Update on Bioterrorism
and Aerospace Operations
Glenn W. Mitchell, MD, MPH
Outline
• Lifting the veil on bioterrorism
– Pre-2001
• Military and the crazies vs the general public
• Where are we now?
– Initial shock and fear
• Military and public fusion
– Present ennui
• That was so last year….
• Brief primer on Category A threats
• The aerospace world
– Military
– Commercial
• What is the future?
Bioterrorism before 2001
• Pre-20th century
– Messy and inefficient
•
• Bodies with plague; smallpox on blankets
The 20th century
– Science & Technology facilitate nastiness
•
•
•
•
Increasing effectiveness; better delivery; designer bugs
Military uses in Mexico, China; arms race; treaty
Civilian uses in SW Asia, Japan, US (Oregon)
Public does not believe it is a threat to them
• Military and paranoid view
– Just a matter of time….
Who are these people?
Bioterrorism in the 21st century
• The US Mail changed everything
– The clinical impact
• Only 22 people caught anthrax (11 inhalational)
• Only 5 people died; very ineffective bug
– The operational impact in the US
• Mass hysteria; drugs, PPE
• Governmental action; DHS, loss of privacy, funds
• International scene
– War with Iraq
– War on terrorism
– World leaders united in anti-terrorism stance
• Today
– Public losing interest; required attention span too long
– Military split with public rebuilding
– Congress relooking funding; human rights looking at personal
freedoms
Brief Primer
• CDC Category A agents
– "...ability to cause disease that (1) is easily disseminated or transmitted
from person to person; (2) has high mortality, with potential for major
public health impact; (3) may result in panic and social disruption; and
(4) requires special action for public health preparedness."
• The “A” List
–
–
–
–
–
–
Anthrax
Smallpox
Botulism
Plague
Tularemia
Viral hemorrhagic fevers
• JAMA series of articles
Recognition is the Central Problem
• Difficult to obtain and interpret surveillance data
– Too much data to collect
– Little agreement on what to look at
• Difficult to predict locations of attack
• Difficult to train all providers
• Difficult to control movement of individuals
– Point source unlikely
• Difficult to maintain attention
Recognition by Season
National Notifiable Disease Surveillance System, United States, 1992-1999
Recognition by Location
Recognition by Annual
Incidence
180
160
140
120
100
80
60
40
20
0
1992 1993 1994 1995 1996 1997 1998 1999
Anthrax
Botulism
Plague
Tularemia
National Notifiable Disease Surveillance System, United States, 1992-1999
What is this?
What are these findings?
Name these diseases
What are these?
Name these diseases
your state health department at
_________________________
or
your local health department at
_________________________
Aerospace Concerns
• Military
– Contamination of airframes
• DECON undefined
• Dedicated airfleet required
– Effects on aircrew
• Uncertain Dx
• Varying incubation periods
• Antibiotic susceptibilities
– Personal protective equipment
• Effect of function
• Effect on heat load
Aerospace Concerns
• Civilian Aerospace
–
–
–
–
–
–
–
Economics of commercial aviation
Airport security delays and effects
Efficacy of cabin air filtration
Passenger notification of exposure
Liability issues
Boarding of ill passengers
Aircrew exposures
• Space
– Crew exposure preflight
– Contamination of spacecraft
Bioterror Agent Data Sheet
Agent
Size
Usual
Route
Personto-person
spread?
Penetrate
Intact
Skin?
Penetrate
Intact Mucous
Membranes?
Viability
(cool,
moist)
Viability
(warm,
dry)
Anthrax,
Inhalational
Cocco-bacilli
1-2 microns
Inhaled
N
N
N
<2 days
<6 hours
Plague,
Pneumonic
Cocco-bacilli
1-5 microns
Inhaled
Y
N
Y
30 days to
2 years
1 hour +
Tularemia
Cocco-bacilli
1-2 microns
Inhaled
Contact
N
Y
Y
weeks
~1 hour
Smallpox
Virons
0.1-1
micron
Inhaled
Y
N
Y
<1 hour
<1 day
Hemorrhagic
Fevers
Virons
0.1 microns
Parenteral
Contact
±
N
Y
hours
<1 hour
Botulism
Toxin
0.1 microns
Ingested
N
N
±
hours
<1 hour
Disease
Category A
Glenn W. Mitchell, MD, MPH
20 August 2004
It is the Economy…
Air traffic halted, consumer spending fell, businesses
reduced investment, and companies announced
thousands of layoffs. Estimated cost to the US was $21
billion in 2001-02. The government ran budget deficits
for the next three years because of both a recession and
the high cost of combating terrorism. The budget
increased defense spending by 13 percent and doubled
funding for homeland defense.
Travel and leisure industries suffered the worst job losses,
mainly among airlines, hotels, car rental firms, and
restaurants. In just the last five months of 2001, the
travel industry lost 237,000 jobs. Congress approved a
$15 billion emergency assistance package to help the
airlines recover in late 2001.
Copyright ©2004 Council on Foreign Relations
What will happen next?
Personal predictions
•
•
•
•
US and allies will continue to have outbreaks
Flu season may have virulent strain(s)
Insect vectors will be increasingly infective
Envelopes will migrate to more direct methods
– Subways; airplanes
• Smallpox will return
– US will mount effective but costly control program
– Remainder of world will be even more angry
• US military will operate in even more countries
Questions?