1. An Overview of Chemical and Biological Warfare Presented by CPT Michael A. Ladd SGT Lisa Lyon United States Army Chemical School

2. Agenda
Chemical Warfare
Biological Warfare
Question and Answer Period

3. Brief History of Chemical Warfare
1915 Ypres, France (WWI)
No major military use of chem in WWII, but research completed by Germans
Some use of chem during Vietnam (Agent Orange, BZ, CS, etc.)
Use of nerve agent during Iran/Iraq War
Gulf War
Tokyo Subway Attack

4. EXERPT FROM:
THE HUMAN COST, The Aum Shinrikyo victims have their say By Kavitha Rao and Murakami Mutsuko / Tokyo
Ohashi Kenji, 41:
“When he boarded the train, he saw one male passenger slumped in his seat and a woman doubled over. He sensed a strange smell, "sweet as if something was rotten.” Ohashi took a seat and fell into a brief sleep. When he woke up, he was thirsty and started coughing. His legs began trembling.
Everything was black around him and he could hardly breathe. He was rushed to hospital, where he stayed for 12 days.”

5. CHEMICAL AGENTS DEFINED:
“Any chemical substance which is intended for
use in Military and Civilian Operations to kill,
seriously injure or incapacitate man because of
its physiological effects.”
NOTE: Liquid AC can penetrate the skin but, because AC has a high LCt50 and because liquid AC is not likely to be encountered in the field, protective clothing is required only in unusual situations.

6. PERSISTENCY OF AGENTS PERSISTANT (“P-Chem”) And
General description of how long a chemical agent remains dangerous after it’s release / employment. Two categories:
PERSISTANT (“P-Chem”)
And
NON-PERSISTANT (“NP-Chem”)

7. PERSISTENT CHEMICAL AGENTS
Long-Duration Agents (hours or days) used to:
Deny terrain (channelize attacking forces, protect flanks, defend avenues of approach)
Contaminate terrain & material (roads, key terrain or facilities)
Degrade efficiency (forcing extended operations in protective posture)
Neutralize defending strong-points

8. PERSISTENT CHEMICAL AGENTS
Usually appear as an oily, thick liquid in pools, scattered droplets, or puddles
Collect in low-lying areas
Mix with topsoil, mud & standing water, easily spread by traffic (“Gross Contamination”)
High contact hazard
Low to medium vapor hazard (depending on temperature)

9. NONPERSISTENT CHEMICAL AGENTS
Short-duration agents (minutes or less than one hour in open air conditions) used to:
Create favorable fighting conditions
Produce casualties
Degrade or suppress
Occupy without need of decontamination

10. NONPERSISTENT CHEMICAL AGENTS
Usually a colorless, odorless (or faint odor) gas or vapor
Same physical behavior as smoke or fog- travel in clouds with prevailing wind currents, weather conditions will determine spread
Weather away easily- not a source of Gross Contamination
High vapor & contact hazard
Blood, choking, psychochemical and nerve agents are stockpiled in the largest quantities, highest probability of acquisition by terrorist groups
Present highest “payoff” in terms of mass casualties in population centers

11. CLASSIFICATION OF TOXIC MILITARY CHEMICAL AGENTS
Blood
Blister
Nerve
Choking
Vomiting
Incapacitating

12. BLOOD AGENTS

13. Blood
BLOOD AGENTS: Poisons enzyme cytochrome oxidase thus blocking the use of oxygen in the cells.

14. Physiological Effects
BLOOD AGENTS PREVENT CELL RESPIRATION AND THE TRANSFER OF OXYGEN FROM THE BLOOD. OVER- OXYGENATED BLOOD CAUSES CHANGE IN COLOR (Pale to Bluish-tinge visible on the skin).

15. Physiological Effects
EYES
Moderate toxicity
RESPIRATORY SYS.
ENTERS BODY AS VAPOR OR
GAS
SKIN
Not readily absorbed

16. CATEGORIES OF BLOOD AGENTSAC
HYDROGEN CYANIDE CK
CYANOGEN CHLORIDE
Absorbed primarily by breathing

17. AC CHARACTERISTICS Appearance: Colorless liquid or gas Odor:
Bitter Almonds
Protection:
Protective Mask
See Note:

18. AC CHARACTERISTICS Rate of Action…..Rapid. Death w/in 15 min.
Persistency…..Short. Dissipates quickly in air.
Use Designation: Quick acting casualty agent.

