Potential Risks of the Smallpox Threat - Research Paper Example

The Smallpox Threat – Potential Risks & Countermeasures Schools Number and of (e.g., October 12, 2011) Abstract Most biological agents have the potential to be used as bio-weapons by adversaries and hostile terrorist groups. Potential risk factors are necessary to be evaluated and precautionary measures need to be in place before any possible bio-terrorist strike. Smallpox is one among innumerable other biological agents that can easily achieve pandemic proportions even if they primarily affect a very small local population. Immunity against smallpox is diminishing and the global population is highly susceptible to the virus. There is a high probability of smallpox being used as a bio-weapon. It is thus vital for security personnel to be well versed with the necessary precautionary measures as well as methods of detection, avoidance and decontamination of this biological agent, to be better prepared for possible crises involving the virus. The Smallpox Threat – Potential Risks & Countermeasures Innumerable chemical, biological and radiological agents have been identified as major threats to both homeland and international security. With massive technological advancements and increasing availability of information on the go, almost anyone can acquire the power to cause mass damage with the help of biological, chemical or even nuclear weapons. Being alert and prepared for any possible strike is the need of the hour, especially for security personnel. This paper discusses the threats of bio-weapons in general and that of smallpox virus in particular. The smallpox virus is airborne and is easily transmissible, apart from being highly contagious. The fact that the global population is becoming highly susceptible to the virus because of diminishing immunity against it, and that specific treatment and early diagnosis is not possible makes it a very deadly and highly preferable bio-weapon. Objectives The aim of this paper is to introduce the subject of smallpox as a potential bio-weapon, and to discuss ways in which possible infection with the virus can be averted through early detection and avoidance. Methods of individual protection and material and personal decontamination are also discussed. Background Historical Overview Smallpox caused more than 300 million deaths worldwide in the 20th century, which is more than the total number of deaths in all wars of that century (Biden, 2003). Outbreaks of the variola virus (smallpox virus) have played a major role in the rise as well as downfall of ancient empires, from the Egyptians to the Athenians (Koplow, 2004). Accidental outbreaks of smallpox introduced by Spanish conquistadors led to the ruin of the ancient Mayan, Aztec and the Inca civilizations. The deliberate use of smallpox as a weapon is reported to have been first attempted by the British against the French and their Indian allies during the Pontiac rebellion in the 18th century (Koplow). Several reports also suggest that smallpox was used during the American Revolutionary war. The Soviet Union is also known to have weaponized smallpox for attacks on distant targets (Tucker, 2000). Attempts to weaponize smallpox are not new to the United States either. The US had stockpiled about 40,000 liters of biological weaponry by 1969, which included the smallpox virus in powdered form that could be easily aerosolized and disseminated (Koplow). Many other countries are implicated in having carried out covert operations for the development of bio-weapons. The US bio-weapons program was however terminated by President Nixon in 1969. Present Scenario After years of toil and mass vaccinations, smallpox was eradicated by 1980. The World Health Organization (WHO) declared the world free of smallpox. The virus was stored in two reference WHO laboratories—the Center for Disease Control and Prevention (Atlanta, USA) and the State Research Center for Virology and Biotechnology (Novosibirsk, Russia) (Green et al., 2007). All other stockpiles of the virus were not destroyed and are now in possession of official authorities, making it possible to carry out black market trade of the virus for bio-terrorism (Green et al.). Koplow (2004) points out that even if the two stockpiles in America and Russia are destroyed, there is still a possibility of re-emergence of smallpox. He reports that security experts in the US and elsewhere fear that secret stockpiles of the smallpox virus that were never declared or surrendered to the WHO may still exist in Russia, North Korea and several other countries. According to experts, a single case of smallpox in any part of the world would result