UNIT 4 BIOLOGICAL DISASTERS

Structure
4.0 Learning Outcome
4.1 .. Introduction
.
4.2 'Classification of Communicable Diseases
4.3 Factors contributing to Vulnerability
4.4 Typical adverse effects
4.5 Biological Disaster: A Study of Plague at Surat
4.6 Biological Disaster: Preparedness and Mitigation
.
,
4.7 Conclusion
4.8 Key Concepts
4.9 References and Further Reading
4.1 0 Activities

4.0 LEARNINGOUTCOME
After studying this Unit, you should be able to:
• Explain the causes of biological disasters;
• Describe the typical adverse effects of biological disasters; and
• Suggest the risk reduction and preparedness measures.

4.1 INTRODUCTION
Biological disaster has coexisted with human society since primitive days. With rapid advancement
in medical sciences and prevention and social medicine, the impact and frequency of such disasters
have reduced to some extent in advanced countries. But the poor and developing countries continue
to suffer due to biological disasters. It is, therefore, important to understand the measures of
managing biological disasters and mitigating their impact on communities.

What is a Biological Disaster?

A biological disaster is the disaster, which causes sickness and fatalities in human beings and
animals at mass scale, when they come in contact with biological hazards in the form ofliving
organisms, such as, bacteria, virus, fungi, etc. Destruction of crops and plantation also falls within
the ambit of biological disasters.
All communicable diseases, either of human beings or livestock are potential biological disasters.
They spread widely,affecthuge number of people in communities, sometimes across the geographical
limits of provinces and nations.
Biological Disasters have caused havoc in human settlements in the form of communicable disease
since times immemorial. Plague savaged Europe for 300 years from 1300s to 1600s. About 20-
25 million or about one-third ofthe population was eliminated by the deadly epidemic across the
continent. Plague killed 200 people at Surat in Gujarat in 1994.
 Biological Disasters 37

. The pendemic influenza outbreak caused 20 million deathsacross the world in 1918-1919. Similarly
small pox, ebola, and yellow fever have been causing havoc throughout the world, mainly in
underdeveloped and poor societies. The small pox has been eradicated with its virus. It is preserved
only by some advanced countries for research purposes.
Biological disasters essentially appear in the form of epidemics or.pandemics, which are caused by
microorganisms. Different microorganisms cause different types of communicable diseases. The
micro-organisms, which cause co~unicable disease could be categorized as follows:
• Bacteria - These are small free-living organisms. They can be grown on solid or liquid
culture media. The disease caused by bacteria is usually treatable with specific antibiotic
therapy.
• Virus - These microorganisms replicate in living cells and cause disease, which are mostly
non-responsive to antibiotics. Such disease may sometimes respond to antiviral compounds.
• Rickettsiae - These microorganisms share characteristics of bacteria and virus. In the case
of virus, they grow only within living cell; and in case ofbacteria, they too have cell membranes
and metabolic enzymes. Besides, they use oxygen and are susceptible to antibiotics.
• Chlamydia- these are intracellular microorganisms not capable of generating their own energy
source. They grow in living cells like viruses, and respond to broad-spectrum antibiotics as in
the case of bacteria.
• Fungi - These are primitive plants, which draw nutrition from decaying vegetable matter.
Most fungi form spores, and free living forms are found in soil. Fungal disease normally
responds to anti-microbial drugs.
• Toxins - These are poisonous substances produced by living plants, animals or
microorganisms. Some toxins can be produced by chemical means also.