19. AC SYMPTOMS: HIGH CONCENTRATIONS
Increased heart rate
Violent convulsions
Breathing stops 1 min
Heart stops in 2 min.

20. AC SYMPTOMS: MODERATE CONCENTRATIONS
Dizziness
Nausea
Headache
***All appear rapidly
ALSO:
Convulsions
Death

21. AC SYMPTOMS LONG EXPOSURE
LACK OF OXYGEN TO THE MUSCLES
IRRATIONALITY
COMA AND CONVULSIONS

22. CK CHARACTERISTICS
Appearance: Colorless, highly volatile liquid or gas
Odor: Pungent, biting; may go unnoticed
Rate of Action: Very rapid. Immediate intense irritation
Protection: Mask (may damage filters)

23. CK Persistency: Short (may persist in jungles)
Use Designation: Quick acting

24. CK SYMPTOMS CK IS CONVERTED BY THE BODY TO
AC WITH IRRITATING EFFECTS LIKE CS
*Immediate intense irritation (nose/throat)
*Coughing, tight chest,heavy water flow from the eyes
*Dizziness and unconsciousness
*Breathing may stop/Death
*Convulsions, involuntary urination/defecate.

25. FIRST AID - BLOOD AGENTS
Continue Normal Activities
General Rule of thumb- after 5 min of exposure, anyone still breathing / ambulatory requires no first aid
Seek Medical Attention
Oxygen therapy
Keep warm and rested

26. Blister
BLISTER AGENTS: These agents cause inflammation, blisters and general destruction of tissues. Vulnerable areas include the eyes, mucous membranes and respiratory tract.

27. MUSTARDS ARSENICALS URTICANTS BLISTER AGENTS
All Blister Agents are PERSISTENT
MUSTARDS
ARSENICALS
URTICANTS

28. ACTION ON THE BODY PHYSIOLOGICAL
Damage ANY TISSUE they come in contact with, specific damage to:
EYES
LUNGS and RESPIRATORY SYSTEM
Causes Vomiting & Diarrhea

29. ACTION ON THE BODY Penetration of the body
Eyes, skin, respiratory and digestive tracts.
Symptoms: There are distinct differences among each type.

30. MUSTARD AGENT CHARACTERISTICS
(H - HD - HN - HN1 - HN2 - HN3)
APPEARANCE (20 deg C / 68 deg F)
HD…colorless to pale yellow
HN SERIES…dark liquid
Freezing point of Mustard Agents is deg F

31. CHARACTERISTICS Odors: HD - Strong garlic / horseradish smell
HN-1 - Faint fishy / musty smell
HN-2 - Soapy smell (low concentrations)
Fruity smell (high concentrations)
HN-3 - No detection by smell (if pure)

32. CHARACTERISTICS Vapor Density: 5 to 7 times heavier than air
Body Effects…irritation to eyes, tissues, and respiratory tract.
Rate of Effectiveness….Delayed
Duration…..Several days under normal conditions

33. CHARACTERISTICS Protection LEVEL A OR MOPP IV Persistency
Depends on quantity. Weeks to months in cold.
Use
Delayed acting
First Aid
Do not break blisters; if in eyes use water; decon with M258A1/M291

34. PHASES OF HD LATENT PHASE 4 - 6 HOURS ERYTHEMA PHASE
Red Skin with itching
VESSICATION PHASE
Blisters from hours
NECROSIS
Tissues die and decay

35. SYMPTOMS FOR MUSTARD AGENTS
EYES- most susceptible. Immediate burning sensation, swelling of tissue 1-12 hours, burns & lacerations
SKIN- affected more by hot, humid weather & direct contact (e.g., sitting / standing in agent)
Lungs- delayed action (days to weeks), cumulative dose poison, increased respiratory infections

