- Note: The following article from Vaccine
Weekly summarizes a presentation given at the International Conference
on Emerging Infectious Diseases held in Atlanta March 8-11th.
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- Is preparing for biological terrorism
really worth such great effort and expense? The answer is an emphatic yes,
according to D.A. Henderson, Distinguished Service Professor at Johns Hopkins
University and former Chief of the CDC's Surveillance Section.
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- "We cannot delay in the development
and implementation of strategic plans for coping with bioterrorism,"
Henderson said. "The needed stocking of vaccines and drugs as well
as the training and mobilization of health workers both public and private,
at state, city, and local levels will require time."
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- Henderson spoke in a plenary address
to the International Conference on Emerging Infectious Diseases, held March
8-11, 1998, in Atlanta, Georgia.
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- He warned that the ability to create
and effectively deploy lethal disease organisms can be acquired with relative
ease not only by nations but also by terroristic groups. And this is not
merely a vague possibility: Iraq in 1995 confirmed production and deployment
of bombs, rockets, and aircraft spray tanks filled with anthrax bacillus
and botulinum toxin. The Japanese cult Aum Shinrikyo in 1995 released a
nerve gas in a Tokyo subway station; the group was later found to have
amassed sophisticated materials and plans for biological terrorism.
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- "Included in its arsenal were large
quantities of nutrient media, botulinum toxin, cultures of anthrax, and
drone aircraft equipped with spray tanks," Henderson said. "Notably,
members of this group had traveled to Zaire in 1992 to obtain samples of
Ebola virus for weapons development."
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- The Johns Hopkins researcher also noted
that Russia's most sophisticated bioweapons facility, known as Vector,
comprised 30 buildings and a 4000-person operation once protected by an
elite guard and an electrified fence.
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- "Here is where the smallpox virus
is kept and here is where work has been going on using Ebola, Marburg,
the hemorrhagic fever viruses such as Machupo and Crimean-Congo, as well
as others," he said. "Visits this autumn disclose a half-empty
facility, the electric fences no longer electrified and a handful of guards
who had not been paid for months. No one can say where the scientists have
gone."
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- Henderson argued that the front lines
in a bioterrorism attack will almost definitely be infectious disease specialists.
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- "The rapidity with which they and
those manning the emergency rooms reach a proper diagnosis and the speed
with which preventive or therapeutic measures are applied could well spell
the difference between thousands and perhaps tens of thousands of casualties,"
he said.
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- There is some consensus that the most
likely agents to be used in a biological weapons attack would be smallpox,
anthrax, or plague. Henderson reviewed recent smallpox outbreaks [early
1970's - imported cases in Germany and Yugoslavia - JTT] and the panic
they caused. And as vivid as these accounts were, he noted that they took
place among well-vaccinated populations. Today, no more than 10 to 15 percent
of the U.S. population has significant immunity to smallpox. [In US routine
vaccination stoppd in 1972- JTT]
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- It would take only a modest introduction
of smallpox to create an enormous public health emergency, as few physicians
are trained to recognized smallpox and diagnostic reagents are maintained
at only two government laboratories.
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- "Present U.S. stocks of smallpox
vaccine are nominally listed at 15 million doses but, as it is packaged,
the useful number of doses is perhaps half that number," Henderson
said.
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- While only a relatively few doses would
be needed if vaccination were limited to close contacts of confirmed cases,
the realities of a public panic would make such a cautious approach impossible.
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- "Present reserves of vaccine would
rapidly disappear and there is, at present, no manufacturing capacity anywhere
to produce additional vaccine," Henderson said. "If an emergency
effort were made to produce new stocks of smallpox vaccine, many months
to a year or more would be required."
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- An attack with anthrax could be at least
as damaging. Henderson described the hellish scenario that followed the
1979 accidental release of a small amount of aerosolized anthrax from a
bioweapons facility in a remote region of the former Soviet Union. This
disaster, which killed at least 66 people and perhaps "considerably
more than 100," was caused by the release of no more than a gram of
anthrax spores. Iraq admitted that it had produced some 8000 liters of
anthrax solution containing a billion spores per milliliter.
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- "The ramifications of even a modest-sized
release of anthrax spores in a city are profound," Henderson said.
"Emergency rooms would begin seeing a few patients with high fever
and some difficulty breathing perhaps three to four days following exposure.
By the time they were seen, it is almost certain that it would be too late
for antibiotic therapy. Essentially all would be dead within 24 to 48 hours."
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- Henderson said that there is now very
little anthrax vaccine available and no plans to produce any for civilian
use. The prophylactic administration of antibiotics on a large scale would
be problematic at best.
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- In the best of all possible worlds, prevention
of bioterrorism via international treaties and moral consensus would be
possible. But we do not live in such a world.
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- "We need to be as prepared to detect
and diagnose, to characterize epidemiologically and to respond appropriately
to biological weapons use as we need to be prepared to respond to the threat
of new and emerging infections," Henderson warned. "Knowing what
little has been done to date, I can only say that a mammoth task lies before
us. ... If we can and are willing to spend tens of billions to deal with
the threat of nuclear weapons, as is now the case, we should be more than
prepared to devote hundreds of millions to cope with the greater threat
of new and emergent infections, whether naturally occurring or induced
by man."
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