i .m.1 m srvpet documien ad-a280 772 i iiiii 11 ,t- - dtic · 2011. 5. 14. · rocket launchers...

Arm ApprovedSRVpeT DOCUMIEN AD-A280 772 MAR ________-j ---mtt `-Crt• ."ofein0,Flt.Om Can "Otci

X-Pr-rit ir r-iom.),nI~A.q "t* lica mW.t"., 1.10 Me M A ~ s Wi F" Flo in-,____-toot___ Me"___________

S.. ...Z V i .M.1 m r .....r- III 1111 1 N11111 11 ,t"- I IIIII ...1. AGV210' UI .15 HLY .JLJve Vianx) 2. '1EPC3T CAT2 2. A2?ORT .YPE AND DAFZý COV~E23

I October 1993 Technical Documentation

14. TITLS AND SUBTITL2 5. ýUNOING NIUMBERSEffectiveness of Medical Defense interventionsAgainst Predicted Battlefield Levels of Bacillus Anthracis Contract No.:

F33615-91-D-0652

" " •U;xCR(S) 1 Delivery Order No. 0002Richard E. McNally, Malcolm B. Morrison, M. Stark, J. FishJ. Bo'Berry, M. Sanzone, and J. Berndt TScience Applications International Corporation A-PCa hj.,lI2•626 Towne Center Drive, Suite 205Joppa, Maryland 21085

I 5. C.UCM-NIG 1 C,,l , AGVIC'! .'A,(S• AND ACDRA'53(.5) 10...;,?.215SC,:.,IG .',ICNITCRING

Director j AC.'•c .t.'CT ;.,UMBE•Division of NeuropsychiatryWalter Reed Army Institute of Research tWashington, DC 20397-5700

:ATrN: COL Steven R. HurshwIt..•u~o,.z'ftltrba JUNC T2 ,,. 1994,111

,2a, CI5T,•IAUTiONi AVAILABILITf 3-TA,.1ENT ,; iC O.DE :U hc

Approved for public release, distribution unlimited.

13. ABSTRACT (Maximum 200 words)

B. anthracis, the causative organism for anthrax, continues to be a biological warfare threat to U.S. forces.Exposure through inhalation is deadly unless the cause of infection is identified and treated before serious respiratorysymptoms present.

Th'e objective of this study was to determine the levels of B. anthracis likely to be found on the battlefield and thepotential imptect of B. anthracis attacks on unit effectiveness. The levels of B. anthracis are critically dependent on theweapons, form of agent dissemination, weather conditions, and time-of-day of an attack. In assessing the effects on a militaryoperational unit following a B, anthracis attack, various defensive measures were considered including the wearing ofprotective equipment, especially the protective mask, and the use of medical interventions such as vaccination and antibiotictherapy.

Modeling results predicted that the use of vaccine could ensure survivability and preserve uniteffectiveness at levels in excess of 90 percent. The study also provides insights into potential operationallimitations imposed on a commander whose troops depend solely on antibiotic therapy and protectiveequipment for survival. Further, the findings illuminate some of the implications for survivability and uniteffectiveness in the absence of the capability to either rapidly detect the presence ofB. anthracis in theatmosphere or to easily diagnose anthrax casualties prior to the onset of symptoms.

14. SUBJECT TERMS 15. NUMBER OF PAGES

Bacillus Anthracis

Medical Defense Interventions 1G. PRICE CODE

Battlefield Levels of Bacillus Anthracis17. SECURITY CLASSIFICATION 18. SECURITY CLASSIFICATION 19. SECURITY CLASSIFICATION 20. LIMITATION OF ABSTRACT

OF REPORT OF THIS PAGE OF ABSTRACTUnclassified Unclassified Unclassified None

NSN 7540.01-280-5500 S'tandard Form 298 (Rev. 2-89)Pret natdC by At.I Std 139.18

29Q,.102

*.IM I~EA RUS~LC; 01O1S F0 R COMP!._TINMG SF 298

The Report Documentation Page (RDP) is usedl ;n announcing and cataloging reports. It is important

that this Infor.-ation *Ce ccr~siszent with r~e --?sz of the reccrt, particularly the cover and :itla :,age.:rstruct;ons 'or fiiling in eacn '_lcclý of 1e ;orr .:Cfow. i,, is Important to staay within the fines zo me

31ccc I.. -,cprnc/'iUse CnJ9 fLix'e --lea.I Icc a Diiuir/Availabilitv Staternen-.t.

I 7',_rozz pblc vailabiiiv/oriimixatc~ns. '_;eary3lcck 1. ' 7vccr' -:a-?. -.I ubiication jav I oe~bia ~ ne~dzc'

.r'.iu~i~c caymont .~rd'~rif 'Ia~azia~~ iritations or s;:eciak marxinas in all cmcizzis (a.-..an I23) -Must c;,:a az 1 astt e't e-:% . IiJFRRL T'

3 1.-%1.'f"-%c r-s -,;ýa I CD - See cDOD 4230.2-., ~srbt

2 7 2C. 2,C). -~ it~r s

lc ck -1 7 r c ;:'::? s ra:<nkr -,m NJA'zA - See *-arcbook MJ-2 2200.2.

zs--2 _ zr- f wn r ? Pc rr :.' a z-_ :r v i cZs 2:7. _- s ~ I Leave~ lan.Za ": C U Br~ Ca 9 ! ,'_ 7.: 4 2- n C 7 3 -, Z .1'~ . 'i' , ? nc; a. . Z ~ r ~ : c

ir c; u.1 e -u bt it! fo r:Iczc c ~ic ',c m e. ~.n -Lae:a

C a5s i 1 CC M- ccr!.' a:r :r-.a ~i! a ':as;r.:o s in c3 t:s an nv~in Pareanrhases. frm'e tnar iibuT;c 'or

Undcassified Scientific sno i,:,ia

ardc -:rart n.urner-; :ny -.rtrarn am-sei men ~uze(~; zrj~z-u~cek~; :a MA.3A - !_.ave '_lank.

rumiber(s), ar.dwcr :Jn:im:r.; Usa ~2 ~S -Lave iblark.

:c~'vclacais:

- - co.ntract PR- I loc: 23. Abs-cract. Include a brief (MVaximum. G. 3r.nt 7 k- 7--sk i 2C0 words) fac-uai summary oi the most.

- Prcra 'AU -',Vrk nitsignificant information contEained in the report.EleentAccassion Mo.

3lcck .3. Autlhor(s). 'NJame(s) of perscn(s) Block 14. Subiect Terms. Keywords or phrasesres ' onsi ble for wNriting the report, performi ng identifying major subjec-ts in the report.the research, or credited WiTh the content of zhereqort. If e2ditor or cooe,-nis should fiothe name(s). cooir oio PclS ubrfaces. Enterthetotal

number of pages.-oloc~k7, Performina Oroanization Mam-e-is and

Addrss~s).Sel-expanaory I3loc! 16. Price Code. Enter appropriate priceBlock 3. Performina Oraanization Reoort code (NTIS only).Number. Enter the unique alphanumeric re 'port

pumerform asin g nte d repo t. eog nzto 3locks 17.- 19. Security Classifications. Self-perfrmin th reprt.explanatory. Enter U.S. Security Classification in

Block 9. Sponsorino/Monitorina Aoencv Name(s) accordance with U.S. Security Regulations (i.e.,and Address(es). Self-explanatory. UNCLASSIFIED). if form contains classified

information, stamp classification on the top andBlock 10. Sponsoring/Monitoring Aaencv hottom of the page.Report Number. (If known)

Block 11. Suoplementary Notes. Enter Block 20. Limitation of Abstract. This block mustinformation not included elsewhere such as: be completed to assign a limitation to thePrepared in cooperation with ... ; Trans. of ... ; To be abstract. Enter either UL (unlimited) or SAR (samepublished in.... When a report is revised, include as report). An entry in this block is necessary ifa sta tem ent whether the new report supersedes the abstract is to be limited. if blank, the abstract

or upplements the older report. is assumed to be unlimited.

Standard Form 298 @ack Meav~ 2-Sq)

Effectiveness of Medical Defense InterventionsAgainst Predicted Battlefield Levels of

Bacillus Anthracis

Contract No. F33615-91-D-0652,Delivery Order No. 0002

October 1993

Science Applications International Cmp tionAn Employee-Owned Company

Prepared By

Richard E. McNallyMalcolm B. Morrison

94-19503 Maureen StarkJoan E. Fisher

John T. Bo'BerryMargaret A. Sanzone

Jack E. Berndt

Science Applications International Coporation626 Towne Center Drive, Suite 205

Joppa, Maryland 21085

626 Towne Center Drive, Suite 205, Joppa, Mar/land 21085-4452 • (410) 679-9800 0 (410) 679-3705Other SAIC Offices- Albuquerque, Colorqdo Springs, Dayton, Falls Church. Huntsville. Las Vegas. Los Altos. LOS Angeles. McLean, Oak Ridge. Orlando. San Diego. Seattle. Tucson

Effectiveness of Medical Defense InterventionsAgainst Predicted Battlefield Levels of

Bacillus Anthracis

Contract No. F33615-91-D-0652,Delivery Order No. 0002

October 1993

Prepared By

Richard E. McNallyMalcolm B. Morrison

Maureen StarkJoan E. Fisher

John T. Bo'BerryMargaret A. Sanzone

Jack E. Berndt

Science Applications International Coporation626 Towne Center Drive, Suite 205

Joppa, Maryland 21085

TABLE OF CONTENTS

EXECUTIVE SUMMARY ........................ ..... iii

LIST OF TABLES .................................................................... vii

LIST OF FIGURES ................................................................... ix

1.0 INTRODUCTION ........................................ 1

2.0 BACKGROUND ......................................... 3

2.1 Characteristics of Bacillus anthracis ........................................ 3

2.2 Effect of Bacillus anthracis Exposure on the Popuiation ................. 3

2.3 Prevalence and Course of the Disease Anthrax ............................ 5

2.4 Diagnosis and Treatment of Anthrax ........................................ 5

2.5 Defense Against Bacillus anthracis as a BiologicalW eapon .......................................................................... 6

3.0 METHODOLOGY ........................................ 9

3.1 Data Sources and Approach ................................................. 93.2 Simulation Models ........................................................... 10

3.3 Limitations and Assumptions ................................................ 10

4.0 SENSITIVITY ANALYSIS ......................................................... 15

4.1 Effective Number and Size of Bacillus anthracis Particles .............. 15

4.2 Sensitivity to Estimates of Median Infective Doses ...................... 16

4.3 Sensitivity to Agent Decay and Toxicity Estimates ...................... 22

4.4 Unit Sensitivity to Casualties from Anthrax ............................... 30

5.0 STUDY RESULTS .................................................................... 47

5.1 Tactical Ballistic Missile with Bacillus anthracis filled Submunitions. 49

5.2 Terrorist Device Filled with Bacillus anthracis .......................... 69

5.3 Twenty-Four Artillery Shells Filled with Bacillus anthracis ............ 87

5.4 Two Hundred-Forty Rockets Filled with Bacillus anthracis ............. 103

5.5 Bacillus anthracis Delivered by Spray ...................................... 119

5.6 intercontinental Ballistic Missile with Bacillus anthracis-FilledSubm unitions .................................................................... 135

im

TABLE OF CONTENTS -- Continued

6.0 CONCLUSION S ........................................................................ 153

REFEREN CES ......................................................................... 155

APPENDIX A: Memo on Technical Input ParametersAPPENDIX B: Environmental Conditions SimulatedAPPENDIX C: Excursions in Delayed Onset of Agent Decay and Increased

ToxicityAPPENDIX D: Reading the Hazard Footprint Graphs

Aooegslon ForNTIS GRA&I KDTIC T to

Bye.

Avalcability Cc sD

. - "l o ii,-

Meiieaa

EXECUTIVE SUMMARY

The mission of the Medical Biological Defense Research Program (BDRP) is todevelop medical countermeasures to deter, constrain and defeat the use of biological agentsagainst U.S. forces. This study evaluates the contribution of the fielded vaccine MichiganDepartment of Public Health-Protective Antigen (MDPH-PA), and antibiotic therapy ascountermeasures to a Bacillus anthracis threat and the associated disease anth.rx. The MedicalBiological Defense Research Program addiesses three lnincipal defense capability issues:

1. Capability to operate in NBC conditions.2. Capability to provide treatment for NBC-related injuries.3. Capability to diagnose threat agent casualties.

This study helps to shed light on the capability of U.S. forces to survive and maintainunit operational effectiveness in a biological warfare environment. The results show that theuse of vaccine can ensure survivability and preserve unit effectiveness at levels in excess of90 percent. The study also provides insights into potential operational limitations imposed ona commander whose troops depend solely on antibiotic therapy and protective equipment forsurvival. Further, the findings illuminate some of the implications for survivability and uniteffectiveness in the absence of the capability to either rapidly detect the presence ofB. anthracis in the atmosphere or to easily diagnose anthrax casualties prior to the onset ofsymptoms.

The methodology in this study is based on computer simulations of a range of attackscenarios and world-wide climates. Weapon systems simulated include artillery, multiplerocket launchers (MRL), tactical ballistic missiles (TBM), and Intercontinental BallisticMissiles (ICBM) with submunitions, spray releases from an aircraft, and man-portable terroristdevices. This choice of weapon systems encompassed a range of total agent mass simulationsfrom 5 kg for a terrorist device to a total of 1,560 kg delivered by an ICBM armed with40,000 submunitions. With these systems and agent fills, the effects of both direct andindirect attacks were portrayed with dosage-hazard footprints, bar charts reflecting post attackunit effectiveness, figures depicting spore concentration/area coverage, and bar chartsillustrating casualty/area coverage. Each attack scenario was simulated in climatesrepresenting South Korea, Southeast Asia, Southwest Asia, and Central Europe at 0500, 1200,and 1900 hours. Results for the different times and climates demonstrate the effects thatatmospheric stability, wind speed, and sunlight have on agent transport, diffusion, andviability.

Sensitivity analyses were conducted on:1. Toxicity and decay estimates.2. Survivability versus unit effectiveness outcomes.3. Organizational unit types (the differences in impact of identical attacks on the

effectiveness of units with different military functions).

iii

An assessment was made of the sensitivity of unit effectiveness for variations in lethaldose between 8,000 and 10,000 spores per soldier; an LDs0 value of 8,689 spores was chosenas the baseline toxicity level for the study. The impact of two sets of decay rates, a "high" anda "low" set, on hazard area coverage and unit effectiveness was also examined. The "high"decay rates ranged from 0.5 at night to 2.5 percent/minute in noonday sun compared to the"low" rates of from 0.1 to 1 percent/minute. The low rates were provided by U.S. ArmyMedical Research and Development Command (USAMRDC) and were used to producemaximum impact on unit effectiveness.

Unit effectiveness was the principal measure of merit used for this study and was basedon calculations of the probability of surviving an attack given the exposure levels that wouldbe experienced at four positions within a typical hazard footprint.

The final sensitivity analysis was a comparative assessment of the relative resiliency offive different types of military units to identical attacks by a terrorist device. The artilleryunit, used as the base case organizational unit throughout the study, was compared with anammunition supply point, a headquarters unit, an anti-armor infantry unit, and an attackhelicopter unit.

The study findings were as follows:

* A unit protected by vaccine would have the capability to operate in an environmentcontaminated with levels of B. anthracis as high as 500 times the LD50.

The vaccine significantly reduces the need for treatment and diagnosis by precludingany appreciable level of infection among troops subjected to the range of attackssimulated in this study.

Predeployment vaccination with the fielded vaccine would preserve unit effectiveness ator above 99 percent in all attack scenarios and climates with the exception of thesimulated MRL attack in winter climatic conditions which would degrade uniteffectiveness to 90 percent. The efficacy of the fielded vaccine is such that, for theattack scenarios simulated, protective equipment would only be required in the event ofa direct MRL attack (exceeding 240 rounds or 240 kg of agent). Although only a maskwould be needed to maintain unit effectiveness at 99 percent for B. anthracis attacks.However, MOPP 4 rather than masking alone would likely be the operational responseuntil it could be confirmed that the attack was not chemical in nature.

One of the important attributes of predeployment vaccine is that it provides anoutstanding level of protection passively. It is neither dependent upon detection ofattack nor timely diagnosis of infection, as antibiotic therapy would be, thus providingcapability to counter a covert attack.

For protection downwind of a target area, the vaccine is sufficiently robust to protect

against the full range of dosages predicted in this study. The implication is that vaccine

iv

protected personnel would not require the use of MOPP 4 (with its attendantdegradation in unit effectiveness to 63 percent in the case of an artillery unit) if they aredownwind of a B. anthracis attack.

Sole dependency on antibiotic therapy against a B. anthracis attack would placeunnecessary burdens on field medical staff, facilities, and medical logistics. Uniteffectiveness and mobility would be unnecessarily impaired; and, more importantly,there would be loss of life that could have been avoided.

Unit effectiveness was shown to be unaffected for spore dose levels ranging from 8,000to 10,000 -- the number of spores per man expected to elicit a lethal response in50 percent of the exposed population.

The high estimates of agent decay rates (1 to 2.5 percent/min) produced by UV lightfor a 1200 hours attack would produce significantly reduced downwind hazards butonly cause approximately a 5 percent reduction in the overall hazard level for unitsunder direct attack.

Skillfully employed B. anthracis can achieve both strategic and tactical/ psychologicalobjectives. As a weapon of mass destruction, strategic objectives might be achievedthrough the execution of a single spray release of 240 kg of agent at night during winterclimatic conditions. Alternatively, tactical objectives might be achieved withessentially no collateral damage to the attacker by a release at noon in summer climaticconditions where high ultraviolet radiation would rapidly decay the agent and limiteffects to the an area less than 30 km in diameter.

v

LIST OF TABLES

Table 1. Weapons Characteristics for Dry B. anthracis Dissemination

Table 2. Synopsis of Environmental Conditions Modeled

vii

LIST OF FIGURES

Population Response Analysis

Figure 1. Probit Score vs. Population Response

Figure 2. Medical Intervention Population Response

Toxicity Sensitivity Analysis

Figure 3. TBM with Submunitions in Central Europe at 1900 Hours: Artillery UnitEffectiveness with Medical Interventions (LD 50 = 8,000 spores)

Figure 4. TBM with Submunitions in Central Europe at 1900 Hours: Artillery UnitEffectiveness with Medical Interventions (LD50 = 8,689 spores)

Figure 5. TBM with Submunitions in Central Europe at 1900 Hours: Artillery UnitEffectiveness Medical Interventions (LD5 0 = 10,000 spores)

Decagy Rate Sensitivitv Analysis

Figure 6. TBM with Submunitions in Central Europe at 0500 Hours: Artilleiy UnitEffectiveness with Medical Interventions (USACRDEC Decay Rates)

Figure 7. TBM with Submunitions in Central Europe at 0500 Hours: Artillery UnitEffectiveness with Medical Interventions (USAMRDC Decay Rates)

Figure 8. TBM with Submunitions in Central Europe at 1200 Hours: Artillery UnitEffectiveness with Medical Interventions (USACRDEC Decay Rates)

Figure 9. TBM with Submunitions in Central Europe at 1200 Hours: Artillery UnitEffectiveness with Medical Interventions (USAMlRDC Decay Rates)

Figure 10. TBM with Submunitions in Central Europe at 1900 Hours: Artillery UnitEffectiveness with Medical Interventions (UJSACRDEC Decay Rates)

Figure 1 ). TBM with Submunitions in Central Europe at 1900 Hours: Artillery UnitEffectiveness with Medical Interventions (USAMRDC Decay Rates)

ix

Unit Sensitivity Analysis

Figure 12. Terrorist Device in SouthwesL Asia at 0500 Hours: Artillery UnitEffectiveness with Medical Interventions

Figure 13. Terrorist Device in Southwest Asia at 0500 Hours: HeadquartersUnit Effectiveness with Medical Interventions

Figure 14. Terrorist Device in Southwest Asia at 0500 Hours: AmmunitionSupply Point Unit Effectiveness with Medical Interventions

Figure 15. Terrorist Device in Southwest Asia at 0500 Hours: InfantryAnti-Armor Unit Effectiveness with Medical Interventions

Figure 16. Terrorist Device in Southwest Asia at 0500 Hours: AttackHelicopter Unit Effectiveness with Medical Interventions

Figure 17. Terrorist Device in Southwest Asia at 1200 Hours: Artillery UnitEffectiveness with Medical Interventions

Figure 18. Terrorist Device in Southwest Asia at 1200 Hours: Headquarters UnitEffectiveness with Medical Interventions

Figure 19. Terrorist Device in Southwest Asia at 1200 Hours: Ammunition SupplyPoint Unit Effectiveness with Medical Interventions

Figure 20. Terrorist Device in Southwes-, Asia at 1200 Hours: Infantry Anti-ArmorUnit Effectiveness with Medical Interventions

Figure 21. Terrorist Device in Southwest Asia at 1200 Hours: Attack HelicopterUnit Effectiveness with Medical Interventions




Figure 25. Terrorist Device in Southwest Asia at 1900 Hours: Infantry Anti-ArmorUnit Effectiveness with Medical Interventions

x


TBM with Submunition -Scenarios

Figure 27. T'BM with Submunitions in Southwest Asia at 0500 Hours: Artillery Unit% Survivors with Medical Interventions

Figure 28. TBM with Submunitions in Southwest Asia at 0500 Hours: Artillery UnitEffectiveness with Medical Interventions

Figure 29. TBM with Submunitions in Southwest Asia at 1200 Hours: Artillery Unit% Survivors with Medical Interventions




Figure 33. TBM with Submunitions in Southeast Asia at 0500 Hours: Artillery UnitEffectiveness with Medical Interventions



Figure 36. TBM with Submunitions in Central Europe at 0500 Hours: Artillery UnitEffectiveness with Medical Interventions



Figure 39. TBM with Submunitions in South Korea at 0500 Hours: Artillery UnitEffectiveness with Medical Interventions

xi


Figure 41. TBM with Submunitions in South Korea at 1900 Hours: Artillery Unit

Effectiveness with Medical Interventions

Figure 42. TBM in Southwest Asia: Spore Area Coverage

Figure 43. TBM in Southeast Asia: Spore Area Coverage

Figure 44. TBM in Central Europe: Spore Area Coverage

Figure 45. TBM in South Korea: Spore Area Coverage

Figure 46. TBM: Casualty Area Coverage

TerrorisLDeyle•Scenarios




Figure 50. Terrorist Device in Southeast Asia at 0500 Hours: Artillery UnitEffectiveness with Medical Interventions



Figure 53. Terrorist Device in Central Europe at 0500 Hours:. Artillery UnitEffectiveness with Medical Interventions

Figure 54. Terrorist Device in Central Europe at 1200 Hours: Artillery UnitEffectiveness with Medical Interventions

Figure 55. Terrorist Device in Central Europe at 1900 Hours: Artillery-UnitEffectiveness with Medical Interventions

xii

Figure 56. Terrorist Device in South Korea at 0500 Hours: Artillery UnitEffectiveness with Medical Interventions

Figure 57. Terrorist Device in South Korea at 1200 Hours: Artillery UnitEffectiveness with Medical Interventions

Figure 58. Terrorist Device in South Korea at 1900 Hours: Artillery Unit


Figure 59. Terrorist Device in Southwest Asia: Spore Area Coverage

Figure 60. Terrorist Device in Southeast Asia: Spore Area Coverage

Figure 61. Terrorist Device in Central Europe: Spore Area Coverage

Figure 62. Terrorist Device in South Korea: Spore Area Coverage

Figure 63. Terrorist Device: Casualty Area Coverage

Artillery Scenarios

Figure 64. Artillery in Southwest Asia at 0500 Hours: Artillery UnitEffectiveness with Medical Interventions



Figure 67. Artillery in Southeast Asia at 0500 Hours: Artillery UnitEffectiveness with Medical Interventions



Figure 70. Artillery in Central Europe at 0500 Hours: Artillery UnitEffectiveness with Medical Interventions

xiii



Figure 73. Artillery in South Korea at 0500 Hours: Artillery UnitEffectiveness with Medical Interventions



Figure 76. Artillery in Southwest Asia: Spore Area Coverage

Figure 77. Artillery in Southeast Asia: Spore Area Coverage

Figure 78. Artillery in Central Europe: Spore Area Coverage

Figure 79. Artillery in South Korea: Spore Area Coverage

Figure 80. Artillery: Casualty Area Coverage

Multi-Rocket Launcher Scenarios

Figure 81. MRL in Southwest Asia at 0500 Hours: Artillery UnitEffectiveness with Medical Interventions



Figure 84. MRL in Southeast Asia at 0500 Hours: Artillery UnitEffectiveness with Medical Interventions



xiv

Figure 87. MRL in Central Europe at 0500 Hours: Artillery UnitEffectiveness with Medical Interventions



Figure 90. MRL in South Korea at 0500 Hours: Artillery UnitEffectiveness with Medical Interventions



Figure 93. MRL in Southwest Asia: Spore Area Coverage

Figure 94. MRL in Southeast Asia: Spore Area Coverage

Figure 95. MRL in Central Europe: Spore Area Coverage

Figure 96. MRL in South Korea: Spore Area Coverage

Figure 97. MRL: Casualty Area Coverage

AerialS Sray Scenarios

Figure 98. Aerial Spray in Southwest Asia at 0500 Hours: Artillery UnitEffectiveness with Medical Interventions



Figure 101. Aerial Spray in Southeast Asia at 0500 Hours: Artillery UnitEffectiveness with Medical Interventions


xv


Figure 104. Aerial Spray in Central Europe at 0500 Hours: Artillery UnitEffectiveness with Medical Interventions



Figure 107. Aerial Spray in South Korea at 0500 Hours: Artillery UnitEffectiveness with Medical Interventions



Figure 110. Aerial Spray in Southwest Asia: Spore Area Coverage

Figure 111. Aerial Spray in Southeast Asia: Spore Area Coverage

Figure 112. Aerial Spray in Central Europe: Spore Area Coverage

Figure 113. Aerial Spray in South Korea: Spore Area Coverage

Figure 114. Aerial Spray: Casualty Area Coverage

!CBM Scenarios

Figure 115. ICBM in Southwest Asia at 0500 Hours: Artillery UnitEffectiveness with Medical Interventions



Figure 118. ICBM in Southeast Asia at 0500 Hours: Artillery Unit

xvi 11[111 I


Figure 119. ICBM in Southeast Asia at 1200 Hours: Artillery UnitEffectiveness with Medical Interventions


Figure 121. ICBM in Central Europe at 0500 Hours: Artillery UnitEffectiveness with Medical Interventions



Figure 124. ICBM in South Korea at 0500 Hours: Artillery UnitEffectiveness with Medical Interventions



Figure 127. ICBM in Southwest Asia: Spore Area Coverage

Figure 128. ICBM in Southeast Asia: Spore Area Coverage

Figure 129. ICBM in Central Europe: Spore Area Coverage

Figure 130. ICBM in South Korea: Spore Area Coverage

Figure 131. ICBM: Casualty Area Coverage

xvii

1.0 INTRODUCTION

Anthrax has been a health problem throughout recorded history. It is thought to havebeen the Fifth Plague of Egypt. Casimir Davaine isolated the bacterium in 1850, and LouisPasteur developed the first major anthrax vaccine in 1877.