36. FIRST AID FOR MUSTARD AGENTS
IMMEDIATE & Continuous Flushing of the Eyes: 86% of all Blister Agent Casualties exhibit contamination in the eyes
Triage- Note exposure possibility for evaluation at Treatment Center: 75% of all Blister Agent Casualties experience latent onset (18-36 hours)effects upon the respiratory tract

37. ARSENICALS
L - HL - PD - ED - MD

38. CHARACTERISTICS ODORS L - Variable HL - Garlic PD - None
L - HL - PD - ED - MD
Persistency: Persistent
Physical States:
L - Colorless to brownish liquid
HL - Dark oily liquid
PD - Colorless liquid
ED - Colorless liquid
MD - Colorless liquid
ODORS
L - Variable
HL - Garlic
PD - None
ED - Fruity / Biting (irritating)
MD- NONE

39. ARSENICAL AGENT SYMPTOMS
Immediate pain (within 30 seconds)
Irritation of eyes
Reddening of the skin (within 30 minutes)
Blisters appear (within 48 hours)
Systemic poisoning

40. ARSENICALS Primary Hazard: Eyes & respiratory tract (vapors)
Skin (direct contact)
Digestive system (ingestion)
Rate of Action:
Eye effects & stinging sensation (immediate)
Prompt, burning redness within 30 minutes
Blisters on 1st or 2nd day
Pain / necrosis more severe than with mustards
NOTE: BECAUSE ARSENICALS VAPORS ARE SO IRRITATING, PUTTING YOUR MASK ON WILL BE OF THE UTMOST CONCERN. ENSURE ALL
SOLDIERS AROUND YOU HAVE DONNED THEIR MASK AND HELP
THOSE THAT CAN'T.

41. URTICANTS
CX Phosgene Oxime

42. URTICANTS Rate of Action: Primary Hazards: Immediate
Eyes, nose & respiratory tract (vapors)
Skin (direct contact)
Digestive tract (digestion)
SYMPTOMS
IMMEDIATE
Strong irritation of mucous membranes
Stinging sensation (bee sting)
Blanching of skin
Eyes, nose & skin
Surrounded by reddening (within 30 secs)
Wheal forms (in about 30 mins)
Blanched area turns brown (24 hrs)
Sloughs off (couple weeks)

43. NERVE AGENTS

44. Nerve
NERVE AGENTS: Inhibits cholinesterase enzymes thus allowing acetylcholine (a neurotransmitter) to collect at its various sites of action. Can be inhaled, ingested or absorbed through the skin.

45. ACTION ON THE BODY (PHYSIOLOGICAL)
Nerve Agents are potent inhibitors of the enzyme cholinesterase. This inhibition permits the build-up in the body of Acetylcholine, a muscle and nerve ending stimulator. The major effects will be on skeletal muscles, parasympathetic end organs, and the central nervous system.

46. ACTION ON THE BODY Penetration
Eyes: Symptoms appear in 2-3 minutes. Kills nearly as rapidly as respiratory exposure.
Respiratory System: Symptoms appear in 2-5 minutes, lethal dose kills in less than 15 minutes.
Skin: Symptoms occur slowly; Lethal doses 1-2 hours; Sweating and tremors may occur.

47. NERVE AGENT SYMPTOMS (MILD)
UNEXPLAINED RUNNY NOSE
UNEXPLAINED HEADACHE
EXCESSIVE SALIVA FLOW
TIGHTNESS OF CHEST
DIFFICULTY SEEING
MUSCULAR TWITCHING
STOMACH CRAMPS
NAUSEA

48. NERVE AGENT SYMPTOMS (SEVERE)
STRANGE/CONFUSED BEHAVIOR
GURGLING SOUNDS WHEN BREATHING
SEVERELY PINPOINTED PUPILS
RED EYES WITH TEARING
VOMITING
SEVERE MUSCULAR TWITCHING
LOSS OF BLADDER CONTROL
CONVULSIONS
UNCONSCIOUSNESS

49. TABUN - GA Non-Persistent Nerve Agent
Appearance…..brownish to colorless liquid
Odor…..faintly fruity; none when pure
Vapor density: times heavier than air.