in a global emergency (Biden, 2003). What Makes Smallpox the most Dangerous Bio-weapon? It is important to understand what makes smallpox such a potential bio-weapon, if effective strategies for its prevention and control are to be devised. There are innumerable reasons as to why smallpox is a highly deadly threat. The most important reason is that at present, there is a very high global susceptibility and receptivity to the virus (Green et al., 2007). As stated earlier, smallpox was completely eradicated by 1980, and it has been more than 30 years ever since mass vaccinations were conducted. A smallpox vaccine provides protection for only up to 5 – 7 years. Therefore, the grim reality is that a large proportion of the global population has already lost immunity to the virus. Due to the vaccine’s side effects, the WHO has prevented any more immunizations, unless an outbreak occurs. About 200 million doses of the vaccine have been stockpiled for use during sudden outbreaks. Another factor that contributes to the dread of smallpox is that its contagiousness is higher than 80%, and the situation is worsened due to long-distance travel (Green et al.). Risk Assessment Smallpox exclusively affects humans. In case of a sudden outbreak, the population under forty years old is highly susceptible to the virus as it includes a young populace that has not been subjected to smallpox vaccination. This population lacks immunological memory against the virus as vaccination was stopped in most countries by 1977 itself (Green et al., 2007; Biden, 2003). Because of lack of specific treatment, duration of hospitalization will be longer. Smallpox has high mortality rates and in the first stage of disease progression, it is difficult to recognize. Diagnosis and laboratory confirmation is also a very time consuming affair. The initial symptoms of the disease are non-specific and may be mistaken for common diseases (Biden, 2003). Moreover, there is currently no facility for vaccine production (Biden). At present, there is no effective antiviral treatment against the disease. Ease of dissemination via aerosols, further facilitated by modern and more advanced methods, makes it a very easily transmissible disease. Long distance travel specially aggravates the epidemiologic capacity of the disease, more so because air conditioning in planes helps in easily transferring the virus via the respiratory route (Green et al.). The disease multiplies in geometric proportions, and can easily become a global pandemic. ‘Dark Winter’ was an operation conducted by the John Hopkins Center for Civilian Biodefense Studies, the Center for Strategic and International Studies and the Institute of Homeland Defense (Biden, 2003). This operation simulated national security meetings in case of a covert release of the smallpox virus in three cities in America. This operation laid out a few bare facts about the susceptibility of the country to the smallpox threat. At the time of this operation, it was realized that in case of an outbreak, there were no sufficient vaccines, the top officials were not prepared for a sudden crisis, enough investments had not been made for proper co-ordination in emergency situations, the public health infrastructure was inadequate and bio-terrorism was not yet set on national high priority (Biden). Countermeasures Now that the potential risk factors have been assessed, it is easier to direct suitable countermeasures for the prevention of infection from smallpox, in case it is used as a bio-weapon in terrorist strikes. The US Air Force, Army, Navy, and Marine Corps have issued several guidelines and measures for application at operational and tactile levels for protection of security personnel from Chemical, Biological and Radiological hazards. The guidelines for protection against biological hazards such as the smallpox virus are discussed here. Defense against a potential biological threat comprises of three main domains – detection of the hazard, protection against contamination, and decontamination. Detection Smallpox is a systemic disease caused by the variola virus, which is a biological agent. It is characterized by skin eruptions, rashes, fever and malaise. Fatality occurs within 5 – 7 days after sufficient disease progression. The incubation period of the disease is 7 – 19 days. The primary mode of dissemination is via aerosols. It is possible that an attack with a biological agent will go undetected by local commanders (Joint staff, 2008). Four main triggers can signal a biological attack. One is the intelligence-warning trigger, which involves information from military or other intelligence sources. Weapons events are the second