New Developments New Developments in in

Biothreats and BiosecurityBiothreats and Biosecurity

Clifton R. Lacy, M.D.Clifton R. Lacy, M.D.

October 17, 2007October 17, 2007

A Taste of the New Jersey ExperienceA Taste of the New Jersey Experience

Imported Lassa FeverImported Lassa Fever

TularemiaTularemia

Severe Acute Respiratory Syndrome Severe Acute Respiratory Syndrome (SARS)(SARS)

Emerging Infectious DiseasesEmerging Infectious Diseases

New Diseases in Past 20 YearsNew Diseases in Past 20 Years

AcanthamebiasisAcanthamebiasis

AIDSAIDS

AnthraxAnthrax

Antimicrobial and insecticide resistanceAntimicrobial and insecticide resistance

Australian Bat LyssavirusAustralian Bat Lyssavirus

Babesiosis Babesiosis

Bartonella henselae Bartonella henselae

BotulismBotulism

CampylobacteriosisCampylobacteriosis

New Diseases in Past 20 YearsNew Diseases in Past 20 Years

ChikungunyaChikungunya

CryptosporidiosisCryptosporidiosis

CyclosporiasisCyclosporiasis

Prion Disease, Creutzfeldt-Jacob (vCJD)Prion Disease, Creutzfeldt-Jacob (vCJD)

Ebola Hemorrhagic Fever Ebola Hemorrhagic Fever

Encephalitozoon cuniculi Encephalitozoon cuniculi

Encephalitozoon hellemEncephalitozoon hellem

Enterocytozoon bieneusiEnterocytozoon bieneusi

Ehrlichia chafeensis Ehrlichiosis Ehrlichia chafeensis Ehrlichiosis

New Diseases in Past 20 YearsNew Diseases in Past 20 Years

Escherichia coli 0157:H7Escherichia coli 0157:H7

Enterovirus 71 Enterovirus 71

Guanarito VirusGuanarito Virus

Hantaan Hemorrhagic Fever with Renal Hantaan Hemorrhagic Fever with Renal Syndrome (HFRS)Syndrome (HFRS)

Hantavirus Pulmonary Syndrome Hantavirus Pulmonary Syndrome

Helicobacter pyloriHelicobacter pylori

Hendra VirusHendra Virus

Hepatitis C Hepatitis C

New Diseases in Past 20 YearsNew Diseases in Past 20 Years

Hepatitis EHepatitis E

HIV HIV

Human herpesvirus 6 (HHV-6) Human herpesvirus 6 (HHV-6)

Human herpesvirus 8 (HHV-8)Human herpesvirus 8 (HHV-8)

Human MonkeypoxHuman Monkeypox

Influenza, H5N1Influenza, H5N1

Lassa FeverLassa Fever

Legionnaires DiseaseLegionnaires Disease

Lyme BorreliosisLyme Borreliosis

New Diseases in Past 20 YearsNew Diseases in Past 20 YearsSabia VirusSabia VirusSARS CoronavirusSARS CoronavirusSindbis Sindbis Sin Nombre VirusSin Nombre VirusStaphylococcal Infection, Methicillin-Staphylococcal Infection, Methicillin-Resistant, Vancomycin-ResistantResistant, Vancomycin-ResistantStreptococcal Infection (toxic shock Streptococcal Infection (toxic shock syndrome, necrotizing fasciitis, etc.)syndrome, necrotizing fasciitis, etc.)Tuberculosis (MDR-TB, XDR-TB)Tuberculosis (MDR-TB, XDR-TB)TularemiaTularemiaMalaria, Drug-ResistantMalaria, Drug-Resistant

New Diseases in Past 20 YearsNew Diseases in Past 20 YearsMarburg Hemorrhagic FeverMarburg Hemorrhagic FeverMonkeypox, HumanMonkeypox, HumanNipah VirusNipah VirusO’nyong’nyong FeverO’nyong’nyong FeverOropuche FeverOropuche FeverParvovirus B-19Parvovirus B-19Plague Plague Rift Valley FeverRift Valley FeverRotavirusRotavirusWest Nile EncephalitisWest Nile EncephalitisWhitewater Arroyo VirusWhitewater Arroyo Virus

