Cholera

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Status Brief
History/Origins:

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2000

Benjamin, Georges C. “Chemical and Biological Terrorism: Planning for the WorstPhysician Executive Volume 26 Issue 1. 80. January/February 2000.

  1. Chemical or biological terrorism is the use of pathogenic microbes or toxins derived from plants, animals, microbes, or chemical agents to achieve terror.” – page 80
  2. ”Chemical and biological weapons, like nuclear weapons, are categorized as weapons of mass destruction (WMD) because of the high number of potential victims that can result from their use.” – page 80 *
  3. ”While any chemical can be weaponized, the chemical agents traditionally of concern fall into four categories: nerve agents like sarin, which create an anticholinergic-like syndrome; vesicants like mustard gas, that cause a blistering or burn-like syndrome; cyanide, which interrupts aerobic metabolism; and riot control agents such as mace, which generally cause incapacitation.” – page 80
  4. ”Biological agents act like chemical agents but have a slower onset of action. Agents of concern include Ricin.” – page 81
  5. ”The ideal bioweapon is hard to detect from the usual microbial flora, has person-to-person spread, and is easy to aerosolize. There are two groups of organisms of public health concern: those that cause a high morbidity or a high mortality.” – page 81
  6. ”Examples of high morbidity organisms include salmonella, cholera, or E. coli. The number of highly toxic organisms is fortunately quite low and includes anthrax, smallpox, and the viruses that cause hemorrhagic fevers, plague, brucellosis, and tularemia.” – page 81
  7. “Clues that biological terrorist events have occurred include an unexplained increase in respiratory cases or deaths, or dead and dying animals. Epidemiological clues include diseases with the wrong mode of transmission, which occur in an inappropriate geographic distribution or infect a new or novel population.” – page 81
  8. “Components of a biological/chemical terrorism disaster plan: plan how to identify the threat; develop an effective public health disease surveillance system; link the public health system and the traditional medical care delivery system; develop command and control systems; determine hospital bed availability; define disease containment, isolation, and quarantine procedures; plan how to obtain extra life support equipment such as respirators; plan how to train clinical staff to identify high-risk unusual diseases; ensure non-clinical staff are trained on the management of suspicious packages and mail; identify experts; plan simple handling and transport; plan how to communicate high risk information; manage medical examiner cases; and maintain a crime scene.” – page 81
  9. ”Effective disease control strategies such as case finding, decontamination, prophylaxis and vaccination, and quarantine must be defined.” – page 82

Chemical, WMD, Bioterrorism, Public Health, Military, Sarin, Japan, Ricin, E. coli, Cholera, Salmonella, Anthrax, Smallpox, Hemorrhagic fever, Plague, Brucellosis, Tularemia, Prophylaxis, Vaccination, Quarantine

2005

KAREN T. MORR, [the Acting Assistant Secretary for Office of Information Analysis in DHS] Statement, ”HEARING BEFORE THE SUBCOMMITTEE ON EMERGENCY PREPAREDNESS, SCIENCE, AND TECHNOLOGY OF THE COMMITTEE ON HOMELAND SECURITY HOUSE OF REPRESENTATIVES, ONE HUNDRED NINTH CONGRESS”, FIRST SESSION JULY 12, 2005. “PROJECT BIOSHIELD: LINKING BIOTERRORISM THREATS AND COUNTERMEASURE PROCUREMENT TO ENHANCE TERRORISM PREPAREDNESS.”