50. GA
Persistency…..depends on weather and munitions; 1-2 days for heavily splashed liquids.
Use Designation: Quick acting casualty agent
Rate of Action: Very rapid; w/in 15 min for lethal dose
Protection
LEVEL A OR MOPP IV; clothing gives off vapor

51. SARIN - GB Non-Persistent Nerve Agent Appearance: colorless liquid
Odor: almost none in pure state
Vapor density: times heavier than air

52. GB Persistency…..same as for GA
Use Designation, Quick acting casualty agent
Rate of Action, Very Rapid
Protection Required: LEVEL A OR MOPP 4 - See GA

53. SOMAN - GD Non Persistent Nerve Agent Appearance…..colorless liquid
Odor…..fruity; impurities give camphor
Vapor density: times heavier than air

54. GD Persistency: same as GA/GB only evaporates at slower rate
Use Designation: Quick acting casualty agent
Rate of Action Very Rapid.
Protection Required: LEVEL A OR MOPP 4. See GA

55. PERSISTENT NERVE AGENTS

56. VX VX is a PERSISTENT Nerve Agent
Appearance: Colorless to Amber liquid
Odor: NONE
Vapor density: 9.2 times heavier than air

57. VX Persistency: Heavily Splashed Liquids May Last For Long Periods
Use Designation, Quick acting casualty agent
Rate of Action and Protection requirements are the same as the other nerve agents.

58. FIRST AID- NERVE AGENTS
Nerve Agent Antidote Kit (NAAK Mark 1). The NAAK Mark 1 contains the AtroPen auto-injector (2mg of atropine) and the Pralidoxime Chloride auto-injector (600mg of pralidoxime chloride) in a compact package which facilitates emergency use.
1 to 3 injections, depending on level of symptoms
Convulsion Antidote for Nerve Agents (CANA). CANA is an auto-injector which contains 2ml of diazepam. It is to be used only as buddy-aid, never self injected

59. Choking
CHOKING AGENTS: Attack lung tissue (dry-land drowning). Choking sensation as a result of nose and throat irritation.

60. CHOKING AGENTS CG PHOSGENE Physiological Action:
Effects are exerted on the lungs resulting in damage to small blood vessels. Anoxia is the cause of death due to flooded air sacs. Symptoms appear three to four hours after exposure and death within 24 hours.

61. PHOSGENE Odor: Green corn, grass, or new-mowed hay
Protection: Protective Mask

62. PHOSGENE Persistency: Short, but may collect in low areas.
Rate of Action: Delayed. Immediate symptoms in high concentrations. Up to 3 hours for low levels.
Symptoms: Tearing, soar throat, coughing, wheezing; Pulmonary Edema in 2-6 hours, nausea, vomiting and gastric pains are common

63. PHOSGENE First-Aid: SELF / BUDDY Aid : 1) Mask,
2) Continue with normal activities.
3) Keep personnel quiet, and casualties should be kept only comfortable warm.
4) Seek medical help.

64. CHOKING AGENTS Protection Required: Decontamination: Dissemination
Tested & Approved Protective Mask
Decontamination:
Aeration (confined areas)
No decon in open air environment
Change contaminated clothing
Dissemination
[Not Limited To]Aircraft spray

65. FIRST AID-CHOKING AGENT
EMS: No standard first aid kit In the ambulance:
ABC’s
O2 monitoring
No exertion
Advanced Providers
IV Fluids
Bronchodilators
No Diuretics

66. INCAPACITATING
AGENTS

67. Incapacitation
INCAPACITATING AGENTS: Agents that attack the neurological center(brain). They are not normally designed to be lethal.

68. INCAPACITAING CATEGORIES
Vomiting Agents DA DC DM
Tearing Agents CA CS CN
CNB
CNC
CNS CR PS

69. CHARACTERISTICS OF INCAPACITATING TEARING AGENTS
THEY CAUSE PHYSIOLOGICAL AND MENTAL EFFECTS THAT LEAD TO TEMPORARY DISABILITY.
THE LETHAL DOSE IS MANY TIMES GREATER THAN THE INCAPACITATING DOSE.

