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CONFIDENTIAL Virtual Drug Development, Inc. Dr. R. Stephen Porter President, CEO, and Chairman Brentwood, TN www.virtualdrugdevelopment.com.

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Presentation on theme: "CONFIDENTIAL Virtual Drug Development, Inc. Dr. R. Stephen Porter President, CEO, and Chairman Brentwood, TN www.virtualdrugdevelopment.com."— Presentation transcript:

1 CONFIDENTIAL Virtual Drug Development, Inc. Dr. R. Stephen Porter President, CEO, and Chairman Brentwood, TN

2 CONFIDENTIAL Bioterrorism History The Threat The Organisms Counter-bioterrorism Deterrence Detection Response VDDI

3 CONFIDENTIAL Common Misconceptions Large scale bioterrorism will not occur Bioterrorism is similar to other WMD events (i.e.. Chemical radiation) The federal Government is equipped to deal with Bioterrorism;Local Governments are not

4 CONFIDENTIAL History Tartars attack on Caffa (1346) Plague French and Indian Wars (1763) Small Pox Blankets (Sir Jeffery Amherst WWI-Germans infected horses and Cattle B. Anthracis (Anton Dilger JHU) 3500 horses infected 1925 Geneva Protocol

5 CONFIDENTIAL Plague According to a traditional story, the plague came to Europe from the town of Caffa, a Crimean port on the Black Sea where Italian merchants from Genoa maintained a thriving trade center. The Crimea was inhabited by Tartars, a people of the steppe, a dry, treeless region of central Asia. When the plague struck the area in 1346, tens of thousands of Tartars died. Perhaps superstition caused the Muslim Tartars to blame their misfortune on the Christian Genoese. Or perhaps a Christian and Muslim had become involved in a street brawl in Caffa, and the Tartars wanted revenge. In any case, the Tartars sent an army to attack Caffa, where the Genoese had fortified themselves. As the Tartars laid siege to Caffa, plague struck their army and many died. The Tartars decided to share their suffering with the Genoese. They used huge catapults to lob the infected corpses of plague victims over the walls of Caffa. As the Tartars had intended, the rotting corpses littered the streets, and the plague quickly spread throughout the besieged city. The Genoese decided they must flee; they boarded their galleys and set sail for Italy, carrying rats, fleas, and the Black Death with them." (Corzine, 1997)

6 CONFIDENTIAL History WWII-Modern Era of BW Japanese Unit 731 in Manchuria ( ) 11 Chinese cities attacked-plague in Chusien U.S. offensive program (1942) S. Marcescens “attack” on SF (1950)

7 CONFIDENTIAL History Korean War (1950s) US offensive program “officially Terminated” (1969) Biological Weapons and Toxic Convention (1972)-103 nations including Iraq Stop development, stockpiling Yearly Reports to UN

8 CONFIDENTIAL History Russian Offensive Program Sverdlovsk (1979) Biopreparat program 55K workers in 6 Labs ands 5 production plants 1992 Yeltsen admitted to program after Ken Alibek defected

9 CONFIDENTIAL History Recent Events Rajneesh attack Oregon (1984) Larry Wayne Harris (1995) Bought plague American Type Culture Collection (ATCC) Shipped Anthrax to Iraq Abortion Clinics TN, KY OH, IN (1998)

10 CONFIDENTIAL Biopreparat All-Union Production Association Biopreparat, created in 1973 by the Central Committee of the CPSU and the USSR Council of Ministers, some 40 research and development (R&D) and production facilities. Biopreparat actively involved in military BW programs. Leading Biopreparat facilities included the State Scientific Center of Applied Microbiology in Obolensk, the Institute of Immunological Studies in Lyubuchany, the State Scientific Center of Virology and Biotechnology (known as Vector) near Novosibirsk, the State Scientific Institute of Ultrapure Biological Preparations in Leningrad, and the Scientific Experimental and Production Base in Stepnogorsk, Kazakhstan. The 15th Directorate of the MOD supervised the work of the Biopreparat facilities and coordinated their activities with those of the MOD’s military biotechnological centers. As the Kazakhstani example will show, in addition to being run by the same upper echelon of the MOD, the military and Biopreparat BW systems shared some technologies and personnel.

