biological warfare

BIOLOGICAL WARFARE

PRESENTED BY: DR. TIMIRESH KUMAR DAS

MODERATOR: DR. ANITA VERMAASSOCIATE PROFESSOR

DEPT. OF COMMUNITY MEDICINE

DEFINITIONS: Biological warfare (also known as germ

warfare) is the use of biological toxins or infectious agents such as bacteria, viruses, and fungi with intent to kill or incapacitate humans, animals or plants as an act of war by a state or nation.1

Entomological (insect) warfare is also considered a type of biological warfare.

DEFINITIONS: Biological agents ("bio-weapons") are

living organisms or replicating entities (viruses) that reproduce or replicate within their host to cause harm.2

They are microorganisms such as viruses, bacteria or fungi that infect humans, livestock or crops and cause an incapacitating or fatal disease. Symptoms of illness do not appear immediately but only after a delay, or ‘incubation period’, that may last for days or weeks.3

Mid-spectrum agents: Toxins and Psychochemical weapons. Do not reproduce in host, Shorter incubation period. Covered under both Biological weapons

convention and Chemical weapons convention.

Toxin : Non-living, poisonous substance produced by many types of living beings, including animals, plants and bacteria.2

DEFINITIONS:

Bioterrorism: The intentional use of microorganisms, or toxins, derived from living organisms, to produce death or disease in humans, animals or plants.3

The deliberate use or threat of use of biological agents as weapons to cause death or disease with the aim of spreading panic order to achieve ideological, religious or political goals by non state individuals or groups.4

Usually on a smaller scale than warfare. No concern of epidemicity or controlled spread. Usually target humans, rather than animals or

crops.

DEFINITIONS:

Biological warfare vs Bioterrorism Biological warfare attack:

Intent is to conquer through incapacitation or lethality

Little concern about deniability Likely to involve a delivery device Dose-response optimized Self-protection is considered

Terrorist attacks are about: Attention to a cause Fear and Disruption Economic impact Social and political pressures to change our

will and society

Biological warfare vs Bioterrorism

HISTORY AND EVOLUTION Ancient history:

6th century BC – Assyrians poisoned wells with decomposing rye ergot (Claviceps purpura)

400 BC – Scythian archers dipped arrows in decomposing bodies and faecal matter.

300 BC – Greeks and Romans – dead animals in wells.

190 BC – Battle of Eurymedon – Snakes in earthenware pots fired on ships by Hannibal.

Medieval period: 1155 – Battle of Tortona, Italy – Barbarossa

put human corpses in enemy water supply.

HISTORY AND EVOLUTION

1346 – Battle of Kaffa – Plague outbreak in Tartar army – corpses of infected soldiers hurled back –> epidemic Christian Genoese sailors fled to Italy Resulted in the European Plague of Black Death.

1767 - French and Indian War Indians greatly outnumbered the British

and were suspected of being on the side of the French

Sir Jeffrey Amherst, Commander of British Forces, directs that small-pox bearing blankets be given to Indians in the Ohio River Valley.

Smallpox decimated the Indians


World War 1: Germany

Developed anthrax, glanders, cholera and wheat fungus.

Attempted to spread Cholera in Italy and Plague in St. Petersburg.

Infected horses in US ( Baltimore) with anthrax developed by Dr. Anton Dilger.

France Planned biological sabotage programme

against German livestock – pigs and cattle.


World War 2: Japan –

Unit 731 in Manchuria, China. Dr. Ishii Shiro.

Human experiments. Used typhoid warheads against Russians

in 1939. Contaminated wells with typhoid in

Harbin, China (1939-40) Caused cholera outbreak in Changchun

(1940). Used plague infested rats in Nanking

(1941). Operation Sei-Go (Scorched Earth) (1942).


Unit 731 headquarters: The square building.

HISTORY AND EVOLUTION World War 2:

Germany – Suspected of producing and using biological

agents Not proved. Hitler persuaded by microbiologists and doctors

not to use?

Soviet Union – Weaponised Bacillus anthracis,Clostridium

botulinum , Yersinia pestis and foot-and-mouth disease virus.

Developed missiles with biological warheads. Did not use during war.

HISTORY AND EVOLUTION World War 2:

United Kingdom – Paul Fildes headed Bacteriological Warfare

Subcommittee. Developed cattle cakes with Anthrax. Aerosolised anti-personel agents developed. Gruinard island used for testing of Anthrax bombs.

