1. Bioterrorism MLAB 2434: Microiology Keri Brophy-Martinez

2. Terms Bioterrorism: use of bacteria, viruses, fungi or toxins to injure people, animals or crops to cause civil and economic unrest. Biological warfare: use of bacteria, viruses, fungi or toxins to injure people, animals or crops to gain military advantage.

3. Biosafety Levels (BSL) Based on microorganism disease potential Combination of standard procedures and techniques, safety equipment and facilities designed to minimize the exposure of workers and the environment to infectious agents. Each increase in level indicates more precautions and work controls

4. BSL’s BSL-1 Organisms that do not normally cause human disease Minimal safety procedures & equipment Ex: Bacillus subtilis BSL-2 Organisms cause human disease but are not transmitted among hosts Work should be performed under class II biological hood Ex: HBV, Salmonellae

5. BSL’s BSL-3 Organism transmitted by respiratory route Causes serious disease Requires use of separate air ventilation systems EX: Mycobacterium tuberculosis BSL-4 Organism transmitted by respiratory route High risk of disease Strict precautions, require containment suits No treatment or vaccine EX: Ebola

6. 3 Categories for Public Health Preparedness A : Agents of greatest impact EX: Bacillus anthracis, Yersinina pestis B : Easily disseminated EX: Brucella, E. coli 0157: H7 C : Emerging pathogens Mass dissemination EX: Multidrug resistant MTB, hantavirus

7. Considerations Biological weapons usually enter host via respiratory tract, GI tract, skin and mucous membranes Primarily aerosols Food or water sources usually not utilized

8. Laboratory Response Network (LRN) Established in 1999 by CDC, FBI and United States Army Medical Research Institute of Infectious Disease(USAMRIID) Goal: Link state and locate labs with advanced capacity clinical, military, veterinary, agricultural, H 2 0 and food testing labs Decentralize testing capabilities

9. Laboratory Response Network (LRN) Structure 1. Sentinel Role Rapid detection and reporting of potential threats Rule out or refer suspicious isolates, not to ID Provide assistance on proper collection, processing, and handling of samples Community hospitals with microbiology capabilities BSL-2

10. Laboratory Response Network (LRN) 2. Reference Role oOffer confirmatory testing for biothreat agents oCulture ID Examples: State public health labs & Dept. of Defense labs 3. National Role o Perform all reference lab tests, and forensic testing o Definite ID of biothreat agents Examples: CDC, USAMRIID, National Research Medical Center BSL-4

11. Indicators of a Potential Biocrime Event A disease entity that is usual or that does not occur naturally in a given geographic area. Multiple disease entities in the same patients. Higher than average morbidity & mortality relative to the number of personnel at risk or within a population that inhabits the same area. Massive point source outbreak. Aerosol route of infection. Illness limited to located or circumscribed geographic areas with filtered air supplies or closed ventilation systems. Sentinel dead animals of different species. Absence of a competent natural vector in the area of an outbreak.

12. Agents of Bioterror Bacillus anthracis Yersinia pestis Francisella tularensis Brucella species Burkholderia species Coxiella burnetii Variola virus- smallpox Viral hemorrhagic fever- Ebola & Marburg virus Ricin Staph enterotoxins Clostridium botulinum toxin

13. References Mahon, C. R., Lehman, D. C., & Manuselis, G. (2011). Textbook of Diagnostic Microbiology (4th ed.). Maryland Heights, MO: Saunders. Patton, M. T. (2010, October). In the Wake of an Attack: Laboratorians on the front line of bioterrorism defense. Advance for Medical Laboratory Professionals, 22(20), 6-7.