West Nile Virus

The Virus

            West Nile Virus is a mosquito-borne virus, particularly of the Culex species of arthropod, with birds being the principle host.  Of the family of viruses known as Flaviviridae, West Nile Virus is closely related to St. Louis encephalitis and Japanese Encephalitis but had not been found in the United States prior to an outbreak in 1999.  West Nile can also be misdiagnosed with Dengue Fever – an increasingly problematic mosquito-borne disease in the Americas as well.   Birds, such as crows, grackles, and blue jays act as amplifying hosts for WNV. (Center for Disease Control and Prevention).  Within 10-14 days of an infected mosquito’s bite, a bird can transmit the disease to a human or other mammal (Guharoy, Gilroy, Noviasky, & Ference, 2004).  An initial infection may not kill a bird but subsequent bites by infected mosquitoes will cause the virus to multiply and eventually sicken and/or kill the bird.  In humans, usually a dead-end host, the virus is very often asymptomatic. Less than 3 percent of the affected population will acquire an active infection. In some instances however, the human can become sick with a quick onset fever, headache, muscle aches, and general malaise.  Acute onset of fever can happen within 2-14 days after inoculation by an infected mosquito.  The aggressiveness of the disease appears to be a direct correlation between the numbers and feeding behavior of infected mosquitoes as well as ecological factors determining human exposure to infected mosquitoes.  Residents in the New York outbreak were found to reside in areas near wetlands where mosquitoes were more prevalent and had greater access to human hosts.  (Hayes & Gubler, 2006).  The West Nile Fever can last a few days to as long as a few months and has been reported to be quite debilitating.  While 80% of WNV infections are asymptomatic, 20% result in West Nile Fever and less than 1% result in nueroinvasive disease – presenting as encephalitis, meningitis, or flaccid paralysis (Hayes & Gubler, 2006).  Humans, horses, and other mammals are susceptible to the virus but not all become sick (Rappole, Derrickson, & Hubalek, 2000).   Before the New York City Outbreak, West Nile Virus was endemic to Africa, West Asia, and had been reported in Israel (Guharoy, Gilroy, Noviasky, & Ference, 2004). 

            The disease can be passed down from female mosquitoes to their offspring after a winter of hibernation.  It has been suspected that WNV made it to the American via migratory birds; however that would explain north-south migration of the disease but not the east-west progression evidenced across the United States.  Peak activity for WNV is July – October (Hayes & Gubler, 2006)

            The disease can be transmitted among humans by blood transfusions and organ transplants, trans-placentally, and perhaps through breast feeding (Hayes & Gubler, 2006).  The cases of West Nile Nueroinvasive Disease (WNND) and death occurs at a slightly higher rate among males (53%), the elderly, and those immunosuppressed individuals who have had organ transplants (Hayes & Gubler, 2006)

The New York City Outbreak of 1999 - Timeline

            At the end of June, 1999, residents of the neighborhoods in northern Queens, New York City, started to notice and report an usual number of diseased and dead crows.  By July, a local veterinarian began to note that some of the diseased birds walked with an uneven gait, possibly denoting a neurological disease (Eidson, et al., 2001). 

            On August 12 a sixty-year old man presented to a New York City hospital with complaints of a fever, nausea, and weakness.  He was admitted.  On August 15^th an eighty-year old man was admitted with complaints of fever, headache, weakness and diarrhea.  He developed flaccid paralysis and subsequently died.  Between the dates of August 18^th and September 6^th six more patients were admitted with similar symptoms (Petersen & Hayes, 2008).  It wasn’t until August 23^rd that a New York City infectious disease physician contacted the New York City Department of Health (NYCDOH) to report an encephalitis-like illness in two of his patients, both New York City residents.  An investigation by the NYCDOH identified a cluster of six other area patients with encephalitis. Of the earliest case patients, eight lived within a two by two mile area of northern Queens. (Center for Disease Control and Prevention, 1999).  At the same time residents were coming down with the mysterious illness zookeepers at the nearby Bronx Zoo were noticing an increase in bird deaths also (Rappole, Derrickson, & Hubalek, 2000).  On August 30th the NYCDOH initiated an active surveillance (Center for Disease Control and Prevention, 1999).  By the 3^rd of September specimens were testing positive for antibodies common in arboviruses and the Center for Disease Control and Prevention (CDC) determined an initial diagnosis of St. Louis encephalitis. An immediate vector control program was initiated on the 3^rd, with areal and ground applications of mosquito pesticides in northern Queens and the south Bronx areas of the city.  Emergency hotlines were set up to help field questions by the public and ease panic. (Center for Disease Control and Prevention, 1999)

