“Botox” Bioterrorism

Botulinum Toxin as a Potential Security Threat
Botulinum toxin, the active ingredient in Botox, is now one of the most important bioterrorism security threats in the U.S. It is extremely neurotoxic, in fact botulinum toxin is the single most poisonous substance known to science. It is easy to produce, transport, and misuse. And, prolonged intensive care is often needed for affected persons.

Botulinum neurotoxin is derived from the genus of anaerobic bacteria named Clostridia. Seven antigenic types of botulinum toxin exist, designated from A through G. They can be identified based on antibody cross reactivity studies, i.e., anti-A toxin antibodies do not neutralize the B through G toxins.

Terrorist Capabilities

Terrorists have already attempted to use botulinum toxin as a bioweapon. Aerosols have been dispersed at multiple sites in downtown Tokyo, Japan, and at US military installations in Japan on at least three occasions between 1990 and 1995 by the Japanese cult Aum Shinriky. These attacks failed apparently due to faulty microbiological technique, deficient aerosol-generating equipment, or because of internal sabotage. The perpetrators obtained their C botulinum from soil they had collected in northern Japan.

A number of other countries have also been named by the U.S. State Department as “state sponsors of terrorism” which have developed or are developing botulinum toxin as a biological weapon.

Naturally Occurring Botulism

Naturally occurring botulism is the disease that results from the absorption of botulinum toxin into the circulation from a mucosal surface (gut, lung) or a wound. It does not penetrate intact skin. The toxin irreversibly binds to peripheral cholinergic synapses, preventing the release of the neurotransmitter acetylcholine from the terminal end of motor neurons. This leads to muscle paralysis, and in severe cases, can lead to a need for mechanical respiration.

The incubation period for food-borne botulism can be from 2 hours to 8 days after ingestion, depending on the dose of the bacteria or the toxin. The average incubation period is 12-72 hours after ingestion. Patients with botulism typically present with difficulty speaking, seeing and/or swallowing. Patients typically are afebrile and do not have an altered level of consciousness. Patients may initially present with gastrointestinal distress, nausea, and vomiting preceding neurological symptoms. Symptoms are similar for all toxin types, but the severity of illness can vary widely, in part depending on the amount of toxin absorbed. Recovery from paralysis can take from weeks to months and requires the growth of new motor nerve endings. In the event botulism is suspected, the hospital epidemiologist and local and state health departments should be contacted immediately.

Natural cases of botulism are rare and typically result from food contamination. Many types of food have been associated in outbreaks in the past, with the common factor being that implicated food items were not heated or were incompletely heated. Heating to temperatures over 185oF (85oC) inactivates the toxin. The largest botulism outbreak in the U.S. in the past century occurred in 1977, when 59 people became ill from poorly preserved jalapeño peppers.

No cases of waterborne botulism have ever been reported. This is likely due to the large amount of toxin needed, and the fact that the toxin is easily neutralized by common water treatment techniques.

Detection and Control

A deliberate aerosol or food-borne release of botulinum toxin could be detected is several ways including a large number of acute cases happening all at once.

Diagnosis and testing are available at Federal Centers for Disease Control & Prevention (CDC) and at some local and state laboratories. In the United States, licensed botulinum antitoxin is available from the CDC via state and local health departments. An investigational heptavalent antitoxin is held by the U.S. Army. Optimal therapy for botulism requires early suspicion of the disease and prompt administration of antitoxin in conjunction with supportive care. Supportive care for patients with botulism may include mechanical ventilators in the intensive care unit, parenteral nutrition, and treatment of secondary infections.

An investigational botulinum toxoid is used to provide immunity for laboratory workers. It has been used to provide immunity against botulinum toxin over the past 30 years. However, supply of the toxoid is limited, and use of it would eliminate possible beneficial uses of toxoid for medical purposes. The toxoid induces immunity over several months and so would not be effective for rapid, post-exposure prophylaxis.

Existing technologies could produce large reserves of human antibody against the botulinum toxin. Administration of such a therapy could provide immunity of up to a month or greater. The development of such a human antibody reserve would require sufficient resources be dedicated to this problem.

Standards and requirements for public health security and bioterrorism preparedness are set forth in 42 Code of Federal Regulations Part 73, Possession, Use, and Transfer of Select Agents and Toxins.

Security Risks

Terrorist attack using biochemicals have become a very creditable element in the criminal threat profile. Lax security and poor access control may now provide “soft” targets for attack for bioterrorism threats as well as more standard security threats.

The probability of a bioterrorism threat is based upon profiles of previous attacks and on the potential for an attack to particular types of operations. For example, pharmaceutical companies are considered to be a high profile target for terrorists. Several generic scenarios influence biochemical terrorist threat levels including: landmark status, high-profile buildings, globally recognizable operations, high-risk operations, domestic and foreign government agencies, facilities that attract large crowds, proximity to such operations, and any other situation that would attract national sensation if destroyed.

Professional Assistance

SecurityNet is experienced at working with pharmaceutical companies and other such entities that are most subject to biochemical threats. We would be happy to answer general questions by corporate managers and building owners at no charge and to discuss options for obtaining expert solutions to specific security challenges. Please feel free to contact us at (415) 392-1810 or by email at carlisle1@securitynet.com.