Selected New Infections By YearSelected New Infections By Year

1973: Rotavirus1973: Rotavirus

1975: Parvovirus B-191975: Parvovirus B-19

1976: Cryptosporidium1976: Cryptosporidium

1977: Ebola 1977: Ebola

1977: Legionella pneumophilia1977: Legionella pneumophilia

1977: Hantaan Virus1977: Hantaan Virus

1977: Campylobacter jejuni1977: Campylobacter jejuni

Selected New Infections By YearSelected New Infections By Year

1980: HTLV-1 1980: HTLV-1 1981: Staphylococcus aureus - Toxic Shock 1981: Staphylococcus aureus - Toxic Shock 1982: Escherichia coli 0157: H71982: Escherichia coli 0157: H71982: HTLV-2 1982: HTLV-2 1982: Borrelia burgdorferi1982: Borrelia burgdorferi1983: HIV1983: HIV1983: Helicobacter pylori1983: Helicobacter pylori1986: Cyclospora cayatanensis1986: Cyclospora cayatanensis1988: Human herpesvirus 6 (HHV-6) 1988: Human herpesvirus 6 (HHV-6) 1988: Hepatitis E1988: Hepatitis E1989: Ehrlichia chafeensis1989: Ehrlichia chafeensis1989: Hepatitis C1989: Hepatitis C

Selected New Infections By YearSelected New Infections By Year1991: Guanarito Virus1991: Guanarito Virus1991: Babesia species1991: Babesia species1992: Vibrio cholerae 01391992: Vibrio cholerae 01391992: Bartonella henselae1992: Bartonella henselae1993: Sin Nombre Virus1993: Sin Nombre Virus1993: Encephalitozoon cuniculi1993: Encephalitozoon cuniculi1993: Hantavirus Pulmonary Syndrome1993: Hantavirus Pulmonary Syndrome1994: Sabia Virus1994: Sabia Virus1995: Human herpesvirus 8 (HHV-8)1995: Human herpesvirus 8 (HHV-8)1996: Creutzfeldt-Jacob disease (vCJD)1996: Creutzfeldt-Jacob disease (vCJD)1997: H5N1 Influenza1997: H5N1 Influenza1998: Nipah Virus Encephalitis1998: Nipah Virus Encephalitis1999: West Nile Encephalitis1999: West Nile Encephalitis

Selected New Infections By YearSelected New Infections By Year

2000: Rift Valley Fever2000: Rift Valley Fever

2001: Anthrax Bioterrorism2001: Anthrax Bioterrorism

2002: Vancomycin-Resistant 2002: Vancomycin-Resistant Staphylococcus aureus Staphylococcus aureus

2003: SARS Coronavirus2003: SARS Coronavirus

2004: Monkeypox, Human2004: Monkeypox, Human

Emerging DiseasesEmerging Diseases

Over 2 billion airline passengers in 2006Over 2 billion airline passengers in 2006

Potential for faster and farther disease spread than Potential for faster and farther disease spread than any time before in historyany time before in history

Outbreak or epidemic somewhere is only few hours Outbreak or epidemic somewhere is only few hours away from being public health threat elsewhereaway from being public health threat elsewhere

Infectious diseases are emerging more rapidly Infectious diseases are emerging more rapidly

Since the 1970s, one or more new diseases have Since the 1970s, one or more new diseases have been identified each yearbeen identified each year

Over 40 diseases now were unknown 20 years agoOver 40 diseases now were unknown 20 years ago

Over 1100 epidemic events during last 5 yearsOver 1100 epidemic events during last 5 years

Causes of Emergence/Re-EmergenceCauses of Emergence/Re-Emergence

Population growth and urbanization Population growth and urbanization – overcrowding, unsanitary living conditions, lack of overcrowding, unsanitary living conditions, lack of

clean water for drinking and washing, poor hygieneclean water for drinking and washing, poor hygiene

Human encroachment on tropical rain forests Human encroachment on tropical rain forests – populations with little or no disease resistance now populations with little or no disease resistance now

in contact with disease organisms and/or vectorsin contact with disease organisms and/or vectors

Economic and social exigenciesEconomic and social exigencies– inadequate health systems and public health inadequate health systems and public health

infrastructureinfrastructure

Causes of Emergence/Re-EmergenceCauses of Emergence/Re-Emergence

Environmental change Environmental change – deforestation, road and building construction, deforestation, road and building construction,

irrigation, increased crop and animal production, irrigation, increased crop and animal production, urban sprawl, poor sanitation, pollutionurban sprawl, poor sanitation, pollution

Movement and encampment of population Movement and encampment of population displaced by wars, civil instability, or natural displaced by wars, civil instability, or natural disasters disasters – overcrowding, lack of clean water, unsanitary overcrowding, lack of clean water, unsanitary

conditions, poor hygiene, malnutrition, exposure conditions, poor hygiene, malnutrition, exposure to new or re-emerging diseasesto new or re-emerging diseases

Human sexual behavior changeHuman sexual behavior change

Causes of Emergence/Re-EmergenceCauses of Emergence/Re-Emergence

Increased global travel, commerce, and Increased global travel, commerce, and terrorismterrorism