In recent history, people began thinking of B. anthracis as a potential weapon. TheJapanese investigated using it against China in the mid-1930s, initially against livestock andthen against large populations. On the Allied side, it was developed as a type of pre-atomicdoomsday weapon specifically for use against civilian populations. However, it was neverused. Enormous amounts of war stocks were later destroyed following WWII, and by the1950s the total reserve could be measured in ounces.

B. anthracis, especially in pseudo_ ;s, proved to be too persistent for its intended useas a weapon. In the West, it was released as a test on the island of Gruinard off the northerncoast of Scotland (in the Hebrides). A single, mass exposure was made there in 1943,amounting to a pseudospore infestation that simulated battlefield concentrations. As of the late1980s, Gruinard Island (nicknamed "Anthrax Island" by the locals) was still too heavilyinfested with the pseudospores to ailow human occupation. This was in spite of having beenfirebombed and thoroughly burned at least once.

The objective of this study was to determine the levels of B. anthracis likely to befound on the battlefield and the potential impact of B. anthracis attacks on unit effectiveness.The levels of B. anthracis are critically dependent on the weapons, form of agentdissemination, weather conditions, and time-of-day of an attack. In assessing the effects on amilitary operational unit following a B. anthracis attack, various defensive measures wereconsidered including the wearing of protective equipment, especially the protective mask, andthe use of medical interventions such as vaccination and antibiotic therapy.

2.0 BACKGROUND

2.1 CHARACTERISTICS OF BACILLUS ANTHRACIS

Anthrax is a disease that attacks both human beings and animals. It is caused by theencapsulated, spore-forming, large gram-positive rod Bacillus anthracts. The bacteria growsvegetatively within the body tissues of the host; sporulation occurs when the vegetativelygrowing organism is exposed to the atmosphere. Virulent strains of B. anthracis produce aprotective capsule composed of poly-D glutamic acid and an exotoxin. As a result,B. anthracis is found in soil (particularly dry soil) as a resistant spore that may persist foryears. Spores vegetate in the soil when the pH1 and temperature conditions are favorable, andan organism-spore-organism cycle can be maintained for years.

The bacillus produces an exotoxin or exotoxins with at least three active fractions:edema factor, lethal factor, and protective antigen. Anthrax toxin and capsule production areassociated with two separate plasmids, pX01 and pX02, respectively. In the host, the actionsof a combination of these factors cause the destruction of phagocytic cells and capillarypermeability, resulting in illness. One study has shown that phagocytosis by humanneutrophils is inhibited in the presence of protective antigen and edema factor, potentiallyincreasing the host's susceptibility to disease. Alum-precipitated antigenic material fromculture filtrates containing protective antigen is used as the current anthrax vaccine forhumans, while live spores of the avirulent, nonencapsulated Sterne strain are used as aveterinary vaccine.

B. anthracis is sens;:'ve to damage by UV light, depending on whether the bacterium isa vegetative cell or a spore. More than 99 percent of the vegetative cells of Vollum 1B andSterne were killed with 20 seconds of exposure to UV wavelengths between 280 and 300 nm atlevels of 0.9 W/m-, while 25 minutes of UV exposure was needed to kill the same amount ofSterne spores. In addition to being less sensitive to UV radiation, spores of B. anthracis aremuch more resistant to dryness and heat than vegetative cells.

2.2 EFFECT OF BACILLUS ANTHRACIS EXPOSURE ON THE POPULATION

B. anthracis can infect humans through a variety of routes resulting in differentmanifestations of the disease. In peacetime, the human exposure naturally found occurs fromingesting contaminated meats or by contact with the hides of infected animals.

Cutaneous anthrax is the most common naturally occurring form of the diseaseaccounting for nearly 90 percent of all cases. It generally develops when a penetratingtraumatic injury results in deposition of the spore under the skin. People who work withanimal-origin products from anthrax-endemic areas are at risk of contracting the disease. Bitesfrom flies may mechanically transmit B. anthracis, but reported cases are rare and sporadic,and this route of infection is not thought to play a role in epidemics.

3

A second common, naturally occurring form of the disease is caused by the inhalationof spores from contaminated dust, wool, or hair, especially when handled in confined space.After inhalation, the spores localize in the mediastinal lymph nodes. A septicemic phasefollows, with concomitant pulmonary involvement.

A third common, naturally occurring form of the disease is intestinal anthrax. Becausespores can be found in meat from infected animals, ingestion of raw meat, blood, orinadequately cooked meat from such aniimals can result in infection. In industrialized nations,intestinal anthrax is less common than the cutaneous or pulmonary form of the disease;however, on a worldwide scale, intestinal anthrax is much more common than inhalationanthrax. The low prevalence in industrialized nations is presumably attributable to thestringent laws concerning animals allowed into the food chain. Human-to-human transmissionis possible but unlikely.

The symptoms of anthrax vary depending upon the route of entry. Two (2) to five (5)days after inoculation of a spore into a wound (cutaneous route of entry), a reddened, papularlesion develops which is commonly mistaken for an insect bite. Later, there is vesiculationthat becomes a depressed, black eschar (scab). Without treatment, septicemia and death mayoccur in up to 20 percent of affected patients. With treatment, death is rare.

Initially, inhalation anthrax is associated with signs of mild respiratory disease, i.e.,mild fever, malaise, and a nonproductive cough. Within 7 days of onset of the symptoms, thedisease becomes more severe, with progressive respiratory distress and cyanosis. Edema ofthe neck, thorax, and mediastinum signal the beginning of a rapidly fatal course. Treatment israrely successful after onset of symptoms.

A less common, clinical form of the disease, intestinal anthrax, is characterized bygastroenteritis with emesis, bloody feces, and signs of septicemia. Death is the usual outcome.There is also an oropharyngeal form of anthrax in people. Those affected develop fever,edema, and crvical or submandibular lymphadenopathy.

In human beings, the diagnosis of anthrax is made on the basis of clinical signs as wellas results of serologic testing, bacteriologic culture, and inoculation of laboratory animals.Vesicular fluid is the best source of B. anthracis for culture in people with cutaneous anthrax.One disadvantage of reliance upon culture for diagnosis is the rapid course of the disease afterserious symptoms present. If anthrax is not in its advanced stages, antibiotic treatment iseffective, with penicillin or ampicillin considered the drugs of choice in eliminating thebacteria. Results of bacteriologic cultures of wound and blood specimens will usually benegative for B. anthracis if antibiotics have been administered, although this negative readingdoes not necessarily signify that anthrax has been defeated. Current therapy would consist ofadministration of both oral and IV antibiotics plus vaccine.

4

2.3 PREVALENCE AND COURSE OF THE DISEASE ANTHRAX

There are areas of the world where anthrax is endemic (prevalent) in animals. Thisresults in chronic environmental contamination with resulting human and animal disease.B. anthracis is found most commonly in areas with neutral to mildly alkaline soil (pH 6 to8.5), and periods of drought and flooding. Flooding allows the bacteria to accumulate at theground surface in low-lying areas. Subsequent drought affords conditions for exposure of thespores. Anthrax has been reported in the Middle East, Africa, Central and South America, aswell as other areas of the world.

Pulmonary or inhalation anthrax, the form of the disease most likely to be propagatedthrough weaponization of B. anthracis, begins after an incubation period which varies from1-6 days, presumably dependent upon the dose of inhaled organisms. Onset is gradual andnonspecific, with fever, malaise, and fatigue, sometimes in association with a nonproductivecough and mild chest discomfort. In some cases, there may be a short period of improvement.The initial symptoms are followed in 2-3 days by the abrupt development of severe respiratorydistress with dypsnea, diaphoresis, stridor, and cyanosis. Physical findings may includeevidence of dramatically widened mediastinum, often with pleural effusions, but typicallywithout infiltrates. Shock and death usually follow within 24-36 hours of the onset ofrespiratory distress.

2.4 DIAGNOSIS AND TREATMENT OF ANTHRAX

Routine laboratory examinations of hosts reveal a neutrophilic leukocytosis. Whenpleural effusions or evidence of meningitis are present, pleural and cerebrospinal fluids may behemorrhagic. The differential diagnosis of an epidemic of inhalation anthrax while still in itsearly stages of nonspecific symptoms could be impeded by similarities to a wide variety ofviral, bacterial, and fungal infectious diseases. Progression of the disease over 2-3 days withthe sudden development of severe respiratory distress followed by shock and death in 24-36hours in essentially all untreated cases eliminates any diagnosis other than inhalation anthi-ax.The presence of a widened mediastinum on chest X-ray, in particular, should alett one tc thediagnosis. Other suggestive findings include chest-wall edema, hemorrhagic pleural effusions,and hemorrhagic meningitis.

Other diagnoses of symptoms similar to anthrax include aerosol exposure toStaphylococcus Enterotoxitn B (SEB); but in this case, onset would be more rapid afterexposure (if known), and no prodrome would be evident prior to onset uf severe respiratorysymptoms. Mediastinal widening on chest X-ray will also be absent. Patients with plaguepneumonia will have pulmonary infiltrates and clinical signs of pneumonia (usually tbsent inanthrax). B. anthtacis will be readily detectable by blood culture with routine media. Smearsand cultures of pleural fluid and abnormal cerebrospinal fluid may also be positive.Impression smears of mediastinal lymph nodes and spleen from fatal cases should be positive.Toxemia is sufficient to permit anthrax toxin detection in blood by immunoassays, and suchassays will be available in field-deployed laboratories. The obvious disadvantage of serologic

and culture diagnostic techniques is the time required for results compared to the rapid andfatal course of the disease without treatment.

Almost all cases of inhalation anthrax where treatment was begun after patients weresymptomatic have been fatal, regardless of treatment. Historically, penicillin has beenregarded as the treatment of choice, with 2 million units given intravenously every 2 hours.Tetracycline and erythromycin have been recommended in penicillin-sensitive patients. Thevast majority of B. anthracis strains are sensitive in vitro to penicillin, although penicillin-resistant strains exist naturally. Moreover, it is not difficult to induce resistance to bothpenicillin and tetracycline through laboratory manipulation of organisms. All strains tested todate have been sensitive to erythromycin, chloramphenicol, gentamicin, and ciprofloxacin. Inthe current setting, treatment should be instituted at the earliest signs of diseage with oralciprofloxacin (1000 mg initially, followed by 750 mg po bid) or intravenous doxycycline(200 mg initially, followed by 100 mg q 12 hours). Supportive therapy for shock, fluidvolume deficit, arid adequacy of airway may all be needed.

2.5 DEFENSE AGAINST B. ANTHRACIS AS A BIOLOGICAL WEAPON

A licensed, alum-precipitated, preparation of purified B. anthracis protective antigen(PA) has been shown to be an effective vaccine in preventing or significantly reducing theincidence of inhalation anthrax. Limited human data suggest that after completion of the firstthree doses of the recommended six-dose primary series (0, 2, 4 weeks, then 6, 12, 18months), protection against both cutaneous and inhalation anthrax is afforded. Studies inrhesus monkeys indicated that good protection is afforded after two doses (1-16 days apart) forup to 2 years. It is likely that two doses in humans is protective as well, but there is too littleinformation to draw firm conclusions. As with all vaccines, the degree of protection dependsupon the magnitude of the challenge dose; vaccine-induced protection is undoubtedlyoverwhelmed by extremely high spore challenge.

In the present setting, three doses of the vaccine (at 0, 2, and 4 weeks) arerecommended for prophylaxis against inhalation anthrax. Given projected stocks, two doses,0.5 ml each, administered subcutaneously on days 0 and 14, are recommended initially. Athird dose should be given two or more weeks after the second dose as additional vaccinebecomes available. Contraindicatior 3 for use are sensitivity to vaccine components (formalin,alum, benzethonium chloride) and/or history of clinical anthrax. Reactogenicity (likelihood ofproducing side effects) is mild to mlderate: up to 6 percent of recipients will experience milddiscomfort at the inoculation site for up to 72 hours (tenderness, erythema, edema, pruritus),while a smaller proportion (< 1 percent) will experience more severe local reactions(potentially limiting use of the extremity for 1-2 days); modest systemic reactions (myalgia,malaise, low-grade fever) are uncommon, and severe systemic reactions (anaphylaxis, whichprecludes additional vaccination) are rare. The vaccine should be stored at refrigeratortemperature (not frozen).

6

Choice of antibiotics for prophylaxis is guided by the same principles as that fortreatment; i.e., it is relatively easy to produce a penicillin- or tetracycline-resistant organism inthe laboratory. Therefore, if there is information indicating that a biological weapon attack isimminent, prophylaxis with ciprofloxacin (500 mg po bid), or doxycycline (100 mg I0 bid)should begin. If unvaccinated, a single 0.5 ml dose of vaccine should also be givensubcutaneously. Should the attack be confirmed as anthrax, antibiotics should be given for atleast four weeks to all exposed. In addition, two 0.5 ml doses of vaccine should be given twoweeks apart to the unvaccinated; those previously vaccinated with fewer than three dosesshould receive a single 0.5 ml booster, while vaccination probably is not necessary for thosewho have received the entire three-dose primary series. Upon discontinuation of antibiotics,patients should be closely observed; if clinical sigrs of anthrax occur, patients should betreated as indicated above. If the vaccine is not available, antibiotics should be continuedbeyond four weeks until the patient can be closely observed until discontinuation of therapy.Vaccine use may be of additional benefit even after exposure, along with antibiotics.

The use of the protective mask can dramatically reduce the exposure to inhaledB. anthracis spores. Tests using salt fog have determined that the median protective ratio ofthe M17A1 mask is 1.67 x 10i. The protective value of the mask is critically dependent on thefit. If fit improperly, the protection afforded by the mask has been measured as low as 10,which would not provide an effective barrier to B. anthracis spores. Wearing a mask [MissionOriented Protective Posture (MOPP) 3 and 4 or special situations where mask only isspecified] at the time of a potential attack is complicated by the difficulty of detecting anaerosol attack with B. anthrocis. In the case of many of the possible delivery methods, itwould be difficult to detect a biological release if it occurred well upwind of friendly forces.Further, it may also be difficult to differentiate a biological release from conventionalmunitions, especially if a conventional attack is used to conceal a biological release.

7

3.0 METHODOLOGY

3.1 DATA SOURCES AND APPROACH

Data were extracted from a review of available literature starting with a bibliographicsearch of the Chemical/Biological Information Analysis Center (CBIAC) and the databasemaintained at the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID).See Appendix A for a summary of values provided by USAMRIID. Basic values wereextracted from these sources to represent:

0 The potential weaponization of B. anthracis.* The physical characteristics of B. anthracis released as an aerosol., The toxicology of B. anthracis without medical intervention, with antibiotic therapy, or

with an effective vaccine.

Potential weaponization concepts developed are shown in Table 1. A preliminary studywas conducted to identify sensitivity to a number of key parameters for the study. Theseparameters included the median infective dose for B. anthracis spores, the protective ratios forantibiotic therapy and vaccination, unit effectiveness levels for military operational unitsplaced at different locations within a hazard footprint, the effects of different climates, theconsequences of releases at different times of day, and finally, the sensitivity to uncertaintyabout the biological decay rate. After a preliminary review of the available data withpersonnel from USAMRIID, the final parameters of the study required to characterize theweapons, the environmental conditions, the aerosol potential of B. anthracis, and thetoxicology parameters were established. These parameters were then used to complete thefinal production simulations for quantifying estimates of the coverage and consequence ofB. anthracis use on the battlefield.

Table 1. Weapons Characteristics for Dry B. anthracis Dissemination

SWeapon Rounds/ DisseminationSystem Total Agent Mass Submunitions Lin--ength Efficiency

(k&) (#) (kin) M%

TBM 78 2,000 5Terror Device 5 1 1Spray 1,200 .,_100 60Artillery 24 24 2.5MRL 240 240 2.5ICBM 1,560 40,000 5

9

3.2 SIMULATION MODELS

Three models were used in conducting the simulations used in this effort. The firstmodel was PLUME, Version 2.6, updated February 28, 1991. PLUME was a modeldeveloped by Mr. Roger Gibbs of the U.S. Naval Surface Warfare Center at Dahlgren, VA.PLUME was originally adapted by Mr. Gibbs for use during the Persian Gulf War as a part ofthe Automated Nuclear, Biological, and Chemical Information System (ANBACIS) II programconducted at the Operations Center at the Defense Nuclear Agency. PLUME was used togenerate footprints of biological attacks which were either precomputed and stored in thedatabase system for near real-time response ox computed based on the projected and estimatedweather patterns. The model results were used to directly prepare the spore-area coveragecharts and the footprint contours indicating the levels of hazard that would be generated byeach attack scenario. The hazard levels at each grid location produced by PLUME were thenused by the CASUALTY model to calculate the expected levels of casualties with and withoutmedical and physical protection. The CASUALTY model was developed by Mr. RichardMcNally of Science Applications International Corporation. The casualty results were thenused to estimate changes in unit effectiveness for units located at different locations on thebattlefield using the Army Unit Resiliency Analysis Model (AURA) developed by Dr.Terrence Klopcic at the U.S. Army Research Laboratory (formerly the U.S. Army BallisticResearch Laboratory).

3.3 LIMITATIONS AND ASSUMPTIONS

Limitations and assumptions frame any simulation project, and certainly this effort wasno exception. The limitation and assumptions can be attributed to the nature and confidence ofthe data and the modeling tools used for the study.

The data used for this study includes environments, weaponization, agentcharacteristics, and unit effectiveness relationships. Unit effectiveness data elements have beencarefully developed by the staff of the U.S. Army Research Laboratory over a number of yearsand have been found to generate adequate representations of the actual units. Uniteffectiveness results were modeled based on soldiers either in MOPP 0 or MOPP 4 in advanceof the attack. No change in MOPP level after the attack was modeled. It was assumed thatthe attack had been detected in time to begin antibiotic therapy starting within 24 hours afterexposure and continuing for 30 days. The predeployment vaccination with MichiganDepartment of Public Health-Protective Antigen (MDPH-PA), completed well before theattack, would have consisted of three doses administered at 0, 2, and 4 weeks.

Agent characteristics deserve special attention for this effort. Toxicity estimates wereextrapolated from animal studies. The quantitative estimates on the benefit of medicalintervention were also based on animal data. The median infective dose estimates of 8,000 to10,000 spores per man reflect a 20 percent relative difference range. If analogy with chemicaldata is relevant, a 50 percent uncertainty in median lethal dose is common. Sensitivityanalysis on this 20 percent range in median lethal doses was conducted and results were found

10

to be insensitive, a finding which is discussed later in this report. One possible factor leadingto this insensitivity is the low probit slope for infective dose. Low probit slopes result in smallchanges of population response for large changes in dose.

It should be noted that the protective value of the vaccine was based on a finding of nolethalities in monkeys exposed to 500 times the median infective dose of spores (Appendix A).A protective value was estimated from this data, but the actual protective value may be higherfor monkeys.

One caution should be noted regarding the toxicity data. Literature could be cited thatpresents relatively simple methods for increasing the infectivity of B. anthracis by as many astwo orders of magnitude. If such techniques were used, the resulting hazard may be severeenough in some cases to overwhelm protection by the vaccine. Appendix C provides theresults of simulations using a 100-fold increase in toxicity. No submunition attacks werecapable of overwhelming the vaccine. Spray attacks achieved some limited success, but evenat the worst, never achieved more than 15 percent degradation in unit effectiveness in a verylimited area.

Other agent characteristics used in this study include the density of the agent, theeffectiveness of dissemination of inhalable particles (less than 5 microns in diameter), and thesensitivity of the agent to UV radiation. The density of the agent and the effectiveness ofdissemination are key factors in the functional capability of the weapon systems that employthe agent. The variety of weapon systems represented in this study covers a considerablerange, and there exist well-characterized data from U.S. programs (undertaken prior to 1969).The sensitivity to UV radiation is an area of higher concern. The values observed in theliterature are from chamber trials where chamber characteristics confound the estimation ofUV exposure with the physical characteristics of the chambers. Two estimates of decay ratewere examined to identify the sensitivity to this factor and will be discussed below. The tworanges studied bound the values found in the literature.

Data on weaponization of B. anthracis by potential enemies is not available. Thechoice of weapons used in this study and the fireplans used for the artillery and multiple rocketlauncher cases provide a spectrum of potential agent area coverage possibilities. Since therewere no threat systems to directly use as data elements, representative weapons volumes andfill weights were used to estimate the mass of agent that might be weaponized in the varioussystems and warhead designs. One system deserves special note. The spray system representsthe largest estimate of the potential fill weights for such a device and may be one to two ordersof magnitude as large as a U.S. designer might have used prior to 1969. This systemcapability was maximized in order to identify the impact of an extreme level of threat onavailable protection systems. Although the representation of any single weaponization schememight be off by some unknown margin from some yet-to-be identified threat, the resultsshould generally prove to be accurate to within an order of magnitude in spore area coverage.Since the spore area coverage results are nearly constant over a large range of spore levels-of-interest for medically unprotected personnel, the level of uncertainty is not viewed to be verysignificant.

