GIS in a context of Bioterrorism Maria Styblińska University of Silesia Institute of Informatics

Deaths in Angola

Deadly Powder

Bioterrorism and Biowarfare Bioterrorism (BT) and biowarfare (BW) are the intentional or the alleged use of infectious biological agents as: viruses, bacteria, fungi, toxins or germs to cause illness and produce death or disease in humans, animals or plants.

Bioterrorism or Biowarfare Micro organisms or their toxins Intentionally produce sickness or death Target people, plants, animals

Anthrax – Bacillus anthracis; Lymth tissue

Biological Diseases/Agents Listing Category A Anthrax (Bacillus anthracis) Botulism (Clostridium botulinum toxin) Plague (Yersinia pestis) Smallpox (variola major) Tularemia (Francisella tularensis) Viral hemorrhagic fevers (filoviruses [e.g. Ebola, Marburg] and arenaviruses [e.g. Lassa, Machupo])

Category B Brucellosis (Brucella species) Epsilon toxin of Clostridium perfringens Food safety threats ( Salmonella species, Escherichia coli, Shigella) Glanders (Burkholderia mallei) Melioidosis (Burkholderia pseudomallei) Psittacosis (Chlamydia psittaci) Q fever (Coxiella burnetii) Ricin toxin from Ricinus communis (castor beans) Staphylococcal enterotoxin B Typhus fever (Rickettsia prowazekii) Viral encephalitis (alphaviruses [Venezuelan equine encephalitis, eastern equine encephalitis, western equine encephalitis]) Water safety threats (Vibrio cholerae, Cryptosporidium parvum)

Category C Emerging infectious disease threats such as Nipah virus and hantavirus

Category Descriptions Category A Diseases/Agents : High-priority agents include organisms that pose a risk to national security because they can be easily disseminated or transmitted from person to person; result in high mortality rates and have the potential for major public health impact; might cause public panic and social disruption; and require special action for public health preparedness.

Category B Diseases/Agents Second highest priority agents include those that are moderately easy to disseminate; result in moderate morbidity rates and low mortality rates; and require specific enhancements of CDC's diagnostic capacity and enhanced disease surveillance. Category C Diseases/Agents Third highest priority agents include emerging pathogens that could be engineered for mass dissemination in the future because of availability; ease of production and dissemination; and potential for high morbidity and mortality rates and major health impact.

The threat of terrorists using biological warfare agents has received increased attention in recent years. The most distinguishing feature separating BW terrorism from conventional terrorism is the extraordinarily larger number of casualties that could follow a major terrorist attack involving biological agents.

Rather, the most likely BW terrorist tactic will be to release BW agents anthrax spores, botulinum toxin, ricin, smallpox or other deadly agents into the air as a biological aerosol, a stable cloud of suspended microscopic droplets of bacterial or virus particles. Since BW agents are invisible, odorless, and tasteless, no one would know that a terrorist attack is under way.

The aerosol release of BW agents could be accomplished in several ways, including using low-flying airplanes, crop dusters, or trucks equipped with spray tanks and releasing the BW agent upwind of populated areas; leaving aerosol canisters filled with the BW agent and timing devices in subways, airports, air-conditioning/heating systems in buildings, or other crowded places; or directly contaminating bulk food supplies in restaurants, supermarkets, or other places with a BW agents.

Bioterrorist attacks can be, at least in theory, executed at several levels: 1.The strategic level, which can cover large populations or geographic areas. This may also be directed against crops and livestock resulting in famine or economic disruption. 1.The tactical level, which is a more directed attack. These are usually limited by the incubation times. They are most effective against a fixed position, e.g.is the intentional contamination of a salad bar at a restaurant in The Dallas, Oregon”82 1.The terrorist approach, which doesn't have to make anybody ill. This may be easy to deliver and difficult to detect, e.g. in Washington D.C. the downtown area was grid locked because somebody sent a petrie dish labeled "anthrax," into rush hour traffic.

1.Large unexplained epidemic with similarly acute patients with an unusual epidemic curve. 2.More severe case of disease than usual with higher mortality, refractory to treatment and usually with respiratory manifestations. 3.Multiple diseases in the same patient. 4.Unusual geographic, seasonal, or patient distribution. 5.Suspicious transmission pattern. 6.Unusual genetic or molecular patterns. 7.Multiple simultaneous epidemics. 8.Unusual clinical presentation. 9.Unexplained animal deaths. 10.Direct evidence of biowarfare munitions. Clues to a biological attack.

