Plague

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Status Brief
History/Origins:

Developmental Milestones/Developments to Date:

Current Assessment/State of the Field:

Problems/Challenges:

Proposals:

1997

Tenborg, M., et. al., “Fatal Human Plague–Arizona and Colorado, 1996,” JAMA, Aug. 6, 1997, Vol. 278, No. 5. P. 380.

  1. 5 cases of human plague in US, 2 fatal. Summary of investigation and recommendation for greater awareness of plague among health care providers in high risk regions.

Plague, CDC

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

 

Inglesby, Thomas, V. et al., “Plague as a biological weapon: Medical and public health managementJAMA, ma3, 2000, vol. 283, No. 17, 2281

  1. consensus statement 1995 microbiologist in ohio acquired plague y pestis by fraudulent means, antiterrorism drawn in response.
  2. Vaccination info/treatment.

Bioterrorism, Plague

2001

Cookson, Clive, “International Economy: Scientists Convert Virus Into Killer Biowarfare Fear,” THE FINANCIAL TIMES LIMITED, Jan 12, 2001. international economy, pg 15.

Smallpox, Mousepox, Viral Research, Plague

2003

Davis, Jim, “The Looming Biological Warfare StormAir & Space Power Journal, Volume 17, Issue 1. 57. Spring 2003.

  1. ”Until very recently, the lack of focus on this subject (biological warfare) has resulted in a lack of appropriate funding and accountability.” – page 58
  2. ”Unless we focus appropriate dollars and develop a coherent national plant to prepare for and prevent such actions, the United States will likely suffer an enormous economic loss that could even lead to our demise as a superpower.” – page 58
  3. ”A belief in one or more of at least six false assumptions or myths helps explain why individuals, including senior civilian and military leaders, do not believe that a mass-casualty biological warfare (BW) attack will occur.” – page 58
  4. ”Myth one: there never really has been a significant BW attack” – page 58
  5. ”Even before the fall 2001 anthrax terrorism in the United States, incidents of BW and bioterrorism have occurred on multiple occasions.” – page 58
  6. ”Today, more countries have active biological warfare programs than at any other time in history, which increases the likelihood that BW will be used again in the future.” – page 58
  7. ”Myth two: The United States has never been attacked by a BW agent” – page 59
  8. ”Myth three” you have to be extremely intelligent, highly educated, and well-funded to grow, weaponized, and deploy a BW agent” – page 59
  9. ”Dr. Tara O’Toole, deputy director for the Center for Civilian Biodefense Studies at Johns Hopkins University, believes we have probably crossed over the threshold from ‘too difficult’ to accomplish to ‘doable by a determined individual or group’” – page 59
  10. “Much of the technical information is readily available on the internet, in libraries, and through mail order channels that provide ‘how-to’ manuals.” – page 59
  11. ”Myth four: biological warfare must be too difficult because it has failed when it has been tried” – page 59
  12. ”Myth five: there are moral restraints that have kept and will keep BW agents from being used” – page 60
  13. ”Morality can be marshaled as a reason both to limit BW use and to advocate mass killings – depending on the decision maker’s values and perspectives” – page 60
  14. ”Myth six: the long incubation period required for BW agents before onset of symptoms makes BW useless to users” – page 60
  15. ”There have already been multiple BW attacks, and to a savvy weaponeer, the incubation period can be used as an advantage rather than a disadvantage.” – page 60
  16. ”There are two primary motivations that might drive an adversary to attack the United States with a BW agent. The first motivation is to gradually ‘erode US influence’ as a world superpower. The second is categorized as ‘revenge or hate’” – page 61
  17. ”The author believes that there are three most likely BW scenarios the United States and its allies might face in the future: an agroterrorist event against the United States, a BW attack on United States and allied troops in the Middle East, and/or a bioterrorist attack against a large population center in the United States or an allied state.” – page 61
  18. ”Such myths continue to inhibit the adequate funding of US and allied biodefense” – page 66

Military, Anthrax, Plague, Smallpox, Tularemia, Sarin, Japan, Iraq, Iran, Nonproliferation, WMD

 

Atlas, Ronald, “National Security and the LabMedical Laboratory Observer, Volume 35, Issue 9. 52. September 2003.

