Reviewed by Guilin Qiao, US Defense Threat Reduction Agency

“Biological Weapons Defense: Infectious Diseases and Counterbioterrorism”

LE Lindler, PhD, National Biodefense Analysis and Countermeasures Center (NBACC), Ft. Detrick, MD and Walter Reed Army Institute of Research, Silver Spring, MDFJ
Lebeda, PhD, USRMRIID, Ft. Detrick, MDGW
Korch, PhD, NBACC, Ft. Detrick, MD

Humana Press Inc, Totowa, NJ 07512
ISBN 1-58829-184-7 (2005)
597 pages, $130.50 (Online)

The 9/11 attacks in the US dramatically reinforced  the reality of terrorism; the 2001 anthrax letter attacks emphasized the threat of bioterrorism. Biodefense is no longer solely a military concern.  This book is the most comprehensive and authoritative biodefense reference on this subject to date.

Written for professionals in biomedical research, clinical care, drug/vaccine development, regulatory approval, crisis management and coordination, this book enhances understanding of the material and the ability to follow procedures described.  Governments, military, and other organizations will be better prepared to respond and protect US citizens.   This is a thrilling read because so much information is contained in one source. The uniqueness of this book is the amalgamation of authoritative discussions on US DOD policies, emergency procedures, biodefense databases, integrated time-sensitive surveillance and event modeling systems, up-to-date status of medical countermeasures, and more importantly, the molecular dissection of key biopathogens and the potential application of technology for good or for evil.

The editors and contributors represent leading scientists, clinicians, policymakers, and defense program managers in biodefense communities in the US, UK and Sweden.  They are associated with government agencies, federal research labs, leading academic institutions, biotech/pharmaceutical industries, and private organizations, including USAMRIID, WRAIR, NMRC and CDC of DOD, DHHS and DHS.

Since the anthrax letter attacks, national preparedness for a major bioterrorism attack and biodefense has become a top priority. This book is organized into four sections that describe the legal/procedural aspects of DOD biodefense, technical details of the “omics”, (e.g, genomics, toxigenomics, etc.), diagnostics, medical countermeasures, and genotyping of carefully selected bioagents, along with historical stories and current challenges of each agent.

Section I, describes policies and procedures that DOD follows in supporting civilian management of a bioterrorism crisis.  Sections II and III, detail countermeasures for bioagents in existence as well as in development. Section IV, describes the impressive progress made in molecular diagnosis using gene fingerprinting.  These important topics are systematically integrated into a single reference source, which helps tremendously in understanding the science, medicine and policies.

Specific chapters are devoted to traditional biological agents, some of which were mass produced, field tested, and stockpiled in bulk and in munitions. More importantly, the risks of newly emerging or genetically modified biopathogens and related countermeasures are also elucidated. Seven chapters are dedicated to biological agents, discussion ranging from definition of emerging threats, DOD’s Global Emerging Infections System (GEIS), biodefense database development, genetic fingerprinting, to specific progresse made with F. tularensis and Y. pestis. As a double-edge sword, rapidly evolving biotechnology presents an inextricably linked combination of opportunity and danger, the dual use dilemma.

Section I “Preparation and Military Support for a Possible Bioterrorism Incident” provides behind-the-scenes efforts in the areas of law and policy governing the DOD biodefense programs, medical countermeasure development, approval by FDA, and bioattack event modeling. DOD’s unique disaster modeling, outcome prediction, tabletop exercises, and emergency planning capacity are highlighted.

Section II “Medical Countermeasures and Decontamination” provides general knowledge of selected bioagents and their infections, including pathogenesis, diagnosis, vaccination, prophylaxis, treatment, and decontamination. Anthrax, smallpox, Ebola, Marburg, plague, brucellosis, C. burnetii, glanders, and protein toxins receive special attention in this discussion. Discussions are at the cutting-edge of science and technology in antimicrobial drug and vaccine development and include host immune modulators as a broad-spectrum treatment for mixed or unknown infections. Relevant exposure routes and concentrations of both pathogen and therapeutics are critical in animal model selection and validation for successful countermeasure development and are discussed in detail for these agents.

Section III “Emerging Threats and Future Preparation” describes the “Biodefense of Tomorrow.”  Rapid progress in human genome and biotechnology research should be considered as opportunities for both good and bad.  The rapid progress not only can help mankind combat diseases, but can be used rather rapidly by bioterrorist groups to create novel and much more deadly agents in ways difficult to predict. For instance, among the many validated genetically modified threats, recombinant anthrax pathogen generated by cereolysin gene insertion could largely circumvent the entire existing military anthrax vaccination program. Other validated threats, such as engineered antibiotic resistance and recombinant F. tularensis, are also discussed along with other potential new threats. The potential for rapidly developing nefarious manipulations or discoveries of previously unknown biothreats into bioweapon systems can be readily seen with the recent progress in bioinformatics, genomics and proteomics of bioagents and their interactions in human hosts. This section concludes with “The number of scenarios that an ill-intended group might invent is almost limitless to the point that all possibilities could not be programmed in any reasonable manner.”

Government research programs at DHHS, DOD, and DOE are summarized in Section III. DOD’s Global Emerging Infection System (GEIS) program and its vital role in meeting the new challenge of public health are presented. Prompt recognition of reemerging infections, to include bioterrorism in addition to natural occurrence of new infectious diseases, requires both modern laboratory facilities and rapid identification of community health pattern shifts. The GEIS offers not only domestic, but global, surveillance and epidemiology capacities. The text describes how a new time-sensitive surveillance program can use integrated data sources across various geographical regions and what the pioneering role of the GEIS can be used in creating such a system.

Backbone databases and analytical resources critical for genetic makeup and genetic fingerprinting of key bioagents such as B. anthracis, Y. Pestis, B. melitenis, F tularensis, C burnetii, B. suis, and B. mallei are detailed. This is one of the most thoroughly presented biodefense databases available.

Section IV “Diagnostic Development for Biowarfare Agents” describes the aspects of the development and application of the current biotechnology to identify and characterize those bioagents. Future trends for both lab-based and field-based bioagent identification systems are also covered. A main lesson learned from the 2001 anthrax attack is the lack of timely communication of diagnostic results. This section describes how to improve such a situation in the future.

The authoritative discussions on DOD policies, emergency procedures, biodefense databases, integrated time-sensitive surveillance and event modeling systems, up-to-date status of medical countermeasures, and more importantly the molecular dissection of key biopathogens and the potential applications for good or for evil, all contribute to the uniqueness of this book.

About the reviewer:  Guilin Qiao, DVM, PhD, is currently a Sr. Pharmacologist and Subject Matter Expert in medical countermeasure R&D and FDA regulatory approval for biodefense at DTRA. He served FDA as a Regulatory Pharmacologist (2001-2006) and CDC as a Team Leader in exposure assessment research (1998-2001) after serving as a faculty member at North Carolina State University (1995-1998). As a program panelist, Dr. Qiao has been supporting the peer-reviews of the US Army Chemical and Biological Defense programs since 1999.