During the days of September 7 – 9 officials at the Bronx Zoo noted the deaths of two Chilean Flamingos, a Cormorant, and an Asian Pheasant.  Necropsies on the birds revealed cases of meningo-encephalitis and severe myocarditis.   By the 10^th of September tissue specimens from the zoo birds and one crow were sent by zoo officials to the United States Department of Agriculture’s National Veterinary Service Laboratory (NVSL) for further testing.  Common avian pathogens and equine encephalitis tests all turned up negative.  The NVSL then isolated tissue from the birds and sent them on to the CDC on September 20 for further identification.  By September 23^rd testing at the CDC indicated the disease was closely related to West Nile Virus, previously not found in the Americas.  Eidson reports that initial evaluations were made by the New York State Department of Environmental Conservation’s Wildlife Pathology Unit and the Wildlife Conservation Society and the CDC confirmed West Nile Virus on September 25^th (Eidson, et al., 2001).  Meanwhile, specimens of brain tissue collected from three human encephalitis cases, sent from the NYCDOH to the University of California, Irvine, were genetically analysed and found to be positive for a West Nile-like virus (Center for Disease Control and Prevention, 1999).  In response to these test results, local health departments were requested to complete active surveillance for disease and deceased birds, collect the birds and send them to the New York and Connecticut State Health Departments.

The 1999 Outbreak is estimated to have caused 8200 human infections in which 1700 resulted in West Nile Fever (Petersen & Hayes, 2008).  The disparity in numbers estimated and numbers confirmed is due to the fact that asymptomatic people certainly did not seek medical care and those who came down with WNF may have weathered the disease without seeking healthcare as many people tend to pass things off as “the flu” and suffer at home until symptoms ease.  By September 28, 1999, there were 17 confirmed cases, 20 probable cases, and 4 deaths in New York City and surrounding counties.  It was determined that onset dates ranged from August 5 – September 16 but after mosquito control measures were expanded to include the entire city no more cases were reported for that year (Center for Disease Control and Prevention, 1999).

Despite the evidence that an encephalitic disease was causing nueroinvasive disease and in some cases death in humans, information was not published by the Center for Disease Control until its October 1, 1999 Morbidity and Mortality Weekly Report. 

In 2011 the CDC has reported, as of November 15, a total of 429 cases of WNND (68%) and non-nueroinvasive disease manifestation of the disease as 198 total cases (32%) for the year of 2011 alone.  ArboNET, the surveillance system set up to monitor West Nile, reported 627 cases with 36 of these resulting in death.  117 individuals who were asymptomatic at the time of donating blood tested positive.  The bias lies in the fact that serious cases are more likely reported than mild cases, as noted before, and that syndromic surveillance systems cannot detect asymptomatic cases (Center for Disease Control and Prevention)

Lessons Learned

While it is commendable that surveillance systems were set up after the reporting of diseased and deceased birds in the New York City neighborhood of Queens and around the Bronx Zoo, it took nearly a full month before vector control measures were put into place.  It was also reported that when vector control measures were begun, emergency hotlines were set up for individuals in the New York City area who might have concerns.  No mention is made about media coverage and if the media caused any kind of suspicion in the public that something worse was besetting the city.  It seems odd that Morbidity and Mortality Weekly published its first report on October 1^st if hotlines were already in place September 3^rd.  This suggests that the media was in some respect reporting the unusual deaths of birds and sickness in humans.  If this is the case, the Center for Disease Control should have been more pro-active in alerting the healthcare community AND the public as to their initial findings and on-going testing. 

It is obvious from this outbreak that animal specialists, such as zookeepers, conservationists, avid bird watchers, veterinarians, and organizations dedicated to the health and welfare of wildlife should continually communicate with human health care specialists when special circumstances affect the animal world.   In this way, novel zoonotic diseases can be identified early through testing of both animal and human specimens.  The wider movement of migratory animals and the changing climate add to animals moving into areas they have not previously inhabited.  This increases the introduction of diseases not endemic to these areas.  Humans will be vulnerable to many of these “new” zoonotic viruses.  Therefore, surveillance systems need to be kept up to date and programs like ArboNET kept in active status.  In the 1999 West Nile Virus outbreak public health officials made good use of the information they had at the time.  Though not documented in the readings, the CDC has put clear instruction on their website dedicated to West Nile Virus information on how individuals can protect themselves from mosquito bites by using personal protective gear (long sleeves, long pants, socks, hats, etc) and the pesticides that are safe to use on skin and clothing.  Steps to remove favorable mosquito breeding habitat is also described (removing areas of stagnate water such as accumulates in old tires and bird baths). It is through personal responsibility in protecting oneself from being bitten and city-wide efforts to enforce vector control that will help minimize the arboviruses that continue to cause disease.  West Nile Virus spread from New York City in 1999 to now be found, in 2011, in nearly every state, as well as Canada.  It isn’t going to go away as quickly as it came. 