11

The environmental factors important for the battlefield levels of B. anthracis are theamount of sunlight, wind direction, wind speed, atmospheric stability, and surface terrain Alisting of the hourly values used in this study can be found in Appendix B; Table 2 provides asynopsis of environmental conditions modeled. It should be noted that the comparativelylower casualty results for Southeast Asia reflect the impact of the forest terrain which reducesthe number of spores reaching troops.

Table 2. Synopsis of Environmental Conditions ModeledRegion Central Eurooe Southwest Asia Southeast Asia South KoreaWind Speed(km/hr) 9-14 7-16 6-5 3-12Surface Type Barren Sand Forest BarrenAgent DecayRate (%/min) 0.1 to_1 0.1 to 1 0.1 to 1 0.1 tol

Sunlight exposure increases agent decay as a result of UV radiation. There are twolevels of uncertainty regarding UV radiation and decay rates. First, there is some uncertaintyas to the levels of UV radiation in the atmosphere depending on meteorological conditionsthroughout the day for each location. Second, there is uncertainty attributable to the responseof the agent to various UV radiation exposures. This uncertainty in agent decay rate wouldresult in more variation than would estimates of differences in UV radiation variations.

Wind direction changes over time can have dramatic effects in the shape of thefootprints from any attack, but no wind direction changes were portrayed in this study becausethey are critically dependent upon synoptic wind patterns and topographic influences whichwere not represented in this analysis. However, the casualty and unit effectiveness estimateswould not be expected to differ significantly as a result of simulating wind direction changesover time since the spore area coverage results would be nearly the same.

Wind speed is known to vary considerably over small time scales. Available data forthe climatic regions studied in this effort were represented at hourly intervals. The changes inwind speed over the course of the diurnal cycle should provide reasonable representativevalues. Long-term tracer studies have had considerable success in validating the modeling ofwind speed variations.

The changes in atmospheric stability when combined with wind speed variations overthe 24 hours of a day can dramatically change the hazard footprint. Data on the precise timewhen stability changes occur are not recorded by weather authorities. The stylized Pasquill-based stability values used in modeling the transport and diffusion of biological agent must becorrectly represented to generate an accurate footprint for agent releases that transition throughperiods of night, dawvn/dusk, and strong sunlight. Appendix B documents the stability valuesused in this study on an hourly basis. Release times of 0500 hours and 1900 hours werechosen to encompass multiple environmental periods while the 1200 hours release was chosen

12

to remain in the sunlight period. The choice of release times would minimize the impact ofthe uncertainty of the exact time of the change in stability.

In addition to the limitation of toxicology data on the analysis and reliability of theresults, the modeling tools make assumptions and place further limitations on the study. ThePLUME model is a flat-terrain, tri-variant gaussian transport and diffusion model. It has beenmodified to represent changes in wind speed, wind direction, atmospheric stability, and agentdecay rate on an hourly basis. NO validation of the model has been published. Because of thelarge grid necessary to accommodate successful releases of B. anthracis (several hundred kmdownwind travel), grid artifacts can sometimes be generated. For instance, the circular patternformed by the submunition impacts of ballistic missiles generally cannot be seen in the hazardfootprints. Hot spots with very high contamination ievels may not be depicted due to theabsence of a grid point at the hot spot.

13

4.0 SENSITIVITY ANALYSIS

Four key issues for the study of the effective levels of B. anuhracis spores wereoutlined: the effective number of spores that can be released with particle sizes appropriate forretention within the respiratory system; the population response to spores/vegetative cells ofB. anthracis; the impact of a protective mask or medical intervention using pre- or post-exposure antibiotic therapy and/or vaccination; and the consequences on unit effectivenessfrom the casualties created during the attacks.

4.1 EFFECTIVE NUMBER AND SIZE OF BACILLUS ANTHRACISPARTICLES

A wide range of potential delivery systems was studied in the United States before1969. These systems examined the release of dry spores as well as wet releases. Essentially,the release of B. anthracis spores can be accomplished by small devices using explosives,generators which use either explosives or compressed air, or spray devices using either single-or double-nozzle systems. The efficiency of release varies considerably with different releasemechanisms (Table 1). The efficiency of release combines several factors. The first of twoprincipal factors includes the ability to release sufficient quantities of viable agent tosuccessfully infect a person if inhaled, ingested, or introduced into wounded or intact skin.The second principal factor includes the ability to generate aerosols with particles of theappropriate size.

The ability of particulates to attach on a surface depends on the surface characteristicsof both the surface and the particulate in addition to the size of the particulate. The surfacecharacteristics of particulate and surface can only be determined after specific testing. Thetendency of particulates to be attracted to either hydrophobic or hydrophilic surfaces can begenerically determined. The size of particulates has been established to be of primaryimportance in determining the region of the respiratory tree where deposition might occur andthe level of deposition expected in that region. Particulates or droplets greater than 100microns tend to be retained in the nasopharynx. Particulates or droplets between 0.1 and 5microns in size tend to be nearly completely retained in the lowest levels of the respiratorytree, especially the terminal bronchioles and the alveoli.

The number of B. anthracis spores of size less than 5 microns in diameter required toprovide a lethal dose to 50 percent of the population (expressed as LD50) has been estimated tobe between 8,000 and 10,000. The LD5 0 for rhesus monkeys has been determined to be 8,689spores. Population response sensitivity to the range of 8,000 to 10,000 spores became the firstissue to be addressed in this study.

The concentration of spores in dry agent has been found to be between 0.9 x 10"2 and1.02 x 1012 spores/g while the concentration of wet agent was approximately 2 x 10"0

15

spores/mi. The packing density of dry agent is 0.15 g/cm3 while wet agent would have adensity approaching 1 g/cm3. A dry agent was used in this study.

4.2 SENSITIVITY TO ESTIMATES OF MEDIAN INFECTIVE DOSES

Two issues related to the estimate of median infective dose must be addressed. Thefirst issue is the representation of the effectiveness of antibiotic therapy and/or vaccine. Ifantibiotic therapy is going to be effective, numerous sources cite that the therapy must beinitiated before the onset of symptoms. After symptoms start, little success has been found inpreventing death from pulmonary anthrax. Based on studies of available data, the U.S. ArmyMedical Research Institute of Infections Diseases (USAMRIID) has determined that antibiotictherapy is effective in reducing the lethality of B. anthracis pseudospore exposure if therapy isinitiated in the first days after exposure and before the onset of symptoms. The use ofantibiotic therapy was found to constitute approximately an LD10 at 10 times the untreatedLD50. Probit analysis techniques were used to develop a protective ratio of 670 for antibiotictherapy.

To illustrate this analysis, Figure 1 shows the classic relationship between populationresponse and probits. A probit is one standard deviation of population response and a probitlevel of 5 is assigned to the 50 percent response level.

Problt Scale

10

8---------------------------------------------

S........................................

4-1--------------------------------------------

0 10 20 30 40 50 60 70 80 90 100

% Population Response

Figure 1. Probit Score vs. Population Response

Figure 2 demonstrates the use of the probit relationship as applied to the problem ofestimating median infective doses for antibiotic and vaccine. Antibiotic therapy usingdoxycycline was protective against 10 inhaled LD5 os in 9 of 10 rhesus monkeys (Appendix A).Figure 2 shows that a factor of 10 times the untreated median infective LD50 dose (10 x 8689

16

spores) moves the untreated response line to the right such that the line intercepts a pointrepresenting a 10 percent population response (3.7 on the probit scale) on the vertical axis, andlog(o . &689 , or 4.94 on the horizontal axis. The protective value of antibiotic therapy isbased on the assumption that the probit slope does not change with medical intervention.

A similar procedure is followed in the case of vaccination. USAMRUD has found thata dose 500 times the untreated infective dose for a 50 percent population response did notresult in a single infection for vaccinated populations. [The results were specific to MDPH-PA efficacy, i.e., the currently fielded vaccine. In these experiments, ten adult rhesusmonkeys were immunized with MDPH-PA at 0 and 2 weeks. At 8 weeks, the animals werechallenged with 506 aerosol LDsos of B. anthracis Ames spores. All monkeys survived. Fivecontrol monkeys given saline rather than MDPH-PA died following challenge with 439 aerosolLD50s of Ames spores. In a longer term experiment, three monkeys received MlDPH-PA at 0and 2 weeks. At 38 weeks (8.5 months) th%- monkeys were challenged with 203 aerosol LD50sof Ames spores. All three monkeys survived.)' Graphically from Figure 2, shifting theuntreated response line to the right 500 times the untreated LDs0 dose (or 2.7 log units), thevaccine dose response line must intersect the treated dose response surface at a populationresponse level representing 0 percent on the Y-axis. Zero (0) percent was conservativelyestimated using a probit value of 2 which represents three standard deviations below themedian value. The protective ratio for the vaccine is thus determined to be 9,390,000, aconsiderable level of protection.

Probit Scale'1

8----------------------

Medlcal Interveillons

- No Therapy"An Atibiotic Therapy

4---------=- Vaccination

-. - - - - - - -

0 -

0 1 2 3 4 5 6 7 8 9 1011 12

LOG[Expcsure (spores)]

Figure 2. Medical Intervention Population Response

The footprints in Figures 3 and 5 show the consequences of varying the median

infective dose between 8,000 and 10,000 spores. Contours are based on the B. anthracis

t From a memo by COL David Franz, Headquarters USAMRIID, Ft. Detrick, MD, dated 7/30/93.

17

The footprints in Figures 3 and 5 show the consequences of varying the medianinfective dose between 8,000 and 10,000 spores. Contours are based on the B. anthracisdosage that results in 5 percent and 50 percent population response (deaths) with no medicalintervention, 50 percent population response with antibiotic therapy started in the first day ofexposure, and contours representing 50 percent population response with vaccinated personnel.While the range in number of spores represents a 25 percent increase in the mediantoxicological values, it can be seen that there was no appreciable increase in the LD50 areacoverage without medical interventions. Further, as can be seen in the panels displaying uniteffectiveness, there is no perceptible difference across toe three figures. Figure 4 shows anintermediate infective dose of 8689 spores which was based on monkey data and was the valueused to represent the median infective dose in humans; it was used for the remainder of thestudy. (For additional assistance in interpreting footprint hazard graphs, see Appendix D.)

18

Unit Effectiveness (%) MOPP 012 3 4 M

. . .... I I : . - -. IntI V ars

40 ... 44

"0.2 20 40 60 80 10 120 140 160 180 ______

kilometers

Unit Effectiveness (%) MOPP 4

24 4 M49IOS

I------------- - ;i

liftm~h liii W%:~ jEI -8 I. E~oci

Figure 3. TBM with Subrunitions in Central Europe at 1900 Hours: Artillery UnitEffectiveness with Medical Interventions (LD5 0 = 8,000 spores)

19

I~~- 3 4

Unft Effectieness (%/) MOPP 0luIntuventons

Non

24 4

L2A _I- _ _a) 0 + r - O W

O0-16 -~ 160W 180 50-A__

-2 4 . 20 40 60 'O 1 0 2 0 1 0 O 1 0 L * o

kilorneters

Unit Effe~ctveness (%/) MOPP 4

Figure 4. TBM with Submunitions 'M Central Europe at 1900 Hours: Artillery U~nitEffectiveness with Medical Interventions (Ll)50 = 8,689 spores)

20

Unit Effectiveness (%)/ MOPP 012 3 4 M•dk

10 a - Iran ions, A

44 - -- -' - 4

© -1 6 "m Lw*W an m~

S24 20 40 60 80 100 120 140 160 180 Sa1Imo"

klom e t ers

Unit Effectiveness (%) MOPP 4........

-Y -- i4 8 '1 0 0 4 6 o . . . La" Vof G %

Figure 5. TBM with Submunitions in Central Europe at 1900 Hours: Artillery UnitEffectiveness Medical Interventions (LO50 = 10,000 spores)

21

S. . .. .... i . ... | . . .. ... . .. i .. a .. . . .... | ... ..I ... -... ... . .. .. .i... .No.. . ... m . ...i ... .i..... ....... i... .

4.3 SENSITIVITY TO AGENT DECAY AND TOXICITY ESTIMATES

Figures 6 and 7; 8 and 9; and 10 and 11 (pages 24-29) show comparisons of high andlow ranges of decay rates for cases where attacks occurred at 0500, 1200, and 1900 hoursrespectively. For the three times of day modeled, the strongest decay effects were seen for the1200 hours releases, where decay ratios were highest. The "low" range of decay rates (0.1 to1 percent/minute) used as the baseline in this study was based on U.S. Army Medical Researchand Development Command (USAMRDC) knowledge of the relationship between the chamberdata and expectations for operations in the field. (See Appendix B for a listing of the hourlydecay rates used as the standard for the simulations in this study.) The "high" range of decayrates (1 to 2.5 percent/minute) examined for comparison was based on data found in U.S.Army Chemical Research, Development and Engineering Center (CRDEC) sources2. Thepotential effects on the level and duration of hazard due to the uncertainty in decay rates canhave an appreciable effect on the outcomes of model results.

As would be expected, the most pronounced effect of the "high" decay rates relative tothe "low" would be the alteration of the extent of the downwind hazard. Figures 6-11incorporate the effects of transport and diffusion, as do all the footprint maps in this study.However, if the effects of transport and diffusion are disregarded, the effect of differences indecay alone can be calculated. A decay rate of 0.5 percent/minute over a period of 10 hourswould result in a loss of agent viability of 95 percent; a decay rate of 0.1 percent/minutewould result in a loss in viability of only 45 percent.

Although transport and diffusion are the dominate phenomena affecting agentconcentration for any given source strength, use of the "high" decay rate in an analysis canappreciably lower the estimate of the level of threat. For example, the artillery unit modeledin this analysis would occupy a deployment area 600 meters by 400 meters or approximately240,000 m2. If the artillery unit were to experience a direct attack at midday with a windspeed of 5 km/hour, the airborne agent would be expected to clear the area occupied by theartillery unit in 10 minutes or less. Based on the "high" decay rate of 2.5 percent/minute, aloss of 22 percent in the viable agent mass would occur within the 10 minute time frame.Another way of looking at this effect is to say that the amount of mass released, or the sourcestrength, would be reduced as a result of decay on the average by 11 percent as it wastransported across the targeted artillery unit. Again, using the example of an attack on anartillery unit but substituting the "low" decay rates, a loss of viability of 10 percent of theagent mass would occur within the 10 minute time frame, resulting in, on average, a 5 percentdecrease in source strength across the target. The implication is that for direct attacks, therewould be an overall variation of about 6 percent in the total agent mass conserved whencomparing the "l'igh" and "low" ranges of decay rates examined.

The effects of variations in decay rates on downwind units is easier to visualize on thefootprint maps. In the comparison maps, differences in decay rate estimates produce enoughvariations in the extent of the downwind hazard to exclude some units from the attack when

2 Recently renamed Edgewood Research, Development, and Engineering Center (ERDEC).

22

using the high decay rates that would be included in the downwind hazard drift when using thelow decay rates.

One of the operational implications of releases during periods of maximum decay isthat the extent of the hazard area is much more controllable. For example, based onhypothetical validation of the "high" decay rates, an Iraqi attack against Kuwait could be timedso as to nearly totally decay (99 percent in three hours at 2.5 percent/minute) before ananticipated shift in the on-shore wind pattern that might otherwise threaten Iraq.

Undocumented sources have suggested that decay can be prevented for the first 2 hoursfollowing release and that B. anthracis may be 100 times more toxic than the levels determinedby USAMRDC. Appendix C addresses these issues by providing examples of the results thatwould be achieved by following these assumptions. Based on the lower decay rates used in thecurrent study, which range from 0.1 percent/minute in darkness to 1 percent/minute in brightsunlight, the effect of a two hour delay in decay would be to conserve between 12 and 30percent of the agent total mass that would be expected to decay in the first 120 minutes afterdisseminatior.. However, on a target such as an airfield attacked at night, the agent wouldclear the associated 4 km diameter area in about one hour or less assuming winds ranging from3 to 9 km per hour. In this airfield attack case, the absence of decay in the first hour wouldonly conserve about 6 percent of the total agent mass. Therefore, since the current study isbased on an assumption that decay does occur during the first two hours after release, theresults simulated in this study would provide only a slightly lower estimate of the resultinghazard and, consequently, a slightly more robust estimate of unit effectiveness than thealternate supposition.

The issue of a 100-fold increase in agent toxicity presents a much more seriousoperational challenge. To assess the operational impact and potential resultant medicalworkload, the sensitivity of unit effectiveness of an artillery unit and the capability of themedical products vis-4-vis this challenge were modeled for TBM submunition and sprayattacks in Central Europe and Southwest Asia. The general conclusion was that the protectivecapacity of the vaccine was robust enough to maintain unit effectiveness above 85 percent inall cases without the protection of the mask. However, antibiotic therapy could be decisivelyoverwhelmed for areas as large as 15,000 square km for the simulated spray attack at 0500 inCentral Europe. If the unit was in MOPP 4 at the time of the attack, antibiotic therapy wouldhave been required to sustain unit effectiveness at 63 percent -- the normal level of degradationfor MOPP 4. Without antibiotic therapy, the protective ability of MOPP would also havebeen overwhelmed. If one does indeed believe that the toxicity of B. anthracis is 100 timesmore toxic than the level estimated by USAMRDC, then there is an unequivocal case for avaccine policy that immunizes personnel prior to deployment, or at least in-theater prior toexposure.

23

Unit Effectiveness (%) MOPP 02 3 4

40I ...... .

4011111 41 Theropy" " " mNone

An*thra L&eavl n that

2iHatom eald

ED 12 Lethai Does . ., .

0 with Vaodne

~ + L~aothoes 0%

S 0 20 4-0 60 80 100 120 140 160 180 ____Does___

kilometers

Unit Effectiveness (%o) MOPP 41 2 34 MedCol


24

Unit Effectiveness (%) MOPP 01 2 3 4 M&

low IOf INtI~f~hS. -. . V"-s

ENone

Antvm Levei. an the

• 24U12 U •uihm,••IamO

U 0 LW LDo* W%

0 12 LM osW~24 L20 o0 60 80 1O •120'140 160 180 o __________

kilometers

Unit Effectiveness (%) MOPP 42 3 4 MUWl.. .. . .. . .F- - - ... . ... . ... ' . . .. r

4" " 4:N H U"" " i Vaccin

44 4


25

Unit Effectiveness (%) MOPP 01 2 3 4 Ins

oa~ia IJ H .... []Vane

, II

Unit ~ ~ ~ ~ - Noneiees % MP

An~ma LavW* an the

cn 242U Mioe

Q) 12wfth Vac 4.4 Letwa Do"e W%

Fie '. T whLthal Doese W%

-24 I Le" aDoe. a%-~0 20 40 60 80 '100 120 140 160 180

k ilome t ers

Unft Effectiveness (0/) MOPP 4


26

Unit Effetdveness (%) MOPP 01 2 3 4 M"CW

42 41 4 4v4n

S24 -27

22 3Mft

C~ 12


27

Unit Effectiveness (%) MOPP 01 2 3 4 Medca

IN of Intarven~ons

44 46- -4 . ."

14 0 0 40 60 8 1 0 1 0 4 60 1 0 _ _ __ _ _

:MO I a m ete2Md24

Fgr 14ti a 190 H o240 + C3 ,W Do r . .. 0 %.~ ~ ',

20 4,0 60 80 100 120 14"0 160 180

kilometers

UntEffetivenesdls (,tn) MOPP 4D1 2 3 4 M•2

-------- .... . . . . .. . . .. .. . . . In Veuve in e

Figure 10. TBIA withi Submunitions in Central Europe at 1900 Hours: Artilery UnitEftective,,ness with Medical Interventions (USACRDEC Decay Rates)

28

Unit Effectieness (%) MOPP 0

24 Ar

-~12 h SW

0 LWW~ Dci 60%

0 24 20 40 60 8"0 1800 12 ý'1 40' 160 8 uIo6

kilometers

Unit Effectiveness (%) MOPP 42 4M*"ca

*vaccinoTOmacip

*Nami

Figure 11. ThM with Submunitions in Central Europe at 1900 Hours: Artillery UnitEffectiveness with Medical Interventions (USAMRDC Decay Rates)

29

4.4 UNIT SENSITIVITY TO CASUALTIES FROM ANTHRAX

An artillery unit is used throughout the study as the target of attacks using six differentweapon systems. In order to illustrate the unit sensitivity of various operational units, anattack with a terrorist device was also simulated against a headquarters unit, an ammunitionsupply point, an infantry anti-armor unit, and an attack helicopter unit for comparison.

A headquarters unit is most sensitive to casualties because the members of the unit havespecialized tasks to perform; the loss of a few highly skilled workers is hard to absorb withouta significant loss in unit effectiveness. Attack on an artillery unit, infantry anti-armor, orattack helicopter unit result in unit effectiveness degradation approximately proportional to thepercentage of casualties suffered from an attack.

Figures 12-26 illustrate the relative resilience of these five units to personnel losses.Unit effectiveness is shown for a point in time after all casualties would be absorbed (meantime to death is approximately 7.5 days) but without any replacements. Above each hazardfootprint, the unit effectiveness of a unit located at any of four locations on the battlefieldrelative to the attack is shown with recults for Mission Oriented Protective Posture 0(MOPP 0) with three alternatives of medical therapy: (1) vaccine protection, (2) antibiotictherapy begun on the day of the attack, and (3) no medical intervention. Below each footprint,the corresponding values for the same units are displayed but with MOPP 4 assumed beforethe attack and maintained until such time that it can be ascertained that there is no longer athreat of infection. This may take many days in the absence of a biological agent detector. Asa point of reference, note that donning protective equipment causes a decline in uniteffectiveness independent of casualties. The expected degradation attributable to MOPP 4would result in 63 percent unit effectiveness for artillery, infantry, anti-armor, or attackhelicopter units, 60 percent for headquarters units; and 2r percent for ammunition supplypoints, according to AURA calculations,

As a tool for comparison, a unit with an effectiveness level of 90 percent is consideredto be fully functional while a unit with 70 percent unit effectiveness is considered to beincapable of normal operations. A level of 80 percent unit effectiveness may be looked uponas a reasonable goal for sustaining operations with a safe margin of error. By simply donningthe protectIve equipment of MOPP 4, a unit is no longer capable of sustaining normaloperations at a level equivalent to a non-nuclear, biological chemical environment.

Differences in unit sensitivity can be made by comparing units at the same positions onrespective hazard footprints. For example, a unit located within the LDs0 contour on thefootprint would expect to experience 50 percent casualties if there is no medical intervention.Position 3 on the footprint is slightly within the contour; thus, units at that location would beexpected to experience greater than 50 percent casualties. Note that the ammunition supplypoint at this position is expected to achieve about 55 percent unit effectiveness even thoughlosses are greater than 50 percent. A headquarters unit at the same position, on the otherhand, would be totally ineffective. The other three units would be expected to achieve onlyabout 30 to 35 percent unit effectiveness at the same position. With vaccine, all units would

30

remain totally effective (headquarters unit would be at 98 percent), and the antibiotic therapywould preserve unit effectiveness at greater than 95 percent for all units with the exception ofthe headquarters unit (87 percent unit effectiveness).

31

Unit Effectiveness (%) MOPP 02 3 4 Mel•

t# " " tu• -- Inlterven'dns

... 4er y

None

•n 1 2 3]L ~ O

kilometers

Unit Effectiven~ess (%) MLP a41 23 4Meal

wtU Vaccine

kilometers


32

Unit Effectiveness (%) MOPP 012 3 4 midoj

1ntwevonain

...4..... EVacine

*Nono

W 12 U D W%ý 8 W6• VaOdm

S-4 W LW* Dam W%

0-I r MLathad Doa.o69A0 20 40 60 80

kilometers

Unit Effectiveness (%V) MOPP 413 4 Madlc.

Intsivention• . . . . . a, . . , •

Figure 13. Terrorist Device in Southwest Asia at 0500 Hours: HeadquartersUnit Effectiveness with Medical Interventions

33

Unit Effectiveness (%) MOPP 0- 12 ,34 M"O

I" flN"fl...l

•--• [] Noti.

