Biological Warfare

Quick-reference for managing biological casualties: triage, treatment, isolation, decontamination, and first aid for providers and civilians

U.S. Department of Defense

• Publisher: Madison & Adams Press
• Year: 2017
• eBook ISBN:
  9788026876823
• Topic: Medicine
• Subtopic: Biotechnology in Medicine

The purpose of this book is to provide concise supplemental reading material to assist both, health-care providers and civilians in the management of biological casualties. The main goal is to make this a reference for all those who need basic summary and treatment information quickly. Table of Contents: History of Biological Warfare and Current Threat Distinguishing Between Natural and International Disease Outbreaks Ten Steps in the Management of Biological Casualties Therapy Case Reporting and Epidemiological Assessment Prevention Protective Equipment First Aid Protective Measures and Handling of Causalities Patient Decontamination Infection Control Medical Evacuation Aeromedical Isolation Team Bacterial Agents: Anthrax Brucellosis Plague Q Fever Tularemia Viral Agents: Smallpox Venezuelan Equine Encephalitis Biological Toxins: Botulinum Ricin Staphylococcal Enterotoxin B T-2 Mycotoxins Glossary of Medical Terms Patient Isolation Precautions BW Agent Characteristics BW Agent Vaccines, Prophylactics and Therapeutics Differential Diagnosis Comparative Lethality Emergency Response Contacts

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U.S. Department of Defense

Biological Warfare

Learn What’s at Risk, The Protective Measures & The Treatment of Casualties (Bacterial Agents; Anthrax, Brucellosis, Plague, Q Fever, Viral Agents; Smallpox, Venezuelan Equine Encephalitis, Toxins)

Madison & Adams Press, 2017. No claim to original U.S. Government Works
Contact [email protected]

ISBN 978-80-268-7682-3

This is a publication of Madison & Adams Press. Our production consists of thoroughly prepared educational & informative editions: Advice & How-To Books, Encyclopedias, Law Anthologies, Declassified Documents, Legal & Criminal Files, Historical Books, Scientific & Medical Publications, Technical Handbooks and Manuals. All our publications are meticulously edited and formatted to the highest digital standard. The main goal of Madison & Adams Press is to make all informative books and records accessible to everyone in a high quality digital and print form.

INTRODUCTION

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Medical defense against the use of biological pathogens and toxins as weapons of warfare or terrorism is an area of study previously unfamiliar to many health-care providers. The U.S. military has maintained an ongoing research agenda against biological weapon threats since World War II, but the terrorist attacks on the U.S. mainland in September 2001 and the anthrax mail attacks in October 2001 provided a wake-up call for lawmakers, the public at large, and medical providers of all backgrounds that the threat of biological attacks was real and required planning, training, and resources for response. Consequently, there has been an explosion of interest among health-care practitioners to understand better how to manage the medical consequences of exposure to biological weapons that can lead to mass casualties.

Numerous measures to improve preparedness for and response to biological warfare (BW) or terrorism are ongoing at local, state, and federal levels. Training efforts have increased in both military and civilian sectors. A week-long Medical Management of Chemical and Biological Casualties Course taught at both USAMRIID and USAMRICD trains over 560 military medical professionals each year on biological and chemical medical defense. The highly successful USAMRIID international satellite courses on the Medical Management of Biological Casualties have reached over 110,000 medical personnel since 1997.

Through this handbook and courses noted above, medical professionals learn that effective medical countermeasures are available against many of the bacteria, viruses, and toxins that might be used as biological weapons against our military forces or civilian communities. The importance of this education cannot be overemphasized and it is hoped that health-care professionals will develop a solid understanding of the biological threats we face and the effective medical defenses against these threats.

The global BW threat is serious, and the potential for devastating casualties is high for certain biological agents. There are more than 10 countries around the world suspected to have offensive biological weapons programs. However, with early recognition, intervention, and appropriate use of medical countermeasures either already developed or under development, many casualties can be prevented or minimized.

Even if providers have not read the text thoroughly, the purpose of this handbook is to serve as a concise pocket-sized manual that can be pulled off the shelf (or from a pocket) in a crisis to guide medical personnel in the prophylaxis and management of biological casualties. It is designed as a quick reference and overview, and is not intended as a definitive text on the medical management of biological casualties. More in-depth discussion of the agents covered here may be found in infectious diseases, tropical medicine, and disaster management textbooks.

HISTORY OF BIOLOGICAL WARFARE AND CURRENT THREAT

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The use of biological weapons in warfare has been recorded throughout history. During the 12^th –15^th centuries BC the Hittites are known to have driven diseased animals and people into enemy territory with the intent of initiating an epidemic. In the 6th century BC, the Assyrians poisoned enemy wells with rye ergot, and Solon used the herb hellebore to poison the water source of the city of Krissa during his siege. In 1346, plague broke out in the Tartar army during its siege of Kaffa (at present day Feodosia in Crimea). The attackers hurled the corpses of plague victims over the city walls; the epidemic that followed forced the defenders to surrender, and some infected people who left Kaffa may have started the Black Death pandemic, which spread throughout Europe and is believed to have resulted in the death of one-third of the population of Europe – as many as 25 million people. Russian troops may have used the same tactic against the Swedes in 1710.

On several occasions throughout history, smallpox was used as a biological weapon. Pizarro is said to have presented South American natives with variola virus-contaminated clothing in the 15th century, and the English did the same when Sir Jeffery Amherst ordered his troops to provide Indians loyal to the French with smallpox-laden blankets in 1763 towards the close of the French and Indian Wars. Native Americans defending Fort Carillon sustained epidemic casualties, which directly contributed to the loss of the fort to the English. General George Washington ordered variolation (an early form of smallpox vaccination) for the Continental Army in 1777 after the loss of the siege of Quebec, in part due to devastation rendered on his forces by smallpox, and because of the potential for purposeful spread of smallpox among the colonials by the British.

