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![GLOSSARY OF COMMON TERMS
Biological Laboratory
A facility within which microorganisms, their components or their derivatives are collected, handled
and/or stored. Biological laboratories include clinical laboratories, diagnostic facilities, regional and
national reference centres, public health laboratories, research centres (academic, pharmaceutical,
environmental, etc.) and production facilities [manufacturers of vaccines, pharmaceuticals, large
scale Genetically Modified Organisms (GMOs)] for human, veterinary and agricultural purposes.
Biomonitoring
It is the method of detection of biological agents based on properties like rapidity, reliability,
sensitivity, and specificity so as to quickly diagnose the correct etiological agent from complex
environmental samples before the spreading of illness on a large scale.
Biorisk
The probability or chance that a particular adverse event (in the context of this document: accidental
infection or unauthorised access, loss, theft, misuse, diversion or intentional release), possibly
leading to harm, will occur.
Biorisk Assessment
The process to identify acceptable and unacceptable risks [embracing biosafety risks (risks of
accidental infection)] and laboratory biosecurity risks (risks of unauthorised access, loss, theft,
misuse, diversion or intentional release) and their potential consequences.
Biorisk Management
The analysis of ways and development of strategies to minimise the likelihood of the occurrence of
biorisks. The management of biorisk places responsibility on the facility and its manager to
demonstrate that appropriate and valid biorisk reduction (minimisation) procedures have been
established and implemented. A biorisk management committee should be established to assist the
manager of the facility in identifying, developing and reaching biorisk management goals.
Biosafety
Laboratory biosafety describes the containment principles, technologies and practices that are
implemented to prevent the unintentional exposure to pathogens and toxins, or their accidental
release.
Biosecurity
The protection of high consequence microbial agents and toxins, or critical relevant information,
against theft or diversion by those who intend to pursue intentional misuse.
Biotechnology
The integration of natural and engineering sciences in order to achieve the useful application of
organisms, cells, parts thereof and molecular analogues for products and services. It includes any
technological application that uses biological systems, living organisms, or derivatives thereof, to
make or modify products or processes for specific use. Biotechnology products include
pharmaceutical compounds and research materials.
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![NATIONAL DISASTER MANAGEMENT GUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS
and epizootics. The death of a large number of estimated that a large-scale operation, against a
free range poultry in eastern India activated civilian population with casualties, may cost about
surveillance. The cause of the epizootic was $ 2,000 per sq. km with conventional weapons, $
identified and preventive action was initiated. There 800 with nuclear weapons, $ 600 with nerve gas
was initial reservation and lack of cooperation by weapons and $ 1 with biological weapons. There
the community which depended heavily on poultry have been numerous documented attempts at BT.
for nutrition and income, as well as the inertia of Biological agents are more efficient in terms of
other stakeholders (including medical coverage per kilogram of payload than any other
professionals). However, once the gravity was weapons system. Terrorism by means of
realised, action was initiated and community weaponised biological agents such as anthrax is
participation was forthcoming. The outbreak was no longer a theoretical concept. Anthrax spores
probably triggered by trans-border illegal poultry can be milled to an unexpectedly fine degree—
trade. The reporting of outbreaks in all the countries 100 times smaller than the human strain in size
bordering India has made the establishment of and easily inhaled deep into the lungs. Even the
regional surveillance networks a high priority issue. delivery system for weaponised anthrax need not
These will be coordinated by the international be sophisticated. Accidental release of anthrax
agencies FAO and WHO. The potential of such bacilli from a bioweapons unit at Sverdlovsk [in
outbreaks to initiate a new influenza strain with the former Union of Soviet Socialist Republics,
pandemic potential would challenge the medical (USSR)] and an outbreak of salmonellosis in Dallas,
infrastructure of all the nations. Oregon, in 1984 are well known incidents. The
postal dissemination of anthrax spores (after 9/11)
1.9 Biological Disasters (BT) caused 22 cases, including 5 deaths, and ‘ushered
in the transition from table top bioterrorism
Events in the recent past have shown that the exercises to real world investigation and response’.
threat of BT is real. ‘The arguments advanced to The crucial role of well trained, alert health care
defer consideration of the issues related to providers like Larry Bush, the infectious diseases
bioterrorism have been “without validity” and we physician from Florida, USA, who diagnosed the
cannot delay the development and implementation first case promptly, is underlined by this outbreak.
of strategic plans for coping with civilian
bioterrorism’. Reconstructed scenarios in the case 1.10 Impact of Biological Disasters
of attacks by the more likely BT agents reveal two
patterns. In the case of anthrax and botulinum toxin Dispersal experiments have been attempted
which have high initial effect but no secondary using non-pathogenic Bacillus globigii, which has
cases, the scenario is similar to chemical attacks. physical characteristics similar to Bacillus
However, when the pathogen used has the ability to anthracis. The variables in dissemination have been
set up secondary cases, and probably an epidemic, worked out and the impact of bioterrorist attacks
the scenario is far more complex. The preparation estimated. The dispersal experiments showed that
and action have to be tailored appropriately. an attack on the New York subway system would
kill at least 10,000 people. WHO studies show that
Bioweapons are particularly attractive to a 50 kg dispersal on a population of 500,000 would
terrorist groups because of the ease of their result in up to 95,000 fatalities and over 125,000
production and also their low cost. They have been people being incapacitated. Other experiments
termed ‘the poor man’s nuclear bomb’ since it is have also shown similar disastrous outcomes.
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![PRESENT STATUS AND CONTEXT
thereto. It provides for an institutional and June 2007. The purpose and scope of IHR (2005)
operational framework at all levels for disaster is to prevent, protect against, control and provide
prevention, mitigation, preparedness, response, a public health response to the international spread
recovery, and rehabilitation. This includes setting of disease and to avoid unnecessary interference
up of NDMA, SDMA, DDMA, National Executive with international traffic and trade. A legally binding
Committee (NEC), NDRF, and National Institute of international agreement, it seeks to protect against,
Disaster Management (NIDM). It also clearly spells control and provide a mechanism to initiate a public
out the role of central ministries. It empowers the health response to the threat or spread of disease
district authorities to requisition by order any officer causing a Public Health Emergency of International
or any department at the district level or any local Concern (PHEIC), including that of biological,
authority, to take such measures for the prevention chemical or radio-nuclear origin.
or mitigation of disaster, or to effectively respond
to it, as may be necessary, and such officer or Under IHR (2005), Member States are required
department shall be bound to carry out such orders. to strengthen their core capacity to detect, report
For the purpose of assisting, protecting or providing and respond rapidly to public health events and to
relief to the community in response to any notify WHO, within 24 hours, of all events that may
threatening disaster situation or disaster, the district constitute a PHEIC. It also provides for routine
authority is also empowered to (a) give directions inspection and control activities at international
for the release and use of resources available with airports, seaports, and certain ground crossings.
any department of the government and the local WHO will provide clear guidelines on the outbreak
authority in the district; (b) control and restrict verification process, technical and logistical
vehicular traffic to, from and within, the vulnerable support upon request, and Member States will also
or affected area; (c) control and restrict the entry be eligible for support from the Global Outbreak
of any person into, his movement within and Alert and Response Network (GOARN), which will
departure from, a vulnerable or affected area; and be mandated to conduct global surveillance and
(d) procure exclusive or preferential use of intelligence gathering to detect significant public
amenities from any authority or person. These health risks. WHO will also assist in settling
provisions imply that for biological disasters, international public health differences by
necessary quarantine measures will be legally negotiation, mediation, conciliation and arbitration.
instituted using private sector health facilities also
for comprehensive patient care. Biological and Toxin Weapons Convention
(BTWC)
The Public Health Emergencies Bill being
drafted by MoH&FW is intended to replace the The Biological and Toxin Weapons Convention,
Epidemic Diseases Act, 1897 and provides for which came into force on 26 March 1975, provides
effective management of public health emergencies, for prohibition of the development, production and
including BT. The draft is presently being modified stockpiling of bacteriological (biological) and toxin
after seeking comments from the states. weapons and for their destruction. BTWC now has
146 States Parties, including the five permanent
2.1.4 International members of the United Nations (UN) Security
Council but not including 48 WHO Member States.
International Health Regulations [IHR (2005)] India is signatory to the BTWC. Each signatory of
the BTWC undertakes never in any circumstances
IHR (2005) adopted by the World Health to develop, produce, stockpile or otherwise acquire
Assembly on 23 May 2005 came into force on 15 or retain:
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![PRESENT STATUS AND CONTEXT
All major outbreaks, man-made or natural, if However, there is poor networking and it needs to
not detected early and contained, spread and soon be improved. 70% of health services are provided
go beyond the coping ability of the district by the private sector but their presence is mainly
administration, requiring support from the state/ in urban areas. Private hospitals are better
centre. The primary health care system has to play organised and equipped. However, in mass
a crucial role in detecting the early warning signs. casualty incidents, their utilisation leaves much to
The village health functionaries [ASHA/Anganwadi be desired. The DM Act, 2005 provides enough
worker/ANM/Multi-Purpose Worker (MPW)] interface powers for the DDMA to call for the services of
with the community and are advantageously placed organisations which can contribute to effective
to report public health events to the peripheral management of any disaster.
public health services outlets such as sub-centres
and PHCs. The functioning of the public health
2.4 Important Functional Areas
system at the grass-root level is of paramount
importance in picking up early signals and acting
2.4.1 Human Health Surveillance
rapidly, as is the presence of a communication
network for bi-directional flow of information.
In biological disasters, surveillance is the key
strategy to detect early warning signals and has to
The district health setup includes hospital
have components to include human, animal and
facilities such as district hospitals, sub-district
plant surveillance. Till 1999, when the National
hospitals, CHCs and PHCs. Public health support
Communicable Disease Surveillance programme
is provided by the DHO and other officers related
was launched, there was no organised system for
to public health work such as the immunisation
disease surveillance. It was expanded to cover
officer and district officers for TB and malaria. The
about 100 districts in three states. The lessons
network of PHCs and the network of sub-centres
learned were reviewed and MoH&FW initiated the
is the backbone of the public health system through
IDSP with World Bank support.
which the public health measures are instituted—
be it event-based, house-to-house surveillance,
(A) Integrated Disease Surveillance Programme
provision of safe drinking water through
chlorination, vector control measures, mass
Launched in 2004, the IDSP intends to detect
chemoprophylaxis, sanitation measures, home care
early warning signals of impending outbreaks and
or referral of critical patients. The DHO/CMO
help initiate an effective response in a timely manner.
mobilises medical officers from the PHCs
It is also expected to provide essential data to
supported by health workers from the sub-centres
monitor the progress of ongoing disease control
for field work. The teams are constituted usually
programmes and help allocate health resources
on population norms, covering the entire affected
more efficiently. It is a decentralised, state-based
area. Reinforcements, if required, are arranged by
surveillance programme, using an integrated
the state governments from other districts, medical
approach with rational use of resources for disease
colleges and from central government institutions.
control and prevention. Data collected under the
IDSP also provides a rational basis for decision-
2.3.4 NGOs/Private Sector
making and implementing public health interventions.
NGOs play a major role in all disasters but are
Specific objectives of the IDSP:
largely conspicuous by their absence in biological
disasters. At the district level, the district collector i) To establish a decentralised state-based
would coordinate all the activities of NGOs. system of surveillance for communicable
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![NATIONAL DISASTER MANAGEMENT GUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS
2.4.13 Research and Development Tropical Diseases, Indian Veterinary Research
Institute (IVRI), etc.], professional institutions and
ICMR is the apex body for medical research in a large number of professionals, NGOs, regulatory
India. DRDO also contributes to basic and applied bodies, experts, and stakeholders in the field of
research in the biomedical field. ICMR and DRDO BDM participated in the deliberations.
have established the capacity for basic and
applied research in the area of molecular biology, During the workshop, the present status of the
genomic studies, epidemiological, and health management of biological disasters, including BT,
system research. Private establishments are in the country was discussed and important gaps
excelling in the area of drugs and vaccines and were identified. The workshop also identified
have established their global presence. priority areas for prevention, mitigation and
preparedness of biological disasters and provided
Areas requiring attention are—operational an outline of comprehensive guidelines to be
research in forecasting, using trend analysis, formulated as a guide for the preparation of action
mathematical modelling, GIS based modelling for plans by ministries/departments/states.
molecular research on potential genetically
engineered BT agents, genomic studies, specific A Core Group of Experts comprising major
biomarkers, new treatment modalities and stakeholders as well as state representatives was
advanced robotic tools. constituted under the chairmanship of Lt. Gen. (Dr.)
J. R. Bhardwaj, PVSM, AVSM, VSM, PHS (Retd),
2.5 Genesis of National Disaster Member, NDMA to assist in preparing the
Management Guidelines— Guidelines. Several meetings of the Core Group
Management of Biological were held to review the draft versions of the
Disasters Guidelines in consultation with concerned
ministries, regulatory bodies and other stakeholders
One of the important roles of NDMA is to issue to evolve a consensus on the various issues
guidelines to ministries/departments and states to regarding the guidelines. During these
evolve programmes and measures in their DM Plan deliberations, the core group felt that guidelines
for holistic and coordinated management of for the management of plant and animal pathogens
disasters as identified in the DM Act, 2005. should be taken up as a separate section in these
guidelines. The various recommendations of the
In this direction, a National Workshop on steering group and outcome of the workshop
Biological and Chemical Disasters was convened proceedings—‘Pandemic Preparedness Beyond
by NDMA at its headquarters in New Delhi between Health’, held in April 2008 were also incorporated
22–23 February 2007 as part of a nine-step in these Guidelines.
participatory and consultative process to evolve
the National Disaster Management Guidelines—
Management of Biological Disasters. Stakeholders
from various ministries/departments of GoI (Health,
Home Affairs, Defence, and Agriculture), Interpol,
R&D organisations/Institutes [ICMR, ICAR, CSIR,
Bhabha Atomic Research Centre, NICD, DRDO,
NIDM, All India Institute of Medical Sciences
(AIIMS), Sir Dorabji Tata Centre for Research in
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Uploaded bySUNIL KUMAR KOHLI, IDAS ndc
Management of Biological Disasters: NDMA GUIDLINES
The National Disaster Management Guidelines for the management of biological disasters in India aim to establish a coordinated and proactive approach to handle biological threats, including bioterrorism and pandemics. This comprehensive document covers legal, institutional, and operational frameworks while outlining guidelines for prevention, preparedness, and response to biological disasters. Formulated with input from over 243 experts, the guidelines emphasize the importance of safety and security measures, as well as the need for collaboration among various stakeholders in disaster management.