           

Works Cited

Center for Disease Control and Prevention. (1999, October 1). Morbidity and Mortality Weekly Report. Retrieved November 15, 2011, from Center for Disase Control and Prevention: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a1.htm

Center for Disease Control and Prevention. (n.d.). West Nile Virus. Retrieved November 15, 2011, from Center for Disease Control and Prevention: http://www.cdc.gov/ncidod/dvbid/westnile/index.htm

Eidson, M., Komar, N., Sorhage, F., Nelson, R., Talbot, T., Mostashari, F., et al. ( 2001). Crow Deaths as a Sentinel Surveillance System for West Nile Virus in the Northeastern United States, 1999. Emerging Infectious Diseases , 7 (4).

Guharoy, R., Gilroy, S., Noviasky, J., & Ference, J. (2004). West Nile Virus Infection. American Journal of Health-System Pharmacy , 61, 1235-1241.

Hayes, E., & Gubler, D. (2006). West Nile Virus: Epidemiology and Clinical Feature of an Emerging Epidemic in the United States. Annual Review of Medicine , 57, 181-194.

Petersen, L., & Hayes, E. (2008). West Nile Virus in the Americas. Medical Clinics of North America (92), 1307-1322.

Rappole, J., Derrickson, S., & Hubalek, Z. (2000). Migratory Birds and Spread of West Nile Virus in the Western Hemisphere. Emerging Infectious Diseases , 6 (4).

International Association of Emergency Managers Conference 2011

Two days ago I returned from Las Vegas where I attended the IAEM Annual conference.  It was wonderful, although I have personal thoughts on staying in Vegas alone.  Paris, London, yes - Vegas, no.  However, I met many wonderful people and have a lot of contacts to pursue.  The workshops were helpful and the lectures were educational, motivational and most of them hilariously funny.  Kudos to IAEM planners for getting lecturers that double as comedians! 

I met my favorite author: In fact, I got my picture taken with her, hugged her, and told her how her book changed my life.  Her name is Amanda Ripley and she writes on Disaster Psychology.  Her book is "The Unthinkable: Who Survives Disaster and Why", of course available at amazon.com.  She told the compelling story of a young man who survived the Indonesian earthquake and tsunami but has serious post traumatic stress disorder.  He wanted Amanda to tell his story and I think everyone in attendance was feeling drawn into his ordeal.  One minute you are enjoying a tropical vacation on a beautiful beach, the next you are watching two thousand people being washed under sea water by a 26 foot wall of water.  Survivor's guilt.  I can't imagine.  But Amanda goes on to tell how this young man stayed on and helped survivors as best he could.  Not long after the tsunami he was traveling a highway and saw a bus full of people tumble over a cliff.  He didn't hesitate to run down and start pulling people out of the bus while so many others on the road behind him stopped, got out and just stood and watched him.  He finally yelled at the bystanders to help and they did - many filling their vehicles with survivors and following him and his full truck to the nearest hospital, 45 minutes away.  That day he was able to save lives.  I'm sure he doesn't feel 'vindicated' and will always carry the fate of the tsunami victims within his heart and mind.  But he saved lives and that matters to each and every one of those crash victims and their families.  If I ever find his story written somewhere I will post it.  Very moving. 

That has nothing to do with bioterrorism.  Perhaps I should have a separate blog about disasters but for now I'll just be happy to digress to other subjects from time to time.  Too many other things to do to keep up two blogs. 

I was asked by several people, after introducing myself as a grad student specializing in bioterrorism, what I thought was the biggest threat to America.  After explaining the facts behind smallpox and its possible reintroduction through bioterrorism or biowarfare, (see previous post), and a bit on anthrax, I had to admit that I think our biggest threat - at this point in time - is not biological agents but explosives.  I've long said that I believe we will see suicide bombers and the use of car bombs and IEDs within our borders.  We've thwarted some well publicized plots and no doubt there are many we without security clearances have no idea of.  But today the U.S. thwarted another possible attack:

"New York City Mayor Bloomberg confirms the arrest of U.S. citizen Jose Pimentel, 27, seen left, a suspected Al Qaeda sympathizer, in what New York City police say was an alleged plot to bomb police cars and U.S. troops returning home." ~ Fox News Headline~

   It's my gut-feeling we will see much more of this type plot.  Thankfully we were successful at thwarting an attack once again.  Some may question whether "gut-feelings" have a place in terrorism analysis and that can be debated later but for now I just want to point out that bioterrorism is a bigger challenge to terrorists and in the year ahead I believe we will see many more home-grown jihadists with explosive intentions.  The bioterrorism event will come from a well seasoned biologist who has an extremist ideology - something we should not dismiss the possibility, or eventuality, of.  There has been quite an increase in training classes on suicide bombing response for EMS and law enforcement personnel, signaling a suspicion that the threat is very real for us here in the U.S.  I, of course, will continue to study anthrax and smallpox and hemorrhagic fevers, but with an eye on other types of terrorism methods and our counterterrorism measures in those respects.

