Top Disease Control Expert Urges - Prepare Now for Bioterrorism
By Daniel J. DeNoon
Senior Editor, Vaccine Weekly
From Frank Altomonte
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.
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.
"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."
Henderson spoke in a plenary address to the International Conference on Emerging Infectious Diseases, held March 8-11, 1998, in Atlanta, Georgia.
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.
"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."
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.
"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."
Henderson argued that the front lines in a bioterrorism attack will almost definitely be infectious disease specialists.
"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.
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]
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.
"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.
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.
"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."
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.
"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."
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.
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.
"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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