18 1 15 Biological and Chemical Terrorism 2001 9 11 22 5 1972 Biological and Toxic Weapons ConventionBWC 143 Weapon of Mass DestructionWMD Iran Iraq Sudan Cuba Libya Syria WMD K. Alibekov 1992 Stepnogorsk Soviet Preparat anthrax smallpox plague Marburg
16 91 1 25 tularemia Q-feverQ typhus VEE glanders 4500 1979 Sverdlovsk 66 Alibekov Yelktsin 1993 1991 85 38 aflatoxin 22 1991 25 300 Office of Technological Assessment 1993 WMD 57 190 100 anthrax spores 100-300 1970 WHO 50 50 95,000 125,000 50 kg aerosolized Yersinia pestis 500 150,000 36,000 50 Kg Francisella tularensis 500 250,000 19,000 1990 16 1999 60 smallpox 20 5 1918 AIDS
18 1 17 3 2 1 5 terrorism Terrorism is the unlawful use of force or violence against person or property to intimidate or coerce a government, the civilian population or any segment there-of, in furtherance of political or social objectives. 1. 2. 3.
18 91 1 25 4. 1984 Dalles 751 10 Rajneesh 1. 2. 3. 4. sarin Shoko Asahara 1985 2000 1995 11 sarin 12 1000 4000 1995 5 14 1994 6 3
18 1 19 sarin 7 200 Marburg virus CDC 1999 category A 1.Variola major Smallpox 2.Bacillus anthracis Anthrax 3.Yersinia pestis Plague 4.Francisella tularensis Tularemia 5.Botulinum toxin Botulism 6.Filoviruses and Arenaviruses Viral hemorrhagic fevers category B 1.Coxiella burnetii Q fever 2.Brucella spp. 3.Burkholderia mallei 4.Burkholderia pseudomallei 5.Alphaviruses 6.Rickettsia prowazekii
20 91 1 25 7.Toxins: ricin staph enterotoxin B Clostridium perfringence toxin 8.Chlamydia psittaci 9. category C Nipah virushantavirustick-borne haemorrhagic fevers Bunyaviridae Flaviviridae 1915 1917 mustard gas 1918 phosgene gas 1925 Geneva Protocol 1980 1988 1988 Halabja 5000 1937-1938 1996 Cameroon Mustard agents
18 1 21 Hydrogen cyanide cytochrome C oxidase iron Arsinesarsenic compounds Psychotomimetic agentslsd, etc. Toxins Nerve agent 1.Tabun, GA 2.Sarin, GB 3.Soman, GD 4.GF aerosol 5.VX Tabun atropin sulfate1-2 mg per dose 3-PAMC1 600 mgpralidoximevx AC- Hydrogen cyanide HCNAK- Cyanogen chloride CNCL iv 3% sodium nitrate 10 ml 25% thiosulfate 50 ml Variola virus 1DNA virus family Poxviridaegenus Orthopoxvirus 200 nm monkeypoxvaccinia variola viruses Monkeypox Vaccinia 2Variola virus variola major 30% variola
22 91 1 25 minoralastrim 1% chorioallantoic membrane 3 1977 1980 WHO 4 12-14 7-17 5 1 3-4 asymptomatic viremia 7-8 212-14 3 7-10 4 5Hemorrhagic malignant variola Variola minor 6 varicella 1 2 3 BSL-4 4 HSVVZV 5 PCR restriction fragment-length polymorphism
18 1 23 1 1972 2 20 3 100 250 vaccinia immune globulinvig 4 1 12-14 3-5 2 3 4 5 17 38 6Vaccinia virus 24 31-33 80% 6 Variola virus vaccinia virus 7 scab 35 65% 26 10% 12 8
24 91 1 25 Bacillus anthracis 1 obligate aerobic anthrax Anthrax = 2 24 3 virulent avirulent strainsvirulent strain px01 px02 plasmidspx02 antiphagocytic capsulepolydiglutamic acid px01 protective antigen PAedema factoref lethal factorlf 4 cattlesheephorseswine 5 6 7 1999 11 20 8 2001 10 20 10 6 Ames strain 1 cutaneous anthrax1-3 1-2 macrophage
18 1 25 95% 20% 1% 2 respiratory anthrax 2-4 6-8 biphasic 24 X WBC 3 gastrointestinal anthrax 3-7 25-75% 4 oropharyngeal form meningitis 1 2 blood agar nutrient agar 15-24 3 132 4ELISA capsular antigen Electrophoretic immunotransblot test PA exotoxin 5 anthrax 6 Differential Diagnosis tularemia plague glanders orf parapoxvirus
26 91 1 25 cat-scratch disease localized herpes echthyma gangrenosum 1 penicillin 7-10 penicillin7-10 IV ciprofloxacin 500 mg q8-12h erythromycin tetracycline doxycycline chloramphenicol ciprofloxacin streptomycin 2 contact isolation 3 paraformaldehyde vapor 5% hypochlorite 5% phenol carbolic acid chlorine dioxide chlorine 500 PPM 1 vaccine exotoxin component 92.5% booster inoculation 2 doxycycline500 mgbid ciprofloxacin 500 mgbid 30 60 60 Yersinia pestis JAMA. 2000;283:2281-2290 1 pleomorphic facultative anaerobic 28-30 C Lactose nonfermenter urease indole negative Enterobacteriaceae
