CHEMICAL AND BIOLOGICAL WARFARE AND TERRORISM

By LCDR Rita McCarthy, MSC, USN

Pharmacist

Early Biological Warfare

The use of filth, dead human bodies, animal carcasses, and contagion to cause disease in the enemy camps or cities 400 BC Scythian archers dipped arrows in blood,

manure, and dead bodies 1346 Siege at Kaffa: Tartar soldiers launched

bodies of their fellow soldiers who died of plague over the wall into the city

Early biological continued

1710 Russian troops used plague infected bodies against Sweden

1767 French and Indian Wars (Colonial America): The British Commander orders small pox infected

blankets to be given to the Indians loyal to the French defending Fort Carillon

Modern Development of BW

WWI: Germans infected horses with glanders that were being sold to Allied forces Transferred from horses to humans acute: coughing, fever and the release of an infectious nasal

discharge, followed by septicemia and death within days. Chronic: nasal and subcutaneous nodules develop, eventually

ulcerating. Death can occur within months, while survivors act as carriers.

1937-1945: Japan had program with live subjects in Manchuria Chinese, Russian, and American prisoners of war; tens of

thousands die of bubonic plague, cholera, anthrax and other diseases

Accidentally infected own military units on multiple occasions

Biological Warfare

The intentional use of disease producing microorganisms or biologically derived toxins as weapons to kill or injure humans, animals, or plants

Bio-Terrorism

The use of (or a threat to use) a biological or chemical agent by an individual or a group in order to intimidate or coerce a government of a society in the pursuit of political, religious, ecological, or other ideological objectives

Why use Chem/Bio agents for terror? Cost

Biological agent $1 Chemical agent $600 Conventional explosive $2000

Easily produced Difficult to detect FEAR & TERROR OF GENERAL PUBLIC!

Classification of Agents of Biological Origin

Pathogens BACTERIA Viruses

Toxins

Bacteria

Mechanism of disease Invasion and infection of tissue Produce toxins

Prevention Immunization

Active: vaccine Passive: from mother to child

Treatment Specific antibiotics

What makes a good biological agent? Availability and ease of production Incapacitate or lethal? Particle size Ease of dissemination Stability after production Susceptibility of population

Bacterial Agents

Anthrax Plague Tularemia Brucellosis Q Fever

Anthrax

Bacillus anthracis 1876: first disease for which a microbial

cause was established (Koch) 1881: Attenuated spore vaccine for livestock 1949: human vaccine developed (licensed in

1970)

Why use Anthrax as a Weapon? Easy to produce in large quantities Spores can be spread by aerosol Short incubation period Highly lethal

Anthrax Epidemiology

Reservoir: Soil Herbivores infected during grazing Transmission to humans

Contact with contaminated animals, hides, wool Ingestion of contaminated meat Inhalation of dust with spores

Annual incidence: 2,000 cases world-wide

Anthrax Pathogenesis

Spore enters the body Germinates and transported to lymph nodes Local production of toxins lead to edema and

tissue destruction Spread from lymph nodes…bacteria and

toxin into blood

Inhalation Anthrax

Incubation period: 1-7 days Initial symptoms: mild and flu-like Followed by shortness of breath, labored

breathing, rapid heart rate Rapid progression to shock and death if not

treated soon enough

Treatment of Anthrax

High does antibiotics Ciprofloxacin Doxycycline Penicillin

Plague

Bubonic Malaise, high fever, tender lymph nodes If untreated:

Blood poisoning, death

Pneumonic High fever, chills, headache, coughing up blood,

blood poisoning If untreated:

Respiratory failure, circulatory collapse, heavy bleeding, death

Tularemia

Swollen glands, fever, headache, malaise, weight loss, nonproductive cough

Generally not fatal

Brucellosis

Can spread to humans if they come in contact with infected animals, or by eating or drinking unpasteurized milk or cheese.

May begin with mild flu-like symptoms, muscle pain, swollen glands

May be chronic and last for years Generally not fatal

Q Fever

Fever, cough, chest pain Generally not fatal

Viruses

Smallpox Ebola Venezuelan Equine Encephalitis Yellow Fever

Smallpox History

1500s: >3.5 million die after Europeans introduce smallpox to the New World

1796: Vaccine developed by Jenner 1813: Madison encouraged vaccination 1949: last outbreak in the US 1960: Worldwide eradication program 1980: WHO declares earth free of smallpox

Smallpox as a BW or Terrorist Threat Highly communicable disease (person-to-

person transmission) Vaccine use discontinued…makes a target

population that is susceptible

Smallpox

Incubation 7-14 days Fever, headache, general illness, vomiting Skin “seeded” with virus Scabs form 8-14 days after onset Scabs infectious

Medical Management

Confirm Quarantine all cases Vaccination of all contacts: available from the

CDC

Toxins

Saxitoxins and Conotoxins: marine animals Botulinum: bacteria Mycotoxins: fungus Snake venom Ricin: plant