70. TEARING AGENT CHARACTERISTICS (CA / CS / CN / CNB /CNC / CNS /CR / PS
Persistency: Short (CN Series), varies with others
Physical States: (20 deg C / 68 deg F)
Yellow or Colorless solid, liquid, or powder
Odors:
Soured fruit or pepper- like or apple blossoms

71. TEARING AGENTS Primary Hazard: Respiratory Rate of Action: Immediate
Symptoms: Effects last 5-10 minutes after removal from area
Immediate burning sensation of the eyes
Coughing
Difficulty breathing
Involuntary closing of eyes
Stinging sensation on moist skin

72. TEAR AGENTS Protection Required: Tested & approved protective mask
Secure normal clothing at neck, wrists and ankles
Decontamination:
Aeration (cool shower may help)

73. TEARING AGENTS First Aid: None required (aeration)
Exception: individuals wearing contact lenses at the time of exposure- remove them ASAP!
Medical Treatment:
Prompt irrigation of the eyes
Mechanical removal of agent
Erythmea (calamine / topical corticosteroid)
Blisters (treat as 2nd degree burns)
Secondary infections (treat with antibiotics)

74. Vomiting
VOMITING AGENTS: produce strong pepper-like irritation of the eyes and lacrimation and violent uncontrollable sneezing, cough.

75. VOMITING AGENTS CHARACTERISTICS DA/DC/DM
Persistency: Non-persistent (aerosol)
Physical States: (at 20 deg C / 68 deg F)
DA - White to brown solid
DC - White to pink solid
DM - Yellow to green

76. VOMITING AGENTS Odors: DA - None DC - Bitter almonds / garlic mixture
DM - None
Primary Hazard: Respiratory
Rate of Action: Very rapid (30 sec - 2 mins)

77. VOMITING AGENTS
Symptoms: last from 30 minutes to several hours after removal from contaminated area
Irritation of eyes and mucuous membranes
Viscuous discharge
Sneezing & coughing
Acute pain & tightness in chest
Severe headache
Nausea
Vomiting

78. VOMITING AGENTS First Aid: Mask Let agent take its course
Vigorous exercise / physical activity
Medical Treatment:
Few should require treatment
Symptomatic relief
Pepto-Bismol / Maalox / etc
Aspirin (headaches / general discomfort)

79. VOMITING AGENTS
Protection Required: Tested & approved protective mask (inhalation hazard)
Decontamination: None required (aeration)

80. BRIEF SUMMARY OF AGENTS
CHOKING
NERVE
BLOOD
BLISTER
INCAPACITATING

81. DECONTAMINATION
M291 Skin Decon Kit. Used for skin and equipment decontamination. Is non-toxic, eliminating the need for trainers.
M295 Decon Kit, Individual Equipment (DKIE). The M295 employs sorptive resin technology; consists of a pouch containing four individual wipedown mitts each of which is within a soft, protective packet. The pouch assembly is designed to fit comfortably within a pocket. Used to decon personnel equipment

82. DECONTAMINATION
EXTINGUISHING MEDIA: Water, fog, foam, CO2. Avoid using extinguishing methods that will cause splashing or spreading. INCOMPATIBLES: Negligible on brass, steel, aluminum

83. Chemical Detection and Sample Collection

84. Chemical Detection and Identification Suite
System Response Time Training Needed Results
Detector paper Seconds Few minutes Detects presence of liquid nerve or blister agents by type
Electronic field Seconds One-two hours Detects presence of nerve or blister instruments agent vapors
Wet chemistry kits Minutes One hour or less Identifies specific, selected chemical agents (nerve, blood, blister)
Colorimetric 4-8 Minutes One hour or less Identifies/quantifies specific industrial chemicals, detects nerve and blister agents by type
GC/MS Minutes - Hours One-two weeks for Identifies/quantifies specific chemical trained technician agents (liquid or vapor)

85. Chemical Detector Papers
M9 and M8 chemical agent detector papers
Only for liquids/agents
Prone to false positives
Best for initial recon
Other chemical detector papers V G H L

86. Chemical Identification Kits
“Wet chemistry” chemical agent identification kits
Vapors only
Good specificity
Colorimetric tube sets

87. M256A1 Kit Capabilities: Limitations: Best uses:
Detects nerve, blister, blood agents
Detects below IDLH for most agents
Limitations:
Takes 15 minutes to use
Hand manipulations
Does not detect choking agents
Best uses:
Initial recon
Verification of chemical detection

