Draft Syllabus -- topics and session orders may change -- 8/17/2011
PM 546: BIOLOGICAL THREATS AND TERRORISM
Note: This color scheme has been
abandoned by Homeland Security
Master of Public Health Program, Department of Preventive Medicine,
Keck School of Medicine, University of Southern California
Instructors:
Marc Strassburg, DrPH
County of Los Angeles, Department of Public Health
Information Systems, Web Informatics Division
Tel.: (213) 240-7785
FAX: (213) 250-2594
Email: strassbu@usc.edu
Frank Sorvillo, PhD
County of Los Angeles, Department of Public Health
Health Assessment and Epidemiology
Tel: (213) 240-7785 FAX: (213) 250-2594
Email: fsorvill@ucla.edu
TA:
Donna Decker
Time:
Location:
Office Hours:
Thursdays, 6:00 – 9:30 pm
Soto Street Building Room 117 (Rm to be confirmed)
Virtual (via email/tel) and by appointment
COURSE DESCRIPTION:
Public health professionals are responsible for protecting and maintaining the health of
individuals and communities. Following both the hoax events of 1998-99 and the real ones of
2001 which included the intentional release of Bacillus anthracis, the practice of public health
has evolved to address new threats to public safety. This course provides a comprehensive
introduction to those infectious disease agents that are likely to be used by bioterrorists -- and
also includes chemical, radiation, and genetic engineering threats, although to a lesser degree.
Methods of preparedness, prevention and response are examined and also placed within the
context of emerging infections such as pandemic H1N1, WNV, and SARS.
Students are introduced to the history of bio-warfare and bioterrorism; proper surveillance
techniques, recent research in countering bioterrorism, capacity building for public health and
medical communities, and the importance of effective communications. Various experts in the
field provide lectures throughout the course, and students are assigned one topic and develop
and present a PowerPoint during the class.
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REQUIRED COURSE READINGS:
1. JAMA Consensus Articles -- Recommendations regarding measures to be taken by medical and
public health professionals against possible biological weapons used against a civilian population.
(These can be downloaded from the Blackboard.)
2. Osterhom M and Schwartz J. Living Terrors 2000, Delacorte Press, New York, New York. ISBN: 0385-33480+
3. Pendergrast M. Inside the Outbreaks. The Elite Medical Detectives of the Epidemic Intelligence
Service. Houghton Mifflin Harcourt, ISBN: 978-0-15-101120-9+
+ These books read more like novels, nevertheless, students are encouraged to review relevant
sections pertaining to each lecture by looking up topics in the Indices.
SUPPLEMENTAL COURSE RESOURCE:
1. Control of Communicable Diseases Manual David L. Heymann American Public Health Association
Publication (This is a classic reference Guide for all Infectious Disease Epidemiologists: students will
find that reviewing chapters in this book will provide excellent background on the natural history of
the diseases being discussed see review at http://ije.oxfordjournals.org/cgi/content/full/34/6/1446)
<students who are very interested in infectious diseases will find this to be a valuable aid>
EVALUATIVE CRITERIA:
25% PowerPoint Presentation based on Competencies* – In Class
15% Book/Movie Review** (Fiction or non-fiction --- submit proposed book title for approval)
10% Current Event/Information (each student is expected to present briefly on 2 topics)
20% 5 Homework Assignments (1 page – must be submitted prior to the start of class – each
homework is worth 4 points – Points are deducted if poor quality, late, and/or excessive length)
30% Final Exam
*The PowerPoint Presentation should be approximately 10-15 minutes in length. CDC presentation guidelines
are available for downloading from the Blackboard. Topic areas will be assigned. Grading is based on:
1. Overall effectiveness of presentation, both clarity of slides, balance of text and graphics, and delivery.
2. Depth of presentation
3. Knowledge of subject matter and ability to convey it -- i.e. relating to one's audience
4. Integration of current information and events
5. Ability to go into or drill down into the data/information presented
6. Epidemiological and scientific appropriateness e.g. age-specific rates, adjusted rates, confounders, bias, etc.
7. Observed time limit
**Book Review examples:
http://www.cdc.gov/ncidod/EID/vol9no2/02-0697.htm
http://www.cdc.gov/ncidod/EID/vol10no11/04-0728.htm
STUDENTS WITH DISABILITIES:
Any student requesting academic accommodations based on a disability is required to register with
Disability Services and Programs (DSP) each semester. A letter of verification for approved
accommodations can be obtained from DSP. Please be certain the letter is delivered to me as early
in the semester as possible. DSP is located in on the University Park campus in STU 301 and is open
8:30 a.m. – 5:00 p.m., Monday through Friday. The phone number is (213) 740-0776.