4.2 CLASSIFICATION OF COMMUNICABLE DISEASES

One way to classify the communicable diseases is to list them according to pathogenic agents that
cause the disease, i.e., whether virus, bacteria, or parasite. Communicable diseases, manifesting
themselves in association with natural disaster situations, such as, earthquake, cyclones or floods,
are customarily classified according to the way they are transferred. Following simple classification
is suggested for practical reasons.
• Diseases transmitted by contact
Scabies
Trachoma
Conjunctivitis
Mycosis
• Sexually transmitted
Gonorrhoea
Syphilis
AIDS
• Vector transmitted diseases
Malaria
Dengue

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 38 Understanding Man-Made Disasters

Recurrent fevers
Trypanosomiasis
Yellow fever
Onchocerciasis
~ Schistosomiasis
.
"

• Diseases transmitted through faecal matter

Non specific diarrhea diseases
Cholera
Amoebiasis
Hepatitis
.
, Typhoid fever
Ascariasis
I

Aneylostomiasis (hookworm disease)

• Diseases transmitted through air
1
Acute respiratory infection
l
Tuberculosis
Measles
I
-::' Meningitis
~
Whooping cough 1
Global efforts to eradicate communicable diseases succeeded to eradicate smallpox among the . J
1
communicable diseases totally eradicated so far. It is a matter of concern that thirty new pathogens
have been identified since eradication of small pox. Some of these have already swept the world in
the form of a pandemic (viz. HIV /AIDS), and for many of these (Ebola, virus, lassa virus etc.)
there is no cure, treatment or vaccine and the possibility of preventing or contesting them. Recently
recognised pathogenic microbes and infections diseases are given in the following table.
1

Table 4.1: Pathogenic Microbes and Infectious Diseases

Year
1973
Microbe
Rotavirus
Type
Virus
Disease
Major cause of infantile diarrhoea
worldwide
j
••
1975 Parvovirus B-19 Virus Aplastic crisis in chronic heamolytic
anaemia I j
1976 Cryptosporidium parvum Parasite Acute and chronic diarrhoea ~
I
1977 Ebola virus Virus Ebola haemorrhagic fever
1977 Legionella pneumophila Bacteria Legionnaires disease
1977 Hantaan Virus Virus Haemorrhagic fever with renal syndrome. I
(HRFS) I
j
1977 Campylobacter jejuni Bacteria Enteric pathogen distributed globally
1980 Human T- lymphotropic Virus T-cell lymphoma --leukaemia
l
virus I (HTLV-l) .
1981 Toxin producing strains of Bacteria Toxic Shock Syndrome
Staphylococcus aureus

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Biological Disasters 39

1982 Escherichia coli 0157:H7 Bacteria Haemorrhagic colitis; heamolytic Ureamic

syndrome
1982 HTLV-II Virus, Hairy cell leukaemia
1982 Borrelia burgdorferi Bacteria Lyme disease
1983 HIV Virus AIDS
1983 Helicobacter pylori Bacteria Peptic ulcer disease
1985 Enterocytozoon bieneusi Parasite Persistent diarrhoea
1986 Cyclosporacayatanensis Parasite Persistent diarrhoea
1988 Human herpes virus-6 Virus Roseola subitum
(HHV-6)
1988 Hepatitis E Virus Virus Enterically transmitted hepatitis
1989 Ehrilichia chafeensis Bacteria Human ehlichiosis
1989 Hepatitis C Virus Virus Parenterally transmitted liver infection

1991 Guanarito virus VIrus Venezuelan haemorrhagic fever

1991 Encephalitozoon hellem Parasite Conjuctivitis; disseminated disease
1991 New sps. of Babesia Parasite Atypical babesiosis ,
1992 Vibriocho1erae 0139 Bacteria New strain associated with epidemic
cholera
1992 Bartonella henselae Bacteria Cat -scratch disease; bacillary
angiomatosis
1993 Sin nombre virus Virus Adult respiratory distress syndrome
1993 Encephalitozoon cunculi Parasite Disseminated disease
1994 Sabia virus Virus Brazilian haemorrhagic fever
1995 HHV-8 Virus Associated with Kaposi sarcoma in AIDS
patients
1999 Nipah Virus Encephalitis

Source: Global perspective of communicable diseases, Biological Disaster Management Plan, HPC
on Disaster Management, part Vol.-IV.
J Lederberg, "Future of infectus diseases in Drug resistance mechanisms and management",
communicore, 1998, p.5.