Decontaminated in 1987.

US & Canada – Mostly anti animal and plant agents. Developed Anthrax and Botulinum toxin bombs. Also developed vaccines against rinderpest and

botulin toxin.

Gruinard Island, Scotland

The Black Maria was the first laboratory facility built to accommodate top secret research in US. Ft. Detrick, Maryland.

Recent times: Biological warfare to bioterrorism 1979 – Accidental leak of Anthrax spores in

Sverdlosk, USSR 66 people dead. Iraq (1985 – 1995) – Developed bombs,

rockets and missiles armed with botulin, anthrax and aflatoxin.

South Africa (1981-1994) – Developed toxins for political assassinations . Anti fertility vaccine against blacks.

1984 – 751 people infected with Salmonella by followers of Bhagwan Rajneesh in salad bars in Oregon, USA.

2001 – Anthrax spores through mail in US. 22 cases, 5 deaths.


BIOLOGICAL WARFARE OPERATIONS Offensive:

Anti-personnel: high infectivity, high virulence, non-

availability of vaccines, availability of an effective and efficient delivery system and stability of the weaponized agent.

Bacteria such as B. anthracis, Brucella spp., V. cholerae, Y. pestis, etc.

Viral agents such as Variola virus, JE virus, Ebola virus, Marburg virus, and Yellow fever

Fungal agents like Coccidioides spp. Toxins like ricin, staphylococcal enterotoxin

B, botulinum toxin.

Offensive: Anti livestock

Foot-and-mouth disease and rinderpest against cows,

African swine fever for pigs Psittacosis to kill chicken. Anthrax against cattle and draught animals Glanders in horses.

Anti crop/ anti vegetation Bioherbicides (used by British & US in

Vietnam) Wheat blast & Rice blast were weaponised

by US & USSR

BIOLOGICAL WARFARE OPERATIONS

Offensive: Entomological warfare

Uses insects to attack the enemy Infecting insects with a pathogen and then dispersing the insects over target areas (cholera, plague)

Direct insect attack against cropsUninfected insects, such as bees, to directly attack the enemy.


Defensive: Disease surveillance systems

Most biological warfare agents are primarily animal pathogens animals affected earlier.

Surveillance systems include public health specialists and veterinarians.

Early warning helps reduce morbidity & mortality.

E.g. In Anthrax infections almost 80% of exposed persons can be given antibiotics before development of symptoms if the surveillance and early warning systems are good.


Defensive: Identification of bioweapons (Diagnosis)

integrate the sustained efforts of the security agencies, medical, public health, intelligence, diplomatic, and law enforcement communities.

Doctors & public health officers - 1st line of defence.

First Gulf War - United Nations activated a biological and chemical response team, Task Force Scorpio.

Specific field tools that perform on-the-spot analysis and identification of encountered suspect materials. Multiple sandwich ELISA using gold & silver

nanowires. BiosparQ developed by TNO Labs, Netherlands. BioPen by Ben Guiron Labs, Israel.


AGENTS OF BIOLOGICAL WARFAREKey Features of Biologic Agents Used as Bioweapons1. High morbidity and mortality2. Potential for person-to-person spread3. Low infective dose and highly infectious by

aerosol4. Lack of rapid diagnostic capability5. Lack of universally available effective vaccine6. Potential to cause anxiety7. Availability of pathogen and feasibility of

production8. Environmental stability9. Database of prior research and development10.Potential to be "weaponized"

CDC Category A, B, and C Agents Category A: High priority agents

easily disseminated or transmitted from person to person

high mortality rates potential for major public health impact might cause public panic and social disruption require special action for public health

preparedness Category B: 2nd highest priority

moderately easy to disseminate, moderate morbidity rates and low mortality rates require specifically enhanced diagnostic capacity

AGENTS OF BIOLOGICAL WARFARE

CDC Category A, B, and C Agents Category C: emerging pathogens

general population lacks immunity, could be engineered for mass dissemination in

the future because of availability, ease of production, ease of dissemination, potential for high morbidity and mortality, and major public health impact.