ELECTRONIC COURSE MANAGEMENT:
The USC BlackBoard is the online learning portal through which we will provide electronic copies of
PowerPoint lectures, and other course materials. Students may obtain access at
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https://blackboard.usc.edu/ using their USC computer user name and password. All courses that
students are enrolled in that are using the Blackboard will appear on the page as a link. Simply
follow the link to access online course materials and grades.
KEY COMPETENCIES FOR THIS COURSE:
Identify leading Infectious agents likely to be used in a biological terrorist (BT) attack, and be able to
describe these agents within the context of the ecological framework and the 'Natural History of the
Disease'.
Identify sentinel historical events in the development and use of BT weapons.
Describe other possible non-biological modes of terrorist attacks -- including chemical, radiation, and
genetic.
Identify social and behavioral dysfunctions which might influence individuals to become involved in BT
activities.
Specify interventions which might be applied to mitigate fear and hysteria during a possible or real BT
attack.
Identify surveillance systems which can be used to detect a BT attack. Apply basic informatics and
statistical analytic techniques using hospital and other syndromic data to describe and detect a possible
BT event.
Evaluate the strengths and limitations in utilizing BioSense detection tools
Identify the principles and limitations of public health preparedness plans and the Incident Command
Structures (ICS).
Describe federal and state and local laboratory levels and capabilities related to the testing of suspected
BT agents.
Apply the basic terminology and methods of epidemiology used in outbreak detection and control related
to a BT event.
Discuss various risk communication approaches used to relate key epidemiologic information during a
BT event to both lay and professional audiences.
Specify preparedness approaches for assessing, preventing and controlling BT events.
Develop oral presentations based on specific analysis of a BT topic targeted for both public health
professionals and informed lay audiences.
Demonstrate effective written skills by doing homeworks and reviewing a book /movie on a real or
theoretical BT event/activities.
Apply evidence-based epidemiological, biological, and molecular concepts to the evaluation of likely
threats.
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TOPICS COVERED (PLEASE NOTE THAT THE TOPIC ORDER MAY CHANGE BASED UPON THE AVAILABILITY OF A GUEST
LECTURER
– STUDENTS WILL BE INFORMED OF ANY CHANGES)
TOPIC 1
Topic: Introduction to Class.
Objectives: Obtain a clear understanding of what bioterrorism is and why concern exists over the
potential use of biological agents. Review the history of Bioterrorism. Short review of Epidemiology.
Readings:
History of Biowarfare and Bioterrorism:
http://www.hs.state.az.us/phs/edc/edrp/es/bthistor2.htm
Historical Trends Related to Bioterrorism: An Empirical Analysis
http://www.cdc.gov/ncidod/EID/vol5no4/tucker.htm
Pavlin J. Epidemiology of bioterrorism. Emerging Infectious Diseases 1999; 5: 528-530
http://www.cdc.gov/ncidod/EID/vol5no4/pavlin.htm
Topic 2
Topic: The Psychology of Bioterrorism
Objectives: Identify psychosocial effects of a threat and actual attack of a bioterrorist agent.
Readings:
Mental Health Consequences of Bioterrorism http://www.ima.org.il/imaj/ar02jul-12.pdf
CDC Anthrax site: http://www.bt.cdc.gov/agent/anthrax/index.asp
Homework 1:
You are the head of a terrorist cell located in Los Angeles and are given one gram (the size of a sugar packet) of
weaponized anthrax spores from a sympathetic scientist, to use as you choose. If your goal was to disrupt and
cause the greatest amount of fear in the community of Los Angeles, how would you go about doing that - explain
both your approach to the logistics and the psychological effects?