– transport of disease-causing organisms/vectorstransport of disease-causing organisms/vectors– global commerce of livestock and foodstuffsglobal commerce of livestock and foodstuffs

Indiscriminate use pesticides/antimicrobialsIndiscriminate use pesticides/antimicrobials

– antibiotic resistance in organismsantibiotic resistance in organisms

New strains of all diseasesNew strains of all diseases

– different immunological characteristics, virulence, different immunological characteristics, virulence, contagion, and response to antibioticscontagion, and response to antibiotics

Immunosuppressed and compromised hostsImmunosuppressed and compromised hosts

AS Fauci

Examples of Emerging and Re-Emerging Infectious DiseasesExamples of Emerging and Re-Emerging Infectious Diseases

Examples of Emerging InfectionsExamples of Emerging Infections

HenipavirusesHenipaviruses

–Hendra VirusHendra Virus

–Nipah VirusNipah Virus

Avian Influenza H5N1Avian Influenza H5N1

Intentional BiothreatsIntentional Biothreats

AnthraxAnthrax

TerrorismTerrorism

BioterrorismBioterrorism

TerrorismTerrorism

Repeated violent actionRepeated violent action

Anxiety-provokingAnxiety-provoking

Intimidation, coercion, propagandaIntimidation, coercion, propaganda

Main target not the direct target of violence Main target not the direct target of violence

Assassination / Guerrilla WarfareAssassination / Guerrilla Warfare

Assassination: Assassination:

Main target is the direct target of violence Main target is the direct target of violence

Conventional and guerrilla warfare: Conventional and guerrilla warfare:

Violence/threat to create fear only in victimsViolence/threat to create fear only in victims

BioterrorismBioterrorismDeliberate release of biological agents (viruses, bacteria, Deliberate release of biological agents (viruses, bacteria, fungi, etc.) to cause illness and/or death in people, fungi, etc.) to cause illness and/or death in people, animals, or plantsanimals, or plants

Biological agents are insidious Biological agents are insidious – difficult to detect difficult to detect – illness propagates over hours, days, weeksillness propagates over hours, days, weeks

Some biological agents are infectious and contagious Some biological agents are infectious and contagious – can be spread from person to person (smallpox) can be spread from person to person (smallpox)

Some biological agents are infectious but not contagious Some biological agents are infectious but not contagious – cannot be spread from person to person (anthrax)cannot be spread from person to person (anthrax)

Bioterrorism agents are divided into three categories, Bioterrorism agents are divided into three categories, based on on ease of contagion and severity of illnessbased on on ease of contagion and severity of illness

Select Agents – Category ASelect Agents – Category A

Category A Agents – highest riskCategory A Agents – highest risk

Easily spread or transmitted person-to-personEasily spread or transmitted person-to-person

High death rates and potential major public High death rates and potential major public health impacthealth impact

Can cause public panic and social disruptionCan cause public panic and social disruption

Require special action for public health Require special action for public health preparednesspreparedness

Select Agents – Category ASelect Agents – Category A

Anthrax (Bacillus anthracis) Anthrax (Bacillus anthracis)

Smallpox (Variola major) Smallpox (Variola major)

Plague (Yersinia pestis) Plague (Yersinia pestis)

Botulism (Clostridium botulinum toxin)Botulism (Clostridium botulinum toxin)

Tularemia (Francisella tularensis) Tularemia (Francisella tularensis)

Viral hemorrhagic fevers Viral hemorrhagic fevers – filoviruses like Ebola and Marburgfiloviruses like Ebola and Marburg– arenaviruses like Lassa and Machupoarenaviruses like Lassa and Machupo

Select Agents – Category BSelect Agents – Category B

Category B Agents – second highest priorityCategory B Agents – second highest priority

Moderate illness rates and low death ratesModerate illness rates and low death rates

Require specific laboratory enhancements Require specific laboratory enhancements and disease monitoringand disease monitoring

Select Agents – Category BSelect Agents – Category BBrucellosis (Brucella species)Brucellosis (Brucella species)Glanders (Burkholderia mallei) Glanders (Burkholderia mallei) Melioidosis (Burkholderia pseudomallei)Melioidosis (Burkholderia pseudomallei)Psittacosis (Chlamydia psittaci)Psittacosis (Chlamydia psittaci)Q Fever (Coxiella burnetii) Q Fever (Coxiella burnetii) Epsilon toxin of Clostridium perfringens Epsilon toxin of Clostridium perfringens Food safety threats Food safety threats (Salmonella species, E coli 0157:H7, Shigella)(Salmonella species, E coli 0157:H7, Shigella)Ricin toxin from Ricinus communisRicin toxin from Ricinus communisStaphylococcal enterotoxin B Staphylococcal enterotoxin B Typhus (Rickettsia prowazekii) Typhus (Rickettsia prowazekii) Viral encephalitis (Alpha viruses: Venezuelan Equine Viral encephalitis (Alpha viruses: Venezuelan Equine Encephalitis, Eastern Equine Encephalitis, Western Encephalitis, Eastern Equine Encephalitis, Western Equine Encephalitis)Equine Encephalitis)Water supply threats Water supply threats (Vibrio cholerae, Cryptosporidium parvum)(Vibrio cholerae, Cryptosporidium parvum)

