CIVIL DIMENSION OF SECURITY 186 CDS 05 E Original: English NAT O   Pa rl i a me n t a ry  As s e mb l y CHEMICAL, BIOLOGICAL, RADIOLOGICAL, OR NUCLEAR (CBRN) DETECTION: A TECHNOLOGICAL OVERVIEW ADDITIONAL INFORMATION LORD JOPLING (UNITED KINGDOM) SPECIAL RAPPORTEUR* International Secretariat 30 September 2005 * Until this document has been approved by the Committee on the Civil Dimension of Security, it represents only the views of the Rapporteur. Assembly documents are available on its website, http://www.nato-pa.int

186 CDS 05 1 I. BASIC INFORMATION ON MAJOR BIOTERRORISM AGENTS Disease Incubation period Type of vaccine Treatment Anthrax - bacterial infection caused by the organism Bacillus anthracis - 3 forms of human disease: cutaneous (most common, 95% of cases), inhalation (rare) and intestinal (very rare) anthrax - not contagious / no airborne transmission from person to person - mortality rate of up to 20% for untreated cutaneous anthrax, higher for inhalation or intestinal anthrax - dependent on the dose and route of exposure;   - symptoms usually develop within a week of infection, although it can take up to several weeks in cases of inhalational anthrax Vaccine is protective against invasive disease. However, it is primarily given to military personnel and high risk population.  New generations of anthrax vaccines (recombinant protective antigen vaccines) are currently under development in the US as part of the BioShield programme and through US-UK public-private partnerships Treatment protocols exist for cases of inhalational and cutaneous anthrax; if administered early enough, treatment can be very effective Botulism: -muscle-paralyzing disease caused by a botulinum toxin which is a poison produced by the bacterium Clostridium botulinum. - most poisonous substance known: A single gram of crystalline toxin, evenly dispersed and inhaled, would kill more than 1 million people, With food borne botulism, symptoms begin within 2 hours to 8 days. The three known cases of inhalational botulism caused symptoms approximately 72 hours after exposure. In the US, an investigational vaccine is distributed for high-risk laboratory workers and by the military to protect troops, but it is neither recommended nor available for the general public due to its scarcity and effects. If diagnosed early, food borne and wound botulism can be treated with an antitoxin, which blocks the action of toxin circulating in the blood. This can prevent patients from worsening, but recovery still takes many weeks, if not months.

186 CDS 05 2 although technical factors would make such dissemination difficult. -not contagious - dispersion could be airborne or foodborne - mortality rate between 5-10% Plague: - acute bacterial infection caused by the organism Yersinia pestis -Yersinia pestis used in an aerosol attack could cause cases of the pneumonic form of plague. - pneumonic plague is contagious: the bacteria can spread to others who have close contact with them. - mortality rate is over 90% for untreated pneumonic plague One to six days after becoming infected with the bacteria, people would develop pneumonic plague. -a vaccine for plague exists and is licensed and marketed in Australia. However it is only licensed for use against bubonic plague (cutaneous). A next generation of recombinant vaccine that would protect against primary pneumonic plague is under development, in particular through a joint programme between the US, UK and Canada. To prevent a high risk of death, antibiotics should be given within 24 hours of the first symptoms. Several types of antibiotics are effective. They can be administered to treat infected patients as well as to prevent contamination to the patient’s close contacts. With prompt recognition and antibiotic treatment, fatal cases can be reduced to 5-10%. Smallpox: - serious, contagious, and sometimes fatal infectious disease caused by the variola virus - dispersion is likely to be airborne - patients are not infectious until the onset of symptoms, then most infectious during the first two weeks of illness; later, transmission is still possible This incubation period averages about 12 to 14 days but can range from 7 to 17 days.   -Vaccine availability -If given to a person before exposure to smallpox, the vaccine can completely protect them. Vaccination within 3 days after exposure will prevent or greatly lessen the severity of smallpox in most people. Vaccination 4 to 7 days after exposure likely offers some protection from disease or may decrease the severity of disease. - preventive vaccination is not There is no specific treatment for smallpox disease, and the only prevention is vaccination. Some treatment options are currently being tested on smallpox animal models and could lead to human treatment.