  1. ”The aftermath of anthrax attacks following the horrific 9/11 events increased fear that terrorists could acquire deadly pathogens from legitimate U.S. laboratories, which led to a series of laws and regulations directly impacting clinical microbiology laboratories.” – page 52
  2. ”Enhancement of clinical and public health laboratories is key to the nation’s biodefense capabilities, so the American Society for Microbiology (ASM) worked with the Centers for Disease Control and Prevention (CDC) to develop protocols for diagnostic laboratories to recognize and handle major biothreat agents.” – page 52
  3. ”Since clinical labs have been the sources of the agents used in prior acts of bioterrorism or biocrimes, (e.g., the 1989 use of salmonella by the Rajneesh cult in Dalles, OR), they must exercise appropriate oversight as to who is given access to any pathogen which can be misused to cause harm.” – page 52
  4. ”Clinical labs wishing to retain select agents as clinical specimens or reference standards must meet all of the registration requirements of the Biopreparedness Act, including imposing strict biosecurity procedures and obtaining Department of Justice clearance for all individuals with access to the select agents.” – page 52
  5. ”The CDC and USDA must maintain accurate tracking of the acquisition, transfer and possession of these select agents, and must establish safeguards and biosecurity procedures to be followed by institutions possessing select agents.” – page 52
  6. ”The FBI is responsible for conducting security risk assessments of individuals seeking access to listed agents and toxins, and individuals or entities seeking to register under the Act.” – page 52
  7. ”The Biopreparedness Act, a new regulatory burden, should have minimal impact. The greatest impact is likely to be on the labs in the western United States where plague, tularemia, and coccidioidomycoses occur.” – page 52

Public Health, Lab Security, Anthrax, Salmonella, Tularemia, Plague, CDC, Bioterrorism, Biodefense, Biosecurity

 

Leung, Rebecca, “The Case Against Dr. Butler: Government Investigators Faced With Another Bubonic Plague Scare,” CBS, October 19, 2003. http://www.cbsnews.com/stories/2003/10/17/60minutes/main578660.shtml

  1. Thomas Butler – deadly bubonic plague – missing 30 vials
  2. “There had been reports that Osama bin Laden had an active program to weaponize plague for use in the United States.”
  3. Butler “hand carried the specimens [live samples of the bubonic plague from Tanzania] on the flight home to the US”
  4. violated laws that require that scientists “ship deadly biological agents like plague in special safety containers and label them properly.”
  5. – others in scientific community feel government overreacted

Plague, Scientific Community

 

Editors, “The Thomas Butler Case: Some Unreported Information and Reasons for the Department of Justice’s Prosecution,” THE SUNSHINE PROJECT, October 28, 2003, http://www.sunshine-project.org/publications/pr/pr281003.html

  1. [Butler] “prompted a national bioterrorism scare”
  2. [worked in a] “large and secretive biodefense program supported by the US Army”
  3. “focus on US biodefense investigating anthrax letters in 2001, led to security concerns when vials went missing”
  4.  “need to prevent sensitive research from the public eye”
  5.  “a leak at a sensitive biodefense project isn’t just a potential health or terrorism threat. An accident could be an international liability.”

Open Science, Plague, Bioterrorism, Biodefense

2004

King, Warren, “Washington State Bioterror Monitoring Expands To Animals,” Knight Ridder Tribune Business News, pg. 1, Aug 30, 2004.

  1. “State health officials are expanding their early warning system for a bioterrorist attack by employing the help of rabbits, squirrels, mice and other critters.”
  2. “As part of the state’s biological-warfare defense, state veterinarians recently began monitoring unusual small-animal deaths for evidence of tularemia, plague or other diseases that could be cause by lethal agents.”
  3. “Small animals likely would show symptoms and die faster than humans after being exposed to a lethal biological agent.”
  4. “In the animal reporting system, plague and tularemia are receiving special emphasis because they are considered among the highest risks for an attack and can infect both animals and humans.  Anthrax, often mentioned as a threat, also could be detected in animals, especially cattle, sheep and goats, where it occurs naturally.”
  5. “Plague, tularemia and anthrax…can be easily disseminated or transmitted person to person, can cause many deaths, and can cause panic.”
    *”Plague is usually fatal unless treated with antibiotics within 24 hours of onset.  Typically, those who are infected experience fever, weakness and rapidly developing pneumonia.”
  6. “If inhaled, tularemia bacteria can cause abrupt fever, headache, muscle aches and potentially fatal pneumonia, if not treated quickly with antibiotics.”
  7. “The new surveillance looks for ‘die-offs’ of vulnerable animals — a group of wild animals dying quickly without apparent explanation.”
  8. “Establishing a database of information on wildlife deaths will help veterinarians to determine quickly which infections are natural and which might be from bioterrorism.”
  9. “Unusual, unexplained symptoms may indicate the introduction of a disease from abroad, such as with the monkeypox outbreak a year ago.”

Biosurveillance, Monkeypox, Bioterrorism, Plague, Anthrax, Tularemia

2005

Lowell, Jennifer, “Identifying Sources of Human Exposure to PlagueJournal of Clinical Microbiology. Pg. 650-656. Vol. 43, No. 2.

  1. “Approximately 3,000 human cases occur worldwide annually, with 12 to 15 cases reported each year in the western United States”
  2. “Two of the primary objectives of routine epidemiology plague investigations are to identify the source of human exposure and to assess the exposure site for potential continuing risk.”
  3. “The use of molecular epidemiological techniques in these investigations has been particularly difficult for Y. pestis because of its apparent lack of genetic variation.”
  4. “When combined with epidemiologic information, judicious use of genetic data from nonhuman organisms is highly attractive because of the power of DNA-based analyses to identify exposure sources.”