Toxin vs. Chemical Agents

Natural origin Stable More toxic Legitimate medical use Only one active on skin

Man-made Less stable Less toxic Only use is weapons All active on skin

Botulinum Toxin

Clostridium botulinum Tetanus Botulism

One of the most toxic substances known Neurotoxin The toxin has a legitimate medical use

Botox Treat muscle contractions and can offer relief from

sweating of the hands, feet and underarms

Clinical Symptoms of Botulism 3rd day post-exposure 4th day post-exposure Mucous in throat Difficulty swallowing Feels like a cold No fever Blurred vision

Mental numbness Slow eye movements Dilated pupils Indistinct speech Difficulty walking Extreme weakness “Floppy Paralysis”

Medical Management

Vaccine is available but general use is not necessary

Treat with immunoglobulin before onset of symptoms (from the CDC)

May need to assist with breathing if severely affected or treatment not started in time

May lead to death

Saxitoxins

Paralytic Shellfish Poisoning: From eating shellfish contaminated by "red tides" or

algal blooms Symptoms: tingling, numbness, weakness, limb

paralysis Onset of symptoms: almost immediate;

exposure by inhalation leads to extremelyrapid development of symptoms with death occurring within minutes if not treated.

Conotoxins

Paralytic poisons from Pacific cone snails Symptoms: burning pain; local numbness,

spreading rapidly to involve the entire body but without pain; some cardiac and respiratory distress at the height of the poisoning

Onset of symptoms: almost immediate upon injection from the snail

Mycotoxins

Produced by microfungi that are capable of causing disease and death in humans and other animals

Some used as antibiotics, growth promotants, and other kinds of drugs; still others have been implicated as chemical warfare agents

Severity of mycotoxin poisoning can be compounded by other illnesses; mycotoxicoses can heighten vulnerability to microbial diseases, worsen the effects of malnutrition, and interact synergistically with other toxins

Almost no treatments for mycotoxin exposure

Ricin

Protein toxin from castor beans Plant found world-wide Toxin is fairly easy to produce Castor oil used as lubricant for motors

Symptoms of Ricin Poisoning

Oral ingestion: least toxic (8-10 hours) Bleeding and tissue damage in GI tract Nausea, vomiting, diarrhea, cramps

Inhaled: most common Nausea, vomiting, diarrhea, cramps, dilated

pupils, fever, headache Shock, edema, pneumonia Death on 3rd or 4th day!

Medical Management

Identify if toxin, asthma, or chemical poisoning Supportive care For oral ingestion: administer activated

charcoal to absorb toxin No anti-toxin or immunization yet

Chemical Agents: Early Chemical Warfare 423 BC Sparta used toxic and irritant smoke to

capture a fort held by Athenians 700 AD Greeks invent and use “Greek Fire” (pitch,

sulfur, and rosin) which floated on water to set enemy ships on fire Pitch: a viscous substance produced by plants or formed

from petroleum Sulfur: used to make gun powder Rosin: type of resin

15th and 16th Centuries: Venice used poison chests to contaminate water

Modern Chemical Warfare

1st gas attack: April 22, 1915 Chlorine gas used by Germany in Belgium

WWII no confirmed use by Germany on the battlefield, however, cyanide and other gasses were used in concentration camps Cyanide makes the cells of an organism unable to

use oxygen 1980’s Iraq used chemical agents against

Iran and against it’s own people (Kurds)

Chemical Agents

Lethal (toxic) agents Nerve agents Choking agents Blood agents Blister agents

Incapacitating agents Irritants

Chemical Agents

Solid Liquid Gas

Persistent: effective for >12 hours Non-persistent: inactivated <12 hours

Nerve Agents

Sarin (GB) Soman (GD) Tabun (GA GF VX

Sarin

Lethal agent Developed in 1940s by Germany

Original use was an insecticide Causes death by asphyxiation Is a liquid at room temperature

Soman, Tabun, and VX

Lethal agents Soman: synthesized by Germany in 1944;

similar to sarin Tabun: synthesized by Germany in 1936 VX developed by USA Victims of Soman, Tabun, and VX ,make it

harder to treat casualities than with Sarin

Physical Properties

Clear colorless liquids (when fresh) Not nerve gas! Tasteless: each has identifiable odor May be spread by fine vapor “gas” or as a

liquid on skin Onset of symptoms within seconds to

minutes Large exposure can cause death

Nerve AgentsSymptoms Treatment

Pinpoint pupils Sweating Drooling & runny nose Convulsions Involuntary urination Coma Possible death

Decontamination Atropine Assist with breathing Anti-seizure drugs

Choking Agents

Chorine and Phosgene Developed and used during WWI Head delayed reation time Causes lung damage Can cause blindness if gets into eyes Gas or liquid

Blister Agents

Mustard (H) Nitrogen Mustard (HN) Lewisite (L) Phosgene oxime (CX)

Causes skin blisters Usual/ly does not kill

Others

Blood agent cyanide

Incapacitating agents Psychological effects (LSPD and BZ)

Riot control agents Peper spray, tear gas, mace

Treatment

Decontamination Special antidotes Anti-convulsant drugs Supportive care