon besides smallpox which can cause devastation beyond those persons who are initially infected.

• Botulinum or botulism toxins are deadly.

• A toxin is any toxic substance that can be produced in an animal plant or microbe.

• The toxins produce serious disease in human beings.

• Many natural toxins can be produced by chemical synthesis or can be expressed artificially.

• Toxins are natural and non volatile and generally do not penetrate intact skin, which happens in case of chemical weapons.

BOTULINUM

• There are different type of toxins and they are immunologically distinct, meaning that antibodies developed against one do not cross react against others.

• Humans can be intoxicated either by oral means , inhalation, or wound infection.

• The incubation period ranges from as short as 24 to 36 hours to several days from the time of infection.

TULAREMIA

• Tularemia is caused by Francisella tularensis, which is a non-motile, gram-negative cocco bacillus.

• Tularemia is a zoonotic disease acquired in a natural setting by humans through skin or mucous membrane contact with the body fluids or tissues of infected animals or from being bitten by infected deerflies, mosquitoes or ticks.

• It can remain viable for weeks in environment or in animal carcasses and for years if frozen.

Francisella tularensis

• After an incubation period of 2 to 10 days, pneumonia symptoms develop associated with weight loss and non productive cough.

• The drug of choice for treatment is streptomycin with other aminoglycosides.

EBOLA

• Ebola virus / Zaire ebola virus is one of the four ebola viruses known to cause disease in humans.

• It has the highest case-fatality rate of these ebolaviruses, averaging 83% since first described in 1976, although fatality rates up to 90% have been recorded in one epidemic (2002–03).

• There have also been more outbreaks of Zaire ebola virus than of any other ebolavirus. The first outbreak occurred on 26 August 1976 in Yambuku.

• The first recorded case was Mabalo Lokela, a 44‑year-old schoolteacher. The symptoms resembled malaria, and subsequent patients received quinine.

• Transmission has been attributed to reuse of unsterilized needles and close personal contact, body fluids and places where the person has touched.

SYMPTOMS OF EBOLA

• Bleeding from mouth ,nose, ears.• Increased sensitivity to pain on the skin.• Genital swelling.• Conjuctivitis.• Rashes all over the body.• Reddening of roof of the mouth.

EBOLA INFECTION

MAJOR EVENTS ACROSS THE GLOBE

• Biological warfare has a long history of mass destruction- epidemic and pandemic diseases.

• Mycotoxins have been reported to be used in Afghanisthan.

• The red Indians in North America were given the smallpox infected blankets.

• In 2001 USA experienced biological attacks involving the intentional distribution of Bacillus anthracis spores through the postal system. It created the threat for bioterrorism.

• Medical advances reduced the damages from some of infectious diseases, yet many remain to be conquered.

• Highly pathogenic avian influenza, a disease in birds occurring repeatedly since ancient times, is now found worldwide.

• The World Health Organization (WHO) announced on February 15, 2007 that of 273 bird flu victims in 11 countries in Asia, the Middle East, and Africa, 166 have died.

• Since bird flu does not spread easily to human beings, the number of victims is limited.

• The worst historically recorded ones involved Spanish flu, which started in 1918 during World War I among French and German soldiers and spread globally, resulting in 20 million to 60 million deaths.

• Spanish flu - said to have been named after its effects on the Spanish royal family - is known to have caused the highest number of deaths of any single infection.

DOCUMENTED INTENTIONAL USE OF BIOLOGICALS:

• Dispersal of anthrax spores due to accident in production unit in USSR caused 68 deaths in 1979.

• In 1984, Osho followers used Salmonella typhimurium in salad in a restaurent in Oregaon , USA leading to 751 cases.

• Anthrax spores through postal envelopes in USA in Oct-Nov 2001 leading to 22 cases and 5 deaths.

PRESENT STATUS AND CONTEXT:

• Plague which has assumed epidemic proportions in the early to mid 19th and 20th centuries, has nearly been eliminated.

• SARS outbreak in 2003 caught the attention of the world- spread of a disease from a single hospital case to a global pandemic in less than 3 months.

• Similarly, the outbreak of avian influenza among poultry in Nandurbar and Jalgaon districts of Maharastra and adjoining districts of Gujarath and Madhya pradesh (2006) saw the poultry industry plummet.

• The 1918 influenza pandemic killed an estimated 7 million people in India.

• Slow , evolving epidemics such as HIV/ AIDS- socio – economic disruption.

• Emerging and re-emerging diseases , notably SARS, avian influenza, Nipah virus, leptospirosis, dengue, Chickengunya, and Rickettsial are also posing serious threats.

PREVENTION AND MITIGATION MEASURES OF BIOLOGICAL DISASTERS

• The general population should be educated and made aware of the threats and risks associated with it.

• Only cooked food and boiled/ chlorinated/ filtered water should be consumed.

• Insects and rodent control measures must be initiated immediately.

• Clinical isolation of suspected and confirmed cases is essential.

• Therefore a network of specialized laboratories should be established for a confirmatory laboratory diagnosis.

• Existing disease surveillance system as well as vector control measures have to be pursued more rigorously.

• Mass immunization programme in the suspected area has to be more vigorously followed up.

FUTURE PLAN

• Since vaccines against a number of potential biological warfare agents have already been in use,mass immunization of the population would be done on a priority basis.

• Vaccines against remaining agents should have to be reasearched and developed.

• Mass public awareness before, doing and after such an attack

must be emphasized upon.