Public Health, Pandemic, Plague, Decontamination, Biodetection, Bioterrorism, Biodefense, Biosafety

 

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, Academia, Lab Safety, Flu, Vaccination, Law Enforcement, WMD, Plague, Anthrax, Biosurveillance, Nuclear, Radiological Surveillance, Cholera, Tularemia

2008

Hsu, Spencer, “Costly Weapon-Detection Plans Are In Disarray, Investigators Say,” The Washington Post, A-Section, Pg. A15, July 16, 2008.

  1. “Bush administration initiatives to defend the nation against a smuggled nuclear bomb or a biological outbreak or attack remain poorly coordinated, costing billions of tax dollars while basic goals and policies remain incomplete.”
  2. “Separately, a five-year-old program to detect the airborne release of biological warfare agents such as anthrax, plague and smallpox in more than 30 major U.S. cities still lacks basic technical data to help medical officials determine how to respond to an alert triggered by the sensors.”

Public Health, Biosurveillance, Plague, Anthrax, Smallpox

 

Hsu, Spencer, “Modest Gains Against Ever-Present Bioterrorism Threat; An Attack Could Be Hard To Predict With Current Tools,The Washington Post, A Section, Pg. A10, Aug 3, 2008.

  1. “The result: modest gains, at best, toward preventing another attack similar to the one in 2001, in which anthrax bacteria killed five people and sickened 17.”
  2. “‘The potential for something to happen is much greater now than it was in 2001, simply because of developments of technology and education.'”
  3. “The government has not developed a general-use anthrax vaccine.  A new generation of sensors that would sniff out threats more quickly has been delayed.  A coordinated plan to respond to a widespread outbreak still doesn’t exist.  And the rapid increase in the number of researchers registered to work with biological agents, now 15,000 people, has come without enough oversight.”
  4. “A significant bright spot…is the dramatic improvement in government preparations to respond to threats such as smallpox, botulism (botulinum), plague and other biological agents.”
  5. “The Strategic National Stockpile, a emergency cache of critical pharmaceuticals that can be sent within 12 hours to counter outbreaks, has been greatly expanded.”
  6. “The stockpile…has 60 million treatment courses of antibiotics for anthrax and pneumonic plague.  About 300 million doses of smallpox vaccine can also be shipped.”
  7. “Officials say that the government is retooling efforts to encourage drug companies to invest in BioShield projects. and that the effort is paying off in new antitoxins for anthrax and botulism.”
  8. “All 50 states now can receive urgent disease reports around-the-clock and conduct year-round surveillance for diseases such as influenza.”
  9. “But the nation still lacks plans and an organized structure to respond to a massive disease outbreak with thousands of victims.”

Bioterrorism, Biosurveillance, Flu, Plague, Anthrax, Botulinium, Project Bioshield, Smallpox

2009

Fitzsimmons, Emma, Graves, “Researcher Had Bacteria For Plague At His Death,NYT, A 13, Sept. 22, 2009.

  1. “researcher, Malcom Casadaban, 60 had a weakened strain of the bacteria Yersinia pestis in his blood when he died from an infection on Sept. 13, university officials said.”
  2. [He was] studying the bacteria to create a better vaccine for plague.”
  3. “As a precaution, though, the University of Chicago medical Center offered antibiotics to about 100 people who knew the researcher, including his family members, friends and colleagues.”
  4. “Plague is rare in the United States, with fewer than 15 cases reported annually, mostly in rural areas in the Southwest, according to the C.D.C.  About 1,000 to 3,000 cases of plague are reported globally each year, many in Africa.”
  5. “Dr. Casadaban had hoped to create a better vaccine for plague in part because of concerns about its possible use in bioterrorism.”
  6. “Officials are investigating whether Dr. Casadaban may have become infected through breathing, through a cut in his skin, or through his eyes or mouth.”
  7. “… required to follow safety guidelines, including wearing gloves, a lab coat and goggles and using a biosafety cabinet, a device that has a filter to clean the air in a laboratory, according to the C.D.C.”

Lab Safety, Bioterrorism, Vaccination, Plague, CDC, Biosafety

2010

Rees, Nick, “Fifth Black Death envelope found,” http://www.bioprepwatch.com/news/211556-fifth-black-death-envelope-found January 8, 2010.

  1. A fifth envelope has been discover at University of California – Irvine containing white powder and a message with the words “black death.”
  2. “Two envelopes carrying the “black death” message were discovered on Monday and a third was discovered Tuesday morning. Following their discovery, the buildings they were found in were evacuated and a HAZMAT team was called to the scene.”
  3. “Field tests performed by the FBI showed that the powder in the three envelopes was not a biological hazard like anthrax.”

Plague, Anthrax