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Magazine
Spectre of bio-terrorism
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While there is speculation about the use of anthrax spores as a biological weapon,the real threat could be from smallpox, writes DR. S. MOHAN RAJ.
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A clear-plastic tent creation to fend off biological or chemical attack. A family can huddle in the pressurised, filter-protected room-sized.
SMALLPOX: OBITUARY — This is how the chapter on communicable diseases began in the textbook of Preventive and Social Medicine (by J. E. Park and K. Park) while we were students in the 1980s. The obituary recalled the international campaign by the World Health Organisation (WHO) from 1967 to 1979 to eliminate smallpox. It was a historical moment on May 8, 1980 when the WHO declared that smallpox had been eradicated from the world.
Was it true? Not really. Some stocks were kept in two WHO designated laboratories in the United States and Russia "for future research, if needed". Does it remind you of a Hollywood film in which a little bit of the villain is left behind (be it human or dinosaur) so that a sequel can be made? Now, that sequel seems to be in the making. What the WHO managed to accomplish over many years of intense efforts may be vulnerable to a new breed of real life villains.
First, the prelude. His gun does not identify the new breed of terrorist. He might look like you and me. He walks into a post office, and posts some letters. Some of the envelopes have anthrax spores, probably taking the cue from virus being attached to e-mail.
But there have been incidents in real-life recently where:
Senator Tom Daschle's office received a letter with anthrax that forced the Capitol Hill to be evacuated.
Three persons have died of anthrax, two of them postal workers.
At the time of writing, 32 persons have been exposed to anthrax. Ten persons had developed clinical symptoms, four with pulmonary anthrax and six with cutaneous anthrax.
Why anthrax? What is it about anthrax that makes it a choice as a biological weapon? I asked Dr. Suniti Solomon, microbiologist and Director, Y.R.G. Centre for AIDS Research and Education.
"The anthrax spores,'' she said. The spores can survive for several years in the environment. They do not require any nutrition and are resistant to heat and drying, which makes it possible to send it as a dry powder. Moreover, the aerobic nature (using oxygen for cell respiration) of the organism helps it survive. Once conditions are favourable, the spores become the vegetative form — the anthrax bacilli. Other spores like tetanus which is anaerobic in nature (using nitrogen for respiration) do not survive on exposure to oxygen and so cannot be send the same way as the anthrax spores.
In the U.S., the panic displayed by both the media and the people is out of proportion to the real threat. A biological weapon like anthrax will have a major impact only when it is unleashed unawares on a population. In routine clinical practice, common diagnoses are considered first and anthrax could be missed.
But once the index of suspicion is very high among the doctors, as it is now, there is no need to panic as early treatment and prophylaxis can be instituted. Effective treatment is available in Ciprofloxacillin, Doxycycline and Penicillin. The risk of person-to-person transmission of pulmonary anthrax is minimal. Transmission by insect bite does not happen.
The investigation report that Mohammed Atta, one of the pilots on the suicide mission on September 11 was trying to hire crop dusters only heightened paranoia.
Gas masks and guns were much in demand. Later came the envelopes that led to closure of banks, shops and offices. The impact of anthrax in U.S., so far, has been more psychological than physical.
In India, the ministries of home and health, several key installations and many State Government offices received their quota of chalk powder, talcum powder, flour and sand. At the time of writing this, none of the powders delivered in India contained anthrax spores. But rumours could spread faster than the truth. People respond in a bizarre fashion when they are misinformed.
Dr. Solomon recalls the AIDS scare in Chennai three years back. "More than 20 men came to our centre for testing. They were convinced that they had been pricked with needles contaminated with HIV, while travelling in the bus or two wheeler. Their skin showed no puncture marks. They were counselled and their blood samples were sent for investigation. Both the initial tests as well as the second test, done after three months were negative." What we need to tackle are the rumours. The media has had to do a tightrope walk — of educating the public about anthrax and other biological weapons without triggering panic.
Picture of the spores and vegetative cells of anthrax.
The use of anthrax as a biological weapon is not new. Many countries have meddled with anthrax as a possible weapon, since World War I. In 1937, Japan tested it in Manchuria. Since, 1942, the United Kingdom had been conducting experiments with anthrax at Gruinard Island, off Scotland. Fort Detrick, Maryland was the venue for U.S. experiments since 1943. An accident at a military facility in Russia, in 1979, killed about 68 people. Iraq, a late entrant, said in 1995, that it had produced about 8,500 litres of anthrax spores. Not much is known about development of other biological weapons in other countries.
The real threat could be from smallpox. Vaccination was discontinued in 1982.
Dr. Suniti remembers WHO personnel visiting the General Hospital, Chennai, then a nodal centre for smallpox eradication, and destroying the samples. By 1980, only six labs had stocks and by 1983, the number was down to two — the Centre for Disease Prevention, Atlanta, U.S. and Research Institute of Viral preparations, Moscow, Russia. Theft or diversion to biological warfare programme cannot be ruled out.
Theoretically, newer antiviral medication should be effective against smallpox but in practice, this needs to be tested. In the current context, WHO Director General, Dr. Gro Harlem Brundtland has asked the smallpox advisory group to review the guidelines on smallpox vaccination.
No sane group would release smallpox virus into the population, as it cannot be restricted to "enemy territory". Smallpox has the potential to become a pandemic, i.e., to affect the whole world. It does not recognise political boundaries.
Let us fervently hope that the obituary to smallpox remains unedited.
The writer is a consultant psychiatrist based in Chennai.
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