11 CONFIDENTIAL Renaissance Island Vozrozhdeniye Island open-air test site in the Aral Sea tons of powdered anthrax

12 CONFIDENTIAL

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14 THE THREAT Why use bioweapons? Cheap- 800x than nuclear weapon Easy to acquire-dual use High fatality –1993 OTA Report 100 Kg anthrax could kill more (3 million) than H bomb (1.9M) High fear/panic factor

15 CONFIDENTIAL THE THREAT Why have bioweapons not been used? Unpredictability Reprisals/Accountability Superpower stability Conventional weapons work

16 CONFIDENTIAL THE THREAT Bioterrorist Profile (Simon 1989:OTA) Not concerned about response to attack History of large scale violence with high causalities Sophistication in weaponry and tactics State Sponsorship Willingness to take risk

17 CONFIDENTIAL THE THREAT Likely Perpetrators Japanese RED Army (JRA) World revolution Aum Shinrikyo cult- Shoko Asahara World revolution Neo-Nazi/Militia in US and Europe

18 CONFIDENTIAL THE THREAT Likely Perpetrators Cont… Islamic extremist-Hezbollah, Ramsi Yousef Sikh extremists in India Animal rights grps. In US State Sponsored- Libya, Iran, Iraq, N.Korea, Cuba

19 CONFIDENTIAL THE ORGANISM Ideal organisms Easy to obtain Easy to cultivate Highly Infectious Stable in Environment Contagious

20 CONFIDENTIAL THE ORGANISMS Means of Delivery Food and Water Supply Chlorination and cooking kill agents Requires huge amounts Aerosolization-sprayers Mechanical stress kills agents Particle size.5 to 5 Microns Metrological conditions Zoonotic delivery

21 CONFIDENTIAL Anthrax

22 CONFIDENTIAL Anthrax as a WMD Inhalational Anthrax Requires 8k-50k spores Biphasic illness-incubation 2-43 days Necrotizing mediastinitis; meningitis Diagnosis difficult-sputum cultures; blood cultures are too late Treatment with IV PCN, TCN, Cipro for 4-8 wks Side effects Resistant Strains AVIP: Vaccination X 6 doses over 18 months

23 CONFIDENTIAL Life Cycle Stages for Intervention NAD Synthetase X

24 CONFIDENTIAL B. Anthracis; USAMRIID Data

25 CONFIDENTIAL B. Anthracis Infections Efficacy Assay Dixon TC, Meselson M, Guillemin J, Hanna, PC. Anthrax. 341(11) N. Engl J. Med. 1999;341:

26 CONFIDENTIAL SMALL POX “..the most terrible of all ministries of death” Marcus Aurelius 180 AD), Tsar Peter II (1730) Hapsburg dynasty (18 th Century) Last case in Somalia in 1977 Declared eradicated in 1980 Last vaccination in 1972

27 CONFIDENTIAL SMALL POX Good bioweapon Highly infective organisms Stable in environment Contagious Infection Constitutional sxs follow in 3 days by typical rash 30% mortality

28 CONFIDENTIAL SMALL POX

29 CONFIDENTIAL SMALL POX Dx clinical. PCP, cx from lesions Treatment (cidofovir, Vistide) Isolate close contacts for 17 days Vaccine-Vaccina Small pox only survives at CDC and in Moscow Virologic Institute.