88. Colorimetric Tubes Capabilities: Limitations: Best uses:
Detect, identify family of chemicals: nerve and blister agents
Identify, quantify (ppm) choking and blood agents
Sampling unknown agents
Limitations:
Hand manipulations
8 specific tubes required
Best uses:
Industrial chemicals
Verification of chemical detection

89. Chemical Detection Instruments
Hazardous chemical detectors
- PID, FID, Multi-gas meter
Chemical agent detectors
-ICAM -APD2000
-AP2C -M-90 CAD
-SAW MINICAD -ICAD
Chemical agent alarms
Laboratory instruments

90. Chemical Agent Monitor
Capabilities:
Point detection of nerve, blister agents
Detects down to IDLH
Semi-quantitative indication
Limitations:
Many false positive readings
Not a “survey” device
May become supersaturated
Best uses:
Detection of contaminated areas
Check at decontamination corridor

91. Gas Chromatograph and Mass Spectrometer
Portable gas chromatograph
Portable GC/MS
Laboratory analysis

92. Detect / Sample / Handle
Proper procedures are of vital importance to:
Protect Responders
Treat Victims
Prevent Spread of Contamination
Alert Supporting Agencies
Gather Evidence
Throughout every step of the response cycle, from Initial Assessment to Transportation to Hospitals

93. Chemical Detection Process
Observe signs and symptoms
Don appropriate protection
Initial entry (radiation; pH paper; O2, LEL, CO; PID)
Chemical agent detector papers (M8, M9)
Chemical detector instruments (CAM)
Detection kits (M256A1), colorimetric tubes
Samples for GC/MS

94. Chemical Agent Sampling
Air samples
Liquid samples
Solid samples
Quality of sample

95. Current Proliferation
   
Nuclear
Biological
Chemical
   
       
            .
           
                   
Number of Countries 5 14 15 25
Source:

97. Major Concerns Break up former Soviet Chemical Scientist
Rogue nations procurement of chemical stores
ICBM and delivery systems
Willingness of radicals to use chemical (Tokyo, Iran/Iraq War)

98. Video Break

99. Biological Warfare

100. What is Biological Warfare?
Warfare involving the use of living organisms (as disease germs) or their toxic products against men, animals, or plants.
“Webster’s” definition
Biological warfare is a frightening term, especially now when America is faced with an enemy that seems more than capable, and more importantly, willing to use this type of warfare.
Although we are focused on the mass infection of humans with this type of warfare, plants and animals are at risk as well. Using biological warfare on crops can destroy a towns, cities or even a countries harvest. Farm animals can be infected causing economic hardships. Ex/ mad cow disease. Imagine if America’s cattle was infected as Britains.

101. What are Biological Agents?
Biological agents are the living organisms, or the toxins derived from, causing disease in man, animals or plants.
Bacteria
Virus
Toxins
Bacteria - Ex/ plague, anthrax - we have all heard of bacteria. A house hold name is salmonella (a bacteria that causes food poisoning, usually from undercooked chicken).
It is single-celled and asexual. When it enters the body it usually will target a specific area. Ex/ strep throat targets your esophagus. Bubonic plague targets the lymphnodes. Bacteria invade tissues, produce toxins, or both. Often specific tissues are targeted.
Virus - Ex/ flu, colds, smallpox, hemorraghic fevers - we are all familiar with the word virus. We have all been infected at one point or another with a virus. Be it a cold or the chicken pox. Viruses require a host cell to reproduce. Often a specific host cell is needed.
Toxins - Toxins are made from organic sources. Ex/ fire coral, venom, puffer fish, and bacteria. Botulism is common word. The bacteria is found in improperly canned foods and once in the body begins producing toxic wastes. This toxin is a neurotoxin and blocks the chemical messages in your nervous system.. Other toxins disrupt cellular function. Ex/ ricin, inhibits ricin inhibits ribosomes from making proteins.