4.3 FACTORS CONTRIBUTING TO VULNERABILITY

In India, urban, semi-urban and rural population all are vulnerable to biological disasters, though
for different reasons and in varying degree. Some of the factors uniformly applicable are:
• Population growth
Leading to sub-standard and unhygienic living conditions, presenting a perfect condition for
epidemic to set in.
• Poverty
A logical consequence of over population limits the capacity of individuals and communities
to limit or nullify the impact of epidemics.
• Lack of Rapid Response Epidemic Control and Containment Mechanisms
Paucity of medical resources coupled with geographical locations and problems of
communication make communities in rural areas comparatively more vulnerable.

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 40 Understanding Man-Made Disasters

• Low Public Awareness

Lack ofbasic health and hygiene education and in some cases superstitions add to vulnerability
of certain sections of population. .

• Poor Health and Malnutrition

Poor health and malnutrition lead to depleted body resistance to diseases. Thus, certain
'. groups in urban areas, and women and children in backward rural areas become more
vulnerable .
• ' Poor state of Health Care System
, Callous approach to public health' and safety coupled with meagre resources at the disposal
of civic bodies at all levels also contribute to enhancement of vulnerability to biological disasters.
• Congestion in Urban Areas
.. Congestion in urban areas leads to problem of waste disposal, which provides fertile ground
for various diseases to spread.
, • Bio Terrorism
Ignorance towards emerging threats ofbio-terrorism, in general, enhances the vulnerability.
• Modern Means of Transport and Communication
It is a paradox that modem means of transport and communication have made the world
shrink, which also add vulnerability to communicable diseases because of frequent travel and
greater social mixing.

Bio Terrorism
Possibilities of occurrence ofthe biological disasters due to certain dangerous biological agents,
which are used by terrorist organisations have increased. Biological warfare is nothing but bio-
terrorism and is universally condemned.

Biological Disasters: Causal Phenomenon

Communicable diseases leading to biological disasters often erupt and spread due to poor and
unhygienic living conditions of individuals and families within communities. The general living conditions
and state of medical services coupled with awareness levels of individuals also determine the
vulnerability of individuals and communities to biological hazards. It is very natural, therefore, that
affiuent communities are less vulnerable to biological hazards as cornparedto poor communities.
Causes for epidemics and pandemics may be generalised as under:
• Congested living areas with inadequate hygiene and sanitation arrangements.
• Movement of infected personnel to non-epidemic areas carrying the micro-organisms during
their incubation period.
• Movement of non-immune persons to endemic areas. In case of malaria, for example, the
mortality rate in endemic regions is very high during first two years oflife. In groups from non-
endemic areas who move into endemic regions, all individuals run the risk of developing
severe form of malaria.
• Malnutrition, particularly among children.
• Ecological changes conducive to breeding of vectors.
• Poor or insufficient water supply system, leading to consumption of contaminated water,
leading to water borne diseases.
• Poor Health Services and lack of programmes for immunisation and vector control.

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 Biological Disasters 41

4.4 TYPICAL ADVERSE EFFECTS

Typical adverse effects of biological disasters include following aspects:
• Enhances vulnerability due to economic consequences and levels of poverty.

"
• Loss oflivelihood, even for personnel in unorganised sectors due to decline in business and
economic activities in general.
"
• Post Traumatic Stress Disorders (PTSD).
• Crisis of availability oflabourers, who migrate in search of employment in normal conditions
and work in other areas.

4.5 BIOLOGICAL DISASTER: A STUDY OF PLAGUE AT

SURAT
Surat, one ofthe largest industrial towns ofGujarat was hit by plague epidemic in October 1994.
Approximately six hundred people died and about 1/3 ofthe population of the town are believed
to have fled mainly due to fear and panic. The epidemic had far reaching economic repercussions
too.
Some ofthe major observations, which could be noted as lessons for improving biological disaster
response, are listed below.

Conditions before the outbreak of Plague

• Congestion in town.
• Inadequate garbage disposal arrangements.
• Lack of functional disease surveillance organisations.
• Lack of overall preparedness on behalf of civic administration to combat outbreak of an
epidemic of this nature.