 

The following is a policy paper I wrote for class.  There is this prevailing thought among certain friends and acquaintances that what I study is irrelevant.  I assure you it isn't.  It's timely, relevant, and bioterrorism it a growing threat.  Although I've made claims that I believe terrorists will choose easier and less expensive means to attack America in the near future, which I still hold to, biotechnology is making it easier to build viruses from "scratch" and bioterrorism wrought by terrorists with basic knowledge of microbiology will become a bigger threat in the future.  It is also an international concern: The Cold War ended but what we've learned since is that nations see nonproliferation agreements as welcome opportunities to gain the upper hand by establishing secret biowarfare programs. 

EXECUTIVE SUMMARY

The convicted one waits patiently under heavy lock and key. Incarcerated since 1976, this killer has continued to receive a stay of execution since its death sentence was advocated. Set to die in 1996, this killer remains alive today. After 15 years of debate, international authorities cannot come to consensus on whether this horrible monster should be left to live or should be executed, once and for all.

The convicted is the virus that causes smallpox. Eradicated from nature in the 1970s by a world-wide campaign to cause its extinction, remaining smallpox stocks at two World Health Organization (WHO) repositories are the cause of heated international debate. Is there viable reason to continue to shelter the live virus so that scientists can continue research and development goals or should it be destroyed and finally labeled “extinct”?

     The variola virus that causes smallpox has killed more than 500 million humans in the 20th century alone (Weinstein, 2011). An ancient disease, smallpox causes 30% of its victims to succumb to death and those that live bear the permanent scars and disfigurement smallpox leaves behind. A vaccine made from another genetically similar virus, vaccinia, has made it possible to eradicate the disease and was declared so by the WHO in 1980. The World Health Assembly requested that any remaining stocks of smallpox be destroyed or be sent to one of two repositories, either the Center for Disease Control and Prevention (CDC) in the United States or to a laboratory in Russia, where it was later moved to a repository called Vector. The WHO maintained little oversight during this period. Destruction or transfer of smallpox strains to one of the repositories was based on the “honor system”. In 1975 a WHO survey indicated that of all biomedical labs existing 74 held stocks of the smallpox virus (Tucker, 2011). This, too, was taken at the word of the countries holding the virus. However, since its eradication from nature smallpox outbreaks have not been unheard of. Laboratory accidents have been reported. An outbreak that occurred in Aralsk, Kazakhstan, in 1971 proved that the Soviet Union had an extensive biological warfare program that included the development of smallpox, including the more deadly strains of “flat type” and “hemorrhagic” smallpox. The “flat type” smallpox, where lesions run together, has a nearly 100% fatality rate and hemorrhagic smallpox has a 100% fatality rate. (Center for Nonproliferation Studies, 2002). This indicates that even while countries such as the Soviet Union were in the forefront of the eradication program, behind the scenes they continued to develop smallpox as a biological weapon. Because of this, there is no certainty that all smallpox stocks are contained within the two repositories the WHO endorses. There remains a possibility that stocks are hidden elsewhere and perhaps developed by rogue nations as weapons or sold on the black market to terrorist groups. Careful consideration must be given to the risks of smallpox being used as a bioweapon in the future before the two known smallpox stocks are destroyed.

Current policy that addresses the problem:    

      Current policy is at an international stalemate. The United States and several of its allies favor continuing research on smallpox. Many bioweapons and bioterrorism experts are in favor of retaining smallpox for defensive reasons. Those who wish to see smallpox spared from destruction are called “retentionists”. On the other hand, there are those experts who favor the destruction of smallpox stocks because there will always be a risk of an outbreak from a laboratory setting as long as smallpox is used for research, and most believe that the threat of a bioterrorism or bioweapons attack using smallpox has been grossly exaggerated. Those who favor destruction are, appropriately, called “destructionists” (Tucker, 2011). Many developing countries favor destruction. The ravages of smallpox still fresh in their memory, they suffered the longest because of the disease and lack the financial and public health resources to fight smallpox should it make a comeback. During the World Health Assembly in May of 2011, smallpox was once again given a stay of execution. The debate will continue to rage on.

Potential alternatives in addressing the problem:

     There appear to be only two viable alternatives as to what to do with smallpox. Destroy existing stocks at the two repositories, or keep them under lock and key, continuing to use them for research purposes. Either alternative is a gamble. There appears to be no promise of compromise. With only two repositories, each in a country unlikely to voluntarily destroy their stocks when the other refuses to, the only viable option is an international consensus on the fate of smallpox and international oversight if destruction is finally decided upon.

Arguments for and against each alternative:   

    Fenner believes the greatest danger of a smallpox outbreak comes from the laboratory stocks of the variola virus (Fenner, Henderson, Arita, Jezek, & Ladnyi, 1988). Due to the conditions in which the stocks are heavily sealed, locked and guarded, combined with the extensive procedures qualifying scientists work with the virus, there seems little danger that an outbreak should come from either repository due to a mishap (Henderson, 2011). Scientists working with the virus would quickly recognize a mistake and take precautions to contain the disease before it could infect the public. It is the virus stocks that are not known to exist, if they do at all, that pose the biggest threat should they be mishandled or sold on the black market.