18 1 27 family 2 virulent 72-kilobase plasmid V-W antigens plasmid 3 28 C coagulase bacteriocinpesticin 4 ground squirrels 5 fleaxenopsylla cheopis 6 1-7 7 50 1700 1 90% bubonic plague 50-60% septicemic plague endotoxic shock disseminated intravascular coagulationdic 20% secondary pneumonic plague primary pneumonic plague pharyngeal plague 2 2-4 DIC 3
28 91 1 25 X WBC 4 51947 1996 360 84%13%2% 14%22%57% 1 safety pin 2fluorecsent antibody test antigen-capture ELISA 3 fraction I antigen 4Blood agarmacconkey agar 48 5 1 WHO 2 isolation drainage/secretion precautions strict isolation 48 3 concurrent disinfection 4 quarantine 7 quarantine 7 5 tetracycline15-30mg/kg/day chloramphenicol 30 mg/kg/day 6
18 1 29 7 gentamicin 2.0 mg/kgivloading dose 1.7 mg/kgq8h iv streptomycin 1.0 gmq12him or iv doxycycline 100 mg po or ivbid Madagascar 13% plasmid-mediated multi-drug resistance chloramphenicol 500 mgqidpo or iv ciprofloxacin levofloxacin ofloxacin gentamicin sulfathiazole, 56 sulfadiazine sulfamerazine trimethoprim-sulfamethoxazole 24 8 1 2 3 4 killed bacteria vaccine 1-3 Francisella tularensis JAMA. 2001;285:2763-2773 1 coccobacillus Tulare County Pastereulla tularensis tularemia Jellison type AF. tularensis biovar tularensi s glycerol citrulline ornithinerabbit LD 50 10 bacteria Jellison type BF. tularensis biovar palaearctica rabbit LD 50 >10 7 bacteria 2 3 cattlehard ticks
30 91 1 25 rabbit rodent-mosquito cycle 4 DermacantorAmblyomma ticksdeer fly Chrysops Aedes nosocomial infections 5 1-14 6 14 15 C 7 1 type A type B ulceroglandular type glandular type oropharyngeal type typhoidal type 30-60% 2% pleuropulmonary type hilar lymphadenopathy oculoglanduar type 2Jellison type A 5-15% Type B 31966-1967 600 140 type B26% 12% 31% 9%
18 1 31 31% erythema multiformeerythema nodosum 4 influenza atypical pneumonia anthrax plague 1 tube agglutination >1:160 microagglutination titer >1:128 Brucella 2 3 cysteine-glucose blood agar chocolate agar cysteine heart blood agar buffered charcoal-yeast agarthioglycollate broth 37 24 4 plaguestaphylococcal or streptococcal infection cat-scratch feversporotrichosis 1Streptomycin 7.5-10 mg/kgq12him or iv7-14 15-20 mgq12him7 gentamicin 3-5 mg/kg/dayiv7-14 ciprofloxacin 500 mg pobid doxycycline tetracycline chloramphenicoltetracycline doxycycline chloramphenicol bacteriostatic 14 2 meningitis chloramphenicol 500 mgpo or ivq6h 3 vaccine 4 drainage/secretion precautions 5 110 70%
32 91 1 25 6 7 Clostridium botulinum toxin JAMA. 2001;285:1059-1070 1 neurotoxin botulism 2 zinc proteinase neuromuscular junction acetylcholine 100 C20 80 C30 855 100 biological toxins1 100 3 botulinum toxin cervical torticollisblepharospasm associated with dystonia strabismusmigraine headachechronic low back painstroketraumatic brain injurycerebral palsyachalasia dystonias 4 A-G ABE FType A type B type E type F 5 foil-wrapped baked potatoyogurtcream cheesegarlic in oilsauteed onion 1 cholinergic synapses neuromuscular and autonomic acetylcholine neurotransmitter Synapse presynaptic axon
18 1 33 synapse acetylcholine 2 cranial neuropathies 3 food-borne botulism infant botulism wound botulism Food-borne botulism 12-36 1-2 3-4 Autonomic dysfunction type BE toxins Type A toxin cranial nerve dysfunction Infant botulism colonization constipationhypotonia feeding difficulty increased drooling weak cry 1-2 achlorhydria C. baratiic. butyricum Wound botulism spore sinusitiscocaine inhalation 1 myasthenia gravis Lambert-Eaton myasthenic
34 91 1 25 syndromelems autonomic dysfunction= tick paralysis Dermacantor tick acute inflammatory polyneuropathyaipnguillain-barre syndrome areflexic= cranial neuropathy= pupillary dysfunction= poliomyelitis magnesium intoxication Organophosphate poisoning brain stem infarction diphtheria 2 anti-toxin 3 75% Mouse bioassaygel hydrolysiselisa 4Electrophysiologic studysingle fiber electromyography LEMS 1 2Trivalent equine antitoxin types ABE urticariaserum sickness 3 Penicillin 10-20 MU/daymetronidazole 500 mg qid amoxicillin 500 mgpoaminoglycosides tetracyclines neuron infant botulism 4 5 6 polyvalent antitoxin ventilatory support mortality 70% 10% 7 ph 4 or less germination of
18 1 35 spores 1. 2. 3. autopsy 4. 5. 6. 7. 8. 9.