Select Agents – Category CSelect Agents – Category C

Category C Agents – third highest priorityCategory C Agents – third highest priority

Include emerging pathogens that could be Include emerging pathogens that could be engineered for mass spread in the futureengineered for mass spread in the future

Easily availableEasily available

Easily produced and spreadEasily produced and spread

Potential for high morbidity and mortality rates Potential for high morbidity and mortality rates and major health impactand major health impact

Nipah Virus Nipah Virus

Hanta virusHanta virus

Multi-Drug-Resistant Tuberculosis.Multi-Drug-Resistant Tuberculosis.

Biowarfare HistoryBiowarfare History

Poisoned wellsPoisoned wellsContaminated arrowsContaminated arrowsVenomous snakesVenomous snakesDead/infected animalsDead/infected animalsDead/Infected humansDead/Infected humansInfected fomitesInfected fomitesInfected insectsInfected insectsFood poisoningFood poisoningBioagent releaseBioagent release

Synthetic BiothreatsSynthetic Biothreats

Genetic engineering of bioagentsGenetic engineering of bioagents

Creation of bioagentsCreation of bioagents

Re-creation of bioagents Re-creation of bioagents

Purchase of DNA sequencesPurchase of DNA sequences

Genomics and Future Biological WeaponsGenomics and Future Biological Weapons

Modify infectivityModify infectivity

Modify virulenceModify virulence

Modify antigenic properties Modify antigenic properties

Enhance antibiotic resistanceEnhance antibiotic resistance

Transfer pathogenic properties Transfer pathogenic properties

Alter to make harder to detect, diagnose, and treatAlter to make harder to detect, diagnose, and treat

Sneak stealth viruses covertly into genome Sneak stealth viruses covertly into genome – Population-specific Population-specific – Triggered at a later timeTriggered at a later time

Target genome of specific population Target genome of specific population – Design specific pathogenDesign specific pathogen

Synthetic BiothreatsSynthetic Biothreats

“…“…DNA can be synthesized from the DNA can be synthesized from the [genetic] sequence, and this could be [genetic] sequence, and this could be done by any third-rate terrorist.”done by any third-rate terrorist.”

– Vincent Racaniello Vincent Racaniello

Virologist, Columbia UniversityVirologist, Columbia University

Synthetic BiothreatsSynthetic Biothreats

““The most worrisome thing… is that the The most worrisome thing… is that the field of synthetic biology is going to enable field of synthetic biology is going to enable people to create potentially very people to create potentially very dangerous diseases that don't otherwise dangerous diseases that don't otherwise exist or to re-create ones that have been exist or to re-create ones that have been wiped off the face of the earth.” wiped off the face of the earth.”

– Edward Hammond, biological weapons expertEdward Hammond, biological weapons expert

System Failures and Human ErrorSystem Failures and Human ErrorMistakes – Accidents – Operator/System Failures Mistakes – Accidents – Operator/System Failures – Errors of CommissionErrors of Commission– Errors of OmissionErrors of Omission

Poor JudgmentPoor Judgment

CarelessnessCarelessness

Inadequate or Lapsed TrainingInadequate or Lapsed Training

Unintentional Environmental ReleasesUnintentional Environmental Releases

Intentional ReleasesIntentional Releases

Containment Breaches and Security FailuresContainment Breaches and Security Failures

Missing Laboratory Samples or AnimalsMissing Laboratory Samples or Animals

World Health Organization World Health Organization

World Health Report 2007World Health Report 2007

A Safer FutureA Safer Future

Global Public Health Security Global Public Health Security

in the 21st Centuryin the 21st Century

Impact Public HealthImpact Public HealthCommerce and travelCommerce and travel

Reduced vigilance and lapsed programsReduced vigilance and lapsed programs

False rumorsFalse rumors

Armed conflictArmed conflict

PovertyPoverty

Resistant organismsResistant organisms

Weather and climateWeather and climate

Intentional and unintentional releasesIntentional and unintentional releases

Industrial accidentsIndustrial accidents

Natural phenomenaNatural phenomena