There is no animal reservoir that carries the variola virus, so reintroduction from nature is highly unlikely. Suggestions that interred corpses of smallpox victims and the ability of a smallpox scab to still be infectious, after smallpox has been eradicated for so long, has been debunked (Fenner, Henderson, Arita, Jezek, & Ladnyi, 1988).

     Retentionists believe ongoing research is needed on the live variola virus. Vaccine and drug development, they believe, is necessary while the virus is still available to study. A third generation vaccine and antiviral agents are at the center of the argument. Since smallpox was eradicated new diseases and length of life expectancy has added to the number of immune-deficient individuals in the population. These individuals, along with those who have atopic dermatitis are at risk when receiving the smallpox vaccine, and retentionists claim that a vaccine which is safe for these individuals must be developed. Added to that, most of the world’s population is either unvaccinated or, if vaccinated during the eradication program, immunity is no longer viable. Studies have shown that few countries have smallpox vaccine stocks (Henderson, 2011).

     Retentionists also argue that with scientific capabilities being developed, re-creating a smallpox virus is possible, either from a monkey pox or even from scratch. There is also a possibility that a closely related pox virus in nature would morph into a virulent strain that can once again plague mankind (Weinstein, 2011).

     Biotechnology is increasing exponentially, making the creation of viruses from scratch a reality. In 2002 scientists reassembled the entire polio virus using genomic sequencing. It took 2 years to recreate polio’s 7,500 DNA base pairs. In 2003 it took scientists a mere 2 weeks to recreate a bacteriophage containing only 5,300 base pairs. By 2006 the Epstein-Barr virus, which sports 170,000 base pairs in its DNA, was recreated. Smallpox, by comparison, has 180,000 base pairs. Researchers have already assembled a bacterial genome containing 583,000 base pairs. Baker believes it is only a matter of time before smallpox is recreated by a group with nefarious intentions (Baker, 2010). Retaining the original virus could make sense if bioscience brings smallpox back and into the wrong hands.

     There are logistical and financial problems associated with keeping stocks of smallpox vaccine. Henderson quotes a cost of $1.25 billion to have enough vaccine in storage to vaccinate 50 million individuals. Added to that is the exorbitant cost of research and development, a very contentious issue considering the current economy. Advocates for a third generation nonreplicating vaccine (one that is safe for those with immune deficiencies or dermal problems), which would require 2 doses to be effective, are suggesting a cost of $8 billion for 350 million doses (Henderson, 2011). This does not solve the issue of underdeveloped and developing countries who do not have the resources to acquire and stockpile the vaccine. Retentionists must remember that this is a global issue.

      Destructionists may argue that a smallpox outbreak will be quickly recognized and contained. Awareness of bioterrorism issues has been highlighted since the 2001 Anthrax attacks. Preparedness is indeed a current concern and it is unlikely that a smallpox outbreak would demand mass vaccination (Henderson, 2011). The need for development of antiviral medications, based upon research with the smallpox virus, is also considered by Henderson to be a moot argument. Because there are no animal models to test the drugs on, it cannot be certain that antiviral drugs developed from the smallpox stocks would be effective and testing on humans brings ethical considerations to the debate.

Final Recommendations:

      In the remaining time smallpox has left before destruction, research goals should be met if possible. Stockpiles of existing vaccine should be maintained. Since the development of genomic sequencing, it is becoming more likely that smallpox can be made “from scratch” and that warrants keeping the National Strategic Stockpiles up-to-date with viable vaccines. Scientists should work on making the manufacturing of vaccines an easier and timelier process. If smallpox is used as a bioweapon by a state entity, it is likely to be discovered quickly and contained by good public health practices. This, however, may not be true for developing countries. An international agreement must be made to ensure that any smallpox outbreak is considered a global concern and nations with smallpox vaccine are obligated to help struggling nations. As biotechnology increases the need for retaining smallpox stocks should become irrelevant. Therefore, it is financially prudent to look to other sources for vaccine and antiviral development, and to spend needed federal dollars on preparedness and response initiatives than on continued research. Execution should proceed at the next proposed date.

WORKS CITED:

Baker, S. (2010). Skating on Stilts: Why We Aren't Stopping Tomorrow's Terrorism. Stanford, California,USA: Hoover Institution Press.

