Archive for the ‘anthrax’ Category

Even the best of us...smallpox, anthrax, influenza and the CDC

Wednesday, July 16th, 2014
This is our premier laboratory

This is our premier laboratory

The Center for Disease Control and Prevention, AKA the CDC, America's central medical laboratory has recently had multiple problematic episodes. I was trying to follow up on the vials of smallpox virus that were found in an old refrigerator that the FDA apparently had forgotten, The question, of course, was whether the virus samples were long dead or still viable. They had been sent to the CDC to have that highly significant issue resolved.

Since then there has been a followup announcement, but also several articles on significant issues with procedures and safety at the CDC itself. The first was published in The New York Times, AKA NYT, (as well as in other papers, but I get the NYT daily on my iPad , so saw it there first). The startling title was "C.D.C. Closes Anthrax and Flu Labs after Accidents." The current director of the CDC, Dr. Thomas Frieden, called the lab/agency "the reference laboratory to the world," but admitted there had been a series of accidents (actually lapses in set safety procedures), in the recent past, that were quite frightening.

A month ago potentially infectious samples of anthrax, a bacteria found naturally in soil and commonly affecting wild and domesticated animals worldwide, causing an extremely serious, but rare illness in people, were sent to labs that were not equipped to deal with them (anthrax would normally be handled only with the highest level of protective biosafety gear and procedures (BSL-4). The CDC also has a rather simplistic YouTube video discussing anthrax's use as a potential bioterrorism weapon, but in this case 62 or more CDC employees were potentially exposed to the bacteria in the course of their work.

The good news is it appeared nobody was in danger; all those employees were given the anthrax vaccine and also begun on antibiotics. The background information available online says there has never been person to person spread of the disease.

It appears that it's exceedingly tough to get rid of anthrax in the environment; I'll go over the classic historical example of how careful government researchers have been with its spores..

In the 1940s, British scientists used a small Scottish island (Gruinard) for germ warfare research. That island, thoroughly contaminated with anthrax spores, remained off-limits for forty+ years before extraordinary efforts, begun in 1986, rendered it safe for ordinary use. The surface of the island was only 484 acres; it was sprayed with a herbicide, then all dead vegetation was burned off. Next 200 tons of formaldehyde solution was diluted in 2,000 tons of seawater and sprayed over the entire island. Perforated tubing was used to ensure that 50 liters of solution were applied to every square meter being treated.

Later the effectiveness of the decontamination process was assessed by taking two duplicate sets of soil samples. Each was tested at two major government labs. Anthrax spores were detected only in "small quantities in a few places." These specific areas were treated in July 1987, followed by further soil sampling in October 1987. No further traces of anthrax spores were found.

Blood samples from local rabbits were also tested for anthrax antibodies. No such antibodies were found.

Following these measures, a farmer grazed part of his flock of sheep on the island for six months. The sheep were inspected monthly by the District Veterinary Officer, and returned to the mainland in October 1987 in excellent condition.

On April 24, 1990, 4 years after the decontamination works had been completed, a Defense Minister visited the island and removed the safety signs, indicating that the island had finally been rendered safe. Then, per agreement  the island was sold back to the heirs of the original owner for the WWII sale price of £500.

But a senior British archeologist said he still wouldn't set foot on the island; he was concerned because of potentially infectious particles found in some of his digs.

Yet another NYT piece, "Ticking Viral Bombs, Left in Boxes," this one written by a distinguished physician, Lawrence K. Altman, M.D. recalls the irony of the outcry for mass smallpox vaccination of our entire U.S. population after 9-11 (when no Iraqi supply of the deadly bacterium was ever located), contrasted with the recent finding of six vials, two with live smallpox bugs, being found in in Bethesda, almost within "spitting distance" of our center of government.