30 CONFIDENTIAL Plague Yersenia pestis The Oriental Rat Flea: Xenopsylla cheopis

31 CONFIDENTIAL Plague According to a traditional story, the plague came to Europe from the town of Caffa, a Crimean port on the Black Sea where Italian merchants from Genoa maintained a thriving trade center. The Crimea was inhabited by Tartars, a people of the steppe, a dry, treeless region of central Asia. When the plague struck the area in 1346, tens of thousands of Tartars died. Perhaps superstition caused the Muslim Tartars to blame their misfortune on the Christian Genoese. Or perhaps a Christian and Muslim had become involved in a street brawl in Caffa, and the Tartars wanted revenge. In any case, the Tartars sent an army to attack Caffa, where the Genoese had fortified themselves. As the Tartars laid siege to Caffa, plague struck their army and many died. The Tartars decided to share their suffering with the Genoese. They used huge catapults to lob the infected corpses of plague victims over the walls of Caffa. As the Tartars had intended, the rotting corpses littered the streets, and the plague quickly spread throughout the besieged city. The Genoese decided they must flee; they boarded their galleys and set sail for Italy, carrying rats, fleas, and the Black Death with them." (Corzine, 1997)

32 CONFIDENTIAL

33 PLAGUE

34 CONFIDENTIAL PLAGUE Pneumonic plague Least common (< 14% of all cases), but most severe form characterized by fulminant pneumonia termed primary pneumonic plague if acquired via respiratory tract and hematogenous spread to lungs overall mortality: 57% The form most likely to be seen in a bioterrorism setting Bubonic plague Most common form (75-97% of all cases) characterized by painful lymphadenitis (buboes) contracted through the bite of an infected flea or handling infected animals overall mortality: 15% This form is unlikely to occur in a bioterrorism setting Septicemic plague Less common form (< 20% of all cases) systemic infection characterized by high-grade bacteremia and sepsis termed primary septicemic plague if no buboes are detected or secondary septicemic plague if developed as a complication of bubonic overall mortality: 22-50%

35 CONFIDENTIAL PLAGUE

36 CONFIDENTIAL PLAGUE According to Dr. Matt Luther, Vanderbilt University Medical Center "The plague often caused DIC in severe forms, and DIC can be fatal. The picture above demonstrates what DIC can look like. In its most deadly form DIC can cause a victims skin to turn dark purple. The black death got its name from the deep purple, almost black discoloration." Victims usually died the same day symptoms appeared. In some cities, as many as 800 people died every day.

37 CONFIDENTIAL PLAGUE Adults streptomycin 1 g IM q 12 hrs (should be avoided in pregnant or lactating women) or gentamicin 2 mg/kg IV/IM load dose then 1–1.75 mg/kg IV/IM q 8 hrs per renal function Children streptomycin 15 mg/kg/day IM q 12 hrs (not to exceed 2g/day) or gentamicin 2.5 mg/kg IV/IM q 8 hrs (q 12 hrs for < 1 wk old or premature infants) Alternative therapies include: doxycycline, tetracycline, ciprofloxacin, and chloramphenicol

38 CONFIDENTIAL COUNTER-BIOTERRORISM Cost of an attack (Kaufman, 1997) Human toll of anthrax attack (100K) 50K infected 33K dead Economic toll of anthrax attack (pop100K) $26 billion

39 CONFIDENTIAL COUNTER-BIOTERRORISM Deterrence Enforce existing laws Prevent use Threat of reprisals and condemnation Immunization Intelligence (HUMIT)

40 CONFIDENTIAL COUNTER-BIOTERRORISM Detection of an Attack Clinical detection need trained local health Explosion of ill patients Animals Weather conditions Antimicrobial resistance patterns

41 CONFIDENTIAL COUNTER-BIOTERRORISM Detection (cont..) Canary chips/biosensors Particle detectors-subways MALDI-TOF

42 CONFIDENTIAL COUNTER-BIOTERRORISM Response to an attack Treat victims/exposed and protect others Abx and immunizations Housing and transporting ill Quarantine, placement of deceased

43 CONFIDENTIAL COUNTER-BIOTERRORISM Response Cont..) Protect unexposed HEPA filters +pressure aerosol disinfectants in buildings Protect water and food

44 CONFIDENTIAL Conclusions Bioterrorist attacks will occur in the future We must prepare for this as a public health event Communication at State and Local level, business government pull together


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