Center for Nonproliferation Studies. (2002, June). The 1971 Smallpox Epidemic in Aralsk, Kazakhstan and the Soviet Biological Weapons Program. (J. Tucker, & Z. R.A., Eds.) Retrieved October 7, 2011, from Center for Nonproliferation Studies: http://cns.miis.edu/opapers/op/op9/pdf

Fenner, F., Henderson, D., Arita, I., Jezek, Z., & Ladnyi, I. (1988). Smallpox and its Eradication. Retrieved October 5, 2011, from World Health Organization: http://whqlibdoc.who.int/smallpox/9241561106.pdf

Henderson, D. (2011). Smallpox Virus Destruction and the Implications of a New Vaccine. Biosecurity and Bioterrorism , 9 (2), 163-168.

Tucker, J. (2011). Breaking the Deadlock Over Destruction of the Smallpox Virus Stocks. Biosecurity and Bioterrorism , 9 (1), 55-67.

Weinstein, R. (2011). Should Remaining Stockpiles of Smallpox Virus (Variola) Be Destroyed? Emerging and Infectious Diseases , 17 (4), 681-683.

Is Bioterrorism the Greatest Threat to the United States Today?

The threat of a biological attack looms large in the United States today. Advances in biotechnology have made synthesizing diseases from scratch a possibility. While Islamic extremists continue to target the United States it is only a matter of time before they have a trained biologist with the skill to weaponize a disease and unleash a disaster the country is ill prepared to deal with. However, the greatest danger we face as a nation today comes not from the type of attack Islamists may choose to use but that they plan to attack at all.
According to author Stewart A. Baker, former Assistant Secretary for Policy at the Department of Homeland Security, gene sequencing is undergoing exponential progress and it is only a matter of years before a biologist with the right knowledge about DNA synthesis and good lab equipment will be able to recreate smallpox from scratch. In 2002 the polio virus was reassembled and in 2005, Baker claims, synthesizing smallpox became a matter of choice, not capability. (Baker, 2010) And not only smallpox but other diseases are being recreated through the gene sequencing process as well. Diseases such as the bubonic plague and smallpox that once haunted us can re-emerge to cause mass fatalities and panic once again.
As a nation, we are woefully unprepared for such a crisis. In 2006, statistics showed that 11 states and Washington, D.C. lacked the capabilities sufficient to test and detect a biothreat. A whopping 40 states had a shortage of Registered Nurses, the very health personnel we will rely on as first responders during a bioterrorism attack. 12 states, as well as D.C., were not fully compatible with the Center for Disease Control and Prevention’s Electronic Disease Surveillance System – the system used by the CDC to track disease outbreaks. (Trust for America's Health, 2006). The very center of government, from which public health policy emanates, is unprepared for a bioterrorism attack. In the same report issued in 2010 things had not gotten much better. 33 states and D.C. had cut funding for Public Health during the 2008-2009 and 2009-2010 Fiscal Years. Since January of 2008, a total of 23,000 public health jobs had been cut. 21 states could not identify E. Coli 0157:H7 rapidly enough to be of benefit if it were used as a bioagent. In 90% of the cases these same states could not submit lab results within a 4 day period – crucial to detecting and containing a biological attack. (Trust for America's Health, 2010)
With a nation that is unprepared to deal with a large scale bioattack we sit as vulnerable as a duck stuck on a frozen pond. Whether groups like al Qaeda will choose to use bioagents to attack us is not known. Although they have stated their intent on using bioagents against us, we have not yet experienced an attack of that nature (the October 2001 Anthrax attacks were likely not al Qaeda’s work). What they HAVE stated is their intent on changing tactics. In the English publication of al Qaeda’s Inspire Magazine the author(s) blatantly suggest they are ready to try a new tactic. Called Operation Hemorrhage, al Qaeda has stated their intent to bleed America dry by adopting smaller, easier to perpetrate attacks that will overwhelm America and its healthcare infrastructure. They call it the “strategy of a thousand cuts”. Our “security phobia” surrounding airport full body scanners and the uproar over whether the scanners take our civil rights away is but a joke to al Qaeda. Ever adaptable, they will strike in a way that will take us by complete surprise. (Al Qaeda in the Arabian Peninsula, 2010). Their statement that they will stage smaller attacks that are more feasible to pull off, involve less players, less time to launch, and are more frequent suggest tactics such as suicide bombers, improvised explosive devices, or perhaps small scale biological attacks – such as poisoning grocery store produce with botulism.
Homeland Security and other national security agencies must remain open to the possibility of a multitude of tactics to be employed by Islamic radicals. Focusing on one, such as bioterrorism, would be a mistake. While Public Health Departments have a long way to go to be ready in the event of a bioterror attack, America is not ready for attacks by suicide bombers or IEDs either. Healthcare professionals need to be able to recognize the symptoms of biowarfare agents but also need to know how to deal with blast injuries. We rule out one type of terror tactic at the peril of another. We must keep vigilance that any type of method can be used against us. While bioterrorism is a growing threat along with the increases in biotechnology, it has not yet earned the title of the “greatest” threat to the United States. The terrorists who wish to kill Americans by the millions remain the single greatest threat.