Comparative Cost: $/km2 Smart bombs: $80,000 Explosive: $10,000 Nuclear: $4,000 Chemical: $300 Biologic: $5 (Stanford,personal comm,1988)

DEATHS: 1 KT H-BOMB.6M - 2M 100 Kg ATX 1M - 3M (IDSA, 2001)

MASS EFFECT: "Subnational attacks using genetically engineered organisms are inevitable" "Biologic agents now join nuclear agents" (Stansfield Turner, CIA, 2001)

History: Corpses + Catapults 600 BC: Assyrians -- Ergot 300 BC: Greeks -- Wells 1346: Tartars -- Plague 1500: Pissaro -- Smallpox 1710: Russia/Sweden -- Plague

History: Specific Disease Application 1763 Amherst -- Bouquet 1915 Germany Cholera -- Italy Plague -- Russia Glanders, Anthrax -- Rumania, Syria 1925 Geneva Convention

History: Modern Era 1937: Japan -- Many 1943: US -- Bacteria, virus 1945: Japan -- Generators 1969: US -- Stops efforts 1970: Russia -- Bio-preparat

Biologic Arms Race YesMaybe IraqIndia IranPakistan LibyaIsrael RussiaSaudi Arabia Syria Afganistan

How GIS can be used for phases of Bioterrorism planning and response

To detect trend in disease occurrence Detect epidemics Provide estimates of morbidity and mortality Stimulate epidemiologic research Identify risk factor for disease Assess the effectiveness of disease controls Improve clinical practice Improve resource allocation The benefits of infectious disease surveillance are as follows:

GIS has been used for many “after event” analyses Objective is to create dynamic “real time” information systems that allow greater access to the data for decision making and problem characterization

GIS and Events Characteristics of an event starts locally, spreads by water, air, vector, or contact Event is a spatial problem: geographic space (2-3D) and social space GIS has tools for geographic and (to limited degree) social space: visualization, summary, management of attribute and spatial data hydrological and network modeling population models/simulation weather models/simulation

Data Management, Visualization, Analysis/Modeling, Scenario Management Preparedness Detection/Surveillance, Response, Communication Using GIS to turn Data into Information

What is required for GIS? Mandate and management support Spatially enabled data sets: topographic and environmental data provide the spatial context demographic data provide the social context health data provide the health context Trained staff Software to visualize, manage, and analyze the data sets Hardware to store,

GIS issue Security/Privacy of health data legislation and privacy laws GIS architectures stand-alone vs. networked Analysis mapping units statistics error Metadata

Hypothetical application of GIS

A disease surveillance report at the onset and peak of a bioterrorism event plots cases, street networks, community facilities, administrative boundaries.

Predominance of cases in low population density areas

Examples of GIS applications: Examples of GIS applications: CDC BT Scenario - Traffic management

Early Warning Outbreak Recognition System Department of Defense, USA

GIS System ESSENCE - Electronic Surveillance System for Early Notification of Community- based Epidemics, Washington, D.C.

International Biological Warfare Agreements:  The Geneva Protocol of 1925  1972 the Biological Weapons Convention

Thinking About the Unthinkable Kahn H.:Thinking About the Unthinkable. London, England: Weidenfeld & Nicolson; "No return address"

REFERENCES: 1.1. Biological Terrorism Introduction, Center for the Study of Bioterrorism and Emerging Infections, Saint Loius University School of Public Health 2.2. Carter A, Deutch J, Zellcow P.: Catastrophic terrorism., Foreign Affair., 1998; 77: Public Health Emergency Preparedness and Response; Centers for Disease Control and Prevention; US Department of Health and Human Services; Working Group on Civilian Biodefense, USA 5.5. Bioterrorism: Alert and Response; University of Washington, School of Public Health and Community Medicine; Meselson M, Guillemin J, Hugh-Jones M, Langmuir A, Popova I, Shelokov A, et al.: The Sverdlovsk anthrax outbreak of Science 1994;266: Investigation of bioterrorism – related anthrax: Connecticut, MMWR Morb Mortal Wkly Raport, 2001;50: Simnott J.: Bioterrorism, Lecture and Presentation, University of South Florida College of Medicine; Stanford, personal comments, Fiedler R, Hughes T, Garcia M,:GIS Mapping and Use of Spatial Data in a BioTerrorism Scenario, cientific Technologies Corporation Styblińska M.:.Internet GIS Application in Health Care and Medical Information, GIS Polonia 2001, p , Zagreb Bioterrorism GIS Can Help Fight the New Threat; website GeaoWorld; geoplace.com The Authorative Resources for Spatial Information

13. Northwest Center for Public Health Practice at the University of Washington School of Public Health and Community Medicine; Mitchell JT, Everly GS.Critical Incident Stress Debriefing: An Operations Manual for the Prevention of Traumatic Stress Among Emergency Services and Disaster Workers; 2nd ed rev. Ellicott City, Md: Chevron Publishing Corp; 1995, Popovich M., Fiedler R., Fiedler S. Massee J: Bioterrorism GIS Can Help Fight the New Threat; website GeaoWorld; geoplace.com The Authorative Resources for Spatial Information US Congress, Office of Technology Assessment.; Proliferation of Weapons of Mass Destruction: Assessing the Risks.; Washington, DC: Office of Technology Assessment; August Document OTA ISC Kahn H.: Thinking About the Unthinkable.: Weidenfeld & Nicolson, London, England 1962; 1962