  1. “Al-Qa’ida documents recovered from a training camp in Afghanistan show interest in a variety of biological agents and mentioned plague, anthrax, cholera and tularemia.”
  2. “To determine threat, we examine an actor’s capability and intent. We assess capability based on factors such as the actor’s level of skill or knowledge, their ability to acquire a biological agent, the materials necessary to grow the agent and their capacity to effectively disseminate a biological agent. For intent, in addition to the actor’s desire to simply use biological weapons, we discern which agents they are more likely to pursue, their preferred method of deployment and which targets they intend to attack.”
  3. “Last month one of our analysts provided some of the Committee members with a classified briefing on the specifics of the current bioterrorist threat to the Homeland. I will not be able to revisit this classified threat assessment in this open forum but we would be happy to provide this information to additional members in a closed session.”
  4. “On occasion, we require quick access to information that does not reside within IA. In these cases, our analysts are supported to the Biodefense Knowledge Center (BKC)—a 24×7 support cell based at Lawrence Livermore National Laboratory and sponsored by the S&T Directorate. The BKC possesses vast repositories of biological technical information and is able to access SMEs from around the country, such as the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), the U.S. Army Medical Research Institute for Chemical Defense (USAMRICD), and the Armed Forces Medical Intelligence Center (AFMIC), in support of a tasking from IA. The BKC compiles the appropriate information and relays it to our analysts who integrate the information into their finished intelligence analysis.”
  5. “Our analysts regularly collaborate with other intelligence agencies, particularly NCTC, DIA, FBI, and CIA. We also work with experts from government, academic, and private institutions and partner with scientists who keep us abreast of their potential areas of concern and the trends they see.  Interaction with outside public and private sector institutions keeps us well-informed of new and emerging technology that may be exploited or misused by malicious actors.  For example, IA recently hosted a workshop on emerging biotechnologies and the future biological threat.  This provided a forum for non-governmental experts to provide IA with information of which they believe we should monitor.”
  6. “Our analysts are broadly focused and access a wide array of information in gathering source material for our assessments. They use all-source intelligence, scientific and technical information, terrorist profiles, historical trends, and open source information such as media reports and scientific journal articles.”
  7. “We keep current on foreign State biological weapons program developments as these activities may have implications for future terrorist events. We look at the intent of the enemy, their capabilities, potential scenarios, and attack vectors. Working with counterterrorist experts in the Community, we develop link charts on potential associates here in the United States of operatives abroad who may have received training in WMD capabilities or have knowledge of WMD programs.”
  8. “we assessed the implications of the H2N2 influenza shipment in which a U.S. contractor sent a highly virulent strain of influenza to hundreds of laboratories worldwide. We also recently published an Information Bulletin advising State and local Law Enforcement officials of indicators of covert anthrax production. Generally, our products fall into two categories: threat assessments and feasibility assessments.”
  9. “Threat Assessments. Threat assessments are written on known actors and are based on specific intelligence. To determine threat, we examine an actor’s capability and intent. We calculate capability based on factors such as a particular actor’s level of skill or knowledge; their ability to acquire a biological agent and the materials necessary to grow the agent; and their capacity to effectively disseminate a biological agent. For intent, we consider more than just an actor’s desire to use biological weapons. We attempt to discern which agents they are more likely to pursue, their preferred method of deployment, and which targets they intend to attack.”
  10. “Feasibility Assessments. Intelligence is never complete or all-knowing and we cannot wait until intelligence is received in order to consider plausible scenarios or the impact of a particular technique or technology on a bioterrorist’s capability. To move beyond this limitation, IA, in partnership with S&T, conducts assessments of biological processes, emerging technologies, and techniques and determines their feasibility for use in a bioterrorism event. These assessments include indicators that will help to identify if a particular scenario begins to unfold so we can prevent or disrupt events before they occur. In conjunction with the feasibility assessment, we are producing unclassified excerpts with the indicators which are distributed widely to local, State, Federal officials as well as the private sector to enhance awareness in the field and to increase suspicious activity reporting and trigger investigations where necessary.”
  11. “IA also has produced several bioterrorism-specific ‘‘red team’’ products, which explore issues from a terrorist’s perspective using nongovernmental experts and creative thinkers. These topics have included terrorist use of genetically modified food and recombinant DNA technologies to damage the U.S. food supply; possible terrorist exploitation of a U.S. flu vaccine shortage; and the safety and security impacts of a pandemic influenza outbreak.”
  12. “Under the BioShield legislation, DHS is charged with assessing current and emerging threats of chemical, biological, radiological, and nuclear agents; and determining which of such agents present a material threat against the United States population. S&T, supported by IA, has been conducting Material Threat Assessments (MTAs) and Material Threat Determinations (MTDs) in order to guide near term BioShield requirements and acquisitions.”
  13. “MTAs … are speculative and represent a best estimate of how an adversary may create a high-consequence event using the agent/weapon in question. Currently, MTAs are drafted by the S&T and IA provides comments on the assessment before it is provided to HHS. In our review, we ensure that the assessment reflects what IA assesses is the general capability of terrorist groups that are pursuing biological weapons.”
  14. “MTAs result in an estimate of the number of exposed individuals, the geographical extent of the exposure, and other collateral effects. If these consequences are of such a magnitude to be of significant concern to our national security, the Secretary of DHS then issues a formal Material Threat Determination to the Secretary of HHS, which initiates the BioShield process. To date, one MTA has been completed for anthrax and MTAs for plague, botulinum toxin, tularemia, radiological devices and chemical nerve agents are underway and an MTA for viral hemorrhagic fevers will be initiated next month. MTDs have been approved for four agents: smallpox, anthrax, botulinum toxin, and radiological/nuclear devices.”
  15. “IA, in cooperation with NCTC and the FBI, is providing WMD outreach briefings around the country. These briefings outline the terrorist WMD threat, including descriptions of the types of weapons used and indicators and warnings aimed at increase awareness and reporting. In the near future, we hope to expand these briefings to other audiences such as academia and the private sector to further increase awareness and reporting.”
  16. “IA will be playing a key role in supplying current intelligence to the National Biosurveillance Integration System (NBIS) operations center once it begins operation later this summer. NBIS will fuse information on human, plant, and animal health with environmental monitoring of air, food, and water systems. This information will be integrated with threat and intelligence information to provide real-time situational awareness and identify anomalies or trends of concern to the Homeland Security Operations Center.”