CITATIONS
Al Qaeda in the Arabian Peninsula. (2010). Inspire Magazine. Unknown: Al-Malahem Media Production.
(2010). Skating On Stilts: Why We Aren't Stopping Tomorrow's Terrorism. S. A. Baker. Hoover Institute Press.
Trust for America's Health. (2006). Ready or Not? Protecting the Public's Health from Diseases, Disasters, and Bioterrorism. Robert Wood Johnson Foundation.
Trust for America's Health. (2010). Ready or Not? Protecting the Public's Health from Diseases, Disasters, and Bioterrorism. Robert Wood Johnson Foundation.

Joplin Tornado Victims Experiencing Fatal Fungus

Here is a link to the article about the fungus. Apparently they dealt with this in the Indonesian tsunami but this is the first I've ever heard of it.
http://www.latimes.com/health/la-he-joplin-fungus-20110611,0,5212890.story

Inspire Magazine

Al-Qaeda's Inspire Magazine qoutes: "In such an environment of security phobia that is sweeping America, it is more feasable to stage smaller attacks that involve less players and less time to launch and thus we may circumvent the security barriers America worked so hard to erect." This is called "Operation Hemorrhage" or in some places "the strategy of a thousand cuts". It began with the printer cartridges placed on UPS aircraft. Full body scans are apt to find nothing, as Al-Qaeda has decided to shift tactics. We've been successfull in foiling many small attacks but can we be everywhere all the time? I've said for years that I see a day when suicide bombers are common within our borders. Al - Qaeda and jihadists mean to "bleed" us to death. America is not ready for mutliple sustained attacks, neither medically nor psychologically. And recently a suicide bomber in Israel was found to have Hepatitis - thus spreading the disease through the intrusion of shrapnel into the victims. There are numerous way to introduce bioagents into more traditional weaponary. I contend we are not ready for this scenario.

"Smallpox is back, or nearly so" ~ Stewart Baker ~

I was having a conversation with a friend the other day about a report that the Pentagon is diverting funding from preventing bioterrorism to response.  I made the argument that advancements in bioresearch are leaving us wide-open to increasing types of threats.  Today I found the following article while chasing some other topic of bioterrorism and I include it here for both my friend and others who might find it as chilling as I do....

Here is an excerpt from a book called "Skating on Stilts: Why Aren't We Stopping Tomorrow's Terrorism?" by Stewart Baker.  I have not read this book yet, but found the excerpt in a Huffington Post article.