36 91 1 25 1. 2. 3. 4. 5. 6. 7.
18 1 37 1.CDC guidelines AMA consensus reports 2.ProMed EIN 3.The New Terrorism, by Walter Laqueur, Oxford, New York, 1999 4.Living Terrors, by M.T. Osterholm and J. Schwartz, Dell, New York, 2000 5.Biohazard, by Ken Alibek and S. Handelman, Dell, New York, 1999 6.Six Nightmares, by Anthony Lake, Little Brown, Boston, 2000 7.Terrorism, by John Pynchon Holms and T. Burke, Kensington, New York, 2001
38 91 1 25 LCt 50 LD 50 mg. min/m 3 mg/ -------------------------------------------------- Tabun 200 4000 Sarin 100 1700 Soman 100 300 VX 50 10 7-17 days 14-21 days 2-4 days 10-14 4-7 14-28 <14
18 1 39 1. 2 88 7 1 88 3 88 10 89 2 2. 1 2 3. 1 - - 4.Total no. of specimen 1999.3.1-2002.1.9 35% 30% 25% 20% 15% 10% 5% 0% 1999/3/1-14 4/26-5/9 Total specimen no. 6/21-7/4 8/16-29 10/11-24 12/5-18 1/23-2/5 3/19-4/1 5/14-27 7/9-22 9/3-16 10/29-11/11 12/24-31 2/11-24 4/8-21 6/3-16 7/29-8/11 9/23-10/6 11/18-12/1 1/13-26 Pan-EV(%) 2500 2000 1500 1000 500 0
40 91 1 25 Coxsackie A Coxsackie B Echo 1999.3.1-2002.1.9 8% 7% 6% 5% 4% 3% 2% 1% 0% 1999/3/1-14 4/12-25 5/24-6/6 Echo(%) CA(%) CB(%) 7/5-18 8/16-29 9/27-10/10 11/8-21 12/19-31 1/23-2/5 3/5-18 4/16-29 5/28-6/10 7/9-22 8/20-9/2 10/1-14 Sabin vaccine virus EV71 1999.3.1-2002.1.9 11/12-25 12/24-31 1/29-2/10 3/11-24 4/22-5/5 6/3-16 7/15-21 8/26-9/8 10/7-20 11/18-12/1 1/1-5 5% 4% 3% 2% 1% 0% 1999/3/1-14 4/12-25 5/24-6/6 S-polio(%) 7/5-18 8/16-29 9/27-10/10 11/8-21 12/19-31 1/23-2/5 3/5-18 4/16-29 5/28-6/10 7/9-22 8/20-9/2 10/1-14 11/12-25 12/24-31 1/29-2/10 3/11-24 4/22-5/5 6/3-16 7/15-21 8/26-9/8 10/7-20 EV71(%) 11/18-12/1 1/1-5
18 1 41 Inf-A Inf-B 1999.3.1-2002.1.9 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 1999/3/1-14 4/12-25 5/24-6/6 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 1999/3/1-14 4/12-25 5/24-6/6 Total specimen no. Inf-A(%) Inf-B(%) 7/5-18 8/16-29 9/27-10/10 11/8-21 12/19-31 1/23-2/5 3/5-18 4/16-29 5/28-6/10 7/9-22 8/20-9/2 10/1-14 Adeno RSV 1999.3.1-2002.1.9 Total specimen no. Adeno(%) RSV(%) 7/5-18 8/16-29 9/27-10/10 11/8-21 12/19-31 1/23-2/5 3/5-18 4/16-29 11/12-25 12/24-31 1/29-2/10 3/11-24 4/22-5/5 6/3-16 7/15-21 8/26-9/8 10/7-20 11/18-12/1 1/1-5 2500 2000 1500 1000 500 5/28-6/10 7/9-22 8/20-9/2 10/1-14 11/12-25 12/24-31 1/29-2/10 3/11-24 4/22-5/5 6/3-16 7/15-21 8/26-9/8 10/7-20 11/18-12/1 1/1-5 0 2500 2000 500 0 1500 1000