Project Bioshield, Al-Qaeda, Information Policy, Biosurveillance, Plague, Tularemia, Anthrax, Cholera, WMD, Academia, Lab Safety, Flu, Vaccination, Law Enforcement, Nuclear, Radiological Surveillance

2009

Brown, David, “System Set Up After SARS Epidemic Was Slow To Alert Global Authorities,” The Washington Post, A-Section, pg. A01, Apr 30, 2009.

  1. “Despite huge efforts in the past six years to make the reporting of disease outbreaks fast and automatic, there were significant delays in bringing Mexico’s swine flu outbreak to the full attention of international authorities.”
  2. “The delay in making the global health community aware happened despite the adoption in 2005 of international health regulations regarding nations to report to the WHO within 24 hours any disease outbreak that is serious, unusual, at risk of spreading internationally or potentially disruptive by trade.”
  3. “By the time international authorities became fully aware of the outbreak, there were about 800 cases and at least 50 deaths, and the virus was unknowingly bring carried into other countries.”
  4. “The (international health) regulations descend from the First International Sanitary Conference, held in Paris in 1851 to fight cholera. In content, they owe much to the severe acute respiratory syndrome (SARS) epidemic of 2003.”

Biosurveillance, SARS, Cholera, Flu, Mexico, WHO

2010

Kushner Jacob, “In Haiti, cholera could heighten earthquake miseryAP Last accessed October 27, 2010. http://news.yahoo.com/s/ap/20101025/ap_on_re_us/cb_haiti_disease_outbreak;_ylt=Am.a.5Ci64U5npHceqWUsLnVJRIF;_ylu=X3oDMTJ1NnEyYnVjBGFzc2V0A2FwLzIwMTAxMDI1L2NiX2hhaXRpX2Rpc2Vhc2Vfb3V0YnJlYWsEcG9zAzEEc2VjA3luX2FydGljbGVfc3VtbWFyeV9saXN0BHNsawNpbmhhaXRpY2hvbGU-