In January 1970, a German electrician fell ill after a trip to Pakistan. He was hospitalized with what appeared to be typhoid fever. He had been isolated for several days when the doctors realized that he didn't have typhoid fever.
It was smallpox.
Fear riffled through the hospital, and the community beyond. Smallpox has probably killed more human beings than any other disease. And it kills them with particular cruelty. After starting out like a bad flu, after a few days the disease attacks the victim's skin. Tiny spots appear, spread, and then harden into pus-filled blisters. Gradually, with excruciating pain, the blisters pull the outer layer of skin away from the under-layers. Sometimes the skin pulls loose in sheets. Sometimes the blisters attack not just the skin but the eyes, the throat, and every other orifice, ripping loose skin inside the body as well. Desperate with thirst, the victims can't drink; swallowing is just too painful.
Throughout it all, the victim remains fully conscious. A third or more of the victims die. Those who survive are often permanently scarred, or blind or both.
The electrician lived. But many who came into contact with him were infected. Several died.
What was most frightening was how the virus spread. One victim spent only fifteen minutes in the hospital. All he did was ask directions, briefly opening a door that led to a corridor thirty feet from the patient's room. That was enough. He came down with smallpox.
Three other victims were even farther away -- two floors above the electrician's isolation ward. It was January, but tests revealed that opening the hospital windows just a crack allowed currents of air to drift between rooms on different floors. The virus had floated out the patient's window and along the outside wall; it then slipped into three different rooms two stories above, infecting patients in each room.
Seven years later, in 1977, Ali Maow Maalin also fell ill with smallpox. This time, though, it turned out to be good news.
Maalin was a cook from Merca, Somalia -- where smallpox was making its last stand. Vaccination was slowly tightening a noose around the disease. Because smallpox reproduces only in humans, widespread vaccination left fewer and fewer places for the virus to reproduce and spread.
The first vaccination for smallpox--or indeed for any disease -- came in 1796. That was when Edward Jenner realized that milkmaids who caught cowpox seemed to be protected from smallpox, to which cowpox was related. Jenner's vaccine based on cowpox marked the beginning of man's counterattack on smallpox. By the 1970s, vaccinations had gradually reduced the disease's natural range to the wilds of Somalia and Ethiopia.
The World Health Organization hoped to make Ali Maow Maalin the last victim of smallpox in history. It quickly vaccinated everyone who had been in contact with him, then held its breath. Would other cases flare up?
WHO waited.
A year.
Two years.
Three.
At last, after three years with no natural cases of smallpox, the World Health Assembly declared victory. It triumphantly called a special 1980 meeting.
"[T]he world and all its peoples have won freedom from smallpox," the assembly declared. This was "an unprecedented achievement in the history of public health." Together, the nations of the assembly had "freed mankind of this ancient scourge."
Copies of the virus were locked away in Atlanta and Moscow for research purposes, but the disease was gone from nature. Vaccinations stopped. Few Americans born after the 1960s have the dimpled scar on their arm that is the last trace of mankind's worst nightmare.
It had taken a bit less than two centuries for vaccination to free the world from "this ancient scourge."
Today, the likelihood that the world will remain free from this ancient scourge is close to zero.
Smallpox is back, or nearly so.
Within ten years, any competent biologist with a good lab and up-to-date DNA synthesis skills will be able to recreate the smallpox virus from scratch. Millions of people will have it in their power to waft this cruel death into the air, where it can feed on a world that has given up its immunity.
How can I be so sure? Easy. I've seen the same thing happen already, and so have you. The very same revolution that made possible the explosion of information technology--and set the table for network attacks--is now transforming biology, with consequences that are both exalting and frightening.
The same relentlessly exponential improvement in technology that gave us Moore's Law and that democratized the computer is now democratizing the technology of life. It is empowering an army of biologists to tinker with biology in ways that will help us all live longer and more comfortable lives.
And then, unless we do something, it will kill us in great numbers.
"Synthetic biology" blends biology, chemistry, and engineering. The field really began to take off when it moved from laboriously replacing a single gene to building whole stretches of the genome from scratch.
DNA is organized like a spiral staircase, and each step on the stairs is called a base pair. Linking base pairs together into longer sequences allows researchers to make more complex genes--and ultimately more complex organisms. So progress in synthetic DNA is measured by how many base pairs have been successfully strung together. In recent years, progress has been exponential.
In 2002, after a two-year effort, a team of researchers announced that they had assembled the entire polio virus. To do that, the team had to assemble 7,500 base pairs of DNA, precisely in order. The next year, scientists managed to knock years off the process, assembling a bacteriophage with 5,300 base pairs in just two weeks.
Two years later, in 2005, researchers' capabilities had tripled. A team managed to synthesize an influenza virus with 14,000 base pairs. Just a year later, they had surpassed that mark by a factor of ten, synthesizing the Epstein-Barr virus, with 170,000 base pairs.
Smallpox has 180,000.
By 2005, whether smallpox would be synthesized was simply a matter of choice, not of capability.
The following year, the outgoing secretary general of the United Nations, Kofi Annan, grew alarmed. He pointed to researchers' successes in building an entire virus from scratch and said, "In the right hands, and with the appropriate safety precautions, these are sound scientific endeavours that increase our knowledge of viruses. But if they fall into the wrong hands, they could be catastrophic."
Too late. By 2009, the state of the art had left 180,000 base pairs in the dust. A team of researchers announced that it had assembled a bacterial genome with 583,000 base pairs. Creating smallpox from scratch was no longer even an interesting challenge.
Nor were these capabilities confined to a few specialty laboratories. Foundries sprang up to sell made-to-measure DNA, at ever-declining prices that put Moore's Law to shame. Synthesizing DNA cost $10 per base pair when George W. Bush ran for president in 2000. By the time of his second inauguration, the price was $2 per base pair. When he left office in 2009, the price was down to about 25 cents. For those who don't want to use a foundry, DNA synthesizers are available for sale on eBay.
Kofi Annan was wrong. This technology isn't going to fall into the wrong hands. Just like jet travel and powerful computers, it's going to fall into everybody's hands. The Mayo Clinic. Hezbollah. Pfizer. Al Qaeda. Apple. Ted Kaczynski, Timothy McVeigh, and the Fort Hood shooter.
They won't need their own labs to build bugs to order. Even today, it's possible to obtain long sequences of synthetic DNA simply by sending a message to the private "foundries" that assemble DNA to order.
Struggling to survive in a new market with thin margins, the foundries' sense of responsibility for what they make is, well, limited. The Guardian newspaper in Great Britain demonstrated this when one of its journalists successfully ordered a lightly modified piece of the smallpox genome over the web. The order was mailed to his home, no questions asked. When a dozen foundries were asked whether they screened DNA orders to see whether they were providing sequences that terrorists could turn into weapons, only five answered "yes."
As many as half the foundries questioned by journalists did not routinely screen their orders to make sure that they were not helping terrorists construct a dangerous virus. The order came in, and they filled it, often with no questions asked.
If current trends continue, anyone who can get his hands on a computer virus today will soon be able to get his hands on a custom built biological virus.
And who can get his hands on a computer virus today? In an age of drop-down-menu malware attacks, the answer is simple.
Anyone who wants to.

"Skating on Stilts" can be ordered from Amazon