TOPIC 3
Topic:
Likely bacterial agents to be used in a bioterrorist attack – anthrax, plague, tularemia, etc.
Objectives: To identify the leading bacterial agents; describe the natural history of these diseases
and method(s) of dispersal.
Readings:
Bioterrorism-Related Inhalational Anthrax: The First 10 Cases Reported in the United States
http://www.cdc.gov/ncidod/eid/vol7no6/jerniganG2.htm
Ring Vaccination and Smallpox Control http://www.cdc.gov/ncidod/EID/vol10no5/03-0419.htm
TOPIC 4
Topic: Viral agents that could be used in a bioterrorist attack – Example Smallpox
Objectives: To explain why smallpox is considered to be a primary threat for use as a bioterrorist
agent; the Smallpox Eradication Story.
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Readings:
Strassburg, M.A.: The Global Eradication of Smallpox, American Journal of Infection Control.
Vol 10 Nu 2, May 1982 (Blackboard)
Homework2: If smallpox was introduced into a community at a single point source, what would be
the differences in control strategies resulting from this act of bioterrorism vs strategies in controlling
a naturally occurring smallpox outbreak?
Topic 5
Topic: Other Viral agents that could be used in a bioterrorist attack. Also the Age of Pandemics:
SARS, H1N1
Objectives: The hemorrhagic fevers in perspective and update students on pandemic influenza and
SARS, and how preparing/dealing with an emerging infection has similarities to that of BT
preparedness and response.
Readings:
H1N1 Flu Summit http://www.flu.gov/plan/2009flusummit.html
Avian Influenza: assessing the pandemic threat
http://www.who.int/csr/disease/avian_influenza/pandemic/en/index.html
http://www.who.int/csr/disease/influenza/WHO_CDS_2005_29/en/
AARC SARS Guidance Document www.aarc.org/resources/sars/aarc_sars_b.html
Topic 6
Topic:
Likely parasitic agents to be used in a bioterrorism attack. Environmental monitoring.
Objectives: Identify the leading parasitic agents (Cryptosporidium, Baylisascaris, Toxoplasma,
etc.), understand the natural history of these diseases and method(s) of dispersal.
Readings:
Sorvillo et al Baylisascaris procyonis: An Emerging Helminthic Zoonosis Emerging Infectious
Diseases • Vol. 8, No. 4, April 2002 http://www.cdc.gov/ncidod/EID/vol8no4/01-0273.htm or http://www.cdc.gov/ncidod/EID/vol8no4/pdf/01-0273.pdf
Homework3:
Dr. Sorvillo’s paper (above) on Baylisascaris presented new information on a common roundworm
infection of raccoons which could possibly be utilized as a bioterrorist agent. Should such
information be published in the literature? Take a pro or con stance, and provide the rationale for
your position.
Topic 7
Topic: Responding to bioterrorism – Command structures, local stockpiles of biological and other
resources and communications and event coordination
Objectives: Recognize the importance of stockpiles, coordination, and communication in responding
to a bioterrorist event.
Readings
The Public Health Response To Biological And Chemical Terrorism - Read Appendix 1
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http://www.bt.cdc.gov/Documents/Planning/PlanningGuidance.PDF
http://www3.niaid.nih.gov/biodefense biodefense Web site of the National Institute of Allergy and
Infectious Diseases (NIAID),
Homework4:
In a pre 9/11 American Public Health Association editorial entitled Bioterrorism Initiatives: Public
Health in Reverse? By Drs. Cohen, Gould, and Sidel, the authors state “Bioterrorist initiatives may
divert resources from other, more urgently needed public health tasks or may place public health
agencies and personnel under the control of military or law enforcement officials..” Please read this
editorial and comment on whether you agree or disagree – give reasons.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1509000
Topic 8
Topic: Likely agricultural and veterinary agents to be used in a bioterrorist attack.
Objectives: Recognize the likely agricultural and veterinary agents of bioterrorism, their natural
history and probable method(s) of dispersal; explain the possible involvement of agricultural
products and livestock as targets.