  1. “A cholera outbreak that already has left 250 people dead and more than 3,000 sickened is at the doorstep of an enormous potential breeding ground: the squalid camps in Port-au-Prince where 1.3 million earthquake survivors live. Health authorities and aid workers are scrambling to keep the tragedies from merging and the deaths from multiplying.”
  2. “Five cholera patients have been reported in Haiti’s capital, heightening worries that the disease could reach the sprawling tent slums where abysmal hygiene, poor sanitation, and widespread poverty could rapidly spread it.”
  3. “If efforts to keep cholera out of the camps fail, “The worst case would be that we have hundreds of thousands of people getting sick at the same time,” said Claude Surena, president of the Haiti Medical Association. Cholera can cause vomiting and diarrhea so severe it can kill from dehydration in hours.”
  4. “Some health experts were hopeful that they will be able to control the outbreak of cholera in impoverished Haiti.”

Cholera

 

Editors, “WHO: Pakistan Confirms 99 Cases of CholeraAP Last accessed October 27, 2010. http://abcnews.go.com/Travel/wireStory?id=11963757

  1. “The World Health Organization says Pakistan has confirmed 99 cases of cholera from across flood-affected areas.”
  2. “WHO says it was alerted by Pakistan on Oct. 12.”
  3. “Geneva-based WHO also said Monday that Pakistan has reported 26 cases, including 3 deaths of Crimean-Congo haemorrhagic fever. It says there also have been more than 1,500 laboratory-confirmed cases of dengue fever, including 15 deaths.”

Cholera, Dengue, WHO, Hemorrhagic Fever, Pakistan

 

Katz J., “CDC: Haiti cholera matches South Asian strainAP Last accessed November 6, 2010.

  1. “A cholera outbreak that has killed more than 300 people in Haiti matches strains commonly found in South Asia, the U.S. Centers for Disease Control and Prevention said Monday.”
  2. “The finding intensifies scrutiny on a U.N. base above a tributary to the Artibonite River that is home to a contingent of recently arrived peacekeepers from Nepal, a South Asian country where cholera is endemic and which saw outbreaks this summer.”
  3. “It is also a significant step toward answering one of the most important questions about the burgeoning epidemic: How did cholera, a disease never confirmed to have existed in Haiti, suddenly erupt in the vulnerable country’s rural center?”
  4. “Speculation among Haitians has increasingly focused on the U.N. base. The outbreak began among people who live downstream from where the tributary meets the Artibonite and drank from the river. On Friday, hundreds of protesters marched from the nearby city of Mirebalais to demand the Nepalese peacekeepers be sent home.”
  5. “The Associated Press found questionable sanitation in an unannounced visit to the base last week and an exclusive tour of the facility given by peacekeepers Sunday. Despite earlier statements that sanitation at the base was up to international standards, on Monday the mission acknowledged there are santiation problems and said they are being solved.”
  6. “The finding does not identify the source of the disease or say how it arrived in Haiti, but it eliminates other possibilities including a hypothesis that the strain might be related to a 1990s South American outbreak, Braden said. He said the strain was “fairly common.””
  7. “The outbreak is spreading across Haiti, its transmission eased by a lack of immunity among the population. A confirmed case of cholera had never been detected in Haiti before the current outbreak, said Claire-Lise Chaignat, head of the World Health Organization’s global task force on cholera control.”
  8. “The AP visited the Nepalese U.N. base last Wednesday to follow up on a statement by the mission that its sanitation measures met U.S. and U.N. standards. The area between the base and the river reeked of human waste. Several pipes were leaking, including a broken plastic pipe emitting a foul-smelling black liquid near what the soldiers identified as latrines. A U.N. engineer later said the liquid was most likely run-off from the camp kitchen.”
  9. “The dump site for the human waste was a few hundred yards (meters) away, across the street from the base in shallow, shovel-dug pits next to several homes. Neighbors said the pits often overflow and run to the river. They said they had stopped drinking from the river and sought fresh water uphill.”
  10. “The AP returned Sunday for a tour with U.N. officials, who acknowledged the facility had undergone a cleanup since then: Septic tanks were emptied, a drainage canal was cleared and the leaky pipe was replaced. The smell of excrement was mostly gone.”

Cholera, CDC, UN