AGENTS OF BIOLOGICAL WARFARE

CATEGORY A CATEGORY B CATEGORY CAnthrax (Bacillus anthracis) Psittacosis (Ch. psittaci) (Emerging

infections)Botulism (Cl. botulinum toxin)

Epsilon toxin of Cl. Perfringens

Hantavirus

Plague (Yersinia pestis) Melioidosis (B. pseudomallei)

SARS coronavirus,

Smallpox (Variola major) Glanders (Burkholderia mallei)

Pandemic influenza

Tularemia (Francisella tularensis)

Food safety threats (e.g., Salmonella spp., E.coli O157:H7, Shigella)

Nipah

Viral hemorrhagic fevers: Lassa, New World (Machupo, Junin, Guanarito,Sabia), Crimean Congo, Rift Valley, Ebola, Marburg

Viral encephalitis [alphaviruses (e.g., Venezuelan, eastern, and western equine encephalitis)] Brucellosis (Brucella spp.) Q fever (Coxiella burnetii) Ricin toxin from Ricinus communis (castor beans)Staphylococcal enterotoxin BWater safety threats (e.g., V. cholerae, Cr. parvum)Typhus fever (R. prowazekii)

Anthrax (Bacillus anthracis) Infection – By cutaneous and inhalational

route Signs/Symptoms-Cutaneous Pulmonary

95% cases 5% cases1-5 days 1-6 days (60 days)Fever, tiredness, headache

Fever, Headache, Cough

Pustules, eschar Dyspnea, Chest pain Diagnosis : Skin biopsy for cutaneous Blood culture ELISA, PCR

Day 5 Day 12

2 months

Hilar prominence and right perihilar infiltrate

widened mediastinum, perihilar infiltrates, peribronchial cuffing, air bronchograms.

Treatment : Ciprofloxacin, Penicillin, Doxycycline. Treated for 60 days.

Prevention: Vaccination – 6 doses over 18 months, booster

anually. Chemoprophylaxis – Cipro/ Doxy 4 weeks

before exposure.

Infectious form: Spores Hardy, resistant to environmental conditions. Relatively easy to weaponise.

Anthrax (Bacillus anthracis)

Example: September 2001, Anthrax used as

bioweapon through US Postal system. 22 cases (18 confirmed) – 11 inhalational + 11

cut. (7 + 4) 5 deaths ( all among inhalational) Ames strain used. (beta lactamase +

cephalosporinase); but luckily susceptible to antibiotics.

Maximum amount of spore in a letter – 2g (100 billion to 1 trillion spores) [ LD 50 = 10000]

Anthrax (Bacillus anthracis)

Geographic location, clinical manifestation, and outcome of the 11 cases of confirmed inhalational and 11 cases of confirmed cutaneous anthrax.

Epidemic curve for 18 confirmed cases of inhalational and cutaneous anthrax and additional 4 cases of suspected cutaneous anthrax.

Letter sent to NBC anchor Tom Brokaw with cutaneous anthrax. Infected Brokaw's assistant, Erin O'Connor.

Plague (Yersinia pestis) Highly contagious. Pneumonic plague is most severe. Signs/ Symptoms:

Bubonic Septicemic PneumonicDue to infection through skin

Usually from bubonic plague

Due to inhalational exposure

Fever, Chills, Nausea, Vomiting

Fever, Chills, Nausea, Vomiting

24 hours

Buboes (1-8 days)

Bleeding in skin, Ischemia in limbs

Cough with blood tinged sputum.

Bubo

Ulcer

Diagnosis: Clinical features Microscopic examination of bubo fluid/ sputum Cultures PCR/ DFA

Treatment: Gentamicin, Streptomycin, Doxycycline

Prevention: Formalin fixed vaccine Flea control measures

Plague (Yersinia pestis)

Spread: Through bite of infected fleas. Through droplet spread from pneumonic

plague patients. Through direct contact with non intact skin.

Weapon potential: Labile in environment ( 1 hour) Highly contagious, person to person spread. Can be weaponised as aerosols. (10 km)

Plague (Yersinia pestis)

Smallpox (Variola) By 1980, close to whole world population

was immune not important as bioweapon then.