Readings:
Bioterrorism Protection Act of 2002 http://www.fda.gov/oc/bioterrorism/bioact.html
Agricultural Bioterrorism http://www.actionbioscience.org/newfrontiers/davis.html
Topic 9
Topic: Elements of chemical terrorism. Likely biological toxins (botulinum, ricin) to be used in a
bioterrorist attack
Objectives: Review possible chemical agents. To recognize the likely biological toxins, their natural
history and probable method(s) of dispersal.
Readings:
http://www.bt.cdc.gov/agent/botulism/factsheet.asp
http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/vhf.htm
Topic 10
Topic: Recognizing bioterrorism
Systems
- the need for disease surveillance and Geographic Information
Objectives: Identify surveillance clues to recognizing a possible bioterrorist event; recognize the
importance of augmented surveillance systems, syndromic surveillance, and development of an
effective alert network.
Readings:
Syndromic Surveillance in Public Health Practice, New York City
http://www.cdc.gov/ncidod/EID/vol10no5/03-0646.htm
The Public Health Response To Biological And Chemical Terrorism Interim Planning Guidance For
State Public Health Officials: Read Section on General Health Surveillance And Epidemiologic
Investigation Considerations starting on page 11.
http://www.bt.cdc.gov/Documents/Planning/PlanningGuidance.PDF
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Homework5 - If you were in charge of setting up a syndromic surveillance system for Los Angeles County, and
cost was no object --- how would you do it? Be Innovative!.
Topic 11
Topic:
Responding to a bioterrorist event – Preparation
Objectives: Identify key elements in Preparedness Plans including public health, medical community
(hospitals), as well as other agencies’ roles in responding to a bioterrorist event. Review what type
of exercises are useful in preparedness.
Readings:
The Public Health Response To Biological And Chemical Terrorism
Interim Planning Guidance For State Public Health Officials: Read Appendix 11:
http://www.bt.cdc.gov/Documents/Planning/PlanningGuidance.PDF
CDC’s Bioterrorism Readiness Plan: A Template for Healthcare Facilities
Topic 12
Topic: . To familiarize the student with the types of natural and artificial radiation exposures which may
occur in the workplace and in the community (and during a “BT” event).
Objectives: Identify sources of radiation and constituents and consequences of a “dirty bomb”
Readings:
http://www.cdc.gov/niosh/topics/emres/sitemgt.html
http://www.bt.cdc.gov/radiation
Topic 13
Topic: CDC Role in Public Health and Emerging Infections
Objectives: Understand the history of CDC and it’s role of the CDC in monitoring and control of
Emerging Infections.
Readings:
http://www.cdc.gov/ncidod/EID/pastcon.htm (search and review several publications with relevant
articles on BT)
BIOTERRORISM RESOURCES
WEB SITES OF GENERAL INTEREST:
 CDC - http://www.bt.cdc.gov/index.asp
 Infectious Diseases: http://www.lapublichealth.org/acd/procs/b73/b73index.htm
 County of L.A.’s BT site: http://www.labt.org
 UCLA Dept. of Epidemiology BT Site: http://www.ph.ucla.edu/epi/bioter/bioterrorism.html
 Center for Public Health and Disasters - UCLA: http://www.ph.ucla.edu/cphdr/index.html
 Center for Civilian Bio-defense Strategies: http://www.hopkins-biodefense.org/
 BT Template for Health Facilities: http://www.cdc.gov/ncidod/hip/Bio/13apr99APICCDCBioterrorism.PDF
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OVERVIEWS
The Looming Threat of Bioterrorism Donald A. Henderson
http://cas.bellarmine.edu/tietjen/ecology/looming_threat_of_bioterrorism.htm
Causation of Bias: The Episcope
http://www.epidem.com/pt/re/epidemiology/abstract.00001648-20010100000019.htm;jsessionid=DLfNnhfTCK6YZZX7Ze3Us91Dl35q82KOOB18G4mCup14X1okU9TV!
1556005714!-949856145!9001!-1
PSYCHOLOGY
Acute Mental Health Response to Children Affected by Terrorism
http://www.bt.cdc.gov/children/PDF/working/mental.pdf
DATABASES:
Government Periodicals Universe [ http://www.lexis-nexis.com/usgpi ] indexes articles in U.S.
government-published periodicals. MSU owns many of these materials in print and/or electronic
form; some are available via the WWW. (requires userid and password)
MAGIC [ http://magic.msu.edu ]. Although not all government information materials are in MAGIC,
you can identify most post-1995 books through the system. One likely search is an LC Subject
Search for "weapons of mass destruction."