,A,_ _ _ _ _ I _ mI

cn 1 LAWh Oce. 60%0 wh = Thol"

0 20 40 60 80 _______a __

kilometers

Unit Effectiveness (%) MOPP 42 3 4 Medk,

Interventdoeu-- "~ ~ .. .. ..... I . _ .J ....... ..• i~ .] Vo~dne

4 . .. .. . .. 44---- , 4 ---- 4 ... . ... . . . .. .. ... Th

Figure 14. Terrorist Device in Southwest Asia at 0500 Hours: AmmunitionSupply Point Unit Effectiveness with Medical Interventions

34

Unit Effectiveness (%) MOPP 0id 2 3 M 4 u,,O•

Intetventons

L8Li

4. + 0J LahJcsOW

0 0 ow OW0%

0 --J -M .. .....

'0 20 4.0 60 s0Kilomneters

Unat Effectieness N% MOPP 4a2 8 4 Medical

" '" "- " I " .. . . .. " .. . .. .. ........ .= .

Figure 15. Terrorist Device in Southwest Asia at 0500 Hours: InfantryAnti-Armor Unit Effectiveness with Medical Interventions

35

Unft Effectvenes (%) MOPP 01 2 3 4Mda

No..

w(n

12nbs

p

"-" .. .... . + . Lo d Da i0%

0 20 40 60 80 1*LathuDo"e8ki -oete rs

Unit Effectiveness ()MOPP 4

S" []Noneu11 4

. It eretl l n s~l

.--- ~4-0 408 [ 4 =6

Figure 16. Terrorist Device in Southwest Asia at 0500 Hours- AttackHelicopter Unit Effectiveness with Medical Interventions

36

Unit Effectiveness (%) MOPP 01 2 3 4 Maedw

,- •,-,. ": .. • .. . ,- - -,etvefiln e

'A Vac*On

"Aj] , Lv Ni [ None

/Z 68"Oeld

cn12 taU LaDole6W%

4 + iLW'J DoemeW%0 wifliThomy

0 20 40 60 80kilometers

Unit Effectiveness (%) MOPP 42 .4 UWi,,........ .-.-........ 1 ........ I~ ........ nt e enw


37

Unit Effectiveness (%) MOPP 01 2 3 4 M",•

.[] Non*

An wa Laiu,/ on 1he

c1 2 2 LvdW an W.S%Wt V*d+8 + +t h VDo"W%

0 + V&Theaw

E- 0 *La Dow W%

• 0 20 40 60 80kilometers

Unit Effectiveness (%) MOPP 412 3 4 U

u- " "B" [ Vaod~ne


K-

Unit Effectiveness (%) MOPP 02 8 4 MU

I. - aint.ou .e t im eo i

U.-j

*dhVae*

Andthmc ~is onfth

"-4 LawOmW%

+_0 _--~L. . •Laod[om6%


Unit Effectiveness (%) MOPP 41 2 3 4 MUdke

- -....... ................. "


39

Unit Effectiveness (%) MOPP 01 2 3 4 M=ddC

Silomenftrs

ULit 8i (%Vaaod) O

"a . . . "W "W " . . I V

-ni Efetvns wit Medial ntevenion

4 F4

Q7Unit~MUim Effetivnes (,Yo M Pe

is$ 2 3 OCC

os. .. . . N .. .. . . s . .. . .. .. . L neU~ivoe6

0#' 20 40- 60 isa 0

Unit Effectiveness with Medica 4nevnin

I ___ ____ edi40

Unit Effectiveness (%) MOPP 01 2 3 4 M"Ca

U. 1 - - - --- i*V"'d

Mntm Lemba n ft

~12 LWD~+-8 ... i Vohone

4 ~ + O1aiadWOMeIW%0 Wthm u oon"~x

0 20 4-0 60 80kilometers

Unit Effectiveness (%) MOPP 42 3 4 Me"

6*- - 1 - - l . .

0None


41

Unit Effectiveness (%) MOPP 01 2 3 4 MadiW

: .. Intf entlons

a . Vaodne'lThwaW

N~vcL.Sonet~

A *m Lw* 0 n to

" 8~ L*Mh Do". 60%A

U 0W Them"A* LWW Dame 10%

0 20 40 60 80 1 La ,Ome"'kilometers

Unit Effectiveness (%) MOPP 412 3 4 M"C

IN Inten'entloneS.. .. . .. . .......... . . . .... * I.

0 ThersW/


42

Unit Effeciveness (%) MOPP 01 2 3 4

N-N"

.. .. . *"V"-' " "" m... . . . . .Intb/n ln

Z "mc LaWim an Owe

12 0Li_ U ..- D- M WNOS%

a 0 ". .. m W epy


Unit Effectiveness (%) MOPP 42 a 3 0 4 uO&

rWn•1C 4

" " U None


43

Unit Effectiveness (%) MOPP 01 2 3 4 ModC

t# tN I|rtuvuon s

112 . .I W

A Lx DW ".6%G) 0 w 7herepy

0 La" Dow 60%

020 40 60 80kilometers

Unit Effectiveness (%) MOPP 42 3 4 Mode

a IntO~emntlo


44L• ... m.•-..•. .--- ;- •m-- -- m-- • --__

Unit Effectiveness (%) MOPP 0314 -O&

- Intaemwfndo

-~~ V-accne44 . . . .

a.. . al . . . . . . . = W

m12

o -80 I •r ,0 20 40 60 80 *mn.Ioae•s%-• kilometers

Unit Effectiveness (%) MOPP 42 34 M ,

4-U- Vulne

Figure 25. Terrorist Device in Southwest Asia at 1900 Hours: Infantry Anti-ArmorUnit Effectiveness with Medical Interventions

45

2 4Mw

,idn

Unit Effectiveness (%) MOPP 01 2 3 Me"

. . . .. " . .. .. "I" ten on

*Vaccdne[I.ii,41101] ,*!.• Noui

-0 20Thw0

,L kilometers

Unit Effectiveness (%) MOPP 42 12 4MO

Inerventions

wriVaccneLahil Dw W

Figure 26. Terronst Device in Southwest Asia at 1900 Hours: Attack HelicopterUUnit Effectiveness with Medical Interventions

46

. . .i i- ,

5.0 STUDY RESULTS

Study results are depicted using four graphical methods: hazard footprints, uniteffectiveness bar charts, spore area coverage charts, and casualty area coverage charts. Eachchart highlights important aspects of the study results.

IHazard Footprints

Hazard footprints, used in this section to display the severity of various B. anthracisattacks and the effect on units at various locations within the target area, provide a measure forquantifying the effectiveness of medical interventions and protective equipment. It isimportant to realize that deaths may still occur outside the footprinted area as the transport ofspores continues beyond the LD5 contour (5 percent expected fatalities). The hazard footprintsfur each weapon delivery system are supplemented with spore area coverage charts for eachregional climate and a probability of casualty chart that compares the defensive capabilities ofvaccine and antibiotic therapy across the theaters of operation.

Unit Effectiveness

Effects of the B. anthracis attacks were meas-zred in terms of nit effectiveness ratherthan survivors for the purpose of quantifying the military significkdance of each scenariosimulated. Nevertheless, it should be noted for basel.Pne reference that casualty and uniteffetctiveness figures are not equivalent. For instance, while 50 percent of a urAt may survivea biological attack, the unit would nOL necessaily maintain 50 percent effectiveness.

The difference between SLivivor and Unit Effectiveness results is illustrated in threeTBM attacks simulated for Southwest Asia (Figures 27-32), first with re.,ilt. shown forsurvivors, then the same results expressed as unit effectiveness. Note that unit effectivenesslevels arc generally lower than survival levels, as would be expected, foi units operating inMOPP 0. However, while survival rates for units assuming MOPP 4 are high (near 100percent), unit effectiveness lev•i1! hover around 63 percent, a result of performancec,.gradstion attributable to the bulkiness of the protective gear doniit.A and the accompanyingimpairment of the field of vision. A 63 perccnt unit effecti1veness in MOPP 4, then isequivalent to approximqtely 100 perc.-nt survival for personnel in an artillery unit. A dipbelow 63 percent effectiveness for MOPP 4 can terefore be interpreted to indicate a failing ofthe defensive measure with a resultant loss of livez. Units may have to remain in MOPP 4 formany days until such time that it can be confirmed that there is no longer a threat fromB. qnthracis.

The implication of analysis of the Survivor versus the Unit Effectiveness results is thatprotective gear, in particular a mask, would provide a high degree of protection againstB.anthiracis attack when used in combination with either vaccine or antibiotic therapy, but at aserious trade-off in unit effectiveness given an 80 percent rule of thumb for measuringoperationality. The use of vaccine alone proved as effective as the use of vaccine plus

47

MOPP 4 in saving lives, except against the intense hazard created by a multi-rocket launcherattack simulated for 0500 and 1900 hours in South Korea (Figures 90 and 92). If onlyantibiotic therapy were available, the combination of protective equipment and antibiotictherapy could achieve a 63 percent unit effectiveness for all the scenarios simulated if soldiersremained in MOPP 4. MOPP 4 alone, without medical intervention, would still result in lossof life as well as a further loss of unit effectiveness for units exposed to the high levels ofB. anthracis produced close to the sit-. of impact of the simulated multi-rocket launcher, sprayand artillery releases.

A further gleaning from the Survivor comparisons in Figures 27, 29 and 31 is thatmasking alone, compared to not masking, would provide individuals a much greater chance ofsurvival following a B. anthracis attack in the absence of medical intervention. Since the mainprotection afforded by MOPP 4 against a B. anthracis attack is to prevent the inhalation ofspores, the results for masking would be equivalent to results for units assuming eitherMOPP 3 or MOPP 4, since both postures include masking. The disadvantages of maskingonly as a defense against biological attacks are: (1) the risk of a poor fit, (2) the difficulty indetecting the nature of the attack and the routes of entry thus at risk, (3) delay in detectionwhich can result in exposure through inhalation, and (4) the possibility of lack of detectionuntil symptoms are observed, resulting in mass casualties,

Spore Area Coverage

Spore area coverage results show the peak levels of battlefield hazard in terms of thenumber of spores per square meter and the number of square meters of the target that containat least that concentration of spores. The results represent total accumulation after the attack.The usefulness of such charts is in allowing a comparison of the diffejences in coverage by thetime of day of the attack, and also in being able to quantify the extent of the hazard in astandardized way. Thus, attacks simulated for the various weapon delivery systems can moreeasily be compared for overall hazard potential and peak dosage levels, a task that would bedifficult to accomplish simply by looking at the hazard footprints themselves since they aredepicted in dosage ranges. In general, spore coverage resulting from 1200 hours releasespresented a lesser hazard, both in overall extent of the coverage and peak concentrations, thanthe 0500 or 1900 hours releases, due in part to the greater instability of the atmosphere at thistime of day ane' also to the effect of UV light in accelerating the decay rate.

Casualty Area Coverage

Finally, casualty area coverage charts were used to compare each weapon system acrossthe theaters of operation for three medical intervention levels: (1) no therapy, (2) vaccine,and (?) antibiotic therapy. "Casualty area" is not a specific area of the target but a measure ofprobability over the entire target area. Probability of casualty percentages are different thanfootprint results because units occupy a finite fraction of the total footprint area used tocalculate casualty area coverage. Results are shown for a unit with MOPP 0. Note that1,000,000 m2 is equal to 1 km 2 and that one order of magnitude reduction in casualty areacoverage represents a 90 percent reduction in casualty probability.

48

The following specific results of the study are organized by weapon systems and attackscenarios.

5.1 TACTICAL BALLISTIC MISSILE WITH B. ANTHRACIS FILLEDSUBMUNITIONS

A release of approximately 2,000 submunitions, each containing just under 39 grams ofB. anthracis, was simulated for three times of day in four different climates. Thesubmunitions release from the tactical ballistic missile (TBM) was executed at an altitude ofapproximately 15 km, impacting an area of about 3,000 meters in diameter.

The TBM attack scenarios (Figures 27.41) for the different climates and release timesproduced a hazard footprint ranging from 60 to 140 km downwind and a crosswind hazardextending out to approximately 25 km at the widest point. Transport time, or the time itwould take for the hazard cloud to clear the target area, would vary from 72A-17 1A hours,depending on the time of day.

Figures 28, 30, and 31 depict the percentage of unit effectiveness for four unitsfollowing a TBM attack in Southwest Asia at 0500, 1200, and 1900 hours. In order to showthe relationship between survivors and unit effectiveness, Figures 27, 29, and 31 depict thepercentage of survivors for corresponding attack simulations. In each pair of figures, notehow closely the percentage of survivors equates to unit effectiveness for an artillery unit inMOPP 0. Recall that artillery units have a somewhat linear relationship between personnellosses and unit effectiveness. The main conclusion here, however, is that while protective gearwould be very successful in achieving survivability, it induces a degradation in uniteffectiveness to 63 percent that could be avoided through the use of either predeploymentvaccination or antibiotic therapy begun the first day of the attack. (Recall that the decline to63 percent unit effectiveness is characteristic for an artillery unit, the target simulatedthroughout the footprints in the Study Results section.) Another factor to be considered forboth individual survival and unit effectiveness is that without masking in advarce of abiological attack, soldiers with no medical protection would be highly vulnerable, resulting inboth large losses of life as well as a severe decline in military capability. Even soldiers withantibiotic therapy would be at risk in the event of a covert B. anthracis attack, since maskingplus antibiotic therapy would be required to prevent casualties.

Across the four theaters of operation, the vaccine would be expected to maintain100 percent unit effectiveness against ihe simulated TBM attack for MOPP 0. The antibiotictherapy would be less effective in several scenarios, notably the 0500 and 1900 hours releasesin the South Korean climate (Figures 39 and 41) and the 0500 release time in the SouthwestAsian and Central European climates (Figures 28 and 36). Here, a considerable fraction of thehazard footprint contained areas where the contamination levels could overwhelm the promptuse of antibiotic therapy, resulting in greater than 50 percent casualties. For all other climatesand release times and in South Korea for the 1200 hours release, prompt administration ofantibiotic therapy was shown to be highly effective in preserving life assuming, of course, thatthe B. anthracis attack would be detected within the first day of the attack so that antibiotic

49

"therapy could be started in time to be effective. Note, however, that if a release ofsubmunitions resulted in a smaller impact area either as a result of lower release alutude or achance combination of environmental conditions, the increased intensity of the attack couldoverwhelm the protective factor afforded by the antibiotic therapy. In other words, thesimulated TBM scenarios tested the limits of the protective ratio of antibiotic therapy so thatany increase in the hazard level, such as that produced by time of day or meteorologicalconditions, could result in a large decrease in the beneficial effects of antibiotic therapy; incontrast, predeployment vaccine was not challenged by any of the scenarios and, therefore,presented a greater margin of safety for defensive capabilities against a TBM attack.

Note the generally lower concentration levels of agent in the footprints for theSoutheast Asia scenarios (Figures 33-35) as evidenced by the narrow contours for the LD50levels either with or without therapy. This can be attributed to the fact that the surfacemodeled in Southecast Asia was forested, and the treetops create a much rougher surface to airflow than sand or barren ground by approximately two orders of magnitude. This increasedroughness decreases the relative stability of the atmosphere and reduces the effectiveness of theagent dissemination.

50

MOPP 0 (%) SURVIVORS2 3 4 Medc

0 U0 Vaccine

~NoneeC 24

(U 1 LAW Dow W0%

,, _ .. W.-_' " D 6 %

'- 20 40 60 80 100 120 140 160 180 ML*eIDo* 6%k iom e te rs

MOPP 4 (%) SURVIVORS-2 34 Mole


51

Unit Effectiveness (%) MOPP 01 2 3 4 dk

a'~o

U U Vedn.

IIN

__Nenm

24 ski"ters-~12 *Low eL4oa0%

Un VEff• • (%cOP

E 0 C3 4 * Wa

S ... ........ DOWN%. .2'0 40 6130 803 '1001201 140 O 160 1110 0 eI

kilo m et ers

Unit Effectiveness ()MOPP 44 Medole


52

MOPP 0 (0/) SURVIVORS

7.Inteevetlon

M ,

AnmU*Non te

huv Law 00 W%

(D 0 1 LWW~ Do" 10%

E-12 0 LN*We6O

-~0 20 40 60 80 100 120 140 160 180kilo m et ers

MOPP 4 (%) SURVIVORS-2 3 4MedWca

Interventon

INon


53

Unit Effectivenes (%) MOPP 02 34 MeCa

kilometers"

IUffih fftvn () P

1 2 II 4O ne

(D 12WMOCh

0_ 0 ai Oe

24 Lem DoweeI%Figure 0 20 40 60n u 80 100120140160e

kilo mete rs

Unit Effetwveness ()MOPP 4


54

MOPP,0 (%) SURVIVORS23 4 Medical

- Lee Intevendmone

. . . . ... ...V A 3 ThNNon

cn 24 Bd

(D 12 wih Vaccine0 lam Do. 60%

(U 0 wih m.wW

©-12 U I 0" D %

-2 0 20 0 60 80100120140160180-kilometers

MOPP 4 (%) SURVIVORS2 3 4 ModkW

Intretons


55

Unit EffectUveness (%) MOPP 01 2 3 4

.. ... .a - ----- Laow wi.on li

-)12W Va~odQ 0 L$,W mW

S-12

-- 240- * LeAW Dmeo6%

' 20 40 60 80 100 120 140 160 180kilometers

Unit Effectiveness (%) MOPP 42 ;3......... ........".

N".


56

Unit Effectiveness (%) MOPP 01 2- 3 4Me

. .. ... . . .. . .. . . . . V &Gdn*41 . .. . . . 3 m e

Aifwsx Loe on toV)-24

12 L*dtdDOWN1%

~ 0 _ _ 0 tWiDowIW%E12 *mumwrwy

Y 0 20 40 60 80 100 120 140 160 180 M*LoDow$%kilometers

Unit Effectiveness (%) MOPP 41 2 3 4 Medkit ........ 61.. . .7 . . . . : . . . " -

Vaccine


57

Unit Effectiveness (%) MOPP 01 2 3 4 MdW

A01em UriL acnh

"•-24. 20* 0 8 0 2 4 6 8 ljudOc.80tlr••%(U12 w~hVaocin

212 MLWW D440 0%

_ * L" hd= w6%

u 0 20 40 60 80 1u00 120 S140a 160 180kilometers

Unit Effectiveness MOPP 4

Va58r*

Figure 34. TBM with Submunitions in Southeast Asia at 1200 Hours. Artfillery UnitEffectiveness with Medical Interventions

58

unit OWncUVendess8 (%) MI-PP U1 2 3 4

t. a - InteeOrta

IN m n ' ,Md vs L •~ _. 1

.. ..... - . . . . . i . . . . .I• vO*.

O24 DetW Do" W%12 *La VoodooQ)0 A Do WAmm

0 -12 LAW ON* W%

-2 0 20 60 80 100 120 i40 190 180 Do"___%kilometers

Unit Effectiveness (%) MOPP 401 2 3 4 M**

.. . .. ... .. IIIVnto•one

. .SOThen"p


59

Unit Effectiveness (%) MOPP 01 2 3 4 M"Oc

49 ..J . 6 "SP V aLrMN ne

Adm m Lwes on #

M 2 4

212 __ 4 M

0 LafulDe.w 80"%

0 1 2 . . . " . . . . . . . 0 01 . . . " "

[u Therapy

-24 M LAMuaDo" 0%-~0 20 40 60 8'0 100 120 140 160 180

kilometers

UnE t Effeiveness (wM i ) MOPP 412 3 4Modicl

IU 0* 44 .vntereeons

44 40 lbmp

Non.

Figure 36. TBM with Submunitions in Central Europe at 0500 flours: Artillery Unit


60

Unft Effectiveness (%) MOPP 02 3 4 M"W

0 "n..4W,

0m La w Om WS

Ei La D W 0%Jo,, m

0- -2 i-ý 2 -O 190 1,80,-240 20 TO 60 80 '0 2010160 8

kilometers

Unit Effec•ns (%) MOPP 4U-2 3 4• 0

Figure 37. TBM with Submunitions in Central Europe at 1200 6ou0s: Artillery UnitEffectiveness with Medical Interventions

61

Unit Effectiveness (%) MOPP 01 2 4 4

.-- I~ .. . N:". . . . . -4 "4 -T" " I """" m €v: o on y

24*

g_4_..* Cm4.J_,," ]Nray

+) LWW ow W6%

Q)-1 LcowDow W%

a -12LWW~ Dam W%

04 20 06,0 80 100 120 140 160 180 -s*iD"a

kilometers


S.. . . .. : . .. .. : ........ .........IN IN IihWOeWiO

lNm•


62

Unit Effectiveness (%) MOPP 01 2 3 4 MOIAei

Intiewndons

UVaccine

40 .ii. 4

A_2u LarW an to

U) 24c12 _ AhVwun.

S0 V^ Ther

'0 20 40 60 80 100 120 14-0 160 180kilometers

Unit Effectiveness (%) MOPP 41 2 3 4 Me"


63

Unit Effectiveness (%) MOPP 01 2 3 4 MUCa

Go•+ 2o I0t60 ano tdono

klometotersk

4' 44 Thif*Y

*None

Arirax LS#V6d 4n ths

L- *W haDo".IN%W )12 'Vacn

0_ *3 L~hW DOWN 6%

S 0 20 40 60 80 100 120 14-0 160 180

k ilom et ers

Unit Effectiveness (0/) MOPP 41 3 4- nteuvenio


64

Unt Effectiveness (%) MOPP 01 2 3 4 Mo&W

- ---.-. In.e....t neI, a I

""@ " [Eva" . . . c.. . . , - . . . ."'

a. 1I ~Thesy

Nhi Lweonel~

V 24 s

~12 WIUValodn0 +0 L-M DoeM ,0%

0 -121 - Lad DMO W60%S-24( 2' ' ' ' ' ' ' ' M 'eh Olmam ,

-0 20 40 60 80 100 120 140 160 180kilometers

Unit Effectiveness (%) MOPP 42 3 M o4-- - - ] ......... ... .. . ......... " "

Figure 4 1. TBM with Submunitions in South Korea at 1900 Hours: Artillery UnitEffectiveness with Medical Interventions

65

Figures 42-45 depict the spore area coverage potential of a TBM attack for each of thegeographical regions for releases at 0500, 1200, and 1900 hours. Note how consistent theTBM attack would be in terms of hazard potential across the regional climates and times ofrelease: the peak number of spores achievable in an area is well within one order ofmagnitude, and well over 1,000 km2 would be covered by at least 8,000-10,000 spores persquare meter.

Area Coverage (Wn)1.000E+111

1,000E + 10,1,0OE2+091.oooE+o08 Time of Dayi.000E+07I

1,000,000 \ 0500 hours100,000o100,000 1200 hours

100101 0--1900hours

Number of Spores

* Tactical Ballistic Missile (submunitlons)

Figure 42. TBM in Soutihwest Asia: Spore Area Coverage

Area Coverage (ml)1.000 +11 Il.OOOE+101.000E+09I.000E+08 Time of DayI.000E+07

1.0CO000 - 0500 hours100,0)0 "0 1200 hours

10,0001,000 - 1900 hours

10010

'9

Number of Spores

* Tactical Ballistic Missile (submunitions)

Figure 43. TBM in Southeast Asia: Spore Area Coverage

66

Area Coverage (in)1.000E+11

1.OOOE+0 Time of DayI .000E+071,000,000 -0600 hours

00,000o 1200 hours1O0,000

1.000- 1900 hours100

Number of Spores

* Tactical Ballistic Missile (submunitions)

Figure 44. TBM in Central Europe: Spore Area Coverage

Area Coverage (m2)11000E+4111.0001E+101,000E+0911000E+08 Time of Day1,0001E07

1,000,000 0500 hours100,000 ~'1200 hours

10.0001,000 -*1900 hours

100o10

",' •p"•,• IV," Z'J 1<4',• ,•

Number of Spores

* Tactical Ballistic Missile (submunitlons)

Figure 45. TBM in South Korea: Spore Area Coverage

Another method for assessing the effectiveness of the medical products is casualty areacoverage. Figure 46 compares the relative effectiveness of TBM attacks across the fourregional areas for three times of day. As noted earlier, the variability in casualty areacoverage is a function of the wind speed profile for each region and the atmospheric stability atthe time of release. For example, atmospheric conditions for the 1200 hours releases rangedfrom very unstable for Southwest Asia to slightly unstable for South Korea. Noon is also thetime of day experiencing the highest average wind speeds and agent decay due to UVradiation. The action of these meteorological conditions is to lower concentrations of sporesand therefore lessen probability of casualties. On the other hand, the 0500 and 1900 hoursreleases would occur during neutral or slightly stable conditions when wind speeds are

67

typically lower -- a time of day more conducive to effective dissemination. As can be seen inFigure 46, casualty area coverage without medical interventions would be well within an orderof magnitude for all regions and times of release with the equivalent of approximately 1,000km2 receiving a lethal dosage. The vaccine would achieve a reduction in the TBM's casualtyarea coverage potential of approximately three to four orders of magnitude. More specifically,even in the South Korean climate, the vaccine would reduce the probability of casualty toapproximately 1 km2 for the 0500 and 1900 hours releases and to approximately 0.01 km2 forthe 1200 hours release. Antibiotic therapy, in comparison, only reduces casualty area coverageat best by one order of magnitude (Southwest Asia).