Use of biological weapons continued into the 1900s; however, the stakes became higher as the science of microbiology allowed for a new level of sophistication in producing agents. There is evidence that during World War I, German agents inoculated horses and cattle with anthrax and glanders at the Port of Baltimore before the animals were shipped to France. In 1937, Japan started an ambitious biological warfare (BW) program, located 40 miles south of Harbin, Manchuria, code-named “Unit 731.” Studies directed by Japanese general and physician Shiro Ishii continued there until it was destroyed in 1945. A post-World War II investigation revealed that the Japanese researched numerous organisms and used prisoners of war as research subjects. About 1,000 human autopsies apparently were carried out at Unit 731, mostly on victims exposed to aerosolized anthrax. Many more prisoners and Chinese nationals may have died in this facility - some have estimated up to 3,000 human deaths. The Japanese also apparently used biological agents in the field: after reported overflights by Japanese planes suspected of dropping plague-infected fleas, plague epidemics ensued in China and Manchuria. By 1945, the Japanese program had stockpiled 400 kilograms of anthrax to be used in a specially designed fragmentation bomb.

In 1943, the U.S. began its own research and development program in the use of biological agents for offensive purposes. Similar programs existed in Canada, the United Kingdom (UK), and probably several other countries. This work was started, interestingly enough, in response to a perceived German BW threat as opposed to a Japanese one. The U.S. research program was headquartered at Camp Detrick (now Fort Detrick), which was a small National Guard airfield before that time, and produced agents and conducted field testing at other sites until 1969, when President Nixon stopped all offensive biological and toxin weapon research and production by executive order. Between May 1971 and May 1972, all stockpiles of biological agents and munitions from the now defunct U.S. program were destroyed in the presence of monitors representing the U.S. Department of Agriculture, the Department of Health, Education, and Welfare, (now Health and Human Services), and the states of Arkansas, Colorado, and Maryland. Included among the destroyed agents were Bacillus anthracis, botulinum toxin, Francisella tularensis, Coxiella burnetii, Venezuelan equine encephalitis virus, Brucella suis, and staphylococcal enterotoxin B. The U.S. began a medical defensive program in 1953 that continues today at USAMRIID.

In 1972, the U.S., UK, and USSR signed the Convention on the Prohibition of the Development, Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on Their Destruction, commonly called the Biological Weapons Convention. Over 140 countries have since added their ratification. This treaty prohibits the stockpiling of biological agents for offensive military purposes, and also forbids research on agents for other than peaceful purposes. To strengthen efforts to combat the BW threat, signatory states agreed in November 2002 to have experts meet annually through 2006 to discuss and promote common understanding and effective action on biosecurity, national implementation measures, suspicious outbreaks of disease, disease surveillance, and codes of conduct for scientists. However, despite this historic agreement among nations, BW research continued to flourish in many countries hostile to the U.S. Moreover, there have been several cases of suspected or actual use of biological weapons. Among the most notorious of these were the “yellow rain” incidents in Southeast Asia, the use of ricin as an assassination weapon in London in 1978, and the accidental release of anthrax spores at Sverdlovsk in 1979.

Testimony from the late 1970s indicated that Laos and Kampuchea were attacked by planes and helicopters delivering colored aerosols. After being exposed, people and animals became disoriented and ill, and a small percentage of those stricken died. Some of these clouds were thought to be comprised of trichothecene toxins (in particular, T2 mycotoxin). These attacks are grouped under the label “yellow rain.” There has been a great deal of controversy about whether these clouds were truly BW agents. Some have argued that the clouds were nothing more than feces produced by swarms of bees.

In 1978, a Bulgarian exile named Georgi Markov was attacked in London with a device disguised as an umbrella, which injected a tiny pellet filled with ricin toxin into the subcutaneous tissue of his leg while he was waiting for a bus. He died several days later. On autopsy, the tiny pellet was found and determined to contain ricin toxin. It was later revealed that the Bulgarian secret service carried out the assassination, and the technology to commit the crime was supplied by the former Soviet Union.

In April, 1979, an incident occurred in Sverdlovsk (now Yekaterinburg) in the former Soviet Union which appeared to be an accidental aerosol release of Bacillus anthracis spores from a Soviet military microbiology facility: Compound 19. Residents living downwind from this compound developed high fever and had difficulty breathing; a large number died. The Soviet Ministry of Health blamed the deaths on the consumption of contaminated meat, and for years controversy raged in the press over the actual cause of the outbreak. All evidence available to the United States government indicated a release of aerosolized B. anthracis spores. In the summer of 1992, U.S. intelligence officials were proven correct when the new Russian President, Boris Yeltsin, acknowledged that the Sverdlovsk incident was in fact related to military developments at the microbiology facility. In 1994, Meselson and colleagues published an in-depth analysis of the Sverdlovsk incident. They documented that all of the cases from 1979 occurred within a narrow zone extending 4 kilometers downwind in a southerly direction from Compound 19. There were at least 66 fatalities in the 77 patients identified.

In August, 1991, the U.N. carried out its first inspection of Iraq’s BW capabilities in the aftermath of the Gulf War. On August 2, 1991, representatives of the Iraqi government announced to leaders of U.N. Special Commission Team 7 that they had conducted research into the offensive use of B. anthracis, botuli...

Table of contents

• Biological Warfare