102. How can they be disseminated?
Biological agents can be disseminated in a variety of ways.
Mail
Clouds/Spray cans
Food/water
Sick people/animals
What to look for.
Excessive postage. Excessive weight, lopsided or uneven
Incorrect titles or titles without a name
Misspellings of common words
Oily stains,discolorations, odors
Poorly typed or written addresses, no return address
Protruding wires, aluminum foil other visual distractions
Excessive security materiel such as tape, string
Marked with restrictive endorsements/ confidential, personal
City or state postmark does not match return address
What to do:
Do not open! Place in plastic bag and take to local authorities. Or cover with anything (clothing, paper, trash can) and do not remove cover.
Leave area and do not let others near.
Wash hands with soap and water.
List all personnel who was in the area and may be infected.
If leaked powder, do not try to clean it up. Cover it (clothing, paper, trash can).
Leave area and keep others away. Call local police.
Put contaminated clothing into a bag for proper disposal and shower ASAP.

103. Factors in Making Effective Bio Agents
Availability and ease of production in sufficient quantities.
Lethal or incapacitating effects in humans at achievable and deliverable doses.
Appropriate particle size.
Ease of dissemination.
Stability (storage, weapons, environment)
Susceptibility of target.

104. Selected Potential Agents
Anthrax
Plague
Smallpox
Hemorrhagic Fevers
What have you heard of lately concerning the use of biological warfare?
I am going to talk a little about these few agents.

105. Hemorrhagic Fevers Crimean-Congo, Hantavirus, Ebola, Yellow Fever
Symptoms include fever, muscular pain, lack of strength.
Full blown; shock and mucous membrane hemorrhage.
Crimean-Congo - Ticks - Europe, Africa, Asia. Copious hemorrhage and highly infective nature via aerosol route. Qetta city in Pakistan outbreak in April 2001.
Hantaviruses - Infected rodents excreta - Asia, Europe, possibly world wide.
Ebola - unknown natural reservoir - Africa. (reston)
Yellow Fever - mosquito - Tropical Africa, South America. Black vomit, jaundice.
Targets vascular bed, causing microvascular damage and changing vascular permeability (causing internal bleeding). Full blown syndrome includes shock and mucous membrane hemorrhage (bleeding out every orifice) common complaints are fever, muscular pain, lack of strength. Victims melt in front of you, violent spasm of bloody vomit and defication shortly before death.
Mortality from 5% - 20% in recognized cases to 50% - 90% in Ebola outbreaks in Africa.
Treatment is supportive. Rplace lost fluids until body overcomes virus. Yellow fever vaccine. Other vaccines IND but not expected licensed in the near future.

106. Monkey infected with Ebola
African victim
Victim in isolation chamber

107. Small Pox Variola virus
Small Pox: High transmissibility, globally eradicated in the 70’s.
INCUBATION: DAYS
SYMPTOMS: After incubation include fever, headache, neck and backaches.
2-3 days rashes w/ lesions appear.
3-4 weeks scabs develop and fall off.
Treatment: Vaccine during first week of exposure, 30-35% mortality.
According to the world health organization smallpox was eradicated from the world in US stopped vaccinating civilians in Immunity since that time has most likely become ineffective.
Small pox has airborne transmissibility and is contagious through out the course of the disease until the scabs have fallen off. Contaminated clothing and bed spreads will also spread the disease. It is 30% fatal and there is no treatment after symptoms appear. An outbreak affecting people would cause a national emergency control measures due to transmissibility.
First symptoms include fever, lack of strength, headaches and backaches. Severe abdominal pain and sometimes delirium. Rash appears on face, hands, legs and w/in 2 days postules form on outside and inside of the body. They are more numerous on appendages (often on soles of feet and palm of hands). Crust forms 8-9 days later, scabs separate leaving pigment free skin and scars.
It is thought that only the CDC and Moscow repositories are the only existence for smallpox, but the possibility of another country attaining a sample exists.
Vaccinia vaccine - not actual small pox virus but similar to cause resistance.