In 2011 the Birmingham Mail reviewed a tragic lab accident which led to the last known smallpox death . The city, now England's second largest, was a site of a medical research laboratory associated with the local medical school. Viral particles got into an air duct and a photographer whose studio was one story up from the lab became the last known case of active smallpox and died from the disease in spite of having been vaccinated twelve years before

Dr. Altman discusses the pros and cons of eradicating the last two known stocks of the virus, one at the CDC, the other in a Russian lab in Siberia. Even if the natural virus is finally and totally eliminated , a rogue group may well be able to re-establish their own supply from the known genetic sequence of smallpox.

Lastly I saw a NYT article with an even more disturbing title, "After Lapses, C.D.C. Admits a Lax Culture at Labs." CDC workers had somehow shipped a dangerous strain of avian influenza to a poultry research lab run by the Department of Agriculture. Known as H5N1, the virus had killed more than half of the 650 people who had been infected with it since 2003. Again there were no deaths from this mistake.

After all of this recent furor plus the historical examples, I'm heartily in favor of the idea that's been broached saying such dangerous organisms should be confined to a minimal number of labs and even those clearly need to tighten up their standards.







Biological Warfare and Bioterrorism: anthrax accident and attack

Tuesday, July 10th, 2012

This is a safe way to see anthrax bacteria

In 1969 President Nixon, prodded repeated by the Harvard biologist Matthew Meselson, decided to end all United States offensive biological warfare (BW) research. The story is told in detail in Volume III of the National Security Archive; the concept eventually led to the 1972 Biological and Toxin Weapons Convention, signed by more than one hundred nations.

Our BW research scientists were very unhappy with the decision and thought some countries, especially the Soviet Union, would not adhere to the treaty at all; they were eventually proven to be right. Our CIA apparently kept a "small" amount of various infectious agents and toxins including 100 grams of anthrax.

In April 1979 the most lethal anthrax epidemic to date began to unfold near the Denver-sized city of Sverdlovsk in Russia. The winds were blowing in a fortunate direction, so only 68 people died; otherwise the casualties would have likely numbered in the hundreds of thousands. Russia said nothing about the incident.

In late 1979 and early 1980 a Russian-language newspaper published in West Germany reported an explosion at a military installation near Sverdlovsk and estimated  a thousand resultant deaths from anthrax. Our April, 1979, satellite images were reviewed and roadblocks and decontamination trucks were noted in that area in the spring of 1979.

The Russians, in a March 1980 article, denied this was anything other than a naturally occurring outbreak. Later they claimed any deaths resulted from consumption of meat from anthrax-contaminated cattle and that veterinarians had reported deaths in animals before any human casualties. Dr Meselson arranged a 1988 meeting with Soviet scientists and was convinced that the tainted-meat explanation was plausible.

Finally in 1991, after the Soviet Union broke up and Boris Yeltsin headed Russia, he told President Bush that the KGB and Soviet military had lied. Apparently a technician at the BW plant had neglected to place a filter correctly; the result was a plume of anthrax spores. The Russians shut down the Sverdlovsk plant, only to build a larger one in Kazakastan.

October, 2001, brought an anthrax attack to the United States. A sixty-three-year-old man living in Florida was taken to his local emergency department, confused, vomiting and  having an elevated temperature. An alert infectious disease consultant considered the possibility of anthrax after a spinal tap revealed both white cells and the typical bacilli. A prompt response and rapid escalation of information ensued and the bacterium was found in the patient's workplace. Subsequently a history of the victim having examined a powder-containing letter was obtained from his co-workers. Other letters arrived at political and media targets in four states and Washington, DC.

Fast forward to 2010. The FBI finished its eight-year investigation, saying a US biologist who committed suicide in 2008 had been solely responsible for the 2001 bioterroism attack. The man implicated had worked at the Army laboratory at Fort Detrick and the Justice Department concluded he alone mailed the anthrax letters which killed five people, sickened seventeen others and led to a multi-billion-dollar, terror-laced response.

An October, 2011, article in USA Today said each FBI field office now has personnel dedicated to investigate biological attacks, while the bureau itself has an entire major section for counterterrorism: biological, chemical or radiological.