Now susceptible population (50%). High infectivity, can spread at a factor of

10-20. 10-30% mortality in untreated. Signs/ Symptoms:

Incubation period = 7 – 17 days (12-14) Fever, malaise, headache, backache, emesis Maculopapular to vesicular to pustular skin

lesions Centrifugal, same stage of development

Hemorrhagic & malignant forms (5- 10%)

Diagnosis: Culture, PCR, Electron Microscopy

Treatment: Supportive treatment. Cidofovir, Antivaccinia immunoglobulin

Prevention: Vaccinia immunisation

Weaponisation: Infected fomites (historical use) Aerosol sprays

Smallpox (Variola)

Tularemia (F. tularensis) Extremely infectious. (10-50 by inhalation) Infection through non intact skin, mucous

membrane, GI tract, Respiratory tract. Rabbits, ticks, water rats, deer. Signs/ Symptoms:

1-14 days Ulceroglandular (75%) & Typhoidal (25%) Fever, chills, malaise, myalgia, headache Chest discomfort, dyspnea,, Skin rash, Pharyngitis, conjunctivitis Hilar adenopathy on chest x-ray

Diagnosis: Gram stain, culture (blood, ulcer discharge,

sputum) Immunohistochemistry, PCR

Treatment: Streptomycin, Gentamycin, Doxycycline,

Ciprofloxacin Prevention:

Chemoprophylaxis - Doxycycline, 100 mg PO bid x 14 d or Ciprofloxacin, 500 mg PO bid x 14 days

Weaponisation: Aerosol sprays.

Tularemia (F. tularensis)

Hemorrhagic Fever Viruses Includes:

Arenaviridae: Lassa, New World (Machupo, Junin, Guanarito, and Sabia)

Bunyaviridae: Crimean Congo, Rift Valley Filoviridae: Ebola, Marburg

Person to person transmission through direct contact with body fluids. (Lassa, Ebola, Marburg).

Aerosol sprays infectious (animal studies). Upto 90% mortality.

Signs/ Symptoms: Fever, myalgia, prostration, and DIC with

thrombocytopenia and capillary hemorrhage

Maculopapular or erythematous rashes Leukopenia, temperature-pulse

dissociation, renal failure, and seizures Diagnosis should be suspected in anyone

with temperature >38.3°C for <3 weeks who also exhibits at least two of the following: hemorrhagic or purpuric rash, epistaxis, hematemesis, hemoptysis, or hematochezia in the absence of any other identifiable cause.

Hemorrhagic Fever Viruses

Diagnosis: RT-PCR Antigen isolation

Treatment: Supportive therapy Ribavirin, IF , Hyperimmune Ig

Prevention: No known chemoprophylaxis No vaccines Strict isolation and PPE ( N95 mask or PAPR)

Hemorrhagic Fever Viruses

Botulinum toxin (Cl. Botulinum) One of the most potent toxins. Produced by Cl. Botulinum. Toxin is labile in atmosphere (1% per min),

Organism is easily destroyed (chlorine, heat)

Botulism can occur: infection in a wound or the intestine, the ingestion of contaminated food, or the inhalation of aerosolized toxin.

Signs/ Symptoms: 12 – 72 hours Dry mouth, blurred vision, ptosis, weakness, dysarthria, dysphagia, dizziness, respiratory failure, progressive paralysis,

dilated pupils

Diagnosis: Mouse bioassay Toxin immunoassay

Botulinum toxin (Cl. Botulinum)

Treatment: Supportive ( Intubation, Mechanical

ventilation, TPN) Equine antitoxin (only against A &B)

Prevention: Botulinum toxoid is available for high risk

workers Lab workers, military personnel


Examples of use: Botulinum toxin was the primary focus of the

pre-1991 Iraqi bioweapons program. (19000 l conc. toxin.)

Aum Shrinrikyo cult unsuccessfully attempted on a least three occasions to disperse botulism toxin into the civilian population of Tokyo. 1990 - Outfitted a car to disperse botulinum

toxin through an exhaust system and drove the car around Parliament.

1993 - Attempted to disrupt the wedding of Prince Naruhito by spreading botulinum in Tokyo via car.

1995 - Planted 3 briefcases designed to release botulinum in a Tokyo subway.


Cholera (Vibrio cholera) Causes acute, potentially severe

gastroenteritis. Spread through contaminated drinking

water. Signs/ Symptoms:

Begins in 12-72 hrs. Watery rice water diarrhoea. Abdominal pain, cramps. Dehydration, Electrolyte imbalance Seizures and Cardiovascular collapsein

children

Diagnosis: Stool microscopy – dark field

Treatment: Fluid & electrolyte replacement Antibiotics – Doxycycline, Ciprofloxacin,

Erythromycin.

Prevention: Live vaccine – 50% efficacy, 2 doses +

booster. Inactivated vaccine – rapid protection, 2 doses,

85% efficacy, 2-3 years.

Spread: By contamination of drinking water supply. Easily destroyed by heat, boiling, chemical

disinfectants.