triggers. Aerosol sprayer devices are the possible weapons that can be used in such cases and it is reasonable to react to weapon events as if they possibly contain biological agents (Joint staff, 2008). Detection alarm events are the third kind of triggers and involve sophisticated detection and diagnosis devices that rapidly detect the presence of a biological agent. Laboratory reports of samples from air, water, food, etc., also provide sufficient evidence for the presence of biological agents. These detectors, devices and tests may not be very effective as there are chances of false positives/negatives. Moreover, genetically modified biological agents may be elusive to conventional detector devices and diagnostic tools. The fourth and final trigger is a sentinel casualty. When a medical professional diagnoses an infection in a sentinel, the attack using a biological agent is proven. However, commanders should be able to distinguish between infections that may have occurred naturally and those that occurred due to an attack. Avoidance Vaccination. The main form of avoidance from smallpox is vaccination. Though vaccination for smallpox is not routinely done for US security personnel, vaccination may be administered if a threat is detected or expected. Infected personnel should be quarantined and sent to specially designated hospitals for their complete isolation, and a negative air pressure should be maintained in areas that have infected patients and material (Green et al., 2007). Either active or passive immunoprophylaxis are advised for protection against an infection. Chemoprophylaxis. In case an attack is imminent, “command-directed chemoprophylaxis” may be appropriate (Joint staff, 2008, p. 100). Chemoprophylaxis involves the use of antibiotics and antiviral agents. Aerosol avoidance procedures. Smallpox can easily be disseminated via aerosols. These can be sprayed via air or ground bursting ammunitions, aerosol generators and even aircraft spray tanks. Avoidance measures in such cases involve pre-attack, during-attack and post-attack operations. In the pre-attack scenarios, subordinate units should be alerted, preventive medicine programs such as immunizations and hygiene standards should be enforced (U.S. Air Force, Army, Navy, and Marine Corps II, 2006). Protective masks should be used and enemy weapon systems should be intercepted and destroyed. During attack, protective clothing and masks are mandatory for more than four hours after attack and after the agent cloud of aerosol passes the unit area (U.S. Air Force, Army, Navy, and Marine Corps II). The attack should be reported using the CBRNWR. Post attack, collection of samples should be done for identification of the agent and only sealed rations and properly contained water should be consumed (U.S. Air Force, Army, Navy, and Marine Corps II, p. F4). Affected individuals should be separated from un-affected ones. Protection Individual protection. This can be done using both respiratory and dermal protection. As the smallpox virus is an inhalation hazard, fielded respirators with canisters having standard filters of 0.3 micrometers pore size should be used (Joint staff, 2008). Surgical masks may also be helpful, although they are not 100% safe. Self-contained breathing apparatus is also helpful (Joint staff). As smallpox may also spread via contact, skin abrasions should be well covered. Standard uniform clothing is quite protective against dermal contact of infectious agents (Joint staff). Since smallpox virus can also be transferred via mail in powdered form, suitable precautionary measures should be taken while handling suspicious mail. Clothing, blankets and other material of unknown origin should be avoided, as they may be infected with the biological agent. Collective protection. Collective protection against biological agents can be afforded by constructing hardened or unhardened shelters fitted with air filtration units that maintain overpressure. The minimum overpressure to be maintained in a stationary shelter is 25 pascals (0.1-inches water gauge, iwg) in entry areas and 0.2 iwg in main shelter (U.S. Air Force, Army, Navy, and Marine Corps, 2003). Although COLPRO provides efficient protection during an attack with a biological agent, it may also increase the chances of cross-infection between staff and patients who are already infected with the agent. Thus, it is advised that such patients should be treated outside the COLPRO facility using barrier-nursing techniques (Joint staff, 2008). Personal and Material Decontamination As described by the U.S. Air Force, Army, Navy, and Marine Corps I (2006), decontamination is the … removal or