UNBISnet [ http://unbisnet.un.org ] is the catalog of UN documents and publications. MSU owns
many of these materials in microfiche. Key search terms (using the Topical Subjects - Alphabetic
search) are "weapons of mass destruction," "biological weapons," "chemical weapons," "nuclear
weapons," and "radiological weapons."
BACKGROUND INFORMATION, OVERVIEWS, AND MULTI-WEAPON SITES:
Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass
Destruction (aka the Gilmore Commission) [ http://www.rand.org/nsrd/terrpanel/ ] established in
accordance with Section 1405 of the National Defense Authorization Act for Fiscal Year 1999, Public
Law 105-261 (H.R. 3616, 105th Congress, 2nd Session) (October 17, 1998).
United Nations Department of Disarmament Affairs Weapons of Mass Destruction Branch "provides
substantive support for the activities of the UN in the area of disarmament whose main focus will
continue to be on weapons of mass destruction (nuclear, chemical and biological weapons).”
U.S. Arms Control and Disarmament Agency [ http://dosfan.lib.uic.edu/acda/hd.htm ] is the archival
site for the ACDA, now a part of the State Department. It contains reports, speeches, and other
supporting documentation.
U.S. Army Chemical School "develop[s] doctrine, equipment and training for NBC [nuclear, chemical,
biological] defense which serve as a deterrent to ANY adversary possessing weapons of mass
destruction." U.S. Central Intelligence Agency
U.S. Office of Technology Assessment, a now defunct agency, published several reports related to
weapons of mass destruction.


Export Controls and Nonproliferation Policy (May 1994)
Proliferation of Weapons of Mass Destruction: Assessing the Risks (August 1993)
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
Technologies Underlying Weapons of Mass Destruction (December 1993)
[http://www.wws.princeton.edu/~ota/disk1/1993/9344_n.html]
U.S. Department of State. Bureau of Arms Control. Weapons of Mass Destruction [
http://www.state.gov/www/global/arms/bureau_ac/wmd_ac.html ] www site includes testimony,
remarks, briefings, factsheets and treaty texts. [ http://www.state.gov/t/ac/ ].
Warfare - Chemical, Biological, Radiological, Nuclear and Explosives
[http://www.emedicine.com/emerg/WARFARE__CHEMICAL_BIOLOGICAL_RADIOLOGICAL_NUCLEAR
_AND_EXPLOSIVES.htm ], a section of the eMedicine WWW site, provides access to articles
concerning various aspects of these weapons.
LEGISLATIVE INFORMATION:
GPO Access [ http://www.access.gpo.gov/su_docs/index.html ] provides access to selected U.S.
legislative, judicial and executive branch materials. Amongst the materials available are selected
Congressional hearings, Weekly Compilation of Presidential Documents, Public Papers of the
President, Supreme Court decision, House and Senate Documents and Reports, and Congressional
Committee Prints.
Thomas: U.S. Congress on the Internet [ http://thomas.loc.gov/ ] provides access to bill texts, bill
summaries, committee information and the Congressional Record.
BIOLOGICAL WEAPONS:
Center for Civilian Biodefense Studies (Johns Hopkins University) [ http://www.hopkinsbiodefense.org/ ] provides quite a lot of background material as well as links to major government
reports.
Center for Disease Control Bioterrorism Preparedness and Response [ http://www.bt.cdc.gov/ ]
CHEMICAL WEAPONS:
Organisation for the Prohibition of Chemical Weapons was created via a provision of the Convention
on Chemical Weapons. The site includes material on chemical weapons, a list of signatories, and
documents of the first through sixth Convention of States Parties.
NUCLEAR WEAPONS:
Comprehensive Nuclear-Test Ban Treaty
USEFUL NON-GOVERNMENTAL SITES:
Special Weapons Primer [ http://www.fas.org/nuke/intro/index.html ] and Special Weapons News [
http://www.fas.org/news/index.html ] from the Federation of American Scientists.
USC_BT_Syllabus 8/17/2011 mas
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