Cholera (Vibrio cholera)

SAMPLES TO BE COLLECTED

WEAPONISATION It is the process of converting the

biological agent into a usable weapon.

Delivery device- Bombs Missiles Spray systems – Aerial, Aerosol based. Non traditional – food, water supplies, animals,

insects.

ADVANTAGES1. Multiple Methods For Delivery2. Wide Utility - non-discriminating, cause

sickness, death, panic, may disseminate widely, may be persistent

3. Good Logistics - cheap to make and store4. Versatile - can be in small or large

quantities5. Defence May Be Difficult6. Cause No Damage To Infrastructure7. Easy To Conceal8. ‘Status’ WMD - ‘poor man’s nuclear

weapon’

DISADVANTAGES

1. Slow onset (except toxins)2. Indiscriminate3. Difficult to control distribution ( IF

contagious)4. Preventive and/or Treatment measures

available for some.5. Level of technical sophistication

required for effective delivery.6. International taboo (deterrent to state/

nations)

TREATIES AND CONVENTIONS

Before the 20th century, biological agents were clubbed with chemicals as ‘poisons’.

Various treaties have tried to restrict or ban the use of such ‘poisons’ and asphyxiants. The Brussels convention on laws and

customs of war, 1874. The Hague Declaration concerning

asphyxiating gases, 1899 The Treaty of Versailles, 1919

Geneva Protocol, 1925 League of Nations, the “Conference for the

Supervision of the International Trade in Arms and Ammunition and in Implements of War” - May 1925.

Appeal by International Red Cross & Poland. “Protocol for the Prohibition of the Use of

Asphyxiating, Poisonous or Other Gases, and of Bacteriological Methods of Warfare” was adopted by the international community in Geneva on 17th June 1925.

Customary international law. A no-first-use agreement only.


Biological Weapons Convention (BWC), 1972 Eighteen-Nation Disarmament Committee in 1969. Convention on the Prohibition of the Development,

Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on Their Destruction was signed on 10th April, 1972.

Entered into force on 26 March, 1975. First treaty to ban an entire class of weapons. Prohibits development, production, stockpiling and

acquisition of biological weapons. Does not obstruct non-hostile use of biological

agents but still covers future weaponisation of agents.


PUBLIC HEALTH IMPORTANCE Most bio-agents are communicable

diseases. Usually 1st identification is by public health

professionals and/or physicians.

Biological weapons have brought together security/defense establishment and public health.

Biological weapon preparedness adds some elements to public health.

PUBLIC HEALTH IMPORTANCE

USA’s BioWatch: Network of detectors across US to detect bio-

agents. Also stockpiles vaccines & medicines for biological

threats. WHO’s Global Outbreak Alert and Response

Network (GOARN) : Works for both biological warfare agents as well as

other communicable diseases. World Health Assembly (2001):

Mandated the Director General to “provide technical support to Member States for developing or strengthening preparedness and response activities against risks posed by biological agents”.

PUBLIC HEALTH IMPORTANCE

INDIAN SCENARIO Geneva protocol, 1925:

Signed – 17th June, 1925 Ratified – 9th April, 1930

BWC, 1972: Signed – 15th January, 1973 Ratified – 15th July, 1974

Nodal agencies – DRDO (MoD), NDMA, MoHA, MoHFW.

Indian Biodefence Program – started in 1973

MoHFW

MoHA

MoDNDRF

MoA

INDIAN SCENARIO

NDMA

NCMC

National Disaster Management Authority: Coordinating & mandating government

policies for disaster reduction/ mitigation Devising plans to counter the threat of

biological disaster, both natural and man-made (bioterrorism).

Ensuring preparedness at all levels Coordination of response to disaster and

post disaster relief & rehabilitation. Conducts civilian biodefence and disaster

management activities and drills.

INDIAN SCENARIO

BW MoD

BT MoHA

Outbreak MoHFW

INDIAN SCENARIO

Ministry of Defence: Evacuation, Logistics, Control & Coordination, Clinical First responders

DRDO: R&D Equipment & Materials

AFMS: Command and direction Stockpiling of vaccines/ medicines Exercises and drills Immunisation of 1st responders 25 hospitals for biological disaster management

INDIAN SCENARIO

Indian biodefence establishments under DRDO:

INDIAN SCENARIO

Defence Research and Development Establishment (DRDE), Gwalior

Toxicology, Immunology, Biochemical Pharmacology, Development of diagnostic kits, Decontamination equipment.NBC sensors & shelters.