Casualty Area Coverage (M2)1.000E+111.000E+101.OOOE+091.000E+081.OOOE+07 M lir o

1,000,000 Medical Intervention*

100,000 1 /= No Medical Therapy

10,000 Antibiotic Therapy1,000 U Vaccine Therapy

10010

GO k

Theater of Operation

* Tactical Ballistic Missile (Submunitions)

Figure 46. TBM: Casualty Area Coverage

68

5.2 TERRORIST DEVICE FILLED WITH B. ANTHRACIS

The terrorist device was modeled with a 5 kg payload of dry B. anthracis disseminatedby an explosive charge. The technology of the device is simple, but it is unlikely that aterrorist group would be able to generate the freeze dried product that was chosen as the fill.The freeze drying process would dictate that the material would probably have originated froma sponsor state. It is possible, however, to generate similar results using a liquid B. anthracisfill. Liquid B. anthracis can be produced by a terrorist group independently from statesponsorship. Liquid B. anthracis is not only easier to produce than the dry product, it is muchsafer to handle and does not require the use of protective equipment and masks for theproduction process.

Hazard footprints (Figures 47-58) show that even the small quantity of agentdisseminated by this system can extend a considerable distance downwind. The footprints forthe 0500 and 1900 hours releases roughly approximate 3 to 5 hours of transport while thesmaller footprints of the 1200 hours releases approximate 1 to 2 hours of transport. Transporttime is the time it takes for the hazard cloud to clear the target area. Of course, the transportof the spores continues beyond these footprint dimensions, but the concentration and dosage isbelow the LD, level chosen to bound the footprint area.

One of the more striking aspects of the terrorist device scenario is its exceptionaleffectiveness against unprotected personnel. Although labeled as a terrorist device, it could beemployed by special forces personnel very effectively. As can be seen from the footprints, thedevice could potentially achieve LD50 levels of hazard 20 to 40 km in length with crosswindwidths of 3 to 5 km for releases at 0500 and 1900 hours. The 1200 hours releases would bethe least effective due to unstable atmospheric conditions prevailing at noontime, particularlyin Southwest Asia.

The implications for unit effectiveness following an attack with the terrorist devicesimulated are severe. Without the medical interventions of vaccine or antibiotic therapy, theunit effectiveness of an artillery unit in MOPP 0 could easily be degraded below 30 percent forall regional climates for 0500 and 1900 hours releases. In fact, there is a wide window ofopportunity for covert release in the hours of darkness between 1900 and 0500 hours. Sincedosage is a product of time and agent concentration, the closer the device is activated to thetargeted unit, the greater the concentration and the quicker that the lethal dose level could beachieved. For an unprepared unit (MOPP 0), even a brief period of exposure before maskingcould potentially produce lethal infections. As seen in the unit effectiveness charts,vaccination of personnel prior to deployment could completely eliminate this covert threat.While antibiotic therapy could be expected to maintain unit effectiveness above 80 percent inmost of the scenarios, there are environmental conditions such as those of the South Koreanwinter climate that could enable a 5 kg terrorist device to break the protective value ofantibiotic therapy (Figures 56 and 58). Additionally, the time required for diagnosis ofinfection with B. anthracis is critical to the therapeutic value of antibiotics -- a considerableuncertainty given a covert attack.

69

Unit Effectiveness (%) MOPP 01 2 3 4 Medical

IN t#intmrventlonat ti

" " • VLAYdonto

C, 12

4U Lai Own WS%

0 -8 -i- -J LaOoe060 80 7&"_____

kilometers

Unit Effectiveness (%) MOPP 42 3 4Meia

Vaocln*


70

Unit Effectiveness (%) MOPP 01 2 3 4 MdCa

T Intmewn~ns

if* Non*

Anthrax Lavel on tha

S12 Latha Do" 60%EJwid Vanclo

wfthThempyLat- Dose 60%

- ~Lahaj Do" 6%0 20 40 60 80

kilometers


Lu LWM- Intervention2. 4.

ofoc


71

Unit Effectivenesa (%) MOPP 01 2 4 e1

-4 nt evm.toe ia,

"- Dc 4.60 0 I 0% ow

0 ~~~ 2040608

-• kilometers

Unit Effeotivenea (%) MOPP 4

Non2n 12 4 OWW


72

i i i IF i I -- i i i I I i

Unit Efectiveness (%) MOPP 01 . 2 3 4 Mdial

ItIf . . . . . . ... . . .

.. . ... . . . . .. . . . ./ N

Ar~vax Lew•W on 1ho

212

n . . . . Do" " " " " 0.. i %•

whhLaiew~~a¶

~~8 0 6 80.Lee Do". W%

E-4: Lam 00" W.%

kilometers

Unit Effectiveness ()MQPP 42 34

NmN


73


Ohl_ ta ___ Mwdlone

'41 44 46lEL

,n12 • " Omm4ww%

0 Law 0W6%0 20 40 60 80 _

"kilometers

nuiEtfectiveness3(%) MOPP 4

# ~ ~ ---- .. ...... ".....n.. ~lNI a]A Vacdne


74

Unit Effectiveness (%) MOPP 02 3 4 Med•cSInterventons

go . . .] Vacdne

,4 4 - 44 4 Tlmnamt. .* 20-14 o IM None

'nthrm jc ees on the

~12 ULOOVAI 136" 505with Vaccine

44 C Ladia Do". W%W 0:with Therap

E -4 Lethal Do". 0%

C -ar Lethal rmae6%"0 20 40 60 80

kilometers

Unit Effetiveness (%) MOPP 41_ 3 4 Medkal

" l Inteentions

40 4 44Therapy


75

Unit Effeotiveness (%) MOPP 01 2 3 4 M"Ca

40 lag if - -e v l

-o t M Name" ..A ' U.

_ _ z

4 kilometers

0g 40--Th erap

30. . . .N .~

AMi LAWe DON%~

4ý 40 60h 806

Unt Effetivene ss (wMi ) MOPP 4

1 i Mi , cI-i

ag INome


76

Unit Effectiveness (%.) MOPP 0.2 04 !n"Cnton

""4 . - i t .

L L None

W 12 Ladug Do" 60%

+~ Lethw 6%e o

1 0 20 4.0 60 80kilometers

Unit Effectiveness (%) MOPP 42 3 4 uMWIO,

LAOIc LiI0 nterventOwe

"... "a Vacdneo 4 Therap

"I" []*None


77

Unit Effectiveness (%) MOPP 013 4 34

LU14 I Untm~endona

S...... V..ine

" "LiiJ1 , []4.

44 . .] .~h 4O4 - 1,'-= -80 2 0 4-

UnitEei N"M

AMivm Lwools an ft

212 LAW 4_ ~Wih Vmdoe

0_ whht Then"*L*.aDow"O%

" _ 1 "_ M L" "u lDo"g1%20 40 60 S0

kilame t ers

Unit Effectiveness (%/) MOPP 4


78

Unit Effectiveness (%) MOPP 01 2 3 4 Ut

I, --. . Interventlons

, . . . . . . .] V lu~lne

3', 4.. c-1 Terupy

• • 20 4.0108 AUitiEfteLeveco Woes )iP

~12

8 LeMW DWOa 60%

"". . wid' TherapyE-4-- MLetai Do"s 60%

0 060 s0o ______-

kilometers

Unt Effectiveness (wM) MOPP 41 2 4 Medlc7

Vaoolne444

3 rwp

None

Figure 56. Terrorist Device in South Korea at 0500 Hlours: Artillery UnitEffectiveness with Medical Interventions

79

Unit Effectivenessa(% MOPP 0

41 T a

60 g 0

Unit~A~ Effetivnes (%) too

0 4 w flogn

4'0 LaWo in.%

UntEffectiveness with Meia4nevnin

80

Unit Effectiveness ()MOPP 0

it 2o .3 .. I. Interventionsa

-G - - - -- Vaccine

4C4K LIIKI 4 4 hea3 0 20 . 0 .6 0 . 0

-~ *None

Figre 8. errris DeiceinSouh Kreaat 900Hous:ArtimLevery Unith

Efeciens withh Medica 6n0rvton

81 aci

The spore area coverage charts (Figures 59-62) provide additional insight into thehazard potential of 5 kg of agent explosively released by a terrorist device. As was seen in thefootprint charts, the 1200 hours releases would be the least effective in all four regionalclimatic conditions for both peak number of spores achievable (X-axis) and spore areacoverage (Y-axis).

Very noticeable for the 1200 hours releases were the effects of relatively higher windspeeds, unstable atmospheric conditions, and accelerated agent decay rate due to exposure tosunlight. The overall result was a combined reduction in the peak number of spores as well asthe area covered by at least one spore. This reduction would be very significant for everyclimate examined.

Overall, the 5 kg device is approximately an order of magnitude less effective than the78 kg TBM release discussed earlier, in terms of peak numbers of spores per square meter andarea coverage at the 8,000 to 10,000 spores per square meter level. It is interesting to notethat the 1200 hours terrorist device releases were from one to two orders of magnitude lesseffective in area coverage at the 8,000 to 10,000 spores per square meter level than either the0500 or 1900 hours releases. This difference was at a minimum for the South Korean climateconditions where the noontime winter environment would be only slightly unstable.

Area Coverage (M2)1.000E+111.O0OE+ 101.000E+091.000E+08 Time of Day1.000E+07

1,000.000 0500 hours100,000 * 1200 hours

10,0001,000 1900 hours

10010

Number of Spores

Figure 59. Terrorist Device in Southwest Asia: Spore AreaCoverage

82

Area Coverage •m2)1.OOOE + I11,000E+10I.OOOE 4.09,1,000E+07 Time of Dayl.000E+0771.000.000 - 0500 hours

100,000 4- 1200 hours10,0001,000 - 1900 hours

10010

-o ,. . 0 ,

Number of Spores

Figure 60. Terrorist Device in Southeast Asia: Spore AreaCoverage

Area Coverage (rn2)1.000E+111.0QOE+101.000E+091.00021 0 Time of Day1.000E+071,000,000 0500 hours

100.,000 - 1200 hours10,0001,000 - 1900 hours

10010

4.,9

Number of Spores

Figure 61. Terrorist Device in Central Europe: Spore AreaCoverage

83

Area Coverage (mge1,000E+ I I1.000E+101,000E+00.

1Th00E+07 h de ime of Day1100,oo0oo00 0500 hours

100,o000 1200 hours

10,0001.000 "-1900 hours

10010

Number of Spores

Figure 62. Terrori.st Device in South Korea: Spore Area Coverage

The casualty production potential of the terrorist device is depicted in Figure 63. Notethat the vaccine would provide a very high level of protection from anthrax for all conditionsexamined as evidenced by reduction of the lethal area coverage to between 10 and 10,000square meters. By comparison, the lethal area coverage for personnel with no medicalprotection would range from 1 to 100 square kilometers. While antibiotic therapy wouldprovide approximately a 90 percent decrease in lethal area coverage compared to the use of nomedical interventions, a considerable area of the target (0.1 to 10 km2) would still experiencelife threatening levels without the additional use of protective gear. For personnel protectedby the vaccine, even the low wind speed, stable atmospheric case of South Korean winterconditions resulted in less than 0.01 km2 of probable lethal area coverage compared to apotential lethal area of approximately 100 km2 for unprotected personnel. In summary, theappropriate use of antibiotic therapy is effective in reducing the probable lethal arca against thesimulated terrorist device attack by approximately one order of magnitude or by 90 percent,while the vaccine reduces the probable lethal area by four to five orders of magnitude.

84

Casualty Area Coverage (M2 )1.000E+11

1.0001E+101,000E+091,000E+08

1.000E+07 Medical Interventions

1,000,000I No Medical Therapy

100,00010.000 / []Antibiotic Therapy

1,000 U Vaccine Therapy

100

10


Figure 63. Terrorist Device: Casualty Area Coverage

85

5.3 TWENTY-FOUR (24) ARTILLERY SHELLS FILLED WITHB. ANTHRACIS

This simulation represented an attack with twenty-four 152 millimeter artillery roundseach filled with 1 kg of dry B. anthracis spores, released explosively. This attack wasrepresented for three release times in four climates. It is possible to generate similar resultsfrom a liquid B. anthracis fill. The fireplan was constructed based on doctrine originated bythe former Soviet Union for a 3-volley battery fire. A 6-tube artillery battery is typical of theformer Soviet Union force structure.

The hazard footprints (Figures 64-75) show that even the small quantity of agent(24 kg) disseminated by this attack could affect considerable distances downwind whichroughly approximate 5 to 10 hours of transport with the 0500 and 1900 hours releases and I to2 hours for the 1200 hours releases The footprint charts also show the resultant uniteffectiveness of an artillery unit located at four points within the footprint for the threepotential therapy options. The longer range 152 millimeter artillery could reach U.S. Armyartillery units at Position 1. Positions 2, 3 and 4 could reflect unit deployments to the rear ofthe forward line of troops.

A comment on the effectiveness of the simulated artillery attack relative to thepreviously reviewed tactical ballistic missile and terrorist device attacks is instructive.Although these attack scenarios are subject to the same meteorological parameters and times ofattack, the shape of the footprints was driven by the fireplan (warhead impact points) and totalmass of agent delivered. The tactical ballistic missile attack was based on a total of 78 kg ofmass dispersed by 2,000 submunitions (about three times the total mass of the artillery attackwith 83 times as many impact points). The terrorist device delivered 5 kg at one release pointcompared to the artillery attack in which a total of 24 kg of agent was delivered at 24 releasepoints. The capability of a 1 kg artillery round to achieve greater effect than the 5 kg releaseof the terrorist device would be due to the reinforcing effect of 24 rounds in producing agentconcentration and dosage. The effect of the artillery fireplan would be to saturate acomparatively small target area with a fairly well-distributed hazard. In this way, the artilleryattack is more similar to the fireplan for the tactical ballistic missile attacks, but on a smallerscale. Thus, the artillery footprints show significant areas where even antibiotic therapy wouldallow for more than 50 percent casualties (as noted by the white contours).

The implications for unit effectiveness would be severe, especially for 0500 hoursreleases in all regional climates. For the 0500 hours releases, units in MOPP 0 and relying onantibiotic therapy suffer greater sacrifices in unit effectiveness in relation to their proximity tothe centroid of the fireplan. Protective equipment would be needed to supplement theantibiotic therapy in order to avoid considerable loss of life and to maintain unit effectiveness.Even so, for this time of day, the best unit effectiveness that could be expected for units in anyposition with antibiotic prophylaxis would be the 63 percent inherent for MOPP 4. Incontrast, the vaccine would be expected to provide 100 percent unit effectiveness even againsta direct attack at 0500 hours with no protective gear.

87

Unit Effectiveness (%) MOPP 01 2 l 1o° 4 MWOW

Iflte4f11lOll

4 . . 4 ... . Vazu. .to.ThwawO

Antm Lws on the

C)~ LaOMDo" W%• " wtt VacdiM

CD -4 Wi"mmepi,

o0 20 4,0 60 80kilometers LMDo" O

Unit Effectiveness (%) MOPP 41 2 4 MedICa

le ld Intemvendwsn

,-. ....... ... .-- ----- -.... .. .. ..r~S~~j~oiL * V.Mrie*None


88

Unit Effectiveness (%) MOPP 02 3 4 MUdOW

- IntiormeiilonilI is. i.• - I lC n

,,. . .. .... ,, "1, •- ' . . . U

44 41 . 4. -o None

~EZd / /Lth /on'he

-4 WihVotreft

0 0 20 -0 60 s0-2 kilometers 12 00aoeeS%


2 3 4 ModlouS"Inteoreir~os

Nodne4 ' ,6 4 " C Th wonl


89

Unit Effedtiveness (%) MOPP o1 2 4 Medical

'4 i4

" W 211 M None

Le" wiDo V 0IO%

o 20 40 60 80kilometers ' a iui.c,6

Unit Effectiveness (%) MOPP 42 3 4 Mil-

'a 0 VAccin*


90

Unit Effectiveness ()MOPP 02 34 Mdicah

lie 1*610 Intiven1ons

.0 2 0 .0 80 . 10 T

1U 2 4~t Vod"c0S kO LedO 00"mralo

UntEffectiveness with Medica 4nvnin

1 2 3 4Modi91

Unit Effectiveness (%) MOPP 01 2 3 4 MedloWl

too de I e o

1IH~1- - NVaccine

A] C]qh OTle •

0 0 2 41 4 0

if to II l M 0 None

Aio eax Levels on toeBawefdw

wini Vacine

M Ltd Doe. 60%

S0 20 40 60 80*kilometers LLM w5

Unit Effectiveness (%) MOPP 42 3 4 Medloa

too tW too6 Internnllone

644. ' 4. N"* .. . "r - ** '1 .. Vacc ne] -44

4


92

Unit Effectiveness (%) MOPP 01 2 3 4 Medlei

Intrdentilolaof.. ... ... f v -

Ia .. . . .. ... .a . . .T h.. .W40 .. 40 - - 4 . . 4 .

0 . 2- . 0 . . 20 - Not

UnitEffctienes () MPP

Ajionix Levele oni the

0Lathal 00" Go%

21 4 4 Mo~drili

0~ Liatha Do". 60%

oD 0 20 40 60 80kilometers 111ah Der.

I ~ Unit Effectiveness (%) MOPP 4:••a ...... " .•... -------- -IT . . I Nm[Vado

- - -V- ---ne

40 ~ 40 44erp


93

Unit Effectiveness (%) MOPP 01 2 _ 4 Medlo-i

id - Intoventanstii - a S0 II - . o --e•/ in

II "V.n*

Id o 44eUnit E tNone

Anfax Lay" on the

wEe tVaaIe tne0 CL Uia Do" 60%

-4 wiU Therapya a Lethw 00" 0%

C 020 A a 60 80E3L* fi ,kiflometers

Unit Effectieness (%) MOPP 41 23 4Medlot

-7 LNIntervenllons

LIJIJJ Nom


94

IU

Unit Effectiveness (%) MOPP 01 2 4 Modl

Intewvandone

41 40 .. . . .. 4vn s0 .. . . ..

IV ..- 'L,.c• •.ktL-t he, tap•o

Unit Effectiveness (ntet) MOPP 42 3 4 U•,G9

14 .. . . . . .. do . .. . . . . . o . . . .

. .. . a do V a o dn o


95

Lm

Unit Effectiveness (%) MOPP 01 2 8 4 Medica

Log IQ$ --o v.nt.ons

x44 40 44£ Uw

]777] MLL~ None

'0 84 0111 D0 400 20 40 60 so0

kilometers LaU• Iu 6

Unit Effectiveness (%) MOPP 412 3 4 ModlcW

"is, * ....... 1

Sl:-- 0 s111o] ] •21 U. .W w e" •N


96

Unit Effectiveness (%Y) MOPP 01 2 3 _ 4 Madloui

too Go to@ tionof so. . .-

20 - -a

ArftIax Loyelo on th*

(Dsh 0 60%

o 020 40 60 80 *LW D1Io"W%kilometers M Latha1Do" 5%

Unit Effectiveness ("Y) MOPP 41 234 M~dWs

I I IN 104Interventions

a0 00 U V*Adcn*44 4641[4 Therapy

20" 20H0w


97

Unit Effectiveness (%) MOPP 01 2 3 4 MadieWIGO - led I e" I"nh.ons

.. ..... vaccine

S/ -M-None_Liii~Aft LL&ii LILn dit:he-- , wthW 0"llW%vwfig Vadcne,

. .+ 0 La 'Dose60%

o 0 20 40 60 s0ki Iometers L L.tha•Dow 6%

Unit Effectiveness (%) MOPP 4213 4 Madic

to to Inteiventlona

CTherapyII. . . . ... . . III .. ...... ~

la aa mNone


98

Unit Effectiveness (%) MOPP 01 2 3 4Ul

11 . . . lt 41 Go Inta-rventions

4 ., ..- . ]K . -4 .... e. 414~ . .. . . . . . . . . .

"', " " i " H . .I 7 .. .. . ..._t None

AnWva Lew*s on1 IN

"nLedhiIDo" 60%wt Vwclno

+ CLeuO" o" 60%

wIit TherapyM eOVW Do" 60%C 20 40 60 80

kilometers ____ Do"_6

Unit Effectiveness (%) MOPP 42 3 4 Medica

I. . .. . .0. Inte.vent"ons

41 40 vacc4 CII~2 M1t ] I


99

The hazard potential in terms of spore area coverage is depicted in Figures 76-79.Note that the range for the peak number of spores achievable for all regions and release timeswas well within an order of magnitude and in absolute terms exceeds 10 million spores persquare meter. For the climatic conditions of South Korean winter, the peak number of sporeswas essentially the same for all three times of release (approximately 100 million spores persquare meter). The 1200 hours release, affected by higher wind speeds, lapse atmosphericconditions and increased agent decay due to sunlight, would achieve considerably less sporearea coverage. This decrease applies both to the overall area covered by at least one spore persquare meter and to areas covered by at least 10,000 spores per square meter (an area coverageof interest since a dose of 8,000-10,000 spores can be lethal without medical intervention).

Area Coverage (m2)1.000E+111.000E+10

1.000E+091.OOOE+08 Time of Day

1,000.000 0500 hours100,000 1200 hours

10,0001,0eo -0 1900 hours

10010

N'- '

N' N' N N"

Number of Sporus

Figure 76. Artillery in Southwest Asia: Spore Area Coverage

Area Coverage (0n)1.000E+111.000e+101 .OOOE+0S1.000E+081.000E+0, Time of Day

1,000,000 0500 hours100,000 1200 hours

10. ,001,000 -• 1900 hours

100101'

N" N' N' N'

Number of Spores

Figure 77. Artillery in Southeast Asia: Spore Area Coverage

100

Area Coverage (m2)1,000E+111 I

1.OOOE+1091.000E+09•

1.00E+0.o Time of Day1.Oo0,00o' 0500 hours

100,000- 1200 hours

10,000 •1900 hours1.000

100toI

Number of Spores

Figure 78. Artillery in Central Europe: Spore Area Coverage

Area Coverage (m2)1.0001! + I I1,0O01•+ 101.000c + 09

1,00E+07 -,Time of Day

1,000,000 - 0500 hours100,000 \1200 hours

t.000\ 1900 hours

10Io \

Number of Spores

Figure 79. Artillery in South Korea: Spore Area Coverage

101

i L MT Ii

The highly beneficial effects of medical interventions, as seen in the earlier attackscenarios, are confirmed again in Figure 80. However, the artillery attack scenario wouldachieve the greatest peak number of spores presented thus far. The vaccine would limit thecasualty area coverage to a maximum of about 100,000 ml (0.1 k1m2) in the South Koreanclimatic environment, the worst case scenario. Overall the vaccine would reduce the potentialcasualty area coverage by four to five orders of magnitude for the 0500 and 1900 hoursreleases and by about four orders of magnitude for the 1200 hours releases. The antibiotictherapy would achieve approximately a one order of magnitude or 90 percent reduction inoverall casualty area coverage.

