May 16, 2012

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Bioterrorism — Are We Prepared?

Martin J. Carey, M.D.

For most of us, bioterrorism seems out there with alien invaders as something likely to occur on television but not in real life. Or perhaps if we do think about it more in terms of the here and now, a sort of panicky sense of "It's too scary, " sets in and we push it out of our minds as quickly as we can.

Hospital emergency rooms, however, don't have this luxury. Many of them have begun to develop procedures for dealing with various bioterrorist events because, in the past twenty years, there have been a number of bioterrorist attacks around the world:

1979	An accidental release of anthrax spores from a Russian military base in Sverdlovsk kills between 40 and 1,000 people. The number remains unknown because of a massive Soviet cover-up.
1984	Attempting to disrupt a local election, members of a religious cult poison 751 residents of The Dalles, Oregon, by contaminating restaurant salad bars with salmonella.
1995	A dozen commuters are killed when members of Aum Shinrikyo, another religious sect, intentionally release Sarin, a type of nerve gas, on a Tokyo subway.
1996	An unknown person leaves muffins contaminated with a rare and dangerous bacteria in a Texas hospital.
1998	FBI agents seize small amounts of a substance reported to be anthrax from two men in Las Vegas.
2000	A Texas man is indicted for causing an anthrax scare, becoming the first person in the nation to face such charges. He left a vial of what was alleged to be anthrax , but which actually contained water, in a bin at the U.S. Postal Service mail center.
2000	Anthrax contamination threats are made against numerous Planned Parenthood clinics across the U.S. So far, none has been carried out.

Bioterrorism is not a paranoid fantasy. It did not die with the end of the Cold War. It does not happen only in obscure Third World conflicts. Ironically, the threat of a massive chemical or biological attack, especially with certain infectious agents such as smallpox and anthrax, exists because of the achievements of modern medicine that have eradicated these scourges.

Together with recent advances in biotechnology, that have made it very easy to mass-produce microorganisms, we now face a real threat from these biological agents. What do we know about smallpox and anthrax? Is there anything we can do to protect ourselves and our communities from such agents?

Smallpox

Smallpox is an extremely contagious viral disease. Capable of killing up to 40% of those it infects, smallpox has afflicted mankind since prehistory in successive waves of great epidemics. Imported by European explorers and settlers to the New World, it killed more Native Americans than all the settlers' bullets and swords.

Smallpox can be contracted through breathing or by contact with the skin of an infected person. After an incubation period lasting approximately two weeks, sufferers come down with fever and aches. A few days later, blisters spread over the body. These blisters fill with pus, then open and crust over, causing painful itching. Those who survive the disease are left with terrible pockmark scars.

In the 20th century, the worldwide vaccination campaign against smallpox achieved amazing results."

While there is no actual treatment for smallpox, Englishman Edward Jenner, in 1796, used the related cowpox virus to create immunity to smallpox. The word vaccination derives from "vacca," the Latin word for cow. Modern versions of Jenner's vaccine gave complete immunity from smallpox, as long as periodic booster shots were taken. But if the booster shots are not continued, the degree of immunity provided by the vaccine gradually declines, over several years, to zero.

In the 20th century, the worldwide vaccination campaign against smallpox achieved amazing results. By the 1960s, the disease was eliminated in the U.S. and vaccinations ceased in 1971. In 1980, the World Health Organization (WHO) declared that smallpox had been eliminated worldwide.

Today, smallpox virus is known to exist in only two places: in stores maintained by the U.S. Centers for Disease Control and Prevention (CDC) and by the Russian government. However, fears that other nations or organizations may have secret stockpiles of the disease prompted WHO to postpone, until at least 2002, its controversial plan to destroy all remaining stocks of the smallpox virus. Critics of the plan had argued that samples of smallpox might be needed for research purposes in the event of an attack or outbreak.

In 1998, Dr. Donald A. Henderson, the scientist who directed WHO's smallpox eradication program from 1966 to 1977, warned that smallpox still presents a formidable danger to mankind. Speaking of the former bioweapons center at Novosibirsk in Russia, he recalled that through the early 1990s, the 30-building facility had been surrounded by electric fences and patrolled by an elite guard. Recently, however, the facility stood decrepit, half-empty and poorly guarded. "There's no way of knowing for sure where all the scientists have gone," he said. "Nor is there confidence that this is the only storage site for smallpox virus outside CDC." Some Russian scientists from Novosibirsk are rumored to have traveled to Iran to participate in bioweapons research there.

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