Most mail is absolutely safe

The same infectious disease expert involved in the uncovering of the 2001 letter attacks wrote a followup article published in January 2012 in the Annals of Internal Medicine. He mentioned the initial victim, a photo editor for a supermarket tabloid newspaper, was the 19th known case of inhalational anthrax in the US since 1900 and the first since 1976. Each of the other patients' exposure was directly associated with their work in mills or labs.

One other piece of irony was a Canadian study of anthrax published in September 2001 showing even unopened envelopes containing anthrax spores were a threat. The results had been emailed to our CDC on October 4, 2001, but the message was never opened.


Biological warfare and Bioterrorism part two: anthrax

Friday, July 6th, 2012

Don't ever open one of these sacks, unless it's your job and you're in full protective gear

I'm reading a book called Germs: Biological Weapons and America's Secret War. It was written in 2001 by three Pulitzer-prize-winning senior newspaper reporters and starts with an event most of us never heard about; immediately after the horrific 9-11 attack: a trained New York National Guard team was sent to NYC to determine if there had also been an accompanying germ warfare attack.

There's a difference between biological warfare and bioterrorism; in one sense it's a matter of scale. In another it's a matter of purpose. In biological warfare the intent is to kill or incapacitate an enemy force. Actually, utilizing the latter approach is likely to be more effective, as it ties up large numbers of support personnel, moving the sick and taking care of them in medical facilities.

Bioterrorism attacks may injure or kill a much smaller absolute number of victims, but, as the term suggests, can spread terror through a huge population base.

So why concentrate on anthrax?

Sheep can get anthrax

Anthrax has a long history in North America, likely arriving thousands of years ago via the Bering Land Bridge. It's been a rare cause of death in the US: most cases here involved mill employees working with wool, farmhands, those who work in tanneries and, potentially, veterinarians. Anthrax was known as a disease of hoofed animals and people caught it from infected beasts. The usual form was cutaneous with a sore like a bug bite that could eventually turn into a black, usually painless skin ulcer. If unrecognized and untreated, the bacteria could spread to the blood (sepsis) with a 20% chance of death; less than 1% died if treated.

Most sources say anthrax spread from person to person never occurs; a few mention rare transmission of the cutaneous form.

But there are two other forms of the disease: the gastrointestinal kind occurs when a person consumes meat from an infected animal. It's been quite rare in the US with one case in 1942 and a second in 2010, but is also quite deadly with a death rate estimated variously at 25 to 60% worldwide and the effects of post-exposure treatment unclear.

And then there is inhalational anthrax, caused when someone breathes in anthrax spores, the dormant phase that can live in soil for many years. When this form occurs, the death rate, which used to be over 90%, even with early recognition and the best possible care, is now estimated at 45%.

The last case of inhalational anthrax occurring naturally in the US was in 1976.

So why did our military gear up to immunize 2.4 million soldiers and reservists in December 1997? After all, President Nixon, in November, 1969, had announced that our country  would totally abandon the use of lethal biological weapons and confine its research in the area to defensive measures. In 1972 the US, the Soviet Union and over a hundred other countries signed the Biological and Toxin Weapons Convention, banning the use of BW.

But many of our own scientists thought this was a mistake. They were proven correct when the anthrax epidemic at Sverdlovsk occurred only seven years later.

The military anthrax vaccination program has a fairly simplistic website, designed to walk young troops through carefully selected and presented facts about the anthrax vaccine. The vaccine has been available since the 1940s and 1950s and was tested in mill workers in the late 1950s. The modern version was licensed in the United States in 1970, and in January, 2002, the FDA allowed the company making it to begin routine distribution from a newer manufacturing plant. The same company is working on a new recombinant version

An October, 2011, Washington Post article discusses the thorny issue of testing the effectiveness of the immunization in children.

Even the safest vaccines have some side effects; the vaccine may not protect versus inhalational anthrax caused by  altered strains of the bacterium and there's no generalized threat at present.

But, what if?