neutralization of hazardous levels of contamination from personnel, equipment, materiel (sic), and terrain. The ultimate purpose of decontamination is to restore full combat power in the shortest possible time (p. I-4). Decontamination is vital for the restoration of forces post-attack, and for gaining normal operating conditions. It involves several stepwise procedures for personal as well as equipment decontamination. Personal decontamination. Once contact exposure to a biological agent such as the smallpox is established or suspected, immediate skin decontamination is required. The exposed victim should be wetted before clothing is removed. This will ensure that the agent adheres to the clothing and not to the body of the victim. This will also prevent possible re-aerosolization (U.S. Air Force, Army, Navy, and Marine Corps I, 2006). Skin is decontaminated using soap and water. Hypochlorite solution and other high-grade disinfectants should be used for immediate cleansing. 0.5% chlorine solution can be used to wash grossly contaminated skin surfaces with a 10 – 15 minutes contact time. IEDKs can be used if water is unavailable (U.S. Air Force, Army, Navy, and Marine Corps I). Material decontamination. Material and equipment can be decontaminated using 0.5% chlorine solution with a contact time of 30 minutes (U.S. Air Force, Army, Navy, and Marine Corps I, 2006). As this solution is corrosive to metals and fabrics, it should be washed away thoroughly and the metal surfaces should then be oiled. USN and USMC aircraft should not be cleansed with bleach and should instead be washed with hot and soapy water (U.S. Air Force, Army, Navy, and Marine Corps I). M291 SDK may be used in absence of water. Medical waste from infected individuals should be placed in biohazard containers and treated in accordance with the appropriate medical waste regulations. The treated waste can be sent to a landfill (3M, 2003). As described by the Committee on Methodological Improvements (2008), the US has stockpiled sufficient amounts of vaccines for smallpox, and swift vaccination of the entire US population is possible in case of an attack, except those affected in the first wave. It is however essential for security personnel to be prepared for any possible attack, as they are highly likely to be primary targets of such bio-terrorist strikes. References Biden, J. R. (Ed.). (2003). Threat of bioterrorism and the spread of infectious diseases: Hearing before the committee on foreign relations, U.S. Senate. n.a.: Diane Publishing. Retrieved 27 October 2011, from http://books.google.com. Committee on Methodological Improvements. (2008). Department of Homeland Security bioterrorism risk assessment: a call for change. Washington, DC: National Academies Press. Retrieved 27 October 2011, from http://books.google.com. Green, M. S. et al. (Eds.). (2007). Risk assessment and risk communication strategies in bioterrorism preparedness. The Netherlands: Springer. Retrieved 27 October 2011, from http://books.google.com. Joint Staff. (2008). Operations in Chemical, Biological, Radiological, and Nuclear (CBRN) Environments. Joint Publication 3-11. Retrieved 27 October 2011, from http://www.dtic.mil/doctrine/new_pubs/jp3_11.pdf. Koplow, D. A. (2004). Smallpox: The fight to eradicate a global scourge. London: University of California Press. Retrieved 27 October 2011, from http://books.google.com. Tucker, J. B. (Ed.). (2000). Toxic terror: Assessing terrorist use of chemical and biological weapons. Cambridge: MIT Press. Retrieved 27 October 2011, from http://books.google.com. U.S. Air Force, Army, Navy, and Marine Corps I. (April 2006). Multiservice Tactics, Techniques, and Procedures for Chemical, Biological, Radiological, and Nuclear Decontamination. FM 3-11.5 MCWP 3-37.3 NTTP 3-11.26 AFTTP(I) 3-2.60. Retrieved 27 October 2011, from http://www.fas.org/irp/doddir/army/fm3-11-5.pdf. U.S. Air Force, Army, Navy, and Marine Corps II. (February 2006). Multiservice Tactics, Techniques, and Procedures for Chemical, Biological, Radiological, and Nuclear Contamination Avoidance. FM 3-11.3, MCWP 3-37.2A, NTTP 3-11.25, AFTTP(I) 3-2.56. Retrieved 27 October 2011, from http://www.fas.org/irp/doddir/army/fm3-11-3.pdf. U.S. Air Force, Army, Navy, and Marine Corps. (June 2003). Nuclear, Biological, and Chemical Protection. FM 3-11.4 (FM 3-4), MCWP 3-37.2, NTTP 3-11.27, AFTTP (I) 3-2.46. Retrieved 27 October 2011, from http://www.fas.org/irp/doddir/army/fm3-11-4.pdf. 3M. (2003). Smallpox Fact Sheet. 3M Commercial Care Division. Retrieved 27 October 2011, fromhttp://multimedia.3m.com/mws/mediawebserver?mwsId=SSSSSu7zK1fslxtUMx_GMxtZev7qe17zHvTSevTSeSSSSSS--&fn=9029.pdf. Read More