Jeffrey R. Ryan

Recognition of Biological Threat

This chapter explores the different types of biological entities that can be harmful to humans, animals, and plants: specifically, bacteria, rickettsia, viruses, fungi, and biological toxins. These make up the agents that would most commonly be exploited for use in a biological weapon. There are characteristics common to all of these agents. Most notably, they may be acquired naturally, especially if one knows where to look for them. All are invisible to the human senses and require incubation periods before disease conditions are noticeable; therefore they might be deployed covertly, and evidence of the event may not be apparent for days or weeks. The four routes of entry into the host are by inhalation, ingestion, absorption, and injection. Most biological weapons formulations have been adapted for entry by inhalation. After infection, patients manifest signs and symptoms of disease. Clinical presentation results in a differential diagnosis, in which many disease possibilities may be considered. After that a tiered diagnostic system may be used so that as additional information is known about the patient, the diagnosis may proceed from suspected to probable to confirmed. The ever-present threat of biological weapons and emerging diseases has given rise to programs and initiatives in biodefense and biosecurity.

Category A Diseases and Agents

This chapter covers Category C diseases and agents. These emerging diseases present a very unique challenge to public health officials and infectious disease specialists. Perhaps they have been with us for millions of years, lurking in a dark corner of the environment, waiting for an opportunity to jump from their natural cycle of transmission to a human host. Or they may represent something totally new. Regardless of their origin, an emerging disease pathogen must be characterized quickly by molecular biologists and microbiologists. The dynamics of disease transmission must be investigated by teams of epidemiologists. Treatment regimens must be formulated by clinicians working on the frontlines of the outbreak. Disease prevention strategies and risk communications must be quickly formulated by public health officials. Finally, media attention for emerging disease outbreaks forces government officials at all levels to address the problem with planning and preparedness activities aimed at preserving the health of the public. Specific examples explored in this chapter include Nipah virus, hantavirus, West Nile fever virus, and the coronaviruses that cause severe acute respiratory syndrome and Middle East respiratory syndrome.

Biological Threat to Agriculture

Chapter 8 discusses the importance of agriculture and food systems to national economies and as an element of critical infrastructure. It also points out that agriculture and food systems are most vulnerable to threats from biological agents. These agents often produce devastating results when outbreaks of animal or crop disease are introduced naturally or accidentally. The malicious and intentional introduction of a crop or animal disease agent is known as agroterrorism. Agroterrorism has potential to undermine the economy of a nation and cause animal health professionals and government officials at all levels to muster an enormous response effort to contain the disease. Biosecurity in an agricultural setting can be described as several best practices aimed at reducing the threat of biological agents to the farm, animal production facility, or food processing and distribution center. Quarantine and stop movement procedures are used to prevent further spread of a disease. Involvement of the state and federal agencies is coordinated and in compliance with the National Incidence Management System and the National Response Framework. Various strategies for containment are discussed as well as quarantine, movement restrictions, disinfection, and carcass disposal activities.

Recognize, Avoid, Isolate, and Notify

Chapter 6 covers the use of the common acronym RAIN, which stands for recognize, avoid, isolate, and notify. This acronym is often used in first responder training and awareness programs for weapons of mass destruction. Not all acts of terrorism are overt. The text emphasizes that biological weapons may be covertly deployed, leaving no outward sign for days or weeks, until the first few cases begin to appear after the agents incubation period. In this event, health-care professionals must be vigilant to note the signs and symptoms of the diseases that make Categories A, B, and C. Alternatively, there may be outward signs that a biological weapon has been deployed. As with the Amerithrax incident, the letters containing the agent came with a warning. Regardless, first responders and first receivers must be properly trained to protect themselves and contain the outbreak. The acronym RAIN provides a framework for guiding their actions. Recognition is the key to an effective response. Knowing that a problem exists precipitates a long list of actions from numerous agencies at all levels. The concept RAIN was introduced here so that it may be applied to the case studies that follow in chapter Case Studies .