Defence Materials and Stores Research and Development Establishment (DMSRDE) , Kanpur

Personal Protective Equipment development & Manufacture,Gloves, Boots, Protective suits,Self contained biological suit (u/d)

Defense Bioengineering and Electromedical Laboratory (DEBEL), Bangalore

Canisters, Face Masks, Respirators,NBC filter fitted evacuation bags

Defence Food Research Laboratory (DFRL), Mysore

Food supply systems for armed forces“Anthra-check Sand-E kit” detects Anthrax

Ministry of Health & Family Welfare: Outbreaks & epidemics Training & deployment of RRTs EMR department:

Primary 1st responder in case of human affliction Formulation of policies & plans to handle medical

problems NCDC:

Investigation of outbreaks Training R & D

ICMR: R & D Training

INDIAN SCENARIO

Ministry of Home Affairs: Nodal agency in bioterrorist attacks.

Threat perception & analysis Threat mitigation Policy development Law enforcement

Technical support from MoHFW & MoD

INDIAN SCENARIO

Stockpile maintenance:

Vaccines – NIV, Medicines – With states, Pharmaceutical

manufacturers PPE – State RRTs, Central RRT, DMSRDE Containment equipment – DMSRDE, DRDE

INDIAN SCENARIO

Patient isolation precautions: Standard precautions

Wash hands before and after patient contact Wear gloves, Wear masks/ face covers Proper handling of equipment & Linen

Airborne precautions (Smallpox, Plague, Anthrax) private room with negative air pressure, a 6 air

changes per hour, and appropriate filtration of air.

Wear respiratory protection when dealing with patient

Droplet precautions private room or group with same patients Wear mask and also use mask on patient during

movt.

INDIAN SCENARIO

Patient isolation procedure: Contact precautions (VHFs)

Private room/ group patients together Gloves. Change gloves after contact. Wear gowns. Use shoe covers Dedicate non-critical equipment that requires

contact (stethoscope)

INDIAN SCENARIO

Sample collection guidelines: Early post-exposure: when it is known that an

individual has been exposed to a bioagent aerosol, aggressively attempt to obtain samples as indicated.

Clinical: samples from those individuals presenting with clinical symptoms.

Convalescent/Terminal/Postmortem: samples taken during convalescence, the terminal stages of infection or toxicosis or postmortem during autopsy.

INDIAN SCENARIO

Sample collection guidelines: Clean line and exit and entry strategy 3 person team is recommended, with 1 clean

and 2 dirty. Personnel protective equipment Waterproof disposable cameras and

waterproof notepads What to collect –

Aerosol – aerosol collector required Swabs/ paper – from any contaminated site Dead animals or humans or parts

Packed in double ziploc bags (Inner bag decontaminated with bleach before putting outer bag)

INDIAN SCENARIO

REFERENCES:1. U.S. Army report to the Senate Committee on

Human Resources, 1977.2. United Nations definition. Report of the secretary

general titled “Chemical and Bacteriological (Biological) Weapons and the Effects of Their Possible Use,” 1969.

3. National Disaster Management Guidelines—Management of Biological Disasters, 2008. A publication of National Disaster Management Authority, Government of India. July 2008, New Delhi.

4. McLaughlin K., Nixdorf K.; BWPP Biological Weapons Reader: Geneva, 2009.

5. Harrison’s Principles of Internal Medicine; 18th ed: 2011. Edited by Fauci AS, Kasper DL, Longo DL.

6. http://www.cdc.org . Website of the Centre for Disease Control and Prevention, Dept. of Health and Human Services, USA.

7. Hunger I. Bioweapons Monitor 2011, 1st ed: 2011.

8. National Strategy for Countering Biological Threats; National Security Council of USA, 2009.

9. http://www.emedicinehealth.com/script/main/art.asp?articlekey=58836

10.www.mapw.org.au ; website of the Medical Association for Prevention of War Australia (MAPW).

11.http://www.proliferationnews.org ; website of the Carnegie Endowment for International Peace.

REFERENCES:

http://www.cdc.org/

http://www.emedicinehealth.com/script/main/art.asp?articlekey=58836

http://www.emedicinehealth.com/script/main/art.asp?articlekey=58836

http://www.mapw.org.au/

http://www.proliferationnews.org/

biological warfare

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