Casualty Area Coverage (m2 )1.000r= A-111.0OOE+~11.000E+0O

1.000E+08

1.000E+07 0 Medical Interventions

1 No Medical Therapy100,000

10,O000 [ Antibiotic Therapy

1,000 [EVaccine Therapy

10010


Figure 80. Artillery: Casualty Area Coverage

102

5.4 TWO HUNDRED-FORTY (240) ROCKETS FILLED WITH B. ANTHRACIS

This simulation represented a multiple rocket launcher (MRL) attack with two hundred-forty 122 millimeter rockets each filled with 1 kg of dry B. anthracis released explosively.This attack was represented for three release times in four climates. The fireplan wasconstructed based on doctrine originated by the former Soviet Union for 40 rockets on 6multiple rocket launchers. In terms of level of effort, the rocket attack represents a tenfoldincrease in agent released compared to the twenty-four 1 kg artillery (24 kg total agent mass)scenarios. Transport time for the 0500 and 1900 hours releases was approximately 5 to 10hours, and the 1200 hours releases would taie approximately 3 to 5 hours to clear the target.

The footprint charts (Figures 81-92) clearly reflect the severity of the hazard that wouldresult from the delivery of this mass of agent (240 kg) as compared to the tactical ballisticmissile which released a total of 78 kg of agent over a much larger area. This attack wouldachieve the greatest peak concentration of spores and, in turn, the most severe challenge to themedical products. Note the extent of the white contours within the footprints representinglethal doses of 50 percent or greater even for units protected by antibiotic therapy.

The intensity of the MRL attack at Position 1 in the footprint would break through theprotective ratios of the vaccine for the 0500 and 1900 hours releases in the South Koreanwinter climate (Figures 90 and 92), the only instances in all the scenarios portrayed in thisstudy where the vaccine would fail to provide 100 percent unit effectiveness to soldiers inMOPP 0. Even though the MRL attack could present a challenge to the vaccine in the SouthKorean winter climate, unit effectiveness would still be expected to remain well above90 percent. This would indicate that the intensity of the attack, as indicated by the peaknumber of spores, would only slightly breach the protective barrier of the vaccine. Theimplication foe antibiotic therapy is that in an attack of this intensity, there would be amilitarily significant portion of the target area for which the antibiotic therapy providesinsufficient protection. Note that the white contour, representing the area of the hazard whereantibiotic therapy would be challenged without masking, extends 20 km downwind from thepoint of the attack for the 0500 and 1900 hours releases in South Korea. Note also that MOPP4 alone in the Korean environments could only achieve a 30 percent level of unit effectivenessfor the 0500 and 1900 hours releases for units under direct attack. Antibiotic therapysupplemented by masking would be required to sustain unit effectiveness following an attack ofthis severity. Further, masking would have to occur prior to the attack to achieve theprotective benefits depicted in this study since MOPP 4 was simulated as a preparatory stancein advance of the attack. This attack scenario makes an exceedingly strong case forpredeployment vaccination.

103

Unit Effectiveness (%/) MOPP 01 2 3 4 Inodnal

to ~~IT . Vaccine.m .2 0 .0 ... 1.4 1 .hrLELU 1 .No ...

S 0 20 40 60A0n10 ~Loyoa on.ft

0~il m eot t0 ea%

Unit Effectiveness ()MOPP 412 3 4Mdca

Ice Intorventlons


104

Unit Effectiveness (%) MOPP 0to 1 o 2 to 3 0 4 MedleW

1 4,to Is - d Vacolne41 4 Therapy

SNone

E6 +fl V Lahdane

0

-• 0 20 40 60 80 100 Leta Do" •%

kilometers

Unit Effectiveness (%) MOPP 41 2 3 4 Medical

tI 7i 71 - - - - InterventionsIs1 . . .. .It

40 "4 Therapyl jLo =j L i *None


105

-i W...

Unft Effectiveness (%) MOPP 01 2 3 4 Meal

tetiWI, Intmadlons

41 , . . . . . . 4d1 - . . . W . . . . . 40 - . . .'al...... U Vacdu-

_____ *Nlonth

L 12 I Loo Do" reo%(D__6 wlithVeocins

0 0 E3 L' ' o soLedm Dome 6%

0 20 40 60 60 100

kilometers

Unit Effectiveness (%) MOPP 42 3 4 Modial

i loo- InterventioVns

44 41] Therp

T1--1 None


106

Unit Effectiveness (%) MOPP 01 2 3 4 MUdlcW

SVIIntmventons

.• - 2. . .... a iA 0 n

Uni46 - Effect [[ffess .IL .416 -

in No

AnUtra Wlelan the U

~12 batuDos W%~

6 fetvns with Meiclntrvnton

10 L*W Dw60%0 0 40 60 80 100 MLaUdW Do" 6%

kilom rnete rs

Unit Effectiveness ()MOPP 41234 Medlcal

L00 Intewvendmen

~j~J~ 6660 UVacocine

16 *Nome


107

Unit Effectieness ()MOPP 0

10 tot

12 00 / z bx 04

60 04 0 LAW 00" W

20 +4 -mh 00" W%

Effeti Efeveness wihMeial InevetOns

2 i" 34108d

Unit Effectiveness (%) MOPP 01 2 3 4 MC

tw i I Irervenw~onsIA' . . . ...."I........... . ....ii a..........

41. I 6 -- - . ho a40...................... U.4 -I40 . . . i Vcn

"2 .. .. ... •.... "" " . . .. r

Ajiirex level. cii

l .. . .l-.ba.eeN

6 With*vccdne

-6w ft merapy0 * Lmhi Doe.60

iomt4e0 6 s 100 Lodhal00ee6kilometers

Unit Effectiveness (%) MOPP 412 3 4 Modkle

o . ......... ........ a, .... .......

40a ... . = . . . . C3 VTheram

20.4 204 4 . . . .up


109


IN IN ntervontons

4 . . . . .| . . . . .. .

40 .. . . . .or

"An#= L a..n NOe

~12

6 : , , • ,, : , 10 Q 13~u Do". 6%

momh "Wome60

0 20 4'0 60 80 100 1 La Do" e%

kilometers

Unit Effectiveness (%) MOPP 412 3 i4 Medml,

........ IO ......... Idm nin

"Vaollne4.-4. 44 Tbm


110

L m ---- m-.

Unit Effectiveness (%) MOPP 01 2 3 4 Me n

to. .. . .. .i .. .o. . nt v nd n

IS. . . . . ... d Vacd4, 0 4I.l li] - ThwaWpy

20 2

12 klometer

uni 6fetvns with MOPP41 2 -4 vacn

fl 0 + :3Lethal Dw WS%E-6 ih Therapy

C)-12 0 20 ZQ 60 8 100 Letal Dow IoAc

kl Im o "iete rs

UnRt EfnectitVness (Ien) MOPPn4

1114


Unit Effectiveness (%) MOPP 01 2 3 4 mC

a.*io i oS Intar"m~ neoo.. .. . N .. .. .... ... . . . .. .. .. ..

aI~n

" 0 20 40 60 80 100 44 Thu1 oa w-< kilometers

Unit Effectiveness (%) MOPP 41 23 4 M• __i

is ... ..... .. ..... to .. ... ,. .. ....._.Z .

el . ... iI . . .. I" " 0 . . . [ Vaoodno

a) " " L -ow Dom W


112

C '1-0L& mW~~~~i I ir it i iii


o . . . . .. . . do

4 . . . . .. 44 . . . .. . ... .- __ 40 . . . . . .. [ e.

"4" r6 - -.0 . . . . .h

- - * Non.

k I me er

Unft Effectiveess (%) MQPP

-- 1 4 m Maed• c

L2 60 0 Inwrvnfonu

Q 0 [] m• Do" W%S-6-[ ,,,o

(D' - 1 2¢ ' ' rzo 2 4 60 so 10O0 I•* Dome r,.%

kilo ete s

Unit Effectiveness (%tMOPP 42 3 4II. . . ... 0 8 log. . InI . . . . . . .n

4a T Xhempy'"H"•Q[ No ne

Figure 90. MVRL in South Korea at 0500 Hours: Artillery UnitEffectiveness with MVedical ]Interventions

113

Unit Effectiveness (%) MOPP 01 2 3 4 MdICW

"{1 ...... LIlI:.... U: !1~ U VOcil*l40 . . e . . . . ,. . , .. a.

to- 12f go. k,[~ q ' 6 S " ' --

MiU-orm Loom an Ithe

~12,LaltosiDome W%6ow vao~dn.

0~ L**ih Does WA%

-12 E' IM LmdwDo".60%

20 40 80 100 ECO eG3lo .se%kIlomete rs


lag- In_ i endnII... .. ... . .. . . . . . . .

1IH J .... 3,o to so . . no&


114

Unit Effectivenea (%) MOPP 0

41z ../ .. 4N Ione

+ wim ThalatpyAlc LOM aDo".30%E -6 UMW Do" W

o -12 1 ' Lel DO" 5%0 20 40 60 80 1 O0

"kilometers

Unit Effectiveness (%) MOPP 42 3 4 Medcal

to Interventlon

41. 44Therapy

Figure 92, MRL in South Korea at 1900 Hours: Artillery UnitEffectiveness with Medical Interventions

115

The spore area coverage charts (Figures 93-96) for the MRL and artillery attacks areremarkably similar with the exception that the MRL peak number of spores was about an orderof magnitude greater than that of the artillery for all regional climates and times of release.The similarity of the MRL and artillery fireplans is the ability to achieve an area of fairly evensaturation, albeit over a smaller area of the target than would be covered by weapon systemssuch as the tactical ballistic missile, spray device or intercontinental ballistic missile. There isa pronounced differerue in the spore area coverage for the 1200 hours releases of the twoweapon systems, attributable to differences in the total source strengths of the two attackscenarios of an order oi magnitude, i.e., 24 kg for the artillery attack versus 240 kg for theMRL attack.

Area Coverage (ml)1,000E + 11

1.000E+09.O0E+06 •,"Time of Day1,000,000 -0600 hours

10.0o000 1200 hours10.000

-1000" 1900 hours

100

k'N % ,N,

NumLtr of SporesL Multiple Rocket Launcher

Figure 93. MRL in Southwest Asia: Spore Area Coverage

Area Coverage (W2)1.000E+10

-- 1,000E +0O10T Time of Day

-1.0co,00 0501) hours-00o.0o -4- 1200 hours

1.00o "1900 hours100

Number of Spores

'Multiple Rocket Launchor

Figure 94. MRL in Southeast Asia: Spore Area Coverage

116

IOO+IArea Coverage (m2)

1.OOO+O&Time of Day1.0005+07- 0500 hours

100,000-4- 1200 hours10,000 -1900 hours

Number of Spores

*Multiple Rocket Launcher

Figure 95. MRL in Central Europe: Spore Area Coverage

Area Coverage (inl

imor0o0E+0G Time of DayI .OOQE+07

11000.00 0500 hours100.0001200 hours

1,0001900 hours

Number of Spores

*Multiple Rocket Launcher

Figure 96. MRL in South Korea: Spore Area Coverage

117

Figure 97 reflects the casualty area coverage potential of the MRL system for each ofthe regions. For Central Europe, Southeast Asia and Southwest Asia, the vaccine wouldreduce the casualty area coverage by approximately three orders of magnitude for the 0500 and1900 hours releases. For the 1200 hours releases, the reduction would be about four orders ofmagnitude. For the South Korean winter climate, the medical interventions would be moreseverely challenged as evidenced also in the footprint and spore area coverage charts. Evenwith vaccine protection, the area covered by lethal levels of B. anthracts would amount to atleast 1 km2. The antibiotic therapy achievvs less than an order of magnitude reduction incasualty area coverage in all cases.

Casualty Area Coverage (M2)

1.0001 + 111.000E+101.OOOE+091.000E+081.00012+07 Medical Interventions1,000,000

1000,000 E No Medical Therapy

10,000 Antibiotic Therapy1,000 U Vaccine Therapy

10010


* Multiple Rocket Launcher

Figure 97. MRL: Casualty Area Coverage

118

5.5 BACILLUS ANTHRACIS DELIVERED BY SPRAY

The spray attacks simulated an aerial release of 1,200 kilograms of dry B. anthrac•.sreleased through a single nozzle for three release times in four climates. AP agent release wassimulated along a 100 km line, 60 meters above ground, resulting in a flux rate of 12 kg/km.This attack represented a VERY intense hazard. Liquid B. anthracis could also be released asa spray.

The hazard footprints (Figures 98-109) show that the quantity of agent disseminated bythis system could affect considerable distances downwind which roughly approximate 12 to20 hours of transport with the 0500, 1200, and 1900 hours releases. The footprint charts alsoshow the unit effectiveness at various points with three potential therapy options. Note that fora unit in MOPP 0, vaccination would be very effective in ensuring survival from this attack.In contrast, a considerable fraction of the spray footprint would represent a threat sufficientlylethal that even prompt use of antibiotic therapy would not prevent unit effectiveness fromdropping to 60 percent. This drop in unit effectiveness would represent loss of life rather thanthe temporary degradation of performance to 63 percent due to the assumption of MOPP 4.

One of the more notable characteristics of the spray attack is the evenness of the hazardlevel along the line of spray as well as downwind. Note the similarity in unit effectiveness forunits assuming MOPP 0 at positions 2 and 3 in the spray footprints. Due to the large extent ofhazard, this attack scenario would clearly constitute an attack with a weapon of massdestruction. What is so remarkable is that attacks by weapons with such enormous potentialfor loss of life could be simply negated through a program of vaccination prior to the outbreakof hostilities.

119

Unit Effectiveness (%) MOPP 01 2 3 4 aw

jjj.. ... .... ]u Vaccnln

oVaodn.

~IITh~WW

0 0 60 90 120 150 180 210kilometers

Unit Effectiveness (%) MOPP


120

....................................

Unit Effectiveness (%) MOPP 01 2 3 4 Medo

46 4

k I o meters60

No


Ammemw*Wonth


121

Unit Effectiveness (%) MOPP 01 2 3 4 UC

*VaOcfri

,.4. ,.,lI-niAW

Ajih4 .L. .a.n the

10 -

C7U. Vudne

Unit ~ ~ ~ ~ W Efecienss() OP

W 44 LNI Do". 8%

E LWid Dow. 5%

1 2a 4M0 30 60 90 120 150 180 210

kilometers

Unit Effectrveness (%) MOPP 4

UNon


122

Unit Effectiveness (%) MOPP 01 2 3 4 mdl"

t: • il I leeInteevsidnu•a.. .. . . ".. . . . " .. . . 'I m~

a I.. .. . . , . . . . , . ... . . . .as..' ".- .' ' " . . . . . . . . . . . . . . . . . . . .

1043

A0w Lsdwob anCn 74 WO VAG(**~u~

Cu~ 444 1 W4 ThSrf"

0~ LMW Ow ~G-

-14

1c 30 60 go 120 150 180 210kilometers


1 4,N 1 4 [ L sti wnflonsJi

N 2 3 4 Mu

BIncomedo


123

Unit Effectiveness (%) MOPP 01 2 3 4 Medd,

Interventlon

. . .... a.. Thar48 t__o_.. ...

S, 4 al mer-i spy.,

0 U L 4n th eG74 LOW dDo" 0%

0 30 o0 90 120 150 180 210kilometers

Unit Effectiveness (%) MOPP 4.F ------:I . .....- -----. .. .- -

13TheamW

Figure 102. Aerial Spray in. Southeast Asia at 1200 Hours: Artillery UnitEffectiveress with Medical Interventions

124

Unit Effectiveness (%) MOPP 01 2 34 4edc

Intso VACCIne,

4 " . . .. . .46 .. . .- l 4g6 - - 46Nm_~ L- LL"..

104,Anthmx Lavah an Itis

U, 74 Ltaud Dme W0%wiVh Vemce

M LWWD'ioes W%

*4 L&&i Dwo. 61A

0 3 60 90 120 i5o 18 21'0kilometers

Unit Effectiveness (%) MOPP 42 3 4 ModiciJ

Ica' 104 InterntomnII. .. . . . . ... .... . . . . . 1 . . . . . . ..

,a .. . .*. . 0a " . . • V n10l~ 60 -h

440 - 6 Therapy


125

i m7

Unit rEffectiveness ()MOPP 01 3 4Medicai

41 44 - 4 Therapy

4' O Vaodne

0 30 60 90 120 150 180 210kilometers

Unit Effectiveness (%/) MOPP 413 4Medlcal


126

Unit Effectiveness (%) MOPP 01 2 3 4 M8L 7 t..Ira Intme~r•ons

S. . .. ,a I Vaodre

U ~ OThW&W

0 -- 50 0 20 5015021

Unit Effectiveness (%) MOPP 42 3 4M•dca

" None

Figure 105. Aerial Spry in Central Europe at 1200 Hours: Artillery Unit


127

Unit Effectiveness (%) MOPP 01 2 3 4 Med•cW

IntwofnilOns

' I - 1 2 1:N ... ... 44

wMi Voodne4 L~mW DWW Go%

Q)~ Thraopy

F= ~L"W 100060%

. . . . . .I . . . . . .. . .

"0 _ , 60 go 120 150 180 210kilometers

Unit Effectiveness (%) MOPP 41 2 3 4 MedIca,,i .... . . ...... . . ....... . ...... . vY r

'I,,iiii i C hrPy


128


too 2 U - InteivantionsU *4 -" .n .. .- a .•-oo-

13 Therapy

0 N •,• M NoneeeAnthm~ Levels on 0%e

(A 74. Ara p oarrit

Effectivenesstha wDth 150-AIneretin

0 30 60 90 120 150 180 210'k ,0Imeters

Unit Effectiveness (%) MOPP41 3 edical

'484

21 acc tl


129

Unit Effectiveness (%c) MOPP 012 34 madicIJ

III - -I&Ir.a

30 Non*

Letieimavee60

(11 7- wit Vaccine

Fiur 4 08 Aewipa nSuhKoe t10 or:A tiler nThrp

UntEffectiveness with Medica 4nevnin

130

Unit Effectiveness (%) MOPP 012 34 Madea

LI IntIIwolns

a.a.dn

I. . Therpy[]None

S104. •Buttdle~d

Cn 7wth Va•ine

+ LA41 ~e.00%+0 + + W e Th6mwo44 L*MW Doe 6%

0 30 60 go 120 150 180 210kilormeters

Unit Effectiveness (0%) MOPP 41 2 3 4 edaleiIn ....... ln-

a. VInie

VM None


131

The Southwest Asian, Southeast Asian, and Central European climates showed noappreciable differences in the area covered by at least one spore. (See Figures 110-113.)Only at very high levels of spores would differences become larger than an order of magnitudebased on the time of release. From a military effectiveness point of view, note that there wasalmost no difference in the capability of the spray release mechanism across the four climaticregions. The spray release was the least sensitive of the six weapon systems simulated relativeto regional climatic differences.

Area Coverage (ma)1.000E+11 r -

1.000a+101.000E+0911.00 E +08 1 li m o1.000E+07 Time of Day1.000,000 -- 0500 hours

101 I000 4-- 1200 hours10,000

1,000 - - 1900 hours10010

1- P-a

Number of Spores

Figure 110. Aerial Spray in Southwest Asia: Sport Area Coverage

Area Coverage (in2)1.000E+ I.I1.0009+10-1.000E+091.000E+08 Time of1.OOOE+07 Day

1.000,000 -0500 hours100,000 "4" 1200 hours

10,0001,000 "= 1900 hours

10010

Number of Spores

Figure 111. Aerial Spray in Southeast Asia: Spore Area Coverage

132

Area Coverage (mnl)1.000E +111.000E+101.000 e+091.000E +081•0002+07 Tme of Day

1,000,000 -0500 hours100,000 - 1200 hours

10,000I.000 1900 hours

10010

Number of Spores

Figure 112. Aerial Spray in Central Europe: Spore Area Coverage

Area Coverage (mig1.000E +11,1.000E10•1,00024+091.000r+07 Time of Day1,000E+07

1,000,000 -0500 hours100,000 * 1200 hours

10,0001,000 "- 1900 hours

1oo10

p. p. z,. ,

Number of Spores

Figure 113. Aerial Spray in South Korea: Spore Area (.overage

133

Figure 114 illustrates the exceptionally high level of casualty area coverage achievableby spray. This can be attributed to two principal factors: (1) The spray device can achievedissemination efficiencies in the range of 60 percent, and (2) The total mass of agent releasedwas 1,200 kg, second only to the fill weight of the intercontinental ballistic missilesubmunitions. As can be seen in the chart, the appropriate use of antibiotic therapy wouldreduce the probable lethal area by less than one order of magnitude or less than 90 percent.However, the vaccine would reduce the probable casualty area by three to four orders ofmagnitude. Without medical therapy, close to 10,000 km2 would be contaminated with lethallevels. With effective vaccination, the likely lethal area coverage would be between 1 and10 km2 for the 1200 hours releases and between 10 and 100 km2 for the 0500 and 1900 hoursreleases.

Casualty Area Coverage (mi)1.000E+111.000E+101.000E+0911.000E+08

1.000E+07 Medical Interventions1,000,000 14 No Medicai Therapy10U.000

10,000 Antibiotic Therapy

1,000 U Vaccine Therapy

100

10


Figure 1 4. Aerial Spray: Casualty Area Coverage

5.6 INTERCONTINENTAL BALLISTIC MISSILE WITH B. ANTHRACIS-FILLEDSUBMUNITIONS

A high altitude release of approximately 40,000 submunitions by an intercontinental,ballistic missile (ICBM) was simulated for attack scenarios in four regional climates for threerelease times. Each submunition was modeled to contain just under 39 grams of B. anthracis,the same as the submunitions modeled for the tactical ballistic missile scenarios.

Figures 115-126 depict the hazard area footprints and estimates of unit effectiveness forunits at four locations within the target area. Although it is unrealistic to think that an ICBMwould be targeted against an artillery unit, the ICBM attack scenario represents the impact theuse of a weapon of mass destruction in a theater of operations might have on a unit that isgenerally representative of an average combat unit. As can be seen from the size of thefootprint, not only frontline units, but also organizational units deep in the rear areas aj well asnearby population centers would be at risk. Results indicate that the vaccine would providecomplete protection and maintain unit effectiveness at 100 percent for units in MOPP 0 for allregional climates and times of releases. By comparison, donning of protective equipment(MOPP 4) would reduce unit effectiveness to 63 percent.

The most notable characteristic of the ICBM attack as modeled is its vast area of lethalcoverage for units without medical therapy or protective equipment. The ICBM attack,however, lacks the intensity of the hazard levels delivered by the other five weapon systems.Consequently, antibiotic therapy can maintain unit effectiveness at 100 percent following the1200 hours ICBM releases simulated across the four regions; and for all other release times, itcan preserve unit effectiveness at about the 63 percent level afforded by MOPP 4. While theeffectiveness levels would seem equivalent, it should be noted that the loss of effectivenesssuffered by troops in MOPP 0 relying on antibiotic treatment alone is due to loss of life ratherthan to the temporary disablement of the protective garments of MOPP 4. Antibiotic therapywould need to be supplement.ed with the assumption of MOPP 4 in order to preserve life, inwhich case the unit would return co 100 percent effectiveness once it left the protectivwposture. Note that a release of submunitions that resulted in a smaller spread of the agenmwould increase the intensity of the attack, a development that could overwhelm the protectionof antibiotic therapy. Operationally this would present a problem: Only masking orvaccination would be left as alternatives. But at what time should soldiers don MOPP 4, anchow long should they remain in that posture? Without a means to determine the termination ofthe threat from a B. anthracis attack, units may be in MOPP 4 for extended periods of time.Use of predeployment vaccination would eliminate the uncertainty associated with detectionand the protective capabilities of antibiotic therapy as well as prevent. the decline in unieffectiveness associated with the assumption of MOPP 4.

off LVAMAE IM DT0 DONS y OT r ?OUT •IL LODUM0,o

135

Unit Effectiveness (%) MOPP 024 M3d 4a

.4

1C2

78

54 Ai mL .Wa

30 30 6k. [] L*Wv Ommo Wo

0 -4-2-•-66

-90i

0 30 60 90 120 150 180 210 240 270 300

kilometers

Unit Effectiveness (%) MOPP 42 3 4 Mda

SI"". ... . . . ........ . .....".". .. . . ..88 U Vacdne

N to Nome


136

Unft EffectIveness (%/) MOPP 01 _2 3 4 dia

T~ Nor,

102 3 09 2 5 8 1 4 7 0

-is

'64

E ntFffectiveness with Medica 4nevnn

21374

Unit Effectiveness (%) MOPP 01 2 3 4 Modeal

102

78

5,4-

030•D 6 •wtha~w

33 edcai~ m

S-18 WM 7hw"•€•

- 66 LM m6

-90i

_11 . . . .. .e~o'0 30 60 90 120 19o 1ý0 210'24..0 270 300

;•' kilometers

Unit Effectiveness (%) MOPP 42 3 4 Madle:


138

Unit Effectiveness (%) MOPP 01 2 3 4 mUdoa

In IN fltevetndons

. ... . Vaodn.