Conditions during the outbreak of Plague

• Paucity of drugs.
• Rumour mongering - there was a rumour that water in the city was poisoned.
• Lack of credible public information system.
• Lack of co-ordination within the medical authorities as well as in various government
departments,
• No plans existed for moving people to safer areas.
• No public health programme to educate common masses to cope with plague epidemic was
m vogue,
• Lack of judicial provisions to enforce medical practitioners to fulfill their social obligations. A
number of private medical practitioners fled the town and many private nursing homes closed
down.
• Inadequacy of medical infrastructure to handle a disaster of such a dimension. It was very
creditable on part of medical personnel to work under great odds. At places even the medical
personnel did not have protective gowns and the sanitary staff ofthe municipal corporation
worked without masks and gloves. . '

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 42 Understanding Man-Made Disasters

• Availability of sanitary staff was reduced to about 50 per cent due to prevailing fear and
panic, which affected garbage disposal and removal of carcasses. '.
Thus, it is evident from the study that specific preparedness measures are required to mitigate the
biological disasters, which are mentioned below.

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4.6 BIOLOGICAL DISASTER: PREPAREDNESS FOR
I
MITIGATION
1
• _ Create a pool of well-trained medical professionals.
• Ensure availability of vaccines and drugs. 1 I

• Ensure adequate stocks and ready availability of diagnostic re-agents. l

• Develop an effective network of surveillance system to detect outbreak of epidemics.
• Improve skills of medical professionals towards early diagnoses and identification of epidemics.
• Improve public awareness to enable people to help the administration and medical authorities
in disaster management.
• Have a reliable and credible public information system for dissemination of factual information
to avoid fear and panic among masses.
The analytical study of plague in Surat revealed the need to immediately implement following
suggestions to mitigate the disaster. Conceptually the epidemic can be resisted and fought against by:
• . Organising mass scale immunisation programme;
• Providing effective and efficient (timely) treatment;
• Maintaining high standards of hygiene and sanitation in the communities;
• Preventing spread of disease; and
• Creating public awareness towards health care. In this regard, following information that
includes symptoms and treatment about certain epidemics will prove to be useful.

Plague
The plague bacterium could be disseminated by aerosol, resulting in the pneumonic form with the
potential for secondary spread of cases through respiratory droplets ofthose infected. J
Symptoms
Within one to six days after exposure, the first signs of illness are fever, headache and weakness,
which can lead to shock and death within two to four days. .

Treatment
Antibiotics within 24 hours of first symptoms.

Botulism
Botulism toxin can be inhaled, viz. contaminated food or water.

Symptoms
Double vision, slurred speech, dries mouth and muscle weakness, which also starts at the top of
the body and works its way down. Symptoms begin from six hours up to two weeks after exposure.
Death can be caused by paralysis ofthe breathing muscles within 24 hours.

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 Biological Disasters 43

Treatment
Botulism anti-toxin, supplied by the CDC
Prevention
Vaccine
Smallpox
,"
The smallpox virus is relatively stable and the dose required for infection is small, making it a
candidate for aerosol release. It could then be further spread by the saliva droplets of infected
people.

Symptoms
The incubation period is about 12 days following exposure. Symptoms include fever, fatigue and
.
, aches, followed by a rash with lesions and can lead to death within the first two weeks of the
illness.

Treatment
No proven treatment at this time.

Prevention
Vaccine
Tularemia

Humans can become infected with tularemia through bites by infected anthropods, contact with
contiminated water or food, and inhalation of infective aerosols.

Symptoms
Earlier symptoms of infection by aerosol could be similar to those of influenza or a typical pneumonia.
The symptoms can occur within a few days or as long as two weeks after exposure. If treated, the
patient experiences progressive weakness and weight loss, and can die within two weeks.

Treatment
Antibiotics

Prevention
A vaccine is currently under review by the U.S. Food and Drug Administration (American Medical
Association)

Viral Hemorrhagic Fevers (VHF)

Many VHF viruses are known to naturally reside in an animal or insect host, however, the hosts of
some VHF viruses remain unknown, including that ofEbola and Marburg viruses. Some VHF
viruses can be transmitted by the body fluids of infected people.

