1. Weaponized Bioagents YSU – Agents of Mass Casualty

2. Agent Classification Military –Foundations may be foreign –May have practical roots Civilian –CDC Classification

3. Military “C” “C” = Class Chemical Classes –C01 to C24 Biological Classes –C25 to C29

4. Chemical Agents Sub-Codes – Examples C01 –GA –GB –GD –GF

5. Military Classes - Bioagents C24 – Anti-Personnel C25 – Anti-Personnel/Vector C26 – Anti-Personnel/Ingestion C27 – Anti-Animal C28 – Anti-Plant C29 - Simulants

6. CDC & EM Classification Category A – Weaponized or Available –Variola virus –Bacillus anthracis –Yersinia pestis –Botulinum toxin –Francisella tularensis –Filoviruses & Arenaviruses

7. CDC & EM Classification Category B – Lower Virulence/Possible Agents –Coxiella burnetii –Brucellae –Burkholderia mallei –Alphaviruses –Ricin –SEB –Foods Agents – E. coli 0157:H7, Salmonellae –Water Threat – Vibrio cholera, Cryptosporidium

8. CDC & EM Classification Category C –Any other emerging pathogen or biological toxin that might be a threat.

9. Anthrax – B. anthracis 12 hrs-5 days (except delay) Inhalation – flu-like, fluid in lungs, severe difficulty breathing, broadening mediastinum Not Contagious – Aerosol or powder Treat With Antibiotics Military Vaccine 30% Mortality (untreated may be higher)

10. Botulinum Toxin Affects in 12 hours to 3 days Flu-like symptoms, difficulty speaking, swallowing, drooping eyelids, paralysis Antitoxin available (not reversible damage) No commercial vaccine Probably disseminated in liquid droplets or on food.

11. Cholera – V. cholera 12 hours to 5 days Severe diarrhea, vomiting and weakness, leg cramps and fluid loss. Not contagious – disseminated in food or water. Treatable with antibiotics – high fluids Newer vaccines not available in U.S. Old vaccine low effectiveness, short-lived

12. Glanders – B. mallei 1-14 days Fever and headache, muscle tightness, chest pain, tearing and light sensitivity Not highly contagious – aerosol diss. Treatable with antibiotics Very few historical cases, up to 50% mortality possible. No vaccine

13. Plague – Y. pestis 1-6 days Flu-like, lymph node pain (buboes), blood- streaked sputum, septic shock Aerosol or food – pneumonic transmissible Treatable with antibiotics – time is critical Vaccine, once available did not prevent pneumonic form. Discontinued in 1999.

14. Q-Fever – C. burnetii 2-3 weeks High fever, throbbing headache, sweating, auditory and visual hallucinations, hepatitis Aerosol or food dissemination, not very transmissible Low mortality, most recover without treatment. Vaccine not available to general public

15. Smallpox – V. major 10-14 days High fever, aches, rash starts in face and arms (then trunk – unlike chickenpox) Aerosol or person-to-person. Contagious stage comes with symptoms. Vaccination 3-5 days after exposure may avoid or lessen disease. No treatment (supportive therapy only)

16. Tularemia – F. tularensis 1-14 days in nature (3-5 in a deliberate act) Flu-like + lethargy. Swollen lymph nodes in systemic infections, red, sore eyes, pneumonia Disseminated as aerosol or on food – no human to human Antibiotics. Some weaponized strains may be abx. resistant.

17. Mortality 1970 World Health Organization Assumed 50 kg of dried agent Disseminated on a 2 km line Upwind of a population of 500,000

18. Results AgentDistance Carried (km) FatalitiesCasualties (Total) VEE140035,000 Typhus59,50035,000 Brucellosis1019,00085,000 Plague10500100,000 Q-Fever>20150125,000 Tularemia>2030,000125,000 Anthrax>>2095,000125,000

19. Other Concerns Residential backflow protectors Food QC Availability of viral hemorrhagic fevers Soviet brain drain

20. Soviet Bioweapons - Rating Smallpox Plague Anthrax VEE Tularemia Q-Fever Marburg virus Others include the flu virus, glanders and epidemic typhus.

21. Detection Rapid Dx Assays –Military Botulinum, SEB, SEA-C-D Dengue Fever, Q-Fever, Plague, Tularemia, Typhus, West Nile –Civilian SMART Tickets DNA Techniques

22. Decon

23. ER + Decon Isolate small areas to 100 ft or more Note weather, population, density and time of day For airborne cloud – shelter-in-place Field Detection – Not Recommended PPE –General rule – Level A – Latex may not be fully protective

24. ER + Decon Remove clothing (aerosol or powder) Double bag Wash w/soap + water 10% bleach wash (10-15 minutes) Rinse solutions should be retained if possible

25. ER + Decon Careful of reaerosolization Treat all items as Haz-Waste Note airflow around patients (bioaerosols) Always try to decon at site if possible

26. NPS or SNS Future module will address Located at secret locations around the nation (12 hour deployment on gov. req.) Enough to treat, perhaps hundreds of thousands (depending on disease)

27. Antibiotics May be classified: –By spectrum –Method of administration –Activity (bacteriacide vs. bacteriastat) –Chemical structure Useful because those in the same class will show similar side-effects, action, toxicity etc.

28. Antibiotics Penicillins Cephalosporins Fluoroquinolones Tetracyclines Aminoglycosides

29. Antibiotics Penicillins –Oldest –Similar in chemistry to cephalosporins –Bacteriacidal –Natural penicillins (“G”) (methycillin) –Aminopenicillins (Amoxil) – broader may require penicillinase inhibitor

30. Antibiotics Cephalosporins –Bacteriacidal –May show similar allergic problems to pen. –1 st, 2 nd and 3 rd generation –3 rd generation cross blood-brain barrier –Work on anaerobes

31. Antibiotics Fluoroquinolones –Synthetic –Reach deep tissues –Bacteriacidal –Cipro, Penetrex, Floxin, Trovan

32. Antibiotics Tetracyclines –Derrived from strep bacteria –Bacteriostatic –Effective against rickettsia + parasites Macrolides –Emycin, Z-pak, Clarithromycin –Effective to penetrate lung tissue –Spectrum similar to penicillins