" Non.

102

78

54 C!••d~Anth Lwels~ on tho

30 Vacnew

Figure 1. MiStthh i Om 0 H

Efetvns with Meicl4neretin

0 -1139

-66

-90

- 114. - 1'0 30 60 9'0 12'0'15'0 180 210 240 270 300

kilometers

Unit Effectiveness (%*) MOPP 412 3 4 M"Col


139


4t4

M NW

1140

Unit Effecdveness (06) MOPP 02 3 4 madUo

, .... ..4Is... . ThOr- Y*Noii.

•m 78

54.

n 0 30509 10 5 10 1 2-020 0

-1 8 .w "n,,,

Sr• t ale Dome 6-A

S•0 .30 60 90 120 150 180 210 240 270 300

k-i Io meters

Unit Effectveness (OA) MOPP 42 3 4 do

N e Inteivontlons:........ :t ......... is ........ .. .. .

ton


141

Unit Effectiveness (%) MOPP 01234 Medca

2 4IN • - - * .. .. . . ... Intermde ons

"Va...ne41 . . .. 4' .. .... . . . . . 'ht L

102

78

0 ~ ~ ~ ~ ~ ~ ~ C Do0 60602%50102024 7 0

Uni Effitvees (%) OPP03 .•dl~Nx on. ll

-4-2 Ls6 t. D es*$%

-66

-90

01 )C 60 90 120 150 180 210 24-0 270 300

kilometers

Unit Effectiveness ()MOPP 42 84 M"CW


142

Unit Effectiveness (%) MOPP 01 2 3 4 medical

UVaccine

102 278/541

"" 6 vDo".,0.

0 ~ ~ ~ ~ ~ ~ ~ LO DWO 60% 2 o a • •, 7

kilometers

Unit Effectiveness (%) MOPP 41 2 3 4 M,•d.,W

Figure 122. ICBM in Ceatral Europe at 1200 Hours: Artillery UnaitEffectiveness with Medical Interv,;ntions

143

Unit Effectiveness (%) MOPP 02I 4Mad,•

c• 54

116 IS' . I . l. t i ., .40 . S. 4

-902

-140 30 60 90 120 150 180 210 240 270 300

kilom ete rs

i Unit Effectiveness (%) MOPP 42 Md4 aIk:

.30.

"L .W 0r W

Figure 123. ICBM in Central Europe at 1900 flours: Artillery Unit


144

"; - 66• - " •: 7- - • -

Unit Effectiveness (%*) MOPP 012 a 4 Medalu

44. - C om~py

La.Aft "aal -, " tean thea

6 Wh Va~cdue

4145

Unit Effectieness ()MOPP 01 2 34moe

444

N~w

1902

U 0 3 09 2 5 8 1 4 7 0

0-42

-66a

Eff Efectiveness with Medica 4nevni

146

Unit Effe~ctiveness (%,) MOPP 0 -1234 Medtcai

'4 U Va0d*.

Unit EfetvnssN)MP

24 Ann ds*W n M

'0

4v. Valcine

Fiur 126 ICBM in" SotWoet 90HusAtleyUi

UntEffectiveness with Meia4nevnin

1 -1-24 Me147

The extent of the vast area coverage of an ICBM attack can be seen in the spore areacoverage charts (Figures 127-130). Note that in every region and for all release times, thearea covered by at least one spore per square meter exceeds W0,000 km'. The peak numbers ofspores achievable is approximately 1-2 million per square meter. This is about an order ofmagnitude less than that achieved by the tactical ballistic missile attack scenario which usedsubmunitions with the same fill weight, but with a total agent weight eqial to one-fifth that ofthe ICBM attack. This difference can be attributed to the much larger impact area of theICBM submunitions which spreads the hazard out instead of concentrating it as in the tacticalballistic missile scenarios. Of the six weapon systems studied, the ICBM attack wouldproduce the lowest peak levels of spore coverage.

Area Coverage (m2)1.000E+11 -- -

1.0002E+101.000E÷091.0001+08 Time of Day1.00015+071,000,000 -0500 hours

100,000110,000 - 1200 hours

1.000 "- 1900 hours100 L _10

V• -. V '

Number of Spores

* Intercontinental Ballistic Missile (submunitlons)

Figure 127. ICBM in Southwest Asia: Spore Area Coverage

148

Area Coverage (ml)1.OOOE+ 1111.0005+101,000+091.0005+08 Time of Day1.00015 +071,000o000 - 0500 hours

100,000 - 1200 hours10,000

1,00 1900 hours100

10

,..

Number of Spores

I Intercontinental Ballistic Missile (submunitions)

Figure 128. ICBM in Southeast Asia: Spore Area Coverage

Area Coverage (m 2)

1.000E+ 11,1.00015+101.000E+091.OOOE+09 Time of Day1.00015E07

1,000,000 - 0500 hours100,000 1200 hours

10,0001,000 "" 1900 hours

100101

• ~ ~ ,, ',,x,•,,J ,,• x,,,, ,.• . .,. N ,.

Number of Spores

* Intercontinental Ballistic Missile (submunitions)

Figure 129. ICBM in Central Europe: Spore Area Coverage

149

Area Coverage (m2)1.00011+ 11 .1.00015+101.0005 4091.000E+08 Time of Day1.0002+07

1.000.000 • 0600 hours100,00010.000-+ 1200 hours

1,000 "" 1900 hourS10010

Number of Spores

Intercontinental Ballistic Missile (submunitions)

Figure 130. ICBM in South Korea: Spore Area Coverage

The casualty area coverage potential of the ICBM attack simulation for MOPP 0 can beseen in Figure 131. Note that without medical intervention, the casualty area coverageexceeds 10,000 kmn except for the Southwest Asian 1200 hours release where it is slightlyless. Use of antibiotic therapy reduces the probable lethal area by less than one order ofmagnitude, or less than 90 percent, for the 0500 and 1900 hours releases while the 1200 hourreleases show a reduction in area coverage. by about an order of magnitude. The vaccinereduces the probable casualty area by five to six orders of magnitude, except for the1900 hours release in the Central European and Southwest Asian climate where the vaccinelimited casualty area coverage to less than 100,000 m2 (0.1 km2).

150

Casualty Area Coverage (mi)1.000E+111.000E+ 10

1.0005E+091.000E+081.000E+07 Medical Interventions1,00000 ["i No Meadical Therapy

10,000 IMAntibiotic Therapy1,000 Vaccine Therapy

100101 %Y 4.


* Intercontinental Ballistic Missile (Submunitlons)

Figure 131. ICBM: Casualty Area Coverage

151

6.0 CONCLUSIONS

The most significant finding within the context of this study is that unit effectivenesscan best be preserved through the use of predeployment vaccination with the fielded MDPH-PA vaccine. For every attack scenario simulated and all release times modeled, uniteffectiveness was maintained at or above the 99 percent level in MOPP 0 with the exception ofthe multi-rocket launcher attack in the Korean winter climate. Even here, unit effectivenesswould be maintained at 90 percent.

The use of vaccine to protect against a B. anthracis attack can obviate the need forMOPP 4 with its inherent degradation of unit effectiveness. This can be especially importantwith weapon systems such as an aircraft equipped with a sprayer or an ICBM withsubmunitions that can create LD50 levels over areas as vast as 10,000 km2. Given knowledgeof such an attack, commanders would be faced with the decision of when protective equipmentshould be donned and for how long. MOPP levels 0 through 4 appear to be optimized foroperation in a chemical environment where multiple routes of agent entry are a concern. Theprinciple threat from weaponized B. anthracis is through the respiratory system; thus, a maskalone would provide an adequate level of protection without the severe decline in uniteffectiveness induced by MOPP 33 and MOPP 4, the two postures in which the mask is worn.Doctrinal consideration should be given to promulgation of guidance on a mask-only posturefor biological agents whose dominate route of entry is respiratory. It is suggested that themedical community include as a scientific technical objective the determination of whichbiological agents would minimally require a mask-only posture to provide an effective defense,absent a policy or resources to vaccinate all personnel prior to world-wide deployment, andsince vaccine for every foreseeable biological threat is not available.

The ease with which a covert B. anthracis attack could be executed via a spray or aterrorist device should be a compelling rationale for a predeployment vaccine regimen sincemedical personnel might first be alerted to such an attack only through the occurrence of onsetof symptoms. Late detection combined with potential logistics difficulties in accessingsufficient quantities of antibiotics could result in loss of life on a catastrophic scale. Even withtimely determination of B. anthracis exposure, there would be an enormous demand for in-theater medical capabilities due to the wide casualty area coverage potential of the agent.Although antibiotics may maintain unit effectiveness at accepted levels, there would likely be atethering of operatioal units to their medical logistics pipelines and facilities, thus restrictingunit mobility --* an operational consideration not modeled in this study.

The unit effectiveness charts show that for MOPP 0, there are numerous plausibleattack scenarios where antibiotic therapy will not preclude loss of life and the attendant declinein unit effectiveness. Of all the attack scenarios simulated, direct multi-rocket launcher andartillery attacks achieved the highest levels of effectiveness against personnel protected only by3 Not modeled in this study, although the results would be equivalent for MOPP 3 and MOPP 4 since the main

protection is afforded by the use of the mask to prevent inhalation of the B. anthracis spores.

153

antibiotic therapy. Fireplans for these weapon systems are capable of creating high levels ofdosage on small area targets, which can significantly breach the protection afforded byantibiotic therapy. Advance masking can reduce exposure and thereby the dosage received,but this is subject to timely detection and notification of an attack.

As was seen in the survivability excursion in the analysis, MOPP 4, because of the useof the mask, maintained unit survivability levels above 90 percent against a tactical ballisticmissile attack even without medical intervention. Although survivability levels could beexpected to decline under direct multi-rocket launcher or artillery attacks in winter climates,the point is that it is the mask that is providing this level of protection against the respiratorythreat, not the other paraphernalia. However, both the mask and antibiotic therapy suffer fromthe same critical operational deficiency -- in order to survive, the soldier must either know thata B. anthracis attack is underway so that he can mask in time or be aware that exposure hasoccurred prior to onset of symptoms so that antibiotic therapy can be started in time to beeffective.

The sensitivity analysis conducted in the study showed that unit effectiveness wasessentially the same for LD50 values based on spore levels in the range of 8,000 to 10,000.

Agent decay can significantly reduce the extent of the downwind hazard, especially forattacks during the hours of bright sunlight (high UV levels). There were significantdifferences in the extent of the downwind hazard when noonday decay rates were varied by afactor of 2.5. However, the increase in decay rates between the USA.MRDC and USACRDECestimates would only account for a difference in hazard levels in the target area ofapproximately 5 percent of the total agent mass released for those units under direct attack.Accordingly, unit effectiveness would be only minimally affected, if at all, based ondifferences in agent decay rates, and the overall effect of using the lower rates provided byUSAMRDC would be to provide a conservative estimate of unit effectiveness for each of themedical interventions modeled.

Finally, there is appreciable uncertainty in some of the data required by the modelingcommunity to conduct analyses and efficacy assessments. This study is no exception. Thebenefit of this and other studies is not in the absolute values derived from the analysis, butrather in the trends that can be recognized and the broader generalizations that can be madebased on the extensive number of simulations underpinning these conclusions.

154

REFERENCES

AURA was developed by Dr. Terrence Klopcic at the U.S. Army Research Laboratory.

Brachman, Philip S. "Anthrax" in Cecil Textbook ofLMedicin_, Ed.,James B. Wyngaarden, M.D., and Lloyd H. Smith, Jr., M.D. Philadelphia: W.B.Saunders Co., 1985.

CASUALTY was developed by Mr. Richard E. McNally of Science Applications InternationalCorporation.

Compton, James A. F. Military Chemical and Biological Agents: Chemical andToxicological Properties. The Telford Press: New Jersey, 1987, pp. 360-361.

PLUME Version 2.6 is the February 1991 update of the model developed by Mr. Roger Gibbsof the U.S. Naval Surface Warfare Center at Dahlgren, Va.

The Problem of Chemical and Biological Warfare: Vol. II: Weapons Today, SIPRI, NewYork, 1973.

155

APPENDIX A

Memo on Technical Input Parameters

A-1

uDEPARTMENT OF THE ARMYU.S. ARMY LMI1CAL 46S9ARCH INSTITUTE OF INfECTIOUS DISEASES

.FREDERIG K, AAR'YLANO 21702,5011

SGOD-T11M (70) 16 Januax'j 1992

MCORAINDUM TIMU

Commander, U.S. Army qledical Research Institute of InfectiousDiseases, ATTN: S8GRD-U'M (LTC Maria Sjogren), Fort Detriok,Frederick, MD .21702-5011

Commander, U.S. Army Mod' al Research Institute of InfecticusDiseases, Fort Detrick, Frederick, MD 21702-5011

FOR Commander, Walter Reed Army Institute of Research,ATTN, SGRD-UWI (LTC Steven R. Hursh), Project Manager,Anthrax Computer Modeling Studyi DlvisiorL ofNeuropsychiatry, Washington, DC 20307-5100

SUBJECT: Answers to Technical Questions, Battlefield Levels ofAnthrax Computer Modeling Project

1. The enclosed document provides the technical input yourequested for the Battlefield Levels of Anthrax Computer ModelingStudy. Answers were derived from discussions with COL ArthurFriedlander, literature sources, and input provided by Mr.William Patrick. Please call it you have any questionsconcerninq this information.

2. Point of contact for this memorandum is LTC Eitzen at DSN343-7655 or Com•mercial (301) 663-7655.

Enal EDWARD X. , R.LTC, MCChief, Operational medicine

A-2

ZATThE71LD LEVELS 07 M1TIMA COMPU'TZl MODlELING VROJECT

This project is a joint project of Walter Reed Armyinstitute of Research (WRAIR) and Science ApplicationsInternational Corporation (SAIC) of Joppatowne, Maryland to tryto assess the potential impact of a biological attack by enemyforces on U.S. Army units. The project manager and arepresentative of SAIC met on 9 January 1992 with COL CharlesBailey, COL Arthur Friedlander, LTC Edward Eitzen, and XAJ LeSterCaudle of USAKRIID to brief USXtRIID personnel on the modelinqproject and to ask for assistance in obtaining answers to severaltechnical questions which might be provided from data generatedby USAKRIID's medical defensive program against biological threataqents. These answers are needed for inclusion in the computermodel which will be used to simulate performance degradation ofAr.y units which might occur due to enemy use of biologicalagents. The answers to the questions below have been developedin consultations between COL Friedlaxider, LTC Eitzen, and MAJCaudle, as well as by Mr. Patrick in his capacity as a USAI~rZDconsultant.

Answers to Technical Questions

1. What is the uncertainty of the toxicological values forexposure to Anthrax aerosols disseminated by enemy forces?

ZD50 8,000-1.,000 cells

The infectious dose for pulmonary anthrax in 50t of animalsis essentially the same as the lethal dose 50 (LDS0). This isbecause pulmonary anthrax is almost uniformly fatal inunvaccinated and untreated animals. Old data from experiments atUSAYM1ID on small rhesus mankeys show a mean LD,0.of 8.,689 totalinhaled anthrax spores. This estimate of.8,000-O0,00( '*Istherefore fairly accurate for the animals studied. How this dataextrapolates to humans is uncertain, but it is the best estimatewe have.

XDq 0.000523 mg-min/m=lD90 0.00415 mg-min/mnins 0.000036 mg-min/m3

These values are less useful because of the units in whichthey are presented. They should be changed to spores or LD5'sinstead of milligrams as a unit.

A- 3

2. Should the computer modal focus on simulated wet or di7diaoemination by a hostile force? what is a reasonabledissemination efficiency?

The question of whether to focus our medical defensiveeffort on wet or dry dissemination depends on the adversaryinvolved and should be answared by tue intelligence community. Asophisticated adversary such as the former USSR would probablyconcentrate on use of dry agents because: they are moreconcentrated, they do not change physically at temperatures abovefreezing, and they provide a higher aerosol recovery ordisseminating efficiency. They are more difficult to produce;tha drying process requires a high level of sophistication. Thesafety aspects of handling dry agents are also more difficult.Advanced countries could produce dry agents; State supportedterrorist groups could potentially do so as well with supportfrom a sophisticated country. Less sophisticated countries orterrorists with limited resources would only be able to produceliquid agents which are unstable above freezing and. are moredifficult to disseminate efficiently.

A reasonable dissemination efficiency for the release of thethreat agent anthrax by a hostile force depends on the type ofweapon or device being used to disseminate the agent in additionto whether the agent is in liquid or'dry form:

oaoletss Domblets Line Sourci Line Source Line Source-eiosivtr gaseous P-ingle nozzle 2 fluid noz2le dry acent

Dry 5% 20% NA NA 60%Anthr=

Liquid 3%10. 3 NAAnthrax

3. What are current medical interveutions?

current interventions include the physical protectionprovided by protective mask, antibiotics such as doxycycline andciprotloxacin, and anthrax vaccine.

a.. what level of protection does vaccination provide?

Vaccine provided prophylacticalily to rhesus monkeys (2 dosesgiven 2 weeks apart) provides protection against the inhalationof 500 LD1's of spores, or against a•pproximately 4,000,000inhaled spores. This is protection :against pulmonary anthrax.cutaneous anthrax cases have occurred, however, in workers givenonly 2 vaccinations.

A-4

b. When must antibiotic therapy start to be effective?

Ciprofloxacin or doxycycline started i day atter inhalationexposure and continued for 30 days was protective against L0inhaled LD 50

1s in 8 of 9 rhesus monkeys in the ciproflokacingroup, and in 9 of 10 monkteys in the doxycycline group.Postexposure anthrax vaccine plus doxycycline protected 9 out of9 experimental animals. There is no data as to whetherantibiotics started on day 2 or 3 would protect; however, it isfelt that some protection might be provided although thepercentage protected would be lower.

c. Will personnel be incapacitated during therapy?

Whether a soldier or sailor is 'incapacitated' by adverseeffects depends on his/her job (i.e., pilot versus infantryman).However, the incidence of side effects can be included in themodel. For doxycycline, 5 to 10 percent will have an axaggeratedresponse to UV light, called photosensitivity. Under the rightcircumstances this could incapacitate a soldier if he/she were toreceive a severe sunburn. About the same percentage will havegastrointest.Lnal symptoms (nausea, abdominal discomfort, ordiarrhea). Ciprofloxacin causes these gastrointestinal symptomsin 3 to 6 percent of individuals; central nervous system symptomssuch as headache, dizziness, agitation, or sleep disturbanceoccur in I to 4 percent; allergic reactions such as rash orpruritus occur in 9.5 to 2 percent; other adverse effects such asseizures, hallucinations, fever, urticaria, or anaphylaxis are rare.

True incapacitation in one limb from anthrax vaccine is veryrare, occurring in 1 of 2,231 patients (0.05%). At USAMkIZD,anthrax vaccine has been shown to cause local swelling,induration, or tenderness in 4.0% of patients, and systemicsymptoms such as headache, rever, or nausea in 1.0% ofrecipients.

4. What is the time distribution of symptom onset after anenemy BW attacx and is this distribution sensitiye to exposurelevels?

The onset of illness after exposure in animal experimentsvaries somewhat with the dose of spores to which they areexposed. Onzset varies from approximately I to 5.5 days afterexposure, with the shorter time to onset occurring after higherinhaled doses. Onset of symptoms generally precedes death inuntreated animals by about z days, or 48 hours. some older datain the literature shows that animals receiving less than 500,000spores had mean time to death (TTD) of 7.5 days while animalsreceiving greater than 500,000 spores had mean a mean TTD of 3days. More recent data from USAKRIID experiments, showed no

A-5

difference in TTD (5 days) between animals exposed to 1,200,000snores versus thoac exposed to 2,000,000 spores. This limiteddata is all that is available concerning this question.

5. What is the duration Of incapacitation for survivors?

This question is best answered by saying that the onlyincapacitation in survivors would be in treated patients from theside effects of treatment (see #3 above). In animal studies ofpulmonary anthrax, with an infecting dose, all untreated animalsdie, and treated animals who survive do quite well.. In cases ofnatural human pulmonary anthrax in humans in this century, 16 of18 were fatal.

6. What factors/intensity levels are assotiated with agent

decay?

Temperature sensitivity

S0! Survival Time, 50 Percnt, .in Days-30" C 4" C 20, C

Dry Anthrax indefinite iiidefinite indefiniteLiquid Anthrax indefinite indefinite indefinite

Nighttime decay of an anthrax aerosol in percent decay perminute is 0.1 percent per minute decay at 75" F at any humiditycondition, either low or high. Below freezing temperatures suchas in an arctic environment, there is no decay of an aerosol.

Radiation Sensitivity

sunlight causes less than 1 percent per minute decay of ananthrax aerosol. other radiation sensitivity is minimal undernormal ambient conditions.

Desiccation Sensitivity

Liquid and dry anthrax are not sensitive to desiccation.

Chemical sensitivity

Liquid and dry anthrax are not sensitive to any commonenvironmental. chemicals. Anthrax spores are killed by adecontaminant solution of 0.5 percent sodium hypochlorite (bleachsolution).

Other Sensitivities

None.

A-6

APPENDIX B

Environmental Conditions

B-1

Southwest Asia Environmental Conditions(Summer)

Wind Speed Stability Agent DecayHour of Day Lk/brl Categorv Rate (%/rain.) Surface Type.