108. Last occurrence of endemic small pox in Somalia in 1977.
Since, the only cases have been from laboratory incidents.

109. Untreated woman 12 days after onset of rash.

110. Plague Yersinia pestis
PLAGUE- Bacteria - Inhalation, Insect bite.
3 Clinical Manifestations
SYMPTOMS: (Occur within 1-6 days)
Swelling of Lymph Nodes (bubonic)
Nausea, fever,chills, vomiting, diarrhea.
Respiratory Distress (pneumonic)
Appendages turn black (Septicemic)
Mortality: Bubonic 23%, Pneumonic and Septcemic near 100% if untreated.
AD 541 Egypt, % of the population. Black Death (Great Pestilence) in million in China and million in Europe.
3 manifestations
Bubonic- flea bites, bacteria travels to nearest lymphnodes. Causes them to inflame and they are very painful. 23% fatal if left untreated.
Pneumonic- nausea, fever, headache, weakness, cough producing bloody or watery sputum, respiratory distress. Very contagious as aerosolized when breathing. Progresses over 2-4 days, causes septic shock and death if not treated early.
Septicemic- plague is in blood system traveling through out body- results from untreated bubonic and pneumonic forms. Fever, chills, vomiting, diarrhea. Acral cyanosis and necrosis in appendages (turn black).
Treatable with antibiotics early (streptomycin, tetracycline, and chloramphenicol), no vaccine.

111. Bubonic Plague - femoral buboes - swollen , painful lymphnodes.
Natural vector is flea.

112. Pneumonic plague

113. Patient recovering from bubonic plague that progressed into septicemic and pneumonic.
Note bandage for tracheotomy and necrosis of nose, fingers and toes on the next slide.

114. Toes of previous patient.

115. Anthrax Bacillus anthracis
ANTHRAX- Spore-forming bacteria. Causes infection and depresses the Central Nervous System.
ROUTE OF ENTRY: Inhalation, Ingestion, or skin lesions.
SYMPTOMS: (Occur within 2-7 days)
Cutaneous- boil like lesion forming into black ulcer.
Inhalation- common cold then respiratory difficulty and shock.
Gastrointestinal- inflammation of intestinal tract, nausea, vomiting, fever, abdominal pain.
Mortality: % if untreated
Anthrax - Greek for coal, due to black scabs.
Forms spores- hard outer coating when bacteria inactive that can last for years. Good for disseminating and storage. Reason for popularity with terrorists and that the inhalation form is generally fatal with out very early intervention of vaccine and antibiotics.
Antibiotics kill the bacteria, vaccine interrupts the three edema toxins it produces from effecting CNS. Produces black mucous where it colonizes and moves through out blood stream.
3 clinical manifestations
Cutaneous- 95% of cases - bacterium enters through skin, cuts or abrasions. From cattle, sheep, wool, hides, leather. Begins with raised itchy bump and 1-2 days forms vesicle then a painless ulcer, black necrotic area in center. Lymph glands in area may swell. Rarely fatal when treated with antibiotics.
Inhalation- Initial symptoms are cold/flu like, progressing into severe breathing difficulty and shock. Usually fatal.
Gastrointestinal- from eating contaminated meat. Acute inflammation of intestinal area, nausea, loss of appetite, vomiting, fever followed by abdominal pain, vomiting blood and severe diarrhea % fatal.

116. Anthrax factory in Russia.
Third world countries are more susceptible to Anthrax due to the mixing of human and animal populations.
Anthrax is gram positive.
Rhesus monkey blood infected with inhalation anthrax.

117. First lesion appears as an itchy bump (like an insect bite).

118. Turns into an ulcer with necrotic tissue in the center (dead).

119. 95% of all Anthrax cases are Cutaneous.
The scab will fall off and usually leave no scar.
95% of all Anthrax cases are Cutaneous.

120. X-ray of Sverdlovsk victim showing the widened mediastinal
X-ray of Sverdlovsk victim showing the widened mediastinal. Indicative of inhalation anthrax.

121. Lungs of victim of Sverdlovsk incident.
Sverdlovsk Russia, Accidental release of Anthrax from a research lab. Caused 66 fatalities with 11 survivors.
Had it been gastrointestinal the guts would be black.
Lungs of victim of Sverdlovsk incident.

122. Monkey infected with Anthrax

123. Want more Information? Centers for Disease Control (CDC) www.cdc.gov/
US Army Medical Research Institute of Infectious Diseases (USAMRIID)
World Health Organization

124. Questions and Answers
Tartars at Caffa City