Symptoms
Reactions vary depending on the type of VHF, but symptoms often include fever, fatigue, dizziness,
muscle aches and exhaustion. Severe cases cause bleeding under the skin and in internal organs.
Some types of VHF cause kidney failure.

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 44 Understanding Man-Made Disasters

Treatment
Generally there are no treatments other than supportive therapy for VHFs:
Prevention
Vaccines are available for only two VHFs: yellow fever and Argentine hemorrhagic fever.
.,
4.7 CONCLUSION
The biological disaster, that is, caused by organisms like bacteria, virus, fungus, and protozoon
leads to epidemics, which occur in large scale. The causative agent could occur naturally or be
created in laboratory and spread as part of warfare and terrorist activity. It has been observed
that the disaster related epidemic arises from the sub-standard living conditions. In this Unit, we
have described the causes, impacts, and management of biological disaster.The Unit has described
the adverse effects of biological disasters, which enhance vulnerability due to economic
consequences and levels of poverty; results in PTSD; loss oflivelihood; and crisis of availability of
labourers, who migrate in search of employment in normal conditions and work in other areas. In
view ofthese problems, we have suggested certain measures for preparedness and mitigation of .
biological disasters.

4.8 KEY CONCEPTS

Botulism Botulism toxin is the most potent lethal substance, which is
. made by the bacterium clostridium botulinum.
Epiderriic Occurrence of a disease ina particular group or population .
such that a high proportion of persons are affected by the
disease.
Pandemic Large epidemic; an epidemic that spreads worldwide or atleast
across a large region.
Plague The causative agent of plague, Yersinia pestis, is found in
rodents and their fleas.
Parasite An animal or plant living in or on another.
Pathogem Disease producing organism.
Smallpox The variola virus, commonly known as smallpox, was
eradicated from the world in 1977, except for stocks of it
kept in the World Health Organization reference labs.
Smallpox comes in two forms: variola minor or the more deadly
variola major.
Smog When smoke andlor pollution combine with fog, the result is
smog (smoke plus fog). Smog takes longer to dissipate and is
very harmful.
Tularemia The causative agent oftularemia is francisella tularensis, which
is considered as one ofthe most infectious pathogenic bacteria.
Viral Hemorrhagic Fevers Viral hemorrhagic fevers (VHF) refer to a group of illness
caused by several distinct families of viruses. While some of
these viruses cause relatively mild illness, others cause severe
life-threatening ones, such as, ebola. Dengue is a VHF.

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 Biological Disasters 45

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4.9 REFERENCES AND FURTHER READING
Biological and Chemical Weapons, at www.CNNcom
"Global perspective of communicable diseases, Biological Disaster Management Plan", HPC on
"
Disaster Management, Vol.-IV, NCDM, IIPA, New Delhi.
Lederberg, 1., "Future of infectious diseases in Drug resistance mechanisms and management",
R.L. Singhal and O.P~Sood (Eds.), 1998 ,communicore.
Nath, Meenakshi," Industrial Disaster: Working Towards oblivion", S. Parasuraman and P.v.
Unnikrishnan(Eds.), 2000, India Disaster Reports, Oxford University Press, New Delhi.
Perrin, Pierre (Ed.), "Communicable diseases ", Jan de Boer & Marcel Dubouloz, 2000,
Handbook of Disaster Medicine. Hentenaar boek BV, Nieuwegein, Netherlands.
Siromony P. Michael Vetha (Ed.), 2000, Source Book on District Disaster Management,
LBSNAA, Mussoorie .

4.10 ACTIVITIES
1) What arebiological disasters? List out importantmicroorganisms, which could cause biological
disasters.
2) How communicablediseases manifestthemselvesin associationwith naturaldisastersituations?
3) Identify and describe the specific factors, which are contributing to vulnerability of biological
disasters .
. 4) On the basis of your study analyse the Indian condition to mitigate the biological disasters,
and suggest remedial measures.