Consequence Management and a Model Program

Abstract Chapter 13 explores in detail the Biohazard Detection System that was built for the US Postal System (USPS) in the wake of the Amerithrax incident. This autonomous detection system was needed to protect postal workers and ensure the safety and integrity of the US mail. The commercial sector worked quickly and efficiently to build the solution that the USPS needed. Autonomous detection systems are built from impressive and intricate technologies. These systems enable us to monitor the environment for a potential attack from a bioterrorist. The biohazard hazard detection system is a perfect example of a model system. It is intended to take advantage of exposure surveillance compared with disease surveillance, which reduces the time for detecting a bioterrorist attack, thereby reducing the risk of disease through postexposure prophylaxis. Consequence management and concept of operation are also important components to well thought-out programs aimed at taking advantage of these systems to the fullest extent possible.

Seeds of Destruction

Abstract This chapter provides the reader with an understanding and appreciation for the scope and importance of biological threats and the opportunity to see where they may be and have become the desire of terrorist groups and the makings of weapons of mass destruction. The history of biological warfare is covered in depth. These major events are important in helping us understand the issues related to using biological substances against an adversary. The difference between biosecurity and biodefense are explained and then related to homeland security and homeland defense, respectively. This chapter also details how expensive these programs are, with nearly

Future Directions for Biosecurity

80billion having been spent on civilian biodefense since fiscal year 2001 in the United States alone. As discussed herein, there is a significant difference in the reality and the potential of bioterrorism. Bioterrorism on a large scale is a low-probability event. Bioterrorism on a small scale is a fairly routine occurrence with little potential. Biological threats remain very much in the news. Recent examples, such as laboratory incidents, the Ebola outbreak of 2014, and other emerging threats, are covered in this chapter.

Chapter 7 – Case Studies

Abstract This chapter discusses the likely future of bioweapons development and the research that is needed to counter them. Methods for creating customized pathogens that can evade an immune system or work around a conventional antibiotic are discussed. In addition, emerging trends in synthetic biology are discussed. Biological warfare and bioterrorism are multifaceted problems requiring multifaceted solutions. Fortunately, the same advances in genomic biotechnologies that can be used to create bioweapons can also be used to set up countermeasures against them. We currently have in place sophisticated and well-developed biosecurity and biodefense programs. These programs are essential to countering the asymmetric warfare threat, but they are costly and perishable. Future directions in biosecurity and biodefense may very well be determined by the “next event.” However, the most likely events are those that naturally and accidentally threaten human and animal health through the emergence of novel pathogens and the reemergence of others in light of new environmental or societal factors.

Biosecurity Programs and Assets

Abstract Chapter 7 presents six case studies that should provoke the reader to delve more into the particulars of each incident. Specifically, the chapter provides details on the Sverdlovsk anthrax incident (1979); the Rajneeshee Salmonella incident (1984); the Surat, India pneumonic plague outbreak (1994); the Fallen Angel ricin incidents (2003–04); Amerithrax (2001); and the outbreak of Ebola virus in West Africa (2014–15). Each of these incidents help illustrate the difference between an unusual natural outbreak and one due to an intentional act. In addition, each case study presented herein shows how confounding these outbreaks can be to public health officials and how fear, panic, and social disruption may ensue.

Response at the State and Local Level

Abstract Chapter 12 explores the programs and assets that have been assembled internationally, nationally, and regionally to safeguard populations from the threat of biological agents. The programs and assets can be viewed with the framework of comprehensive emergency management, which is made up of mitigation, preparedness, response, and recovery. Nations have come together and taken a stance individually to mitigate the threat. For the most part, these programs produce policy and procedures that support the Biological and Toxin Weapons Convention of 1972. Responding to a biological disaster will be frustrating, confusing, and dangerous for first responders, first receivers, and public health officials. Developed countries are far better trained and equipped to deal with the release of a formulated biological agent than they were 15years ago. Specific examples of programs and assets that match up with mitigation, preparedness, response, and recovery are discussed herein.