0000 7 5 .1 20100 7 5 .1 20200 7 5 .1 20300 7 5 .1 20400 7 5 .1 20500 7 5 .1 20600 7 5 .1 20700 11 4 1 20800 11 4 1 20900 13 3 1 21000 15 2 1 21100 16 1 I 21200 16 1 1 21300 16 1 1 21400 16 1 1 21500 16 2 1 21600 15 2 1 21700 14 3 1 21800 13 3 1 21900 11 4 1 22000 11 4 1 22100 7 5 .1 22200 7 5 .1 22300 7 5 .1 2

Pasquill Stability Categories 5urface1 = A (very unstable) 1 = Water2 = B (unstable) 2 Sand3 = C (slightly unstable) 3 Barren4 = D (neutral) 4 Grass5 = E (slightly stable) 5 = Forest6 = F (stable) 6 = Town7 = G (very stable)

B-2

Southeast Asia Environmental Conditions(Tropical)

Wind Speed Stability Agent DecayHour 6k/r 5 .1 Ca), Rate (%/min.) SurfcIye0000 6 5 .1 50100 6 5 .1 50200 6 5 .1 50300 6 5 .1 50400 6 5 .1 50500 6 5 .5 50600 6 5 .5 50700 8 4 1 50800 8 4 1 50900 9 3 1 51000 9 3 1 51100 9 2 1 51200 9 2 1 51300 9 2 1 51400 9 2 1 51500 9 2 1 51600 9 2 1 51700 9 3 1 51800 9 3 .5 51900 8 4 .5 52000 8 4 .1 52100 6 5 .1 52200 6 5 .1 52300 6 5 .1 5

Pasguill Stability Categories Surfac1 = A (very unstable) 1 = Water2 = B (unstable) 2 = Sand3 = C (slightly unstable) 3 = Barren4 = D (neutral) 4 = Grass5 = E (slightly stable) 5 = Forest6 = F (stable) 6 = Town7 =G (very stable)

B-3

Central Europe Environmental Conditions(Spring)

Wind Speed Stability Agent DecayHour of Day (k/hr_• .t..gry Rate (%/ n.)i Surface Type

0000 9 5 .1 30100 9 5 .1 30200 9 5 .1 30300 9 5 .1 30400 9 5 .1 30500 9 5 .1 30600 9 5 .1 30700 11 4 .3 30800 11 4 .3 30900 13 3 .5 31000 13 3 .5 31100 14 2 1 31200 14 2 1 31300 14 2 1 31400 14 2 1 31500 14 2 1 31600 14 2 1 31700 13 3 .5 31800 13 3 .5 31900 11 4 .3 32000 11 4 .3 32100 9 5 .1 32200 9 5 .1 32300 9 5 .1 3

Pasquill Stability Catepories SurfaceI = A (very unstable) 1 = Water2 = B (unstable) 2 = Sand3 = C (slightly unstable) 3 = Barren4 = D (neutral) 4 = Grass5 = E (slightly stable) 5 = Forest6 = F (stable) 6 = Town7 = G (very stable)

B-4

South Korea Environmental Conditions(Winter)

Wind Speed Stability Agent DecayHour ofDy hr) Categog Rate ._niin. Surface Type

0000 3 5 .1 30100 3 5 .1 30200 3 5 .1 30300 3 5 .1 30400 3 5 .1 30500 3 5 .1 30600 3 5 .1 30700 3 5 .1 30800 3 5 .1 30900 6 4 .3 31000 6 4 .3 31100 9 3 .3 31200 9 3 .5 31300 12 2 1 31400 12 2 1 31500 12 2 .5 3.1600 9 3 .5 31700 9 3 .3 31800 6 4 .3 31900 3 5 .1 3200C 3 5 .1 32100 3 5 .1 32200 3 5 .1 32300 3 5 .1 3

Pasguill Stability Categories Surface1 = A (very unstable) 1 = Water2 = B (unstable) 2 = Sand3 = C (slightly unstable) 3 = Barren4 = D (neutral) 4 = Grass5 = E (slightly stable) 5 = Forest6 = F (stable) 6 = Town7 = G (very stable)

B-5

APPENDIX C

Excursions in Delayed Onset of Agent Decay and Increased Toxicity

C-1

Undocumented sources have suggested that decay can be prevented for the first 2 hoursfollowing a release of B. anthracis and that the actual toxicity may be 100 times the levelsdetermined by USAMRDC. This Appendix addresses these issues by providing examples ofthe results that would be achieved by following these assumptions.

Based on the lower decay rates used in the current study, which range from0.1 percent/minute in darkness to 1 percent/minute in bright sunlight, the effect of a 2 hourdelay in decay would be to conserve between 12 and 30 percent of the agent total mass thatwould be expected to decay in the first 120 minutes after dissemination. However, on a targetsuch as an airfield attacked at night, the agent would clear the associated 4 km diameter area inabout 1 hour or less, assuming winds ranging from 3 to 9 km per hour. In this airfield attackcase, the absence of decay in the first hour would only conserve about 6 percent of the totalagent mass.

To assess the operational implications of the increased hazard represented by theseassumptions, sensitivity analysis was conducted to assess implications of a 100 fold increase inthe toxicity level of B. anthracis and the effects of a two hour delay in the onset of agent decayfollowing release. The sensitivity of the unit effectiveness for an artillery unit for vaccineprophylaxis, antibiotic therapy and no medical interventions was examined for two theaters ofoperation and two weapon systems. Attacks were simulated first for a tactical ballistic missilewith submunitions and then for release by a spray device. The climates used to examine eachattack scenario were Central European and Southwest Asian conditions. The bottom line wasthat the protective capacity of the vaccine was robust enough to maintain unit effectivenessabove 85 percent in all cases without the protection of masking. However, antibiotic therapycould be decisively overwhelmed for areas as large as 15,000 kmz for a spray attack at0500 hours in Central Europe. For a unit assuming MOPP 4 prior to the attack, antibiotictherapy would have been required to sustain unit effectiveness at 63 percent -- the expecteddegradation for an artillery unit in MOPP 4. Without antibiotic therapy, however, theprotective ability of masking (MOPP 3 or MOPP 4) would have been overwhelmed.

If one does indeed believe that the toxicity of B. anuhracis is 100 times greater than thelevel estimated by USAMRDC, then there is an unequivocal case for a vaccine policy thatimmunized personnel prior to deployment, or at least in-theater prior to exposure, although thelatter still requires some unfortunate risk in timing.

More specifically, Figures C. 1-C.24 depict the results of the sensitivity study. FiguresC. 1-C.4 illustrate the expected spore area coverage that would result from B. anthracis attacksusing "normal" toxicity rates with decay beginning immediately after release versus "high"toxicity estimates with decay delayed for two hours after release. Simulated TBM attacks forSouthwest Asia and Central Europe and spray attacks for Southwest Asia and Central Europeshow only a barely perceptible change in spore area coverage due to assessments regarding thetoxicity of a spore and differences related to a 2-hour delay in decay.

C-2

B. anthracis Attack by TBMComparison of Normal and High Toxicity Levels

Spore Area Coverage for Southwest Asia

Area Coverage (mi)1.OOOE+ 111.000E+10 Time of Day1.000E+09'

1.000+08 C0500 hours1.00OE+07

1,000,000 " 1200 hours

10.000 -0- 1900 hours1,00010O0 -4- 0500 HI Tox *10 )

1 "d 1200 Hi Tox *

'j zZ.1900 HI Tox *

Number of Spores

• No decay first two hours

• Hi Tox = 100 times normal toxicity

Figure C. 1 TBM in Southwest Asia: Spore Area Coverage

C-3


Spore Area Coverage for Central Europe

Area Coverage (in2)1,0002+11I1.000E+1 0 Time of Day1 .OOO5+091.0002+08 -1O500 hours1.000E+07

1,000,000 -01200 hours100.000

101000 1900 hours1,000

100 ~0500 Hi Tax *101 N NzNz q1200 HiTox *

<,e eýt III1900 HITox *

Number of Spores

"* No decay first two hours"* Hi Tox = 100 times normal toxicity

Figure C.2 TBM in Central Europe- Spore Area Coverage

C-4

B. anthracis Attack by SprayComparison of Normal and High Toxicity Levels

Spore Area Coverage for Southwest Asia

Area Coverage (in2 )1 .0OOE+1 11.000E+10 Tieo a1 .OOOE+09TieoDa1 ,OOOE+08 -4-0500 hours1.000OE+07

1,000.000 -1200 hours100,000

10,000 -0-1900 hours1 .000

100 0500 Hi Tox *

.71 1 120OHl Tax *'0" -z ,01900 111Tox *

NN, N9 N9 ,N

Number of Spores

* No decay first two hours* Hi Tox =100 times normal toxicity

Figure C.3 Aerial Spray in Southwest Asia: Spore Area Coverage

C--5


Spore Area Coverage for Central Europe

Area Coverage (M2 )1.000E +11,== • =•. .

1.0E1=+09 •Time of Day1,OOOE+08 0500 hours1.OOOE+071 .000,000 |" 1200 hours

100,000 I

10o,00- 1900 hours1,000 I

100 "0500 Hi Tox *10

1200 HI Tox *Q, e 0 X,• •,1900HITox*

Number of Spores

"* No decay first two hours

"• Hi Tox = 100 times normal toxicity

Figure C.4 Aerial Spray in Central Europe: Spore Area Coverage

C-6

The implications for casualty area coverage and the resulting levels of B. anthracis onthe battlefield as depicted in the footprints is quite significant. Predicted casualty areacoverage is depicted in Figures C.5-C. 12 first for the TBM scenarios and then for the sprayscenarios. For each weapon system, results for Southwest Asian conditions were included firstand then Central European conditions. The scenarios for each climate were examined both forMOPP 0 and MOPP 4 assumed prior to the simulated attacks. For each of the scenariosexamined in the sensitivity study, a comparison of casualty area coverage was made using thestudy assumptions of decay rate and toxicity as the baseline, represented by the "normal"stackbars. Comparisons are made against the "normal" baseline and results assuming a 2-hourdelay in decay, then against the combination of delayed decay and increased toxicity. For allthe scenarios, there is no perceptible difference between "normal" and delayed decay.However, a combined delay in decay and a 100-fold increase in toxicity would consistentlypresent an increased challenge to units with antibictic or vaccine protection.

In considering the MOPP 0 scenarios and vaccine as a defense, a 100-foldincrease in toxicity resulted in an increase of up to two orders of magnitude in casualty areacoverage, representing approximately a 450 km2 increase in expected lethal area coverage.The overall casualty area coverage with antibiotic therapy was nearly the same as with nomedical therapy for MOPP 0, indicating that antibiotic therapy would not be very effectiveagainst a 100-fold increase in toxicity. Even assuming that personnel would be in MOPP 4 atthe time of the simulated attacks, the high toxicity excursion would produce casualty areacoverage against vaccinated personnel ranging from 1,000 m2 to 1 km2.

C-7


Casualty Area Coverage of Southwest Asia (MOPP 0)

Casualty Area Coverage (in2)1.OO0E+1 111.OOOE+1O1.OOOE+091 .OOOE+081.,OO12+07/

1/0,0 Medical Interventions10,000 El No Medical Therapy

100 EDAntibiotic Therapy10

1 EVaccine Therapy

By Time of Day

*Hi Tox =100 times normal toxicity

Figure C.5 TBM in Southwest Asia: Casualty Area Coverage (MOPP 0)

C-8



Casualty Area Coverage (mn2)1.000E4 111.OOOE+101.OOOE 4091 .OOOE+08__________1 .OOOE+07

1,000,000O Medical Interventions100,000 EoMdiaThrp10,000ElNMeiaThrp

1,000100 gAntibiotic Therapy10

UVaccine Therapy

By Time of Day

*Hi Tox 100 times normal toxicity

Figure C.6 TBM in Southwest Asia: Casualty Area Coverage (MOPP 4)

C-9

B. anthracis Attack by TB3MComparison of Normal and High Toxicity Levels

Casualty Area Coverage of Central Europe (MOPP 0)

Casualty Area Coverage (in2)

1.OOOE*1' 101.00E+1091.OOOE+08 -- / _________

1 .0001+071.000,000 Medical Interventions

100,00010,000 / ENo Medical Therapy

1,00 Ant~boflo Therapy100

10I Vaccine Therapy

By Time of Day

*Hi Tox = 100 times normal toxicity

Figure C.7 TBM in Central Europe: Casualty Area Coverage (MOPP 0)

C-10



Casualty Area Coverage (m2)1.OOOE + 111.OOOE+101.OOOE+091.OOOE+08 --1.000E+071,000,000 Medical Interventions

100,000 T110,000 / No Medical Therapy1.000 ///

100 Antibiotic Therapy

10 U/Vaccine Therapy1 , IQ+o+#+,+%, _oo-+.2,+

By Time of Day

* Hi Tox = 100 times normal toxicity

Figure C. 8 TBM in Central Europe: Casualty Area Coverage (MOPP 4)

C-11



100+1Casualty Area Coverage (M2)

1.OOOE+10i.000E+09 /I1 .OOOE+08__________i .OOOE+07

1,000,000 /Medical Interventions100,000

10,000 C1No Medical Therapy1,000

100 Antibiotic Therapy10 UAilfi Vaccine Therapy

By Time of Day

*Hi Tax =100 times normal toxicity

Figure C.9 Aerial Spray in Southwest Asia: Casualty Area Coverage (MOPP 0)

C-12



Casualty Area Coverage (mr)1.000E + 111.000E+101.000E+091.000E+08 771.0001+07 //1,000,000 Medical Interventions

100,00010,000 No Medical Therapy

1,000100 iAntlblotlc Therapy100 /

10 I 1 ] Vaccine TherapyA //

By Time of Day

* Hi Tox 100 times normal toxicity

Figure C. 10 Aerial Spray in Southwest Asia: Casualty Area Coverage (MOPP 4)

C-13

B. anthrauls Attack by SprayComparison of Normal and High Toxicity Levels


casualty Area Coverage (mn2)1.OOOE + 111.OOOE+101 .OOOE+i09 A1 .OGOE+08 r______I .OOOE+07

1,000,000 Medical Interventions100,000

1,00c100 IAntibiotic Therapy10

1U Vaccine Therapy

By Time of Day

*Hi Tox = 100 times normal toxicity

Figure C. 11 Aerial Spray in Central Europe: Casualty Area Coverage (MOPP 0)

C-14



Casualty Area Coverage (M2 )1.000E+ 111.000E+101.000E+091.OOOE+081.000E+07

77

1,000,000 Medical Interventions100,000

10,000 0 No Medical Therapy1,000

100 //Antibiotic Therapy10 ' Vaccine Therapy

4ýO

By Time of Day

* Hi Tox 100 times normal toxicity

Figure C. 12 Aerial Spray in Central Europe: Casualty Area Coverage (MOPP 4)

C- 15

Figures C.13-C.24 depict the associated hazard area footprints and resultant uniteffectiveness for the 100-fold increase in toxicity and the 2-hour delay in decay, As can beseen, the increased toxicity assumption significantly increases the extent of the contours for50 percent population response with no medical intervention or with antibiotic therapy. In nocase did the attack scenarios produce areas where there would be 50 percent expectedcasualties in MOPP 0 when personnel were protected by vaccine. The high level ofeffectiveness of the vaccine Also translated into high levels of unit effectiveness for the artilleryunit modeled, In most cases, unit effectiveness was sustained at 100 percent with only slightdegradation in effectiveness to about 90 percent.

Without vaccine and sole reliance on antibiotic therapy, the medical workload wouldincrease dramatically as evidenced by the steep decline in unit effectiveness caused bycasualties.

The conclusion drawn from this sensitivity analysis was that a vaccine policy thatimmunizes personnel prior to exposure, preferably prior to deployment, is vital. Dependenceon antibiotic therapy alone would result in significant levels of casualties and the resultingdegradation in unit effectiveness and attendant heavy medical workloads. Based con tix.scenarios studied, predeployment vaccination could effectively maintain combat effectivenessand avoid unnecessary illness and loss of life.

Footprints are shown first for TBM scenarios for Southwest Asia and CentralEurope at 0500, 1200 and 1900 hours, and then for spray attacks for the same climates andtimes of day.

C-16

Unit Effectiveness (%) MOPP 01 2 3 4 Medlcal

L0O - l0o g04 InltwiVorrtJ•ooit Io II .. ... . . ..

it to . Vaccine40*.......................V..40

40 .... .* .'+ . . . 40 -eraw

:0 20l 1• go LM Nw"m"Arth evs on the

baKtildee

0~ Lethal 0044 W%... . Vacci ne

7~ LethillDo" W%

'+ + " []Thma,*W

-,ostholDes Wy

a 23 1.0 75 too 125 150 ¶15 200 Let D~a ose 06%

Kilomreters

Unit Effectivene'ns (%/) MQPP 41 2 34Meca

L~~M ... II 0 nterventioraI I40. . . . .

" " Vacdn4.0 Thmerapy

Figure C. 13 TBM with Submunitions in Southwest Asia at 0500 Hours: Artillery Unit100 Times Normal Toxicity Level, No Decay First Two Hours

C-17

L 1M! I I I 1 I I I ' 1 '

Unit Effectiveness (%) MOPP 01 2 3 4 Md1SCa

ag .Intg Ormdons14. 1 . . . II "

S: ill LOWI D•o" 60%

14

7 wft Varccbn

S-7 i • "lherapy/

M -iIi t.. atfi DowGo%

2 -!9 75 .... 12 Sj7 Il

Kilometers

Unit Effectiveness (%) MOPP 42 3 4 Medicai

00 . 1:: ,ntgil. -ns

to. .. ..a . No.to do 4 Vaccdne


C-18

Unit Effectiveness (%) MOPP 01 2 3 4 MUca

S . . . - - - amm .... ".. ...1 . 20 .Nan.

Antrax -eve]a on e wbadtlfield

LehtOW60%

2) + + wf ther

0 25 SO 75 lad 125 50 175 200Laajo6

Kilometers

Unit Effectiveness (0,%) MOPP 4

2t 3 4

tooe Ireerven ons

•1• - ° .- .. .. I . . ,,,

44 .. Therapy


C-19

Unit Effectiveness (%) MOPP 012 3 4 Medeca"it .t r : : ... ... .

.... ....

I i -" - VccLEEI E TherapyI- .0 . . Nouna

Antrdiolevels on thebosdoofleld

It~~ Lorthgo o Oor6%

7 C3LdMWDoes 60%S- +- '0~ioiS'

0 25 SO 75 too 125 ISO 175 200 OE3 Letha Dos.6%S

Kilometers

Unit Effectiveness (%) MOPP 41 2 3 4 Medicl,, ........--. ....... . ...... ... ........ ' " ' " 0 "'~o n

004 II It00- a.* - -. ... 4

,411 41 . . . VaT Ine

Figure C. 16 TBM with Submunitions in Central Europe at 0500 Hours: Artillery Unit100 Times Normal Toxicity Level, No Decay First Two Hours

C-20

Unit Effectiveness (%) MOPP 01 2 3 4 MediOi

42 4 40 U•e"PL IE.. ..... .. . I _.. .... .4a" '.hII " " C. . [ Vune

"" _ _ 0I Nonue

Fiue0 27 TBM 75t Sum iton in5 Cenra Eu7op a200 H edour:Atlery ni

K0 ile ormelTxters e, oDcy is woFor

32 4 L et alD"

6. . . . . . . . . . . . With Vaok ot

FiueCa7TMwt umuiin nCnrlErp at 1200 a H wour:AtleyUi

21 with~C-21

Unit Effectiveness (%) MOPP 01 2 3 4 uadleLuF•m17]t~il mo " •' ' Interventions

4 . .- 44 . . . .- 4

Antrax Ieves on thebittlefield

+ IYWith Vaci+ + + Lethal Doa. 60%

•- 7 with "lberaW5 3 Lathajloal6o%

- 0 25 S0 75 10 125 M 175 2011 Lethal DWO %

Kilometers

Unit Effectiveness (%) MOPP 42 3 4 Medial

LUo 1"14 Inteivendion

jj1 Ve"cin.41 4 400 Therapy

""4 [] None

Figure C. 18 TBM with Submunitions in Central Europe at 1900 Hours: Artillery Unit100 Times Normal Toxicity Level, No Decay First Two Hours

C-22

Unit Effectiveness (%) MOPP 01 2 3 4 Medlci

'04 so.- I nteoventionsIf ... . . I | . . .. . . .

U I 4 ,. , -1Tcmrp44 .. . . .= .! . 1. 0- .. . h

M M Noune

0 25 50 75 t100 125 45•0 1751 200 225 250 275 .100 325 .350 375

K+lometers

Unit Effectiveness (%) MOPP 4Lta 00T hea

10 ie Nraoict eel oDcy1is w Hours

,Lethal i'o"n3%

-2-2

Unit Effectiveness (%) MOPP 01 2 3 4 MedlcAld" .. . . "-i "-' Inei"~U

.. . . .. .... . Intuenlons

S...41. . .{[.4.._. _. .. .

a ./ . J . t he

ci H LLLJ Th.tapy

0 25 50O 75t t10 125= 150 175 200 2253 250 275i "00 3225 250 275

Ki lometers

Unit Effectiveness (%-) MOPP 4

22 3 4 Medicil

"Figurt Aa Sy in S e .s A

100 Times Normal Toxicity Level, No Decay First Two Hours

C-24

If .'I ..' .... ..! ,..... 4....... I ,tm rt n

Unit Effectiveness (%) MOPP 02 3 4 Medlou

.i . . ... . . . ..... nt n

l 4 * . ..... 4i 4 . .11 ... . ..".r.. 1 .. oy

~None

+~~ Cl UdWl ose 60

• oi , i Vancinb2~~ L4adid os# 60%

0 2A 5•0 75 10 12t 15 1 i •73 2010 225 250 275 ,300 325 35a0 3"75

Kipometers

UnRtEffedtiveness ()MOPIP 42 4 M"edlli.. .... .I , n !l........ , -

"3 :0[ Thoonvy

Figure C.21 Aerial Spray in Southwes As&.- at 1900 Hours: Artillery Unit100 Times Normal Toxicity Level, No Decay First Two Hours

C-25

Unt rEffectiveness (IV) MOPP 012 3 4 Medlcai

Itoo

Un5 Effctvees (%accinPe+ 2 + 4 eha M0" 60%

44 [Im Terapy

Fiur C.2AraLpaei eta uoe t00 or:AtiallDeryni100 TieLomlTxcteLvloDcyFrtha Two" Hour

-722

Unit Effectiveness (%) MOPP 012 Med4 u !

41i ... . .. ... . . 46 ln t Mv r A Po nfill NoneIN ISr-/ N ! . . . . . .

"7: ..... DO M%:i :Lah Do W% t

- A

0 25 50 75 JOG 125 15O 175 200 225 250 275 300 325 350 375

Kilometers

Unit Effectiveness (%) MOPP 412 3 4 Medica

, . .4U4140e

Figure C.23 Aerial Spray in Central Europe at 1200 Hours: Artillery Unit100 Times Normal Toxicity Level, No Decay First Two Hours

C-27

Unit Effectiveness (0%) MQPP 012 Lo 3 4 M"dCal

so OW o" 601ra

a 25 50 75 100 125 150 175 2100 225 250 175 3;0 325 3b0 375

Kilometers

Unit Effectiveness (%/) MOPP 412 3 4 Medletal

tL LU~edo

4 - a. UVaccine

SNonie

Figure C.24 Aerial Sprny Mn Central Europe at 1900 Hours: Artfillery Ujnit100 Times Normal Toxicity Level, No Decay First Two Hlours

C-28

APPENDIX D

Reading the Hazard Footprint Graphs

D-I

Reading the Hazard Footprint Graphs:

B. anthracis footprint maps, combined with unit effectiveness bar graphs, show thecomparative impact of vaccine and antibiotic therapy as a defense against the expected levelsof B. anthracis on the battlefield. The Y-axis on the footprint map indicates the crosswindextent of the hazard cloud on the battlefield, and the X-axis indicates the downwind extent.Since the primary route of entry for B. anthracis is inhalation, the footprints representexposure levels across a plane at 1.67 meters off the ground, or nose level. Contours arebased on the B. anthracis dosage that results in 5 percent and 50 percent population response(deaths) with no medical intervention, 50 percent population response with antibiotic therapystarted in the first day of exposure, and contours representing 50 percent population responsewith vaccinated personnel. It should be noted that the vaccine's protection ratio was greatenough to preclude an LD50 level in any of the scenarios simulated for this study withvaccinated personnel.

On each footprint map, unit effectiveness was represented for units at four positions within thehazard area (noted by black dots). ' ie resulting unit effectiveness for each unit was thenexpressed using bar graphs to compare the beneficial effects of vaccine and antibiotic therapywith results for units with no medical therapy. The bar graphs above the fooiprint representresults for units without physical protection (MOPP 0), and the graphs below the footprintrepresent con esponding results for units assuming MOPP 4 prior to the attack. It should benoted that while protective gear (particularly masking) is highly effective in preventing thecontraction of inhalation anthrax, there is a trade-off in unit effectiveness.

General trends relative to B. anthracis footprints:

Environmental sensitivities (see Appendix B) include UV exposure, atmospheric

stability and wind speed, factors which affect the extent of the hazard. Footprints for1200 hours, therefore, are typically smaller than for other times of day as result ofgenerally higher decay rates and wind speeds as well as unstable atmosphericconditions. Agent transport is controlled by the wind speed profile, and diffusion iscontrolled by atmospheric turbulence. Unstable (or lapse) conditions tend to dissipateagent concemnrations faster than either neutral or stable conditions.

The more stable atmospheric conditions and lower wind speeds of S. Korean winter

produced a relatively more severe hazard compared to the other climates moceled.

D-2

i .m.1 m srvpet documien ad-a280 772 i iiiii 11 ,t- - dtic · 2011. 5. 14. · rocket launchers...

Documents