186 CDS 05 3 until the rash has disappeared, but less likely - disease is fatal in up to 30% of cases recommended for the general public, due, in particular, to proven side- effects of the vaccine, that have caused serious reactions in 0.1% of cases and life-threatening reactions in a few cases - new generation of vaccines are under development Hemorrhagic fever: - group of illnesses that are caused by several distinct families of viruses usually transmitted to humans via contact with infected animal reservoirs or arthropod vectors; - generally not easily contagious, except, for some types of virus (Ebola, Lassa fever, Marburg, and New World Arenavirus), through close contact with infected patients or contaminated body fluids - some viruses cause only mild illnesses, others cause life- threatening infections; case- fatality rate range from as low as 0.5% for Omsk hemorrhagic fever to as high as 90% for Ebola, subtype Zaire -   depends   on   the   type   of   virus; generally  after  2  days  and  not  over 21 days -Vaccines have been developed for yellow fever; they need to be administered preventively to be effective. - A vaccine for Ebola is currently in the human trials phase in the US Patients receive supportive therapy, but generally speaking, there is no other treatment or established cure for VHFs. Ribavirin, an anti-viral drug, has proven effective against Lassa fever, New World Arenavirus and Rift Valley Fever.

186 CDS 05 4 - airborne dispersion can potentially cause serious morbidity and mortality Inhalational tularemia : - zoonosis (infection which can be spread from animals to humans), caused by the bacterium Francisella tularensis - 2 types of the bacterium which can both infect humans: type A (can be fatal) and type B (not fatal) - intentional dispersion would most likely be airborne, although foodborne or waterborne dispersion, or infection through animals is possible - Tularemia is one of the most infectious pathogenic bacteria known. It requires inoculation or inhalation of as few as 10 organisms to cause disease. Inhalation of F. tularensis causes an abrupt onset of an acute, non-specific febrile illness - Not contagious / no person to person transmission - fatality rate for untreated type A range from 4% to 30-60% for more serious cases -Can range from 1 day to 2 weeks, but symptoms usually develop after 3-5 days -Illness beginning 1-14 days after exposure -Release in a densely populated area would be expected to result in an abrupt onset of large numbers of acute, non-specific febrile illness beginning 3–5 days later with pleuropneumonitis developing in a significant proportion of cases during the ensuing days and weeks. In the United States, a live attenuated vaccine derived from a virulent F. tularensis biovar palaearctica (type B) has been used to protect laboratorians routinely working with the bacterium. Until recently, this vaccine was available as an investigational new drug. It is currently under review by the Food and Drug Administration. However, no vaccine is protective against airborne infection. -Available: early antibiotic therapy is effective -In a contained casualty setting, where individual patient management is possible.

186 CDS 05 5 II. TIMELINE FOR THE USE OF BIOSENSORS AND SYNDROMIC SURVEILLANCE IN DETECTING A BIOTERROR ATTACK In Michael Stoto, “Syndromic Surveillance”, in Issues in Science and Technology online, Spring 2005, available at http://www.issues.org/issues/21.3/stoto.html III. RISKIEST MATERIALS FOR RADIOLOGICAL WEAPONS AND THEIR INDUSTRIAL USE Americium-241 To detect petroleum deposits and calibrate instruments, and in industrial gauges. Californium-252 To detect petroleum deposits Cesium-137 Used in industrial gauges and to treat diseases, sterilize food and medical equipment, detect petroleum deposits Cobalt-60 Used in industrial gauges and to treat diseases, sterilize food and medical equipment, and detect hidden flaws in structures. Iridium - 192 To detect hidden flaws in structures and treat diseases. Plutonium-238 To generate low-levels of power Radium-226 Used in industrial gauges and to produce radon for cancer treatment. Strontium-90 To generate low-levels of power In Charles D. Ferguson & William C. Potter (with Amy Sands, Leonard S. Spector, and Fred L. Wehling), The Four Faces of Nuclear Terrorism (2005), p.8.