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Management of Biological Disasters: NDMA GUIDLINES
- 1. National Disaster Management Guidelines Management of Biological Disasters
- 2. National Disaster ManagementGuidelines—Management of Biological Disasters A publication of: National Disaster Management Authority Government of India Centaur Hotel New Delhi – 110 037 ISBN: 978-81-906483-6-3 July 2008 When citing this report the following citation should be used: National Disaster Management Guidelines—Management of Biological Disasters, 2008. A publication of National Disaster Management Authority, Government of India. ISBN 978-81-906483-6-3, July 2008, New Delhi. The National Guidelines are formulated under the chairmanship of Lt Gen (Dr.) J.R. Bhardwaj, PVSM, AVSM, VSM, PHS, (Retd.), Hon’ble Member, NDMA in consultation with various stakeholders, regulators, service providers and specialists in the subject field concerned from all across the country.
- 3. National Disaster Management Guidelines Management of Biological Disasters National Disaster Management Authority Government of India
- 4.
- 5. Contents Contents v Foreword ix Acknowledgements xi Abbreviations xii Glossary of Common Terms xvi Executive Summary xxiii 1 Introduction 1 1.1 History 1 1.2 Biological Agents as Causes of Mass Destruction 2 1.3 Sources of Biological Agents 3 1.4 Threat Perception 3 1.5 Zoonoses 4 1.6 Molecular Biology and Genetic Engineering 5 1.7 Biosafety and Biosecurity 6 1.8 Epidemics 7 1.9 Biological Disasters (Bioterrorism) 8 1.10 Impact of Biological Disasters 8 1.11 Regulatory Institution 9 1.12 Aims and Objectives of the Guidelines 9 2 Present Status and Context 11 2.1 Legal Framework 12 2.2 Institutional and Policy Framework 14 2.3 Operational Framework 21 2.4 Important Functional Areas 23 2.5 Genesis of National Disaster Management Guidelines—Management of Biological Disasters 28 v
- 6. CONTENTS 3 Salient Gaps 29 3.1 Legal Framework 29 3.2 Institutional Framework 29 3.3 Operational Framework 29 4 Guidelines for Biological Disaster Management 35 4.1 Legislative Framework 35 4.2 Prevention of Biological Disasters 37 4.3 Preparedness and Capacity Development 44 4.4 Medical Preparedness 54 4.5 Emergency Medical and Public Health Response 58 4.6 Management of Pandemics 62 4.7 International Cooperation 63 5 Guidelines for Safety and Security of Microbial Agents 65 5.1 Biological Containment 65 5.2 Classification of Microorganisms 66 5.3 Biologics 66 5.4 Laboratory Biosafety 67 5.5 Microorganism Handling Instructions 69 5.6 Countering Biorisks 70 6 Guidelines for Management of Livestock Disasters 73 6.1 Losses to the Animal Husbandry Sector due to Biological Disasters 73 6.2 Potential Threat from Exotic and Existing Infectious Diseases 74 6.3 Consequences of Losses in the Animal Husbandry Sector 74 6.4 Present Status and Context 75 6.5 Challenges 82 6.6 Guidelines for the Management of Livestock Disasters 83 7 Guidelines for Management of Agroterrorism 93 7.1 Dangers from Exotic Pests 93 7.2 Basic Features of an Organism to be used as a Bioweapon in the Agrarian Sector 95 7.3 Dangers from Indigenous Pests 95 7.4 Present Status and Context 95 7.5 Guidelines for Biological Disaster Management—Agroterrorism 104 vi
- 7. CONTENTS 8 Implementation of the Guidelines 108 8.1 Implementation of the Guidelines 109 8.2 Financial Arrangements for Implementation 112 8.3 Implementation Model 113 9 Summary of Action Points 117 Annexures 123 Annexure-A Characteristics of Biological Warfare Agents 123 Annexure-B Vaccines, Prophylaxis, and Therapeutics for Biological Warfare Agents 125 Annexure-C Patient Isolation Precautions 133 Annexure-D Laboratory Identification of Biological Warfare Agents 135 Annexure-E Specimens for Laboratory Diagnosis 137 Annexure-F Medical Sample Collection for Biological Threat Agents 138 Annexure-G OIE List of Infectious Terrestrial Animal Diseases 143 Annexure-H Disposal of Animal Carcasses: A Prototype 146 Annexure-I List of National Standards on Phyto-sanitary Measures 148 Annexure-J Important Websites 149 Core Group for Management of Biological Disasters 150 Contact Us 156 vii
- 8.
- 9. Vice Chairman National Disaster Management Authority Government of India FOREWORD The preparation of national guidelines for various types of disasters, both natural and man-made constitutes an important component of the mandate entrusted to the National Disaster Management Authority under the Disaster Management Act, 2005. In recent years, biological disasters including bioterrorism have assumed serious dimensions as they pose a greater threat to health, environment and national security. The risks and vulnerabilities of our food chain and agricultural sector to agroterrorism, which involves the deliberate introduction of plant or animal pathogens with the intent of undermining socio-economic stability, are increasingly being viewed as a potential economic threat. The spectre of pandemics engulfing our subcontinent and beyond poses new challenges to the skills and capacities of the government and society. Consequently, the formulation of the national guidelines on the entire gamut of biological disasters has been one of our key thrust areas with a view to build our resilience to respond effectively to such emerging threats. The intent of these guidelines is to develop a holistic, coordinated, proactive and technology driven strategy for management of biological disasters through a culture of prevention, mitigation and preparedness to generate a prompt and effective response in the event of an emergency. The document contains comprehensive guidelines for preparedness activities, biosafety and biosecurity measures, capacity development, specialised health care and laboratory facilities, strengthening of the existing legislative/ regulatory framework, mental health support, response, rehabilitation and recovery, etc. It specifically lays down the approach for implementation of the guidelines by the central ministries/departments, states, districts and other stakeholders, in a time bound manner. The national guidelines have been formulated by members of the Core Group, Steering and Extended Groups constituted for this purpose, involving the active participation and consultation of over 243 experts from central ministries/departments, state governments, scientific, academic and technical institutions, government/private hospitals and laboratories, etc. I express my deep appreciations for their significant contribution in framing these guidelines. I also wish to express my sincere appreciation for Lt Gen (Dr.) J.R. Bhardwaj, PVSM, AVSM, VSM, PHS (Retd) for his guidance and coordination of the entire exercise. New Delhi General NC Vij July 2008 PVSM, UYSM, AVSM (Retd) ix
- 10.
- 11. Member National Disaster Management Authority Government of India ACKNOWLEDGEMENTS National Disaster Management Guidelines—Management of Biological Disaster are formulated by the untiring efforts of the core group members and experts in the field. I would like to express my special thanks to all the members who have proactively participated in this consultative process from time-to- time. It is indeed the keen participation by the Ministry of Health and Family Welfare, Ministry of Home Affairs, Armed Forces Medical Services, Ministry of Defence, Department of Health, Ministry of Railways, Ministry of Agriculture, various states and union territories, non-governmental organisations, and the private sector including corporate hospitals that has been so helpful in designing the format of this document and provided valuable technical inputs. I would like to place on record the significant contribution made by Lt Gen (Dr.) D. Raghunath, PVSM, AVSM (Retd), Lt Gen Shankar Prasad, PVSM, VSM (Retd), Dr. P. Ravindran, Dr. R.K. Khetarpal, Dr. S.K. Bandopadhyay, and other core group experts. I am also thankful to the Director General, Indian Council of Medical Research and his team of medical scientists from various laboratories for providing inputs related to research in biological disasters. I would like to express my sincere thanks to the representatives of the other central ministries and departments concerned, regulatory agencies, Defence Research and Development Organisation, professionals from scientific and technical institutes, eminent medical professionals from leading national institutions like the National Institute of Communicable Diseases, National Institute of Virology, Indian Veterinary Research Institute, Defence Research and Development Establishment, Sir Dorabji Tata Centre for Research in Tropical Diseases, National Bureau of Plant Genetic Resources, Indian Council of Agricultural Research, National Institute of Disaster Management and consortiums of the corporate sector for their valuable inputs that helped us in enhancing the contents and overall presentation of the Guidelines. The efforts of Maj Gen J.K. Bansal, VSM, Dr. Rakesh Kumar Sharma, Dr. Raman Chawla, and Dr. Pankaj Kumar Singh in providing knowledge-based technical inputs to the core group and knowledge management studies of global best practices in Biological Disaster Management, are highly appreciated. I would like to acknowledge the active cooperation provide by Mr. H.S. Brahma, Additional Secretary and the administrative staff of the NDMA. I express my appreciation for the dedicated work of my secretarial staff including Mr. Deepak Sharma, Mr. D.K. Ray, and Mr. Munendra Kumar during the convening of various workshops, meetings and preparation of the Guidelines. Finally, I would like to express my gratitude to General N.C. Vij, PVSM, UYSM, AVSM (Retd), Hon’ble Vice Chairman, NDMA, and Hon’ble Members of the NDMA for their constructive criticism, guidance and suggestions in formulating these Guidelines. New Delhi Lt Gen (Dr) JR Bhardwaj July 2008 PVSM, AVSM, VSM, PHS (Retd) MD DCP PhD FICP FAMS FRC Path (London) xi
- 12. Abbreviations The following abbreviations and acronyms used throughout this document are intended to mean the following: AFMS Armed Forces Medical Services AICRP All India Coordinated Research Project AIDS Acquired Immuno Deficiency Syndrome AIG Anthrax Immuno Globulin AIIMS All India Institute of Medical Sciences ANM Auxiliary Nurse Midwife APHIS Animal and Plant Health Inspection Service APSV Aventis Pasteur Smallpox Vaccine AQCS Animal Quarantine and Certification Services ASCAD Assistance to States for Control of Animal Diseases ASF African Swine Fever ASHA Accredited Social Health Activist AVA Anthrax Vaccine BCG Bacillus Calmette-Guérin BDM Biological Disaster Management BSE Bovine Spongiform Encephalopathy BSF Border Security Force BSL Biosafety Level BT Bioterrorism BTWC Biological and Toxin Weapons Convention BW Biological Warfare C&C Command and Control CAC Codex Alimentarius Commission CAM Crassulacean Acid Metabolism CBD Convention on Biological Diversity CBPP Contagious Bovine Pleuro-Pneumonia CBRN Chemical, Biological, Radiological and Nuclear CDC Center for Disease Control and Prevention CGHS Central Government Health Scheme CHCs Community Health Centres CMO Chief Medical Officer CRF Calamity Relief Fund CRI Central Research Institute CrPC Criminal Procedure Code CSF Classical Swine Fever CSIR Council for Scientific and Industrial Research DADF Department of Animal Husbandry, Dairying and Fisheries DBT Department of Biotechnology xii
- 13. ABBREVIATIONS DDMA District Disaster Management Authority DEBEL Defence Bioengineering and Electromedical Laboratory DFRL Defence Food Research Laboratory DGAFMS Director General Armed Forces Medical Services DGHS Director General Health Services DHO District Health Officer DIP Destructive Insects and Pests DM Disaster Management DM Act Disaster Management Act DMSRDE Defence Materials and Stores Research and Development Establishment DNA Deoxyribonucleic Acid DoD Department of Defence DPPQS Directorate of Plant Protection, Quarantine and Storage DPT Diptheria, Pertussis Tetanus DRDE Defence Research and Development Establishment DRDO Defence Research and Development Organisation EEE Eastern Equine Encephalitis EMR Emergency Medical Response EOCs Emergency Operations Centres EPA Environment Protection Act ESIC Employees’ State Insurance Corporation EWS Early Warning System FAO Food and Agricultural Organization FDA Food and Drug Administration FMD Foot and Mouth Disease FMD-CP Foot and Mouth Disease-Control Programme GDP Gross Domestic Product GF-TADs Global Framework for Progressive Control of Transboundary Animal Diseases GIS Geographic Information System GMOs Genetically Modified Organisms GOARN Global Outbreak Alert and Response Network GoI Government of India GPS Global Positioning System HEPA High Efficiency Particulate Air HIV Human Immunodeficiency Virus HPAI Highly Pathogenic Avian Influenza HRD Human Resource Development HSADL High Security Animal Disease Laboratory IAN Integrated Ambulance Network ICAR Indian Council of Agricultural Research ICMR Indian Council of Medical Research ICP Incident Command Post ICU Intensive Care Unit IDSP Integrated Disease Surveillance Programme IHR International Health Regulations IPC Indian Penal Code xiii
- 14. ABBREVIATIONS IPPC International Plant Protection Convention IRCS Indian Red Cross Society ISO International Standards Organisation ITBP Indo-Tibetan Border Police - IVC Act Indian Veterinary Council Act, 1984 IVRI Indian Veterinary Research Institute JALMA Japanese Leprosy Mission for Asia KFD Kyasanur Forests Disease KIPM King Institute of Preventive Medicine KVKs Krishi Vigyan Kendras LBM Laboratory Biosafety Manual LMOs Living Modified Organisms MFRs Medical First Responders MHA Ministry of Home Affairs MoA Ministry of Agriculture MoD Ministry of Defence MOEF Ministry of Environment and Forests MoH&FW Ministry of Health and Family Welfare MoL&E Ministry of Labour and Employment MoR Ministry of Railways MPW Multi-Purpose Worker MRSA Methicillin-Resistant Staphyllococcus aureus NADEC National Animal Disease Emergency Committee NADEPC National Animal Disaster Emergency Planning Committee NBC Nuclear, Biological and Chemical NBPGR National Bureau of Plant Genetic Resources NCCF National Calamity Contingency Fund NCMC National Crisis Management Committee NDDB National Dairy Development Board NDMA National Disaster Management Authority NDRF National Disaster Response Force NEC National Executive Committee NGOs Non-Governmental Organisations NIC National Informatics Centre NICD National Institute of Communicable Diseases NICED National Institute of Cholera and Enteric Diseases NIDM National Institute of Disaster Management NIV National Institute of Virology NPRE National Project on Rinderpest Eradication NRHM National Rural Health Mission OECD Organisation for Economic Cooperation and Development OIE Office International des Épizooties (World Organisation for Animal Health) PCR Polymerase Chain Reaction PED Professional Efficiency Development PFS Plants, Fruits and Seeds PGIMER Post Graduate Institute of Medical Education and Research PHCs Primary Health Centres xiv
- 15. ABBREVIATIONS PHEIC Public Health Emergency of International Concern PHFI Public Health Foundation of India PPE Personal Protective Equipment PPP Public-Private Partnership PPR Peste des Petits Ruminants PQ Plant Quarantine PRA Pest Risk Analysis PRIs Panchayati Raj Institutions PVOs Private Voluntary Organisations QRMTs Quick Reaction Medical Teams R&D Research and Development RRCs Regional Response Centres RMRC Regional Medical Research Centre RRTs Rapid Response Teams SARS Severe Acute Respiratory Syndrome SDMA State Disaster Management Authority SDRF State Disaster Response Force SEB Staphylococcus Enterotoxin B SEC State Executive Committee SMX Sulfomethoxazole SOPs Standard Operating Procedures SPS Sanitary and Phyto-Sanitary SSB Sashastra Seema Bal TADs Trans-Boundary Animal Diseases TB Tuberculosis TMP Trimethoprim UN United Nations UNDP United Nations Development Programme UNICEF United Nations Children’s Fund US United States USA United States of America USAMRIID US Army Medical Research Institute of Infectious Diseases USDA United States Department of Agriculture USSR Union of Soviet Socialistic Republics UTs Union Territories VAC Veterinary Aid Centre VATs Veterinary Assistance Teams VBMs Valuable Biological Materials VCI Veterinary Council of India VEE Venezuelan Equine Encephalitis VHFs Viral Hemorrhagic Fevers WEE Western Equine Encephalitis WHO World Health Organization WHO-SEARO WHO-Regional Office for South-East Asia WMD Weapons of Mass Destruction WTO World Trade Organization WW World War xv
- 16. Glossary of CommonTerms The definitions of common terms used in this document are intended to mean the following: Accountability Accountability ensures that Valuable Biological Materials (VBM), are tracked and controlled, as per their intended usage by formally associating specified material with the individual under whom the material is being used, so that he is responsible for the said material. Agroterrorism Agroterrorism, is the malicious use of plant or animal pathogens to cause devastating disease in the agricultural sector. Anti-microbial Susceptibilities It aims to identify whether bacterial etiology of concern is capable of expressing resistance to the anti-microbial agent that is a potential choice to develop a therapeutic agent. It includes methods that directly measure the activity of the anti-microbial agent against a bacterial isolate and directly detect the presence of a specific resistance mechanism. Bacterin A suspension of killed or attenuated bacteria for use as a vaccine. Biological Agents They are microorganisms such as viruses, bacteria or fungi that infect humans, livestock or crops and cause an incapacitating or fatal disease. Symptoms of illness do not appear immediately but only after a delay, or ‘incubation period’, that may last for days or weeks. Biological Disasters Biological disasters are scenarios involving disease, disability or death on a large scale among humans, animals and plants due to toxins or disease caused by live organisms or their products. Such disasters may be natural in the form of epidemics or pandemics of existing, emerging or re- emerging diseases and pestilences or man-made by the intentional use of disease causing agents in Biological Warfare (BW) operations or incidents of Bioterrorism (BT). Biological Diversity The variability among living organisms from all sources including terrestrial, marine and other aquatic ecosystems and the ecological system. xvi
- 17. GLOSSARY OF COMMONTERMS Biological Laboratory A facility within which microorganisms, their components or their derivatives are collected, handled and/or stored. Biological laboratories include clinical laboratories, diagnostic facilities, regional and national reference centres, public health laboratories, research centres (academic, pharmaceutical, environmental, etc.) and production facilities [manufacturers of vaccines, pharmaceuticals, large scale Genetically Modified Organisms (GMOs)] for human, veterinary and agricultural purposes. Biomonitoring It is the method of detection of biological agents based on properties like rapidity, reliability, sensitivity, and specificity so as to quickly diagnose the correct etiological agent from complex environmental samples before the spreading of illness on a large scale. Biorisk The probability or chance that a particular adverse event (in the context of this document: accidental infection or unauthorised access, loss, theft, misuse, diversion or intentional release), possibly leading to harm, will occur. Biorisk Assessment The process to identify acceptable and unacceptable risks [embracing biosafety risks (risks of accidental infection)] and laboratory biosecurity risks (risks of unauthorised access, loss, theft, misuse, diversion or intentional release) and their potential consequences. Biorisk Management The analysis of ways and development of strategies to minimise the likelihood of the occurrence of biorisks. The management of biorisk places responsibility on the facility and its manager to demonstrate that appropriate and valid biorisk reduction (minimisation) procedures have been established and implemented. A biorisk management committee should be established to assist the manager of the facility in identifying, developing and reaching biorisk management goals. Biosafety Laboratory biosafety describes the containment principles, technologies and practices that are implemented to prevent the unintentional exposure to pathogens and toxins, or their accidental release. Biosecurity The protection of high consequence microbial agents and toxins, or critical relevant information, against theft or diversion by those who intend to pursue intentional misuse. Biotechnology The integration of natural and engineering sciences in order to achieve the useful application of organisms, cells, parts thereof and molecular analogues for products and services. It includes any technological application that uses biological systems, living organisms, or derivatives thereof, to make or modify products or processes for specific use. Biotechnology products include pharmaceutical compounds and research materials. xvii
- 18. GLOSSARY OF COMMONTERMS Bioterrorism (BT) The intentional use of microorganisms, or toxins, derived from living organisms, to produce death or disease in humans, animals or plants. Bioweapon Biological weapons include any organism or toxin found in nature that can be used to incapacitate, kill, or cause physical or economic harm. Biological weapons are characterised by low visibility, high potency, substantial accessibility and relatively easy delivery methods. BSL— Biosafety Level A method for rating laboratory safety. Laboratories are designated BSL 1, 2, 3, or 4 based on the practices, safety equipment, and standards they employ to protect their workers from infection by the agents they handle. BSL-1 laboratories are suitable for handling low-risk agents; BSL-2 laboratories are suitable for processing moderate risk agents; and BSL-3 laboratories can safely handle high-risk agents. BSL-4 laboratories are designated to hold WHO Risk group-IV organisms that pose the maximum risk as well as unknown emergent epidemic pathogens (WHO Risk Group-V). Chemoprophylaxis The administration of a chemical, including antibiotics, to prevent the development of an infection or the progression of an infection to active manifest disease, or to eliminate the carriage of a specific infectious agent to prevent transmission and disease in others. Communicable Disease An infectious condition that can be transmitted from one living person or animal to another through a variety of routes, according to the nature of the disease. Disinfectants Disinfectants are anti-microbial agents that are applied to non-living objects to destroy microorganisms. Droplet Infections Pathogens resistant to drying may remain viable in the dust and act as a source of infection. Small droplets under 0.1 mm in diameter, evaporate immediately to become minute particles or droplet nuclei which remain suspended in air for long periods acting as a source of infection. Epidemics The outbreak of a disease affecting or tending to affect a disproportionately large number of individuals within a population, community, or region at the same time. Epidemiology The branch of medicine concerned with the incidence and distribution of diseases and other factors relating to health. xviii
- 19. GLOSSARY OF COMMONTERMS Eukaryotic Organisms whose cells are organised into complex structures enclosed within their respective membranes and have a defined nucleus, e.g., animals, plants, fungi, and protists. Genetic Engineering A process of inserting new genetic information into existing cells through modern molecular biology techniques in order to modify a specific organism for the purpose of changing one of its characteristics. This technology is used to alter the genetic material of living cells in order to make them capable of producing new substances or performing new functions. Genetically Modified Organisms (GMOs) Organisms whose genetic material has been altered using techniques generally known as recombinant Deoxyribonucleic Acid (DNA) technology. Recombinant DNA technology is the ability to combine DNA molecules from different sources into one molecule in a test tube. GMOs are often not reproducible in nature, and the term generally does not cover organisms whose genetic composition has been altered by conventional cross-breeding or by ‘mutagenesis’ breeding, as these methods predate the discovery (in 1973) of recombinant DNA techniques. Hybridoma Hybridoma are fused cells with continuous growth potential that have been engineered to produce as a single antibody. Immunisation The process of inducing immunity against an infectious organism or agent in an individual or animal through vaccination. Incubation Period The interval between infection and appearance of symptoms. Infectious Diseases Diseases caused by microbes such as viruses, bacteria, and parasites in any organ of the body that can be passed to or among humans, animals and plants by several methods. Examples include viral illnesses, Human Immunodeficiency Virus (HIV)/Acquired Immuno Deficiency Syndrome (AIDS), meningitis, whooping cough, pneumonia, Tuberculosis (TB), and histoplasmosis, etc. Insecticides An insecticide is a pesticide used against insects in all its developmental forms. They include ovicides and larvicides used against the eggs and larvae of insects. Insecticides are used for domestic household purposes, and commercially in agriculture and industry. Laboratory Biosecurity It describes the protection, control and accountability for VBM within laboratories, in order to prevent their unauthorised access, loss, theft, misuse, diversion or intentional release. xix
- 20. GLOSSARY OF COMMONTERMS Livestock Domestic animals kept or raised on a farm for use, sale or profit. Molecular Biology A branch of biological science that studies the biology of a cell at the molecular level. Molecular biological studies are directed at studying the structure and function of biological macromolecules and the relationship of their functioning to the structure of a cell and its internal components. This includes the study of genetic components. Pandemics A pandemic is an epidemic (an outbreak of an infectious disease) that spreads across a large region (for example, a continent), or even worldwide. Pathogens Microorganisms that can cause disease in other organisms or in humans, animals and plants. They may be bacteria, viruses or parasites. Personal Protective Equipment (PPE) Equipment worn or used by workers to protect themselves from exposure to hazardous materials or conditions. The major types of PPE include respirators, eye and ear protection gear, gloves, hard hats, protective suits, etc. Phyto-sanitary Measures The measures to achieve an appropriate level of sanitation and phyto-sanitary protection to safeguard human, animal or plant life or health as per the laid down standards are called phyto-sanitary measures. Polymerase Chain Reaction (PCR) A technique for copying and amplifying the complementary strands of a target DNA molecule. It is an in vitro method that greatly amplifies, or makes millions of copies of DNA sequences that otherwise could not be detected or studied. Prokaryotic The group of microorganisms that do not have a cell nucleus or any other membrane bound organelles. They are divided into two domains—bacteria and archaea. They are mostly unicellular, except for a few which are multicellular. Quarantine Any isolation or restriction on travel or passage imposed to keep contagious diseases, insects, pests, etc., from spreading. Recombinant DNA Technology Recombinant DNA is a form of artificial DNA that is engineered through the combination or insertion of one or more DNA strands, thereby combining DNA sequences that would not normally occur xx
- 21. GLOSSARY OF COMMONTERMS together. This is an exclusively engineered technological process of genetic modification using the enzymes restriction endonucleases. Sentinel Surveillance Surveillance based on selected population samples chosen to represent the relevant experience of particular groups. It is a monitoring method that employs a surrogate indicator for a public health problem, allowing estimation of the magnitude of the problem in the general population. Stockpile A place or storehouse where material, medicines and other supplies needed in a disaster are kept for emergency relief. Surveillance Continuous observation, measurement, and evaluation of the progress of a process or phenomenon with the view to taking corrective measures. Terrestrial Animals Terrestrial animals are those which live predominantly or entirely on land. Toxoid A toxoid is a bacterial toxin whose toxicity has been weakened or suppressed while other properties—typically immunogenicity, are maintained. Toxoids are used in vaccines as they induce an immune response to the original toxin or increase the response to another antigen. Training The act or process of teaching or learning a skill or discipline. Triage Triage comes from the French verb trier which means literally to sort. In the current sense it is from the military system used from the 1930s, of assessing the wounded on the battlefield. The meaning in our context is—one is able to do the most good for the highest number of people in the light of limited resources, especially during a mass casualty event. This concept prioritises those patients who have an urgent medical condition but are most likely to survive if given medical attention as soon as possible. Tropism The involuntary movement of an organism activated by an external stimulus wherein the organism is either attracted to or repelled from the outside stimulating influence. An example is heliotropism, the movement of plants, where they turn towards the sun. Vaccine The term is derived from the Latin word vacca which means cow, as the first vaccine against smallpox was derived from a cowpox lesion. It is a suspension of attenuated live or killed microorganisms (bacteria, viruses or rickettsiae), or fractions thereof, administered to induce immunity and thereby prevent infectious diseases. xxi
- 22. GLOSSARY OF COMMONTERMS Valuable Biological Materials Biological materials that require administrative control, accountability and specific protective and monitoring measures in laboratories to protect their economic and historical (archival) value, and/or the population from their potential to cause harm. VBM may include pathogens and toxins, as well as non-pathogenic organisms, vaccine strains, foods, GMOs, cell components, genetic elements and extraterrestrial samples. Vector A carrier, especially the animal or host, that carries the pathogen from one host to another, e.g., mosquito spreading malaria using a human as host. Vector control Measures taken to decrease the number of disease carrying organisms and to diminish the risk of their spreading infectious diseases. Veterinary Practitioner A graduate of veterinary science registered with the Veterinary Council of India (VCI)/State Veterinary Councils. Virulence Virulence refers to the degree of pathogenicity of a microbe, or in other words the relative ability of a microbe to cause disease. The word virulent, which is the adjective for virulence, is derived from the Latin word virulentus, which means ‘full of poison’. Virus A minute infectious agent, smaller than bacteria, which is capable of passing through filters that can block bacteria. They multiply only within a susceptible host cell. Zoonoses Diseases that can be transmitted to people by animals and vice-versa. xxii
- 23. Executive Summary Background not kill in the short term but thrust nations towards socio-economic disasters. Another example is the Biological disasters might be caused by Human Immunodeficiency Virus (HIV)/Acquired epidemics, accidental release of virulent Immuno Deficiency Syndrome (AIDS) epidemic in microorganism(s) or Bioterrorism (BT) with the use Sub-Saharan Africa, that has wiped out the benefits of biological agents such as anthrax, smallpox, of improved health care and decimated the etc. The existence of infectious diseases have been productive segments of society leading to economic known among human communities and stagnation and recession. civilisations since the dawn of history. The classical literature of nearly all civilisations record the ability Recently, some events experienced in India of major infections to decimate populations, thwart have highlighted such issues. The outbreak of military campaigns and unsettle nations. Social plague in Surat which was relatively small, upheavals caused by epidemics have contributed disrupted urban activity in the city, generated an in shaping history over the ages. The mutual exodus and lead to a massive economic fallout. association of war, pestilence and famine was The ongoing human immunodeficiency virus/ acknowledged and often attributed to divine acquired immuno deficiency syndrome epidemic influences, though a few keen observers realised in different parts of the country is leading to the that some infections were contagious. The diversion of substantial resources. The spread of development of bacteriology and epidemiology the invasive weed Parthenium hysterophorus after later, established the chain of infection. Along with its accidental introduction into India has had wide nuclear and chemical agents, which are derived repercussions on human and animal health, apart from technology, biological agents have been from depleting the fodder output. accepted as agents of mass destruction capable of generating comparable disasters. Infectious agents are constantly evolving, often acquiring enhanced virulence or epidemic The growth of human society has rested largely potential. This results in normally mild infections on the cultivation of crops and domestication of becoming serious. The outbreak of Chikungunya animals. As crops and animals became necessary that started in 2005 is one such example. to sustain a divergent social structure, the depletion of these resources had far reaching consequences. In recent times travelling has become easier. Along with the growth of societies, crop and animal More and more people are travelling all over the diseases acquired more and more importance. world which exposes the whole world to epidemics. As our society is in a state of flux, novel pathogens Epidemics can result in heavy mortalities in emerge to pose challenges not only at the point of the short term leading to a depletion of population primary contact but in far removed locations. The with a corresponding drop in economic activity, Marburg virus illustrates this. The increased e.g., the plague epidemics in Europe during the interaction between humans and animals has middle ages or the Spanish influenza between increased the possibilities of zoonotic diseases 1917–18. Infections like Tuberculosis (TB) might emerging in epidemic form. xxiii
- 24. EXECUTIVE SUMMARY Biological Warfare (BW) and and therapeutic countermeasures. In the case of Bioterrorism (BT) deliberately generated outbreaks (bioterrorism) the spectrum of possible pathogens is narrow, while The historical association between military natural outbreaks can have a wide range of action and outbreaks of infections suggest a organisms. The mechanism required however, to strategic role for biological agents. The non- face both can be similar if the service providers discriminatory nature of biological agents limited are adequately sensitised. their use till specific, protective measures could be devised for the ‘home’ troops. The advances in The response to these challenges will be bacteriology, virology and immunology in the late coordinated by the nodal ministry—Ministry of 19th century and early 20th century enabled nations Health and Family Welfare (MoH&FW) with inputs to develop biological weapons. The relative ease from the Ministry of Agriculture (MoA) for agents of production, low cost and low level of delivery affecting animals and crops. The support and input technology prompted the efforts of many countries of other ministries like Ministry of Home Affairs after World War (WW) I, which peaked during the (MHA), Ministry of Defence (MoD), Ministry of cold war. The collective conscience of the world, Railways (MoR) and Ministry of Labour and however, resulted in the Biological and Toxin Employment (MoL&E), who have their own medical Weapons Convention which resolved to eliminate care infrastructure with capability of casualty these weapons of mass destruction. Despite evacuation and treatment, have an important role considerable enthusiasm, the convention has been to play. With a proper surveillance mechanism and a non-starter. response system in place, epidemics can be detected at the beginning stage of their outbreak While biological warfare does not appear to and controlled. Slowly evolving epidemics do not be a global threat, the use of some agents such cause upheavals in society and will not come under as anthrax by terrorist groups pose a serious threat. the crisis management scenario usually. They will The ease of production, packaging and delivery be tackled by ongoing national programmes like using existing non-military facilities are major the Revised National Tuberculosis Control factors in threat perception. These artificially Programme and National Air Quality Monitoring induced infections would behave similar to natural Programme. There may, however, be specific infections (albeit exotic) and would be difficult to situations when the disaster response mechanism detect except by an effective disease surveillance may be evoked, e.g., an outbreak of Plasmodium mechanism. The threat posed by bioterrorism is falciparum malaria erupting after an exceptionally nearly as great as that by natural epidemic causing wet season in a previously non-endemic region agents. and epidemics occurring as a consequence of an attack of bioterrorism. Mitigation Epidemics do not respect national borders. As international travel is easy, biological agents need The essential protection against natural and to be tracked so that they do not enter new regions artificial outbreaks of disease (bioterrorism) will across the boundaries. This aspect has made include the development of mechanisms for prompt international collaboration crucial for epidemic detection of incipient outbreaks, isolation of the control. International organisations like the World infected persons and the people they have been Health Organization (WHO), Food and Agricultural in contact with and mobilisation of investigational Organization (FAO), Office International des xxiv
- 25. EXECUTIVE SUMMARY Épizooties (OIE)as well as some national agencies been well quantified in the context of deliberate with global reach, e.g., Center for Disease Control action, illustrate the impact of biological agents. and Prevention (CDC), United States of America (USA) have an important role to play and Chapter 2—Deals with the resources available to cooperation with them is necessary. prepare for and face the threat of biological disasters. The current laws and Acts that deal with methods for the control of epidemics have been Structure of the Guidelines enumerated. The Biological and Toxin Weapons Convention has been discussed. The international These Guidelines are designed to acquaint the agencies concerned with biological disasters and reader with the basics of Biological Disaster the related activities of these agencies have been Management (BDM). They deal with the subject in given. A note by the World Trade Organization a balanced and thorough manner and give the (WTO) on the regulation of world trade has been information required by organisations to formulate included. The concerns voiced at the Earth Summit Standard Operating Procedures (SOPs) at various held in Brazil on the disruption of natural levels. It is also envisaged that these Guidelines ecosystems that could result in biological disasters, will be used for the preparation of national, state the role of Interpol in enforcing the concerned and district biological disaster management plans regulations and the role of Non-Governmental as a part of ‘all hazard’ Disaster Management (DM) Organisations (NGOs) have been mentioned. An plans. account of the importance of the integrated disease surveillance project in biologicaL disaster Chapter 1—Introduces the subject and provides management is given. The chapter mentions the the background to these Guidelines. The role of the Armed Forces and Railways who have a characteristics of naturally triggered outbreaks are countrywide infrastructure that can be used in such described and the potential for the use of disaster situations. pathogenic organisms in strategic and tactical modes as well as the potential of bioterrorism are Chapter 3—It is a reality check of the present presented. The mass destruction capability of capability to tackle biological disasters. The areas biological agents in the context of disaster potential that have to be addressed during the preparatory is outlined. The characteristics of biological agents phase are discussed. It also gives a short used or developed as weapons have been listed description of the response to challenges that the in Annexure-A. The section on threat perception country has faced in recent times, e.g., the Plague has been written in the Indian context. The chapter in 1994 (Beed and Surat) and 2002 (Himachal deals with modern concepts on zoonoses in a Pradesh) and the H5N1 outbreaks in poultry. The broad fashion and also indicates the impact of the performance of the responding agencies has been advances in molecular biology on this field. The adequate in the epidemics but could be improved chapter touches on biosafety and biosecurity and upon to meet bigger challenges. the evolution of epidemics In practice, though the course of action to deal with natural and artificial Chapter 4—Provides guidelines for individual outbreaks is similar as far as the infected individuals stakeholders to prepare their respective DM plans. are concerned, subsequent action depends on the The chapter indicates the legislation that can be genesis. Clues to distinguish the two modes have used, mechanics of disaster management and been included, along with an illustrative collation. major modalities for preventing an epidemic The economic aspects of epidemics, which have situation and recovering from it. xxv
- 26. EXECUTIVE SUMMARY The chapter also deals with the community aspect elaborated. Increased transnational traffic following and preparation that is necessary for the the World Trade Organization agreements poses a satisfactory control of an epidemic threat. challenge that the nation has to address. The steps being taken have been discussed in this chapter. Chapter 5—Deals with guidelines for the safety and security of microbial agents. The activities of Chapter 8—Rounds off the Guidelines to provide various countries for developing biological a broad perspective on biological disasters. The weapons have had one benefit—a clearer components for a system necessary to prepare for understanding of the hazards of handling virulent and respond to the threats have been set out. organisms. The erstwhile method of bench top style working is now considered unsafe and is not likely The time lines proposed for the implementation to be used in the 21st century. Natural pathogens of various activities in the Guidelines are considered from new areas or those that have demonstrated both important and desirable, especially in the case epidemic potential have to be handled in of non-structural measures for which no clearances appropriately designed laboratories. This chapter are required from central or other agencies. Precise deals with the levels of pathogens and the schedules for structural measures will, however, corresponding safe handling areas. The security be evolved in the biological disaster management protocol for valuable biological materials has been plans that will follow at the central ministries/state presented. Training requirements and resource level, duly taking into account the availability of materials are given in this chapter. The basic financial, technical and managerial resources. In information necessary for preparing biosafety case of compelling circumstances warranting a manuals is also given. change, consultation with the National Disaster Management Authority (NDMA) will be undertaken, Chapter 6—Deals with the effects of disasters on well in advance, for adjustment on a case-to-case animal husbandry. It discusses the present state basis. of animal husbandry in India, its vulnerability to disasters, the economic consequences of disasters The Milestones for Implementation of the and proposes a plan for dealing with such Guidelines are as Follows: situations. The statutory and legal framework available in the country and internationally is also A) Short-term Plan (0–3 Years) mentioned. Global veterinary issues and the need to interact with various international agencies and i) Regulatory framework. neighbouring countries have been elucidated. The a. Dovetail existing Acts, Rules and intersection of public health and veterinary issues Regulations with the Disaster also finds a place in this chapter. Management Act (DM Act), 2005. b. Enactment/amendment of any Act, Chapter 7—Deals with the issue of crop diseases Rule or Regulation, if necessary for that have economic ramifications. The genesis of better implementation of health this issue and instances of inadvertent/illicit entry programmes across the country for of some plant species and exotic pests have been effective management of disasters. discussed. The national and international regulatory mechanisms have also been described. The recent ii) Prevention. effort by the government to provide the a. Strengthening of integrated infrastructure for plant quarantine and regulation surveillance systems based on of imported agricultural products has been epidemiological surveys; detection xxvi
- 27. EXECUTIVE SUMMARY and investigation of any disease their active participation and outbreak. their sensitisation thereof. b. Establishment of Early Warning System 2) Human Resource Development (EWS). (HRD). c. Coordination between public health, - Strengthening of National medical care and intelligence Disaster Response Force agencies to prevent bioterrorism. (NDRF), medical first responders, medical d. Rapid health assessment, and professionals, paramedics and provision of laboratory support. other emergency responders. e. Institution of public health measures to deal with secondary emergencies - Development of human as an outcome of biological disasters. resources for monitoring and management of the delayed f. Immunisation of first responders and effects of biological disasters adequate stockpiling of necessary in the areas of mental health vaccines. and psychosocial care. iii) Preparedness. 3) Education and training. a. Identifying infrastructure needs for - Imparting basic knowledge of formulating mitigation plans. biological disaster b. Equipping Medical First Responders management through the (MFRs)/Quick Reaction Medical educational curricula at various Teams (QRMTs) with all material levels. logistics and backup support. - Knowledge management. c. Upgradation of earmarked hospitals for - Proper education and training Chemical, Biological, Radiological of personnel, with the aid of and Nuclear (CBRN) management. information networking systems d. Communication and networking and conducting continuing system with appropriate intra-hospital medical education and inter-linkages with state programmes and workshops at ambulance/transport services, state regular intervals. police departments and other h. Community preparedness. emergency services. 1) Community awareness e. Mobile tele-health services. programme for first aid. f. Laying down minimum standards for 2) Dos and Don’ts to mitigate the water, food, shelter, sanitation and effects of medical emergencies hygiene. caused by biological agents. g. Capacity development. 3) Defining the role of the community 1) Knowledge management. as a part of the community disaster - Defining the role of public, management plan. private and corporate sector for xxvii
- 28. EXECUTIVE SUMMARY 4) Organising community awareness early warning systems at regional programmes for first aid and levels. general triage. b. Incorporation of disaster specific risk j. Hospital preparedness. reduction measures. 1) Preparation of hospital disaster ii) Preparedness. management plans by all the a. Institutionalisation of advanced hospitals including those in the Emergency Medical Response (EMR) private sector. system (networking ambulance 2) Developing a mechanism to services with hospitals). augment surge capacities to respond to any mass casualty iii) Capacity development. event following a biological a. Strengthening of scientific and disaster. technical institutions for knowledge 3) Identifying, stockpiling, supply management and applied research chain and inventory management and training in management of of drugs, equipment and chemical, biological, radiological and consumables including vaccines nuclear disasters. and other agents for protection, b. Continuation and updation of human detection, and medical resource development activities. management. c. Developing community resilience. k. Specialised health care and laboratory facilities. iv) Hospital preparedness. 1) Upgradation of existing biosafety a. Testing of various elements of the laboratories and establishing new emergency plan through table top ones. exercises, and mock drills. l. Scientific and technical institutions for v) Specialised health care and laboratory applied research and training. facilities. 1) Post-disaster phase medical vi) Implementing a financial strategy for documentation procedures and allocation of funds for different national and epidemiological surveys. state/district-level mitigation projects. 2) Regular updation by adopting vii) Ensuring stockpiling of essential medical activities in Research and supplies such as vaccines and antibiotics, Development (R&D) mode, etc. initially by pilot studies. C) Long-term Plan (0–8 Years) B) Medium-term Plan (0–5 Years) The long term action plan will address the i) Prevention. following important issues: a. Strengthening of Integrated Disease i) Knowledge of biological disaster Surveillance Programme (IDSP) and management should be included in the xxviii
- 29. EXECUTIVE SUMMARY present curriculum of science and medical ix) Strengthening of the National Disaster undergraduate and postgraduate courses. Response Force, medical first responders, paramedics and other emergency ii) Establishment of a national stockpile of responders. Identification and recognition vaccines, antibiotics and other critical of training institutions for training of medical medical supplies. professionals, paramedics and medical first iii) Initiation of relevant postgraduate courses responders. in biological disaster management. x) Development of post-disaster medical iv) Training programmes in the areas of documentation procedures and emergency medicine and biological epidemiological surveys. disaster management shall be conducted for hospital administrators, specialists, These guidelines provide a framework for medical officers, nurses and other health action at all levels. The nodal ministry—Ministry of care workers. Health and Family Welfare will prepare an action v) Public health emergencies with the potential plan to enable all sections of the government and of mass casualties due to covert attacks of administration machinery at various levels to biological agents will be addressed in the prepare and respond effectively to biological plan through setting up of integrated disasters. The sporadic occurrence of low gravity surveillance systems, rapid health biological disasters will be managed primarily by assessment systems, prompt investigation the existing mechanism of response for medical, of outbreaks, providing laboratory support veterinary and agricultural services. In the current and instituting public health measures. scenario, the private sector is well entrenched in vi) Quality medical care. the primary and tertiary health care sector and is growing at a rapid rate. It would be mutually vii) Strengthening of the existing institutional beneficial for both the private sector and framework and its integration with the government if this infrastructure can be used for activities of the National Disaster biological disaster management in a Public-Private Management Authority, state government/ Partnership (PPP) module. Also unlike the other State Disaster Management Authority two agents of mass destruction (nuclear and (SDMA), district administration/District chemical), biological threats can be controlled to Disaster Management Authority (DDMA) an extent—if protective systems are in place the and other stakeholders for effective influx of infective agents would not have any implementation. disastrous consequences. The implementation of viii) Establishing an information networking these Guidelines through an action plan will lead system with appropriate linkages with state to a state of preparedness, which should be able ambulance/transport services, state police to prevent biological disasters and if any such departments and other emergency services. situation does occur, then will be managed properly. xxix
- 30.
- 31. 1 Introduction Sickness and disease are important subjects and ‘enemy’ troops were equally susceptible to that have exercised human thought since the dawn the disease usually. There were, however, of civilisation. It was realised that certain diseases circumstances when this was not the case and the came in crops and spread from the afflicted to the use of biological agents in combat conditions was healthy. The concept of ‘contagion’ developed and feasible. Thus, there could be a natural or artificial the earliest societies devised methods and systems spread of infections leading to the emergence of that could contain the spread of such diseases to the definition of BW put forward by Prof. Joshua ensure a reasonable level of health for the Lederberg as ’use of agents of disease for hostile populace. The spread of agriculture and purposes’. This essentially simple definition is good domestication of animals led to economic enough for dealing with the subject. development and the realisation that diseases affecting crops and livestock could also affect the well-being of human societies as they became 1.1 History more complex, and populations increased. The increase of population also resulted in the Biological disasters of natural origin are largely congregation of a large number of susceptible the result of the entry of a virulent organism into a people in limited spaces. The larger communities congregation of susceptible people living in a became vulnerable to food supply and trans- manner suited to the spread of the infection. In species migration of infectious agents. Infectious crowded areas, anthrax spreads by spore dispersal agents with innate or acquired ability to spread in the air, small pox spreads by aerosols, typhus from person to person caused extensive morbidity and plague spread through lice, fleas, rodents, or mortality. Medical and literary texts of ancient etc. The average epidemic spreads locally and civilisations describe such epidemics. Diseases dies down if the contagion is localised, but there that caused the largest disruption were plague have been instances where diseases have spread (bubonic and pneumonic), louse-borne typhus, and widely, even across national boundaries. Disasters smallpox, because of their high mortality. Infections have occurred when environmental factors were like malaria, dengue, and yellow fever that conducive, e.g., Black Death occurred when debilitated populations, led to economic disasters. conditions were favourable for increase in the Similar large-scale loss of livestock or crops also number of rats, and cholera attained a pandemic resulted in destruction of the social fabric. form when the causative agent entered urban areas which had inadequate sanitation facilities. Similarly, During WW I, commanders tried to use the post WW I, the movement of population led to the knowledge of infectious diseases to influence their rapid spread of the Spanish influenza virus. military tactics. Until the development of bacteriology and vaccinology, it was not possible Short-duration infections with high mortality for infectious agents to be used in situations where rates harm societies by depleting their numbers. the combating armies were in contact, as, ‘own’ The longer duration infections, with varying 1
- 32. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS immediate mortality, nevertheless, become In the 20th century, the use of bioweapons important when they cause large-scale morbidity became more scientific as technology for the affecting the productive capacity of the population. cultivation of pathogens and vaccinology Malaria and tuberculosis are examples of such developed. During WW I, Germany developed a infections which, in the long run, are as important biowarfare programme to use bacteria to infect or as the more visible florid epidemics. contaminate livestock and feed. There are also accusations of German bioattacks on Italy (cholera) The extension of human activity and its contact and Russia (plague). After WW I, many nations with a hitherto localised microbial environment undertook the development of bioweapons. introduces novel pathogens. The spread of Nipah, Significant research efforts were also made by both Hendra, Ebola, Marburg and Lassa fever viruses sides in WW II. Human pathogens like Bacillus are examples of this phenomenon. In the case of anthracis, Botulinum toxin, Fracisella tularensis, HIV, a sporadically occurring phenomenon—that Brucella suis, etc., and crop pathogens like Rice of transmission of the virus from chimpanzee to Blast, Rye Stem Rust, etc., were developed into man—became a pandemic when it began to be bioweapons. sexually transmitted, and has since become the largest epidemic in history. Post-WW II, the Cold War saw the serious development of bioweapon programmes. Major Human conflict resulting in large-scale state-sponsored research was carried out at population movement, breakdown of social establishments like the US Army Medical Research structures and contact with alien groups has always Institute for Infectious Diseases (USAMRIID) at Fort generated a large number of infections. Until very Detrick, the British complex at Porton Down and recently, the number of casualties due to infections Biopreparat in the Soviet Union. United States (US) far exceeded losses due to arms. President Nixon’s executive orders of 1969 and 1970 terminated the US programme but it As a tactical manoeuvre, the introduction of a continued to maintain ‘defensive’ research. The communicable disease in the enemy camp has Soviet programme started around the 1920s and been exercised by military commanders from the is believed to have continued unabated till the earliest times. Apart from prayers to gods to shower breakup of the Soviet Union. The number of pestilence on the enemy, active measures were countries currently working on biological weapons also adopted. These were based on the observed is estimated to be between 11 and 17 and include link between filth, foul odour, decay and disease/ sponsors of terrorist activities. Even smaller groups contagion. Filth, cadavers and animal carcasses have now acquired bioterrorist capabilities. have been used to contaminate wells, reservoirs and other water sources up to the 20th century. In 1.2 Biological Agents as Causes of the Middle Ages, military leaders recognised the Mass Destruction strategic value of bubonic plague and used it by catapulting infected bodies into besieged forts. Whether naturally acquired or artificially Two such episodes, that of Kaffa (1346) and introduced, highly virulent agents have the potential Carolstein (1422), have been identified as events of infecting large numbers of susceptible that probably initiated and perpetuated the individuals and in some cases establishing infamous Black Death which killed a third to half infectious chains. The potential of some infectious of Europe’s population. There is documentation of agents is nearly as great as that of nuclear weapons the use of biological weapons during the French and, are therefore, included in the triad of Weapons and Indian wars in North America (1754–1767). of Mass Destruction (WMD): Nuclear, Biological 2
- 33. INTRODUCTION and Chemical (NBC).The low cost and widespread warfare or terrorist attack. Of these, anthrax, availability of dual technology (of low smallpox, plague, tularemia, brucellosis and sophistication) makes BW attractive to even less botulinism toxin can be considered as leaders in developed countries. BW agents, in fact, are more the field. It is the causative agents that have to be efficient in terms of coverage per kilogram of catered for in the context of BT at all times. As payload than any other weapons system. In already mentioned, the use of agents that target addition, advances in biotechnology have made livestock and crops could be as devastating as their production simpler and also enhanced the human pathogens, in terms of their probable ability to produce more diverse, tailor-made agents. economic impact on the community. Biological weapons are different from other WMD as their effects manifest after an incubation period, 1.4 Threat Perception thus allowing the infected (and infectors) to move away from the site of attack. The agents used in The general perception that the actual threat BW are largely natural pathogens and the illnesses of BT is minimal was belied by the anthrax attacks caused by them simulate existing diseases. The through the postal system in 2001 which followed diagnosis and treatment of BW victims should be the tragic 9/11 events. BT, rather than BW, has carried out by the medical care system rather than now been perceived to be more relevant. Likewise, by any specialised agency as in the case of the in agriculture, the inadvertent introductions of exotic other two types of WMD. Another characteristic of species have had far-reaching consequences. some of these attacks, e.g., smallpox, is their Nevertheless, deliberate actions have not yet been proclivity to set up chains of infection. recorded. Rapid advances in biotechnology and aggressive deliberate designs could open up The production and use of biological agents opportunities for the hostile use of biological is simple enough to be handled by individuals or resources. groups aiming to target civilians. Thus, BT is defined by CDC as, ‘the intentional release of Anthrax, smallpox, plague and botulism are bacteria, viruses or toxin for the purpose of harming considered agents of choice for use against or killing civilians’. humans. Similarly, crop and livestock pathogens have been identified in their respective fields. However, the perceptions change as public health, 1.3 Sources of Biological Agents veterinary and crop practices evolve. A disease that has been eliminated from a community Theoretically, any human, animal or plant automatically becomes a BW weapon as herd pathogen can cause an epidemic or be used as a immunity wanes. This is the case with smallpox, biological weapon. The deliberate intention/action which was once an endemic infection. In the to cause harm defines a biological attack. A well- veterinary field, the elimination of rinderpest in known example is the incident in the USA where India, without parallel eradication in neighbouring members of a religious cult caused gastroenteritis countries, makes it a potential agent. The by the use of Salmonella typhimurium . The characteristics of various BW agents is given in organism causing the illness was such a common Annexure-A. natural pathogen, that, only the confessional statements of the perpetrators (when the cult broke In the case of India it is generally believed that: up) revealed the facts. However, certain characteristics need to be present for an organism i) BW agents are unsuitable for attacking to be used as a potential biological agent for military formations as troops would, most 3
- 34. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS likely, be protected, while the attacking Biological research is rapidly changing the forces would need to be immunised; hence epidemiology of infectious diseases, thereby the surprise element would be lost. Should altering the threat perceptions which have to be the defending troops be dispersed in reviewed periodically in the long and short term. mountainous or desert regions, a BW attack International organisations (e.g., WHO, FAO, etc.) will not be effective in such terrain and have a major role to play. National surveillance atmospheric conditions. Theoretically, of mechanisms should be upgraded to be able to course, a bioattack can be launched provide useful inputs. Intelligence reports based against discrete targets like naval bases, on epidemiological information, intent to harm, and island territories or isolated military facilities technological developments can give an idea of with a greater probability of success. the threat. Based on these inputs, threat perceptions can be qualified. ii) Bioweapons such as anthrax are more likely to be used by terrorists, possibly encouraged by state or non-state actors, 1.5 Zoonoses against vulnerable populations or industrial centres. Terrorists are capable of WHO defines zoonoses as ‘diseases and manufacturing bioweapons of lower infections naturally transmitted between non-human military efficiency that will be adequate vertebrate animals and human beings’. Emerging against civilian targets, especially to cause zoonotic diseases are ‘zoonosis that is newly panic. In this context BW agents have recognised or newly evolved or that has occurred gained the status of bioweapons rather previously but shows an increase in incidence or than WMD. expansion in geographical, host or vector range’. A catalogue of 1,415 known human infections iii) Consciousness is increasing about the fact revealed that 62% were of zoonotic origin. An that apart from human targets, bioweapons analysis of emerging infectious diseases revealed could be used to attack agricultural crops 75% of them to be of zoonotic origin. Bacteria, and livestock. Recently in India, an viruses and parasites can spread from a wildlife infection of avian flu in a limited area, reservoir. Fungi do not normally adopt this route. required the mass culling of birds, causing massive losses to commercial poultry Historically, plague, rabies and possibly some enterprises, thus highlighting their viral diseases like the West Nile virus, have been vulnerability to attack and the potential of described as zoonoses. The transmission of natural epidemics to cause economic zoonotic infections may be by the following means: losses. i) By direct transmission as in tularemia (by iv) An overloaded urban infrastructure inhalation) or bites as in rabies (inoculation) consequent to rapid urbanisation, along or contact with infected material as in HIV with population movement, is the largest transmission through mucosal breaches. hazard the country faces. Natural outbreaks can occur easily, as also selectively ii) Ingestion of infected animal products used introduced pathogens. The social disruption for food e.g., milk (brucellosis), pork that can occur was clearly evident during (trichiniosis, tapeworms), lamb and goat the Surat plague epidemic in 1994. (anthrax), etc. 4
- 35. I NTRODUCTION iii) Through the bites of insect vectors e.g., 1.6 Molecular Biology and Genetic plague, West Nile virus, Lyme borrelliosis, etc. Engineering Changes in the epidemiology of zoonoses The discovery of the Polymerase Chain occur constantly, either due to natural causes when Reaction (PCR) in 1983 by Kary Mullis has been a the distribution of the animal reservoir or vector major advancement in biotechnology. The resultant varies, or due to anthropogenic causes when human technologies have stimulated the development of activity changes the environment. Thus, in the case diagnostics, enhanced the understanding of the of Lyme borrelliosis, reforestation increased the genetic configuration of living beings and enabled vector population (ticks). Similarly, deforestation the construction of the complete genomes of a and monkey migration increased human–tick large number of living forms. Thus, the genetic interaction to precipitate the Kyasanur Forests configuration of several viruses, bacteria (including Disease (KFD) outbreaks in South India. National more than 100 pathogens), protozoa and higher or international wildlife trade for food or pets bring plants and animals are now known and have been together different species from varied sources into published. We are now in a position to follow gene the human environment permitting re-assortment activities in different situations; e.g., we now have of genes and the emergence of novel pathogens. the complete genomes of the three components It is this type of interaction that is believed to have of the falciparum malaria cycle: man ( Homo triggered the Severe Acute Respiratory Syndrome sapiens), the vector (Anopheles gambiae) and the (SARS) outbreak in South China and thereby caused pathogen ( Plasmodium falciparum ). The the evolution of a new influenza strain with the implications of this in the field of infectious potential of causing an epidemic. diseases are immense—elucidation of the processes of infection, defining vaccine targets Arthropod vectors play an important role in the and identifying sites for therapeutic processes can transmission of zoonoses as well as some non- now be attempted proactively. These advances zoonotic infections. Viral infections such as West have been assessed to be comparable to the Nile, dengue, etc., and bacterial infections such discovery of antibiotics as far as their impact on as filarial, dracunculosis, etc., are transmitted by infectious disease control is concerned. Only the vectors. Vectors transmit the infection by amplifying earliest impacts are currently being felt. the pathogen, e.g., malaria, dengue, etc., and by introducing it in a bite, or by direct implantation as It is now possible to diminish (or enhance) the in louse-borne typhus, or ingestion of the infected virulence of pathogens, change their anti-microbial vector as in dracunculosis. susceptibilities or even their tropism. Simple viral molecular structures can be modified even in silico. Zoonotic infections are not easy to control The results are largely predictable, though some unless the epidemiology is well-established and surprises may arise during experimentation. The specific activities favouring the transmission are experiment to devise an immuno-contraceptive in identified and addressed. Thus, the discovery of mice using the ectromelia virus (with added the involvement of the trombiculid mite in the interleukin-4), which resulted in an unexpected transmission of scrub typhus permitted a specific enhanced virulence, is a case in point. The polio method of control to be adopted. However, such virus has now been synthesised and the product success is unusual. Prevention of human contact proved to be viable. Other viruses are also on the with the source of infection will be the true remedy, synthetic path, i.e., intentional synthesis of wild though not often feasible. strains. Another achievement has been the 5
- 36. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS reconstitution of the Spanish influenza virus of 1918 glycoproteins antigens. The host range may from laboratory preserved tissue and infected be amplified or modified by changing the cadavers frozen in permafrost. genes determining surface attachment motifs. As has happened in the case of other major v) Enhancing the release of a virus or addition technological advancements particularly in nuclear of newer characteristic can result in a and chemical technology, there is considerable simultaneous change in the transmission scope for ‘dual use’ in molecular and genetic characteristics of the organism. technology and the benefits may be overshadowed by the perverted uses that may accrue. In this vi) In vitro processing of pathogens may alter respect, the areas of concern are briefly their surface characteristics enabling them summarised below: to avoid detection or even change their survival profile; e.g., introduction of a novel i) Modifying organisms to change their gene into Bacillus anthracis could result in antigenic profile to render existing vaccines a robust pathogen if the introduced genes ineffective. Examples could be changing remain active in spores. the surface antigens of the smallpox virus to make it resistant to standard vaccination. vii) Some experiments designed to use viral Likewise, the introduction of plasmids into genomes to introduce biologically effective Salmonellae may change their antigenic infectious genetic material in a dormant profile. state may result in changing the profile of populations in a manner suitable for ii) Change of the antibiotic susceptibility molecular manipulation. While such pattern of the pathogen. The introduction clandestine genetic attacks are fictional at of R-factor plasmids or chromosomal present, biotechnology has advanced determinants may result in phenotypic adequately to make it feasible. A modification that renders the organisms mycoplasma genome ( Mycoplasma resistant to useful antibiotics. This can be genitalis) has been synthesised. This is the achieved in Yersinia pestis, Bacillus first free living microorganism to be created anthracis or Brucellae by transformation or in vitro. transduction. If virulence remains intact, the resultant outbreaks can be disastrous. The spread of biotechnology and genetic iii) The identification of virulent genes and engineering has added novel dimensions to both islands in bacteria defines Deoxyribonucleic BW and BT. This technology is largely available Acid (DNA) segments that can be legitimately and is being actively researched to transferred to marginally virulent or avirulent sharpen its thrust. Its potential for good can easily organisms and render them strongly be distorted by unethical manipulation. virulent. In essence, this is a laboratory duplication of natural processes. 1.7 Biosafety and Biosecurity iv) The initiation of infection is strongly dependent upon the pathogen being able The threat posed to laboratory and other to adhere to the susceptible host tissue. investigators studying pathogenic organisms has The specificity of the process determines become evident after cultivation of these agents the infectivity range and is usually dictated became possible. The history of infectious diseases by the configuration of the surface is studded with accounts of workers who 6
- 37. I NTRODUCTION succumbed tothe diseases they studied. The latest iii) Disease occurrence outside the normal example is that of Carlos Urbani who died of SARS. transmission season. Organised BW programmes laid the foundation of iv) Simultaneous outbreaks of different biosafety. The different biosafety classes have been infectious diseases. defined as Biosafety Level (BSL) 1–4 and the necessary standards for the corresponding v) Disease outbreak in humans after laboratory and other precautions have been laid recognition of the disease in animals. down. Thus, laboratory designs to study the various vi) Unexplained number of dead animals or levels have been defined to safeguard the interests birds. of the laboratory worker, the treatment facility and vii) Disease requiring an alien vector. the community at large. This aspect has been a beneficial spin-off from BW activities. These are viii) Rapid emergence of genetically identical dealt with in greater detail in Chapter 4. pathogens from different geographic areas. (B) Medical Clues 1.8 Epidemics i) Unusual route of infection. The introduction of a pathogen capable of ii) Unusual age distribution or clinical establishing a transmission chain into a susceptible presentation of a common disease. population will result in an epidemic. In nature, iii) More severe disease symptoms and higher the initial primary infection(s) are followed by fatality rate than expected. rounds of secondary and tertiary infections and so on. A natural epidemic starts to wane when the iv) Unusual variants of organisms. number of susceptibles decreases or the v) Unusual anti-microbial susceptibility transmission chain is interrupted. In classical viral patterns. exanthemata (e.g., measles), epidemics peter out when the population becomes totally (or at least vi) Single case of an uncommon disease. 90%) immune. In the case of arthropod-borne epidemics (e.g., dengue or Japanese encephalitis), (C) Miscellaneous Clues the onset of cooler weather (decreased mosquito i) Intelligence reports. breeding) interrupts the outbreaks. In some cases, ii) Claims of the release of an infectious agent essentially individualistic infections may adapt to by an individual or group. human activity or ecological changes. The ongoing HIV/AIDS epidemic is an example of such a iii) Discovery of munitions or tampering. phenomenon. Deliberate introduction of pathogens iv) Increased numbers of pharmacy orders for can largely mimic natural outbreaks. However, a antibiotics and symptomatic relief drugs. close examination of the characteristics may offer v) Increased number of emergency calls. a clue to the artificiality. These clues are enumerated below: vi) Increased number of patients with similar symptoms to emergency departments and (A) Epidemiologic Clues ambulatory health care facilities. i) Greater case load than expected, of a Experience with the highly pathogenic avian specific disease. influenza virus (H5N1) in West Bengal in January ii) Unusual clustering of disease for a 2008 is a good example of the economic and health geographic area. issues, and actions needed to control epidemics 7
- 38. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS and epizootics. The death of a large number of estimated that a large-scale operation, against a free range poultry in eastern India activated civilian population with casualties, may cost about surveillance. The cause of the epizootic was $ 2,000 per sq. km with conventional weapons, $ identified and preventive action was initiated. There 800 with nuclear weapons, $ 600 with nerve gas was initial reservation and lack of cooperation by weapons and $ 1 with biological weapons. There the community which depended heavily on poultry have been numerous documented attempts at BT. for nutrition and income, as well as the inertia of Biological agents are more efficient in terms of other stakeholders (including medical coverage per kilogram of payload than any other professionals). However, once the gravity was weapons system. Terrorism by means of realised, action was initiated and community weaponised biological agents such as anthrax is participation was forthcoming. The outbreak was no longer a theoretical concept. Anthrax spores probably triggered by trans-border illegal poultry can be milled to an unexpectedly fine degree— trade. The reporting of outbreaks in all the countries 100 times smaller than the human strain in size bordering India has made the establishment of and easily inhaled deep into the lungs. Even the regional surveillance networks a high priority issue. delivery system for weaponised anthrax need not These will be coordinated by the international be sophisticated. Accidental release of anthrax agencies FAO and WHO. The potential of such bacilli from a bioweapons unit at Sverdlovsk [in outbreaks to initiate a new influenza strain with the former Union of Soviet Socialist Republics, pandemic potential would challenge the medical (USSR)] and an outbreak of salmonellosis in Dallas, infrastructure of all the nations. Oregon, in 1984 are well known incidents. The postal dissemination of anthrax spores (after 9/11) 1.9 Biological Disasters (BT) caused 22 cases, including 5 deaths, and ‘ushered in the transition from table top bioterrorism Events in the recent past have shown that the exercises to real world investigation and response’. threat of BT is real. ‘The arguments advanced to The crucial role of well trained, alert health care defer consideration of the issues related to providers like Larry Bush, the infectious diseases bioterrorism have been “without validity” and we physician from Florida, USA, who diagnosed the cannot delay the development and implementation first case promptly, is underlined by this outbreak. of strategic plans for coping with civilian bioterrorism’. Reconstructed scenarios in the case 1.10 Impact of Biological Disasters of attacks by the more likely BT agents reveal two patterns. In the case of anthrax and botulinum toxin Dispersal experiments have been attempted which have high initial effect but no secondary using non-pathogenic Bacillus globigii, which has cases, the scenario is similar to chemical attacks. physical characteristics similar to Bacillus However, when the pathogen used has the ability to anthracis. The variables in dissemination have been set up secondary cases, and probably an epidemic, worked out and the impact of bioterrorist attacks the scenario is far more complex. The preparation estimated. The dispersal experiments showed that and action have to be tailored appropriately. an attack on the New York subway system would kill at least 10,000 people. WHO studies show that Bioweapons are particularly attractive to a 50 kg dispersal on a population of 500,000 would terrorist groups because of the ease of their result in up to 95,000 fatalities and over 125,000 production and also their low cost. They have been people being incapacitated. Other experiments termed ‘the poor man’s nuclear bomb’ since it is have also shown similar disastrous outcomes. 8
- 39. I NTRODUCTION In the case of smallpox, the emergence of Science Advisory Board for Biosecurity set up by secondary cases at the rate of 10 times the number the US Department of Health and Human Sciences of primarily infected subjects, would add to the could be emulated in our country. A model plan burden. There would also be a demand for large- will be prepared by the nodal ministry with the scale vaccination from meagre stocks and no help of an advisory committee, which will be ongoing production. Inevitably, epidemics would updated periodically. The perceived threat would break out and social chaos would ensue. be the basis for anticipating and executing action. The advisory committee would have strong links The economic impact of BT would be a major with NDMA. burden that could transcend the medical consequences. It has been estimated that the use 1.12 Aims and Objectives of the of a lethal agent like Bacillus anthracis would cause Guidelines losses of $26.2 billion per 100,000 persons exposed, while a less lethal pathogen, e.g., Under Section 6 of the DM Act, 2005, NDMA Brucella suis would cause $477.7 million. The study is inter alia mandated to issue guidelines for also shows that a post-attack prophylaxis preparing action plans for holistic and coordinated programme will be cost-effective, thereby justifying management of all disasters. The Guidelines on expenditure on preparedness measures. The major management of biological disasters will focus on economic losses that occurred due to the fallout all aspects of BDM, including BT, with a focus on of the 1994 Surat plague epidemic of natural origin prevention, mitigation, preparedness, medical is an example of the larger ramifications of BT/ response, and relief. BW. A BT attack on agriculture can cause as much economic loss as an attack on human beings. The Guidelines will form the basis for central The spread of the Parthenium hysterophorus weed, ministries/departments concerned and states to which entered India in the late 1950s along with evolve programmes and measures to be included imported wheat, affected the yield of fodder crops in their action plans. MoH&FW is the nodal ministry and became a crop pest. This is an excellent case for the said issue. The health services of other study on how an inadvertent entry of exotic pests important line ministries with important roles to play can occur and lead to adverse consequences in are MoD, MoR and Employees’ State Insurance the long term. With properly equipped emergency Corporation (ESIC) of the MoL&E. The private sector crews, designated meteorological experts to track is also encouraged to participate in BDM by the movement of airborne particles, stockpiling of adoption of the PPP model. The approach to be prophylactic and therapeutic antibiotics, and a followed will emphasise a preventive approach mechanism for going rapidly to emergency mode, such as immunisation of first responders and the estimated casualties can be reduced to just stockpiles of medical countermeasures based 5–10% of the normal casualty rates. This analysis upon risk reduction measures by developing a succinctly expresses the need for, and value of, a rigorous medical management framework to reduce proper response to BT. the number of deaths during biological disasters, both intentional and accidental. This is to be 1.11 Regulatory Institution achieved through strict conformity with existing and new policies and proactive involvement of all There is need for an agency that can stakeholders. It will include the development of incorporate stakeholders and experts to oversee specialised measures pertaining to the this aspect on a continuing basis. The National management of biological disasters. 9
- 40. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS The important underlying objectives would be Guidelines for the development of BDM in to educate the persons concerned, whether in the ‘all hazard’ district DM plans. actual contact in the field or not, in the diagnosis, ii) All hospitals (government, local bodies, treatment and organisation of relief measures; to NGOs, private and others) will develop lay down the procedures to successfully combat BDM as part of their hospital DM plans using epidemics; to provide a ready source of basic these Guidelines. information on the subject to influence preparedness and execution of relief measures at iii) State medical management plans covering all levels; and to provide the basis for preparation macro issues of capacity development and of BDM protocols at various levels. micro issues pertaining to more vulnerable districts will be developed based on these In addition, the Guidelines will be utilised by Guidelines. the following responders and service providers: iv) All stakeholders connected directly or i) District administrators in coordination with indirectly with BDM will make use of these Chief Medical Officers (CMOs) and other Guidelines to mitigate the effects of such health care providers will use these disasters. 10
- 41. 2 Present Status and Context After Independence, India accorded significant Pradesh (2006) saw the poultry industry plummet. priority to the control and elimination of diseases A still greater threat is the possibility of avian posing a major public health burden. Successful influenza (H5N1) or the circulating seasonal eradication, elimination, and control of major killer influenza virus undergoing a major antigenic shift diseases also contributed in sustaining socio- to become a pandemic virus that may kill millions. economic growth, reflecting the improvement of The 1918 influenza pandemic killed an estimated health in its people. This led to an epidemiological 7 million people in India. and demographic transition. The notable success stories are eradication of smallpox in 1975, a highly Slow, evolving epidemics such as HIV/AIDS contagious endemic disease that accounted for a (5.1 million estimated cases in the year 2004) also third of all deaths in the 18th and 19th centuries. have the potential to cause socio-economic Malaria is another major public health problem disruption as has been witnessed in some African which had caused absenteeism leading to a fall in countries. Emerging and reemerging diseases, economic production with over 75 million cases notably SARS, avian influenza, Nipah virus, annually in the early 1950s, which has now been leptospirosis, dengue, Chikungunya and Rickettsial, successfully brought down to a load of about two are also posing serious threats. So are the spread million cases annually; and plague, which had of drug-resistant TB, drug-resistant malaria and assumed epidemic proportions in the early to other drug-resistant diseases that may emerge in mid 19 th and 20 th centuries, has nearly been the future. Environmental changes and their effects eliminated. can impact the ecological system with potential for new emerging causative agents, notably higher The outbreak of plague in Surat (1994) after a incidences of zoonotic diseases. gap of 28 years, with over 1,000 suspected cases and 52 deaths, caused widespread panic and mass Another facet of biological disasters in the exodus of people from the affected areas. This Indian context is the emerging threat of BT and outbreak badly affected commerce, trade and BW. Though biological agents have been used tourism. The SARS outbreak in 2003 caught the since ancient times for inflicting damage on the attention of the world, establishing how laxity in enemy, there is no direct evidence that such agents infection control practices could result in the have been used in the wars involving India. spread of a disease from a single hospital case to However, the threat remains as our adversaries and a global pandemic in less than three months. terrorist outfits are capable of adopting advanced Though India reported only three probable (that technologies to cause damage. too imported cases), the panic created by the media was unprecedented. Similarly, the outbreak In this context, the subsequent sections review of avian influenza among poultry in small pockets the existing policies, and the legal, institutional, of Nandurbar and Jalgaon districts of Maharashtra and operational framework for managing biological and adjoining districts of Gujarat and Madhya disasters in India and identifying the critical gaps. 11
- 42. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS 2. 1 Legal Framework involved in criminal acts, which includes BT in its ambit. Other provisions under this Act can be According to the constitution, health is a state applied for establishing law and order, enforcing subject. The primary responsibility of dealing with quarantine, etc. biological disasters rests with the state government. There are a number of legislations that control and 2.1.3 National Level govern the nation’s health policies. The government can enforce these legislations to contain the spread The Water (Prevention and Control of Pollution) of diseases. Some of the commonly used legal Act, 1974, provides for the prevention and control instruments are discussed below. of water pollution and the maintenance or restoration of the wholesomeness of water. It provides for the creation of central, state, or joint boards for the 2.1.1 Legislation that Supports Health Action prevention and control of water pollution, and for at Grass-root Level such purposes empowers them to obtain information, inspect any site, take samples for The 73 rd Constitutional Amendment on analysis and take punitive action against the Panchayati Raj Institutions (PRIs) provides for polluter. For this, the rules were laid down in the setting up of a three-tiered structure of local Water (Prevention and Control of Pollution) Rules, governance at district, block and village level. 1975. Health is a subject matter that can be acted upon by PRIs. The amendment mandates setting up of The Air (Prevention and Control of Pollution) health and sanitation committees in each village, Act, 1981, and the Rules (1983) provide for the the most peripheral body at the grass-root level, prevention, control and abatement of air pollution to take decisions on health matters for the community. and establishing boards for such purpose and assigning powers and functions to them relating The municipal Acts are civic Acts that govern to air pollution. the civic responsibilities of local bodies such as municipalities and municipal corporations. The Acts The Environmental (Protection) Act, 1986, and provide for the provision of safe drinking water, the Rules (1986) provide for protection of the hygiene and sanitation, food safety, notification and environment and empowers the government to take control of diseases, and public health concerns, all such measures as it deems necessary or including containment of outbreaks. expedient for the purpose of protecting and improving the quality of the environment and 2.1.2 State and District Level preventing, controlling and abating environmental pollution. This Act also provides for the Biomedical The Epidemic Diseases Act (Act 111 of 1897) Waste (Management and Handling) Rules, 1998 provides for ‘better prevention and spread of with a view to controlling the indiscriminate disposal dangerous epidemic diseases’. This Act, still in of hospital/biomedical wastes. These rules apply force, provides the states the authority to designate to hospitals, nursing homes, veterinary hospitals, any of its officers or agencies to take measures for animal houses, pathological laboratories, and blood the prevention and control of epidemics. banks generating biomedical waste. Relevant provisions under the Indian Penal The Disaster Management Act (DM Act), 2005, Code (IPC) and Criminal Procedure Code (CrPC) provides for the effective management of disasters can be invoked to detain and question persons and for all matters connected therewith or incidental 12
- 43. PRESENT STATUS AND CONTEXT thereto. It provides for an institutional and June 2007. The purpose and scope of IHR (2005) operational framework at all levels for disaster is to prevent, protect against, control and provide prevention, mitigation, preparedness, response, a public health response to the international spread recovery, and rehabilitation. This includes setting of disease and to avoid unnecessary interference up of NDMA, SDMA, DDMA, National Executive with international traffic and trade. A legally binding Committee (NEC), NDRF, and National Institute of international agreement, it seeks to protect against, Disaster Management (NIDM). It also clearly spells control and provide a mechanism to initiate a public out the role of central ministries. It empowers the health response to the threat or spread of disease district authorities to requisition by order any officer causing a Public Health Emergency of International or any department at the district level or any local Concern (PHEIC), including that of biological, authority, to take such measures for the prevention chemical or radio-nuclear origin. or mitigation of disaster, or to effectively respond to it, as may be necessary, and such officer or Under IHR (2005), Member States are required department shall be bound to carry out such orders. to strengthen their core capacity to detect, report For the purpose of assisting, protecting or providing and respond rapidly to public health events and to relief to the community in response to any notify WHO, within 24 hours, of all events that may threatening disaster situation or disaster, the district constitute a PHEIC. It also provides for routine authority is also empowered to (a) give directions inspection and control activities at international for the release and use of resources available with airports, seaports, and certain ground crossings. any department of the government and the local WHO will provide clear guidelines on the outbreak authority in the district; (b) control and restrict verification process, technical and logistical vehicular traffic to, from and within, the vulnerable support upon request, and Member States will also or affected area; (c) control and restrict the entry be eligible for support from the Global Outbreak of any person into, his movement within and Alert and Response Network (GOARN), which will departure from, a vulnerable or affected area; and be mandated to conduct global surveillance and (d) procure exclusive or preferential use of intelligence gathering to detect significant public amenities from any authority or person. These health risks. WHO will also assist in settling provisions imply that for biological disasters, international public health differences by necessary quarantine measures will be legally negotiation, mediation, conciliation and arbitration. instituted using private sector health facilities also for comprehensive patient care. Biological and Toxin Weapons Convention (BTWC) The Public Health Emergencies Bill being drafted by MoH&FW is intended to replace the The Biological and Toxin Weapons Convention, Epidemic Diseases Act, 1897 and provides for which came into force on 26 March 1975, provides effective management of public health emergencies, for prohibition of the development, production and including BT. The draft is presently being modified stockpiling of bacteriological (biological) and toxin after seeking comments from the states. weapons and for their destruction. BTWC now has 146 States Parties, including the five permanent 2.1.4 International members of the United Nations (UN) Security Council but not including 48 WHO Member States. International Health Regulations [IHR (2005)] India is signatory to the BTWC. Each signatory of the BTWC undertakes never in any circumstances IHR (2005) adopted by the World Health to develop, produce, stockpile or otherwise acquire Assembly on 23 May 2005 came into force on 15 or retain: 13
- 44. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS i) Microbial or other biological agents, or guidelines to be followed by state authorities in toxins whatever their origin or method of drawing up the state plan; (e) lay down guidelines production, of types and in quantities that to be followed by the different ministries or have no justification for prophylactic, departments of GoI for the purpose of integrating protective or other peaceful purposes. measures for the prevention of disaster and the mitigation of its effects in their development plans ii) Weapons, equipment or means of delivery and projects; (f) coordinate the enforcement and designed to use such agents or toxins for implementation of the policy and plans for DM; (g) hostile purposes or in armed conflict. recommend provision of funds for the purpose of mitigation; (h) provide such support to other If any signatory feels threatened, it may lodge countries affected by major disasters as may be a complaint with the Security Council of the UN. determined by the central government; (i) take such Such a complaint should include all possible other measures for the prevention of disaster, or evidence confirming its validity, as well as a request the mitigation, or preparedness and capacity for its consideration by the Security Council. Each building for dealing with the threatening disaster State Party to this Convention also undertakes to situation or disaster as it may consider necessary; provide or support assistance, in accordance with and (j) lay down broad policies and guidelines for the UN Charter, to any Party to the Convention the functioning of NIDM. NDMA is assisted by the which so requests, if the Security Council decides NEC, consisting of secretaries of 14 ministries and that such Party has been exposed to danger as a Chief of the Integrated Defence Staff of Chiefs of result of any violation of the Convention. the staff committee, ex officio as provided under the DM Act, 2005. 2.2 Institutional and Policy Framework NDMA is, inter alia, responsible for 2.2.1 National Disaster Management Authority coordinating/mandating the government’s policies for disaster reduction/mitigation and ensuring With the objective of providing for effective adequate preparedness at all levels. Coordination management of disasters, the DM Act, 2005 was of response to a disaster when it strikes and post- enacted on 26 December 2005. The Act seeks to disaster relief and rehabilitation will be carried out institutionalise mechanisms at the national, state by NEC on behalf of NDMA. and district levels, to plan, prepare and ensure a rapid response to both natural calamities and man- NDMA has been supporting various initiatives made disasters/accidents. The Act mandates: (a) of the central and state governments to strengthen the formation of a national apex body, the NDMA, DM capacities. NDMA proposes to accelerate with the Prime Minister of India as the Chairperson, capacity building in disaster reduction and (b) creation of SDMAs, and (c) coordination and recovery activities at the national level in some of monitoring of DM activities at district and local the most-vulnerable regions of the country. The levels through the creation of district and local level thematic focus is on awareness generation and DM authorities. education, training and capacity development for mitigation, and better preparedness in terms of The NDMA is responsible to (a) lay down disaster risk management and recovery at policies on DM; (b) approve the National Plan; (c) community, district and state levels. Strengthening approve plans prepared by the ministries or of state and district DM information centres for departments of the Government of India (GoI) in accurate and timely dissemination of warning is accordance with the National Plan; (d) lay down also in progress. 14
- 45. PRESENT STATUS AND CONTEXT 2.2.2 National Crisis Management Committee home guards and other stakeholders in disaster (NCMC) response. The NCMC, under the Cabinet Secretary, is 2.2.4 Ministry of Health and Family Welfare mandated to coordinate and monitor response to crisis situations, which include disasters. The MoH&FW is the nodal ministry for handling NCMC consists of 14 union secretaries of the epidemics. The decision-making body is the Crisis concerned ministries including the Chairman, Management Group under the Secretary Railway Board. NCMC provides effective (MoH&FW), which is advised by the Technical coordination and implementation of response and Advisory Committee under Director General Health relief measures in the wake of disasters. Services (DGHS). The Emergency Medical Relief Division of the Directorate General of Health 2.2.3 National Disaster Response Force Services is the focal point for coordination and monitoring. The National Institute of Communicable The DM Act, 2005 has mandated the Diseases (NICD) is the nodal agency for constitution of the NDRF for the purpose of implementing IHR (2005) and for investigating specialised response to a threatening disaster outbreaks. The NICD/Indian Council of Medical situation or disaster. The general superintendence, Research (ICMR) provide teaching/training, direction and control of the force is vested in and research and laboratory support. Most states have exercised by the NDMA and the command and a regional office for health and family welfare and supervision of this force is vested in the Director the regional director liaises with the state General of NDRF. Presently, NDRF comprises of government for effective management of biological eight battalions with further expansion to be disasters. considered in due course. These battalions have been positioned at eight different locations in the MoH&FW is vested with the responsibility of country based on the vulnerability profile. This force framing the national health sector guidelines, is being trained and equipped as a multi- providing guidance and technical support for disciplinary, multi-skilled force with state-of-the- capacity development in surveillance, early art equipment. Each of the eight NDRF battalions detection of any outbreak and supporting the states will have three to four states/Union Territories (UTs) during outbreaks in terms of outbreak as their area of responsibility, to ensure prompt investigations, deployment of Rapid Response response during any disaster. Each of these Teams (RRTs), manpower and logistic support for battalions will have three to four Regional Response case management, etc. Centres (RRCs) at high vulnerability locations where trained personnel with equipment will be pre- The National Health Policy, 2002, while positioned. NDRF units will maintain close liaison observing that the decentralised public health with the state administration and be available to outlets have become practically dysfunctional, had them proactively, thus avoiding long procedural advocated developing the public health capacity delays in deployment in the event of any serious within the states up to the grass-root level to provide threatening disaster situation. Besides, NDRF will quality public health services. also have a pivotal role in community capacity building and public awareness. NDRF is also There are various national health programmes enjoined with the responsibility of conducting the run by the DGHS, MoH&FW, either as a central basic training of personnel from the State Disaster sector scheme or in partnership with the state Response Forces (SDRFs), police, civil defence, government. Some of these programmes, such as 15
- 46. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS the National TB Programme, National Vector Borne 2.2.5 Ministry of Home Affairs Disease Control Programme, National Programme for Control of Iodine Deficiency Disorders and MHA is the nodal ministry for BT and partners National AIDS Control Programme which have their with MoH&FW in its management. MHA is networks throughout the country, run as vertical responsible for assessing threat perceptions, programmes, merging horizontally with service setting up of deterrent mechanisms and providing delivery at the grass-root level and have focused intelligence inputs. MoH&FW will also provide the strategic approach with inbuilt components for required technical support. surveillance and monitoring. Many of these programmes were successful in achieving their 2.2.6 Ministry of Defence objective to control/prevent major biological disasters—malaria, smallpox and AIDS are prime The Armed Forces have a hospital network examples. These programmes often dwell on across the country which can support clinical case renewed strategies for emerging threats such as management. Further, they have the capacity to drug-resistant TB, HIV-TB co-infection, drug- evacuate casualties by ambulance, ship, and resistant malaria, etc. The experience gained from aircraft. MoD is the nodal ministry for coordinating the controlling of malaria came handy in preventing war related matters and they have also the capacity the dengue and Chikungunya outbreaks. In fact, for managing the aftermath of BW. MoD provides the rich experience gained in managing national transportation for RRTs and supports supply chain programmes will remain the backbone of managing management. The Armed Forces Medical Services future public health threats. (AFMS) have mobile field hospitals which can be moved to the affected areas for treatment at the The National Rural Health Mission (NRHM) site. Well-equipped ambulances are available for 2005–12 strives to strengthen health delivery at evacuation of patients to hospitals. The hospitals the grass-root level by placing a village health under AFMS are spread out across the entire length worker—Accredited Social Health Activist (ASHA), and breadth of the country. Medical and in each village, supported by the Village Health paramedical staff are well trained to handle and Sanitation Committee. The Primary Health patients who are victims of any disaster. Training Centres (PHCs), the Community Health Centres is imparted at the time of induction and refresher (CHCs), and the district hospitals are being courses are conducted regularly. The role of the strengthened for ensuring minimum public health Armed Forces is discussed below: standards for health care delivery. Once i) The Armed Forces by their inherent strengthened, the primary health care system will organisation, infrastructure, training, be in a position to assess vulnerabilities, detect leadership, communications, etc., are early warning signs, feed information into the suitable as first responders in any national- national surveillance system and help the district level calamity or disaster. health officials in case management. ii) Response to a bioterrorist attack will be no The Central Government Health Scheme different from the response to any other (CGHS) and central government run hospitals situation, except for a few peculiarities, provide general and specialised medical which must be identified and suitably professionals for clinical management of cases. catered for. 16
- 47. PRESENT STATUS AND CONTEXT iii) Since this type of disaster will be more is being carried out in the field of vector control, towards the management of providing biomarkers and vaccine development. DRDO is immediate medical assistance, the MoD also imparting training to trainers for the will coordinate and provide assistance as management of biological disasters. first responders that will be orchestrated by the Director General Armed Forces Medical 2.2.7 Ministry of Agriculture Services (DGAFMS). These will be in the form of earmarking command-wise MoA is the nodal ministry for all actions to be responses, relating to assigned areas of taken for biological disasters related to animals, responsibilities. Basically, the following may livestock, fisheries and crops. Under MoA, the be included: Department of Animal Husbandry, Dairying and a. Upgrade necessary infrastructure and Fisheries (DADF) deals with diseases of animals develop capacity to respond and livestock, including their quarantine, and the adequately. Department of Agriculture and Cooperation in MoA deals with crop diseases and the Directorate of b. Training of earmarked medical Plant Protection, Quarantine and Storage (DPPQS) personnel in the management of deals with pests. Besides, there is a Department casualties occurring on account of any of Agricultural Research and Education under which biological attack, as these will be the Indian Council of Agricultural Research (ICAR) different in nature to war casualties or functions as an apex body for research on casualties on account of any other agriculture and allied sciences. ICAR has Krishi disaster. Vigyan Kendras (KVKs) in many districts of the c. Earmarking of command-wise first country, which work closely with the local responders from all medical resources community on all agriculture related issues. MoA of the Army, Navy and Air Force. will attend to biological disasters involving d. Create adequate stockpile of agricultural crops, poultry and cattle. It will send necessary vaccines such as anthrax teams of experts, collect samples and get them vaccine under various commands with diagnosed. It will mobilise the local machinery on a mechanism to turn over the stocks operational aspects. held. e. Conduct periodic exercises to ensure 2.2.8 Other Supporting Ministries efficacy of response plans. In the context of biological disasters, the f. Immunise adequate number of first Department of Drinking Water Supply (Rajiv Gandhi responders in each command. Drinking Water Mission), and the Urban g. 25 hospitals have been earmarked for Development Ministry/Rural Development Ministry treating casualties caused by (National Sanitation Campaign) play a key role in biological agents. the provision of potable water, hygiene and sanitation. The Indian Railways have their own Defence Research and Development independent medical capabilities, including tertiary Organisation (DRDO): Many establishments of care hospitals, across the nation. A wide network DRDO are deeply involved in developing facilities of trained manpower is an asset available with this for management of biological disasters. Research organisation. It also has the potential for 17
- 48. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS conducting mass evacuation of the affected strains, production of diagnostic kits, and vaccine community. ESIC (MoL&E) caters to 4% of the research. population and has secondary and tertiary care hospitals in major industrial townships. National Institute of Cholera and Enteric Diseases (NICED), Kolkata: It is an ICMR institution 2.2.9 Institutions supporting Management of specialising in diarrhoeal diseases and provides Biological Disasters expertise in tackling national emergencies caused by epidemics of cholera and other diarrhoeal NICD, under the administrative control of the diseases. Directorate General of Health Services, MoH&FW, has various technical divisions and many National Institute of Epidemiology, Chennai: It is specialised laboratories. The institute has three another ICMR institution with the vision of technical centres, viz., Centre for Epidemiology becoming a centre of excellence in the field of and Parasitic Diseases, Advanced Centre for HIV/ epidemiology concentrating on goal-oriented AIDS and Related Diseases, and Centre for Medical programmes of national relevance, operational Entomology and Vector Management; and four research, health systems research, teaching and technical divisions—Biochemistry and field epidemiology training. Biotechnology, Microbiology, Training and Malariology, and Zoonosis. Each centre/division has Vector Control Research Centre: This ICMR several sections and laboratories (molecular institution is involved in developing methods for diagnosis, cholera, hepatitis, polio, TB, HIV/AIDS, rapid response and disaster management with rabies, plague, leptospirosis, kala-azar, malaria, reference to vector-borne disease outbreaks. filaria, intestinal parasite, mycology, etc.) dealing with a wide range of communicable and a few All India Institute of Hygiene and Public Health, non-communicable diseases. The functions of the Kolkata: It is among the oldest public health Institute broadly cover three areas—trained health institutions in India involved in public health manpower development, outbreak investigations, teaching, training and research. It runs regular specialised services and operational/applied postgraduate training programmes in public health, research. It provides teacher training in field environmental health, public health engineering, etc. epidemiology. Advanced laboratory work is supported by a BSL-3 laboratory. NICD is also the Indian Council of Agricultural Research (ICAR): national focal point for IHR (2005). This is a premium research institution in the fields of Agriculture, Animal Science and Fisheries. For Indian Council of Medical Research (ICMR), details, refer to Chapter 7 of the document. New Delhi: It is the apex body in India for the formulation, coordination and promotion of Defence Research and Development biomedical research. Among others, the Council’s Organisation (DRDO): It has an extensive network research priorities include control and management of laboratories in the various disciplines of biological of communicable diseases, and drug and vaccine science. These laboratories have developed research (including traditional remedies). It has a expertise in various aspects relevant to this subject. network of organisations spread across the country. These are: The National Institute of Virology (NIV), Pune, is an apex laboratory of international standards capable Defence Research and Development of viral genomic characterisation, monitoring of viral Establishment (DRDE): DRDE (under MoD) is 18
- 49. PRESENT STATUS AND CONTEXT engaged in research on hazardous chemicals and Vaccine Production Centres biological agents as well as associated The public health load in the country including that toxicological problems. It has developed diagnostic of vaccine-preventable diseases, gives high priority kits for certain biological agents. It also imparts to vaccine manufacturing both in the public and training in the medical management of chemical private sectors. The country is not only self-reliant warfare/terrorism and BW/BT. The Defence in this sector but also supplies vaccines to other Materials and Stores Research and Development countries and international organisations such as Establishment (DMSRDE), Kanpur, is another WHO and United Nations Children’s Fund DRDO institution that specialises in the (UNICEF). Notable among them are the oral polio; manufacture of protective suits, gloves and boots. Diphtheria, Pertussis and Tetanus (DPT); measles; The Defence Bioengineering and Electromedical Bacillus Calmette-Guérin (BCG); yellow fever Laboratory (DEBEL), Bangalore, manufactures face vaccine; anti-rabies; meningococcal; and smallpox masks, canisters, NBC filter fitted casualty vaccines. It also manufactures immunoglobulins evacuation bags, etc., based on the technology and antiserums for tetanus, rabies and snake bite. provided by DRDE. The Defence Food Research India has the R&D facility coupled with latest Laboratory (DFRL) specialises in all aspects of food technology to manufacture second- and third- preparation, security and quality. generation cell culture vaccines. It is one among the six countries in the world, identified by WHO Council for Scientific and Industrial Research for manufacturing avian influenza vaccine that can (CSIR): It is one of the world’s largest R&D be scaled up for manufacture of pandemic organisations having linkages to academia, R&D influenza vaccine. Notable vaccine manufactures organisations and industry. CSIR’s 38 laboratories are the Central Research Institute, Kasauli; Haffkine form a giant network that embraces areas as Institute, Mumbai; Pasteur Institute, Coonoor; BCG diverse as aerospace, biotechnology, drugs and Laboratory, (Guindy) Chennai, and NIV, Pune, all toxicology. in the government sector and the Serum Institute of India, Shanta Biotech, Biological Evans and Department of Biotechnology (DBT): DBT has Bharat Biotech in the private sector. significant achievements in the growth and application of biotechnology in the broad areas of Drug Manufacturing Units agriculture, health care, animal sciences, The Indian pharmaceutical sector is a leading environment, and industry. DBT also has a industry and a major player in the global market. laboratory network throughout the country. The products range from basic essential drugs to third-generation antibiotics, anti-retroviral drugs, The Public Health Foundation of India (PHFI): immuno-modulators and anti-cancer drugs. The It is an autonomous institution set up in 2005 to Drug Controller General of India and drug redress the limited institutional capacity in India controllers in the states ensure good manufacturing for strengthening training, research, and policy practices under the ambit of the Drugs and development in the area of public health. It is a Cosmetics Act. These drug manufacturing units PPP venture and its mission is to benchmark are both in the government and private sectors. quality standards for public health education, establish public health institutes of excellence, 2.2.10 State Level undertake public health research and advocate public policy linked to broader public The SDMA is vested with the powers for health goals. planning, preparedness, mitigation, and response 19
- 50. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS to disaster events, including biological disasters, care are the PHCs and sub-centres spread across in the concerned states. SDMA is assisted by the the districts, established on the norms of one PHC State Executive Committee (SEC). The state plan for 30,000 population and one sub-centre for 5,000 is prepared by SEC based on the guidelines issued population (3,000 in hilly areas). These are the basic by NDMA and SDMA. The latter will also assist the units from where public health information is districts in preparing and executing the district generated and public health service is delivered. plan. 2.2.12 Local Level Health being a state subject, there is wide inter- and intra-state differential in terms of public health At the local level, the local DM committee assets, functioning of the public health (village DM committee) is expected to be trained departments, teaching and training institutions, and and empowered as first responders. Anganwadi public health research. Tamil Nadu, Andhra workers/ASHA/Auxiliary Nurse Midwife (ANM) of the Pradesh, Maharashtra and Gujarat are creating their village/sub-centre will be the peripheral health own public health institutions. In addition, the service delivery point, keeping a watch on disease medical colleges are an important resource both outbreaks and notifying the village health and for public health and medical services. The sanitation committee and the PHC. preventive and social medicine (community health) departments have regular outreach services into Urban municipal corporations and councils the community. The laboratory services of medical look after public health, hospital services, drinking colleges augment the laboratory surveillance under water, sanitation, disposal of dead bodies, and other IDSP. Apart from providing clinical services, the civic functions related to health. medical colleges also act as sentinel sites for surveillance. 2.2.13 Non-governmental Organisations Many states have established SDMAs. Gujarat, NGOs perform a variety of services and Maharashtra, Andhra Pradesh, etc., have prepared humanitarian functions, bring citizens’ concerns to DM plans. Other states are in the process of the attention of the government, monitor policies, establishing SDMAs and preparing their DM plans and encourage political participation at the which will be in accordance with the DM Act, 2005. community level. They provide analysis and State health management plans will form an expertise, serve as early warning signals and help important component of state DM plans. States monitor and implement international agreements. such as Gujarat have developed epidemic control Some are organised around specific issues, such programmes as well. as human rights, the environment, or health. Their involvement, as of now, in the prevention and 2.2.11 District Level control of the health consequences of biological disasters is very limited and would depend on DDMA will be the focal point of planning for government seeking partnership and offering a fair disasters in the respective districts. The District playing field. Health Officer (DHO)/CMO of the district is a member of the DDMA. Under the CMO/DHO, there The Indian Red Cross Society (IRCS) has 655 are programme officers for immunisation, TB and branches at the state/district/divisional/sub-district/ malaria. Under the IDSP a surveillance/IDSP officer , taluka levels spread throughout the country, at the district level is envisaged. The peripheral together with its national headquarters at New units that provide preventive and promotive health Delhi. It has 90 blood banks and promotes blood 20
- 51. PRESENT STATUS AND CONTEXT donation camps. Red Cross volunteers are air quality, chemistry, stationary sources motivated and if given adequate training, can testing, etc. They maintain state-of-the-art complement the primary health care facilities for equipment, employ professionals and case management in home settings during major implement a comprehensive quality control biological disasters. plan. ii) At the request of Member States, the 2.2.14 Role of International Organisations Command and Coordination Centre based at Lyon (France), is mobilised to facilitate (A) World Health Organisation (WHO) the coordination of any large-scale disaster management. The Centre gives priority to WHO provides advocacy, guidelines, training such events, provides services round the and technical support in health related matters. clock, and circulates information to all WHO India Office, WHO-Regional Office for South- concerned anywhere in the world. It also East Asia (WHO-SEARO), FAO and World has direct access to all Interpol facilities, Organisation for Animal Health (OIE) provide e.g., DNA finger printing, etc. Interpol also assistance if the biological disaster involves releases specific resources for disasters agriculture or animal health. such as staff, equipment and premises. iii) The coordinating agency for Interpol in India WHO contributes to global health security in is the Central Bureau of Investigation through the specific field of outbreak alert and response which all the above facilities can be by: (i) strengthening national surveillance obtained. programmes, particularly in the field of epidemiology and laboratory techniques; (ii) disseminating verified information on outbreaks of 2.3 Operational Framework diseases, and whenever needed, following up by providing technical support for response; and (iii) 2.3.1 Central Level collecting, analysing and disseminating information on diseases likely to cause epidemics of global At the national level, NDMA is the authority for importance. Several BW related diseases fall under providing National Guidelines on management of . WHO surveillance. Guidelines on specific epidemic biological disasters, including biowarfare and BT. diseases, as well as on the management of Being the nodal ministry for epidemics, MoH&FW surveillance programmes, are available in printed advocates on policy issues and lays down a national and electronic form. plan. It supports the states in terms of advocacy, capacity building, manpower and logistics. (B) World Trade Organisation (WTO) IDSP, which is described in detail in the foregoing paragraphs will be the backbone for Refer to Chapter 7 of the document disease surveillance and detection of early warning signs. (C) Interpol i) Interpol has an environmental laboratory In a crisis situation, the Crisis Management with multi-disciplinary staff consisting of Group of MoH&FW takes decisions for controlling engineers, chemists, scientists and the outbreak. If the crisis has the potential for socio- technicians. Member States are provided economic disruption or involvement of a number with a full range of environmental testing of states/districts and central ministries, the NCMC services including field monitoring, ambient coordinates the response. The technical inputs are 21
- 52. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS provided by the Technical Committee under DGHS. In case of surge capacity for clinical case Within MoH&FW, the Emergency Medical Relief management, the hospital facilities of the division coordinates all such actions that require Armed Forces, Railways and ESIC can be used. interface between MoH&FW, other central The Indian Railways has mass evacuation potential ministries, the state(s) and other institutions both as well. in the public and private sectors. The control room functions from the Emergency Medical Relief 2.3.2 State Level division and from NICD. Multi-disciplinary RRTs from NICD and institutions under ICMR, manage Under the provisions of the DM Act, 2005, public health problems and provide necessary SDMAs will advice the state on biological disasters laboratory support. Major central government and approve the plan of the state government and hospitals and institutions such as CGHS provide a provide guidelines to act upon. In states which are large pool of medical manpower for case yet to establish the SDMA, the state health management. The Central Medical Stores Depots department is the nodal agency responsible for and some of the Public Sector Undertakings have planning and to be in a state of preparedness. expertise in handling material logistics and support This includes capacity development in terms of the states with drugs, disinfectants and surveillance, early detection, and rapid response insecticides. The vaccine production centres and containment of any outbreak. In case of a supply vaccines as required. bioterrorist attack, epidemiological clues have to be delineated to establish the nature of the attack. For epidemics which threaten to spread across The state health department is to prepare SOPs in the states and tend to be endemic, or from an instituting the public health response. In crisis endemic situation to an epidemic outbreak, situations, the state health department has to MoH&FW decides on the strategic approach for depute the RRTs, conduct clinical and their control/elimination. They draw up various epidemiological investigations, and institute public programmes in consultation with WHO on various health measures to contain the outbreak. relevant issues. Diseases of international public health concern are required to be notified to WHO 2.3.3 District and Sub-district Level as per the requirement under IHR (2005). The disease trend is monitored on a day-to-day basis DDMA is the authority to plan and execute the till it ceases to be a public health problem. DM programme at the district level. In districts where DDMA is yet to be constituted, the district The agriculture ministry would attend to collector assumes the prime responsibility. He is biological disasters involving the agriculture/poultry/ vested with powers under IPC and various other cattle segment. enactments to direct and mobilise resources for containment of the outbreak. He also decides on In the context of biological disasters, the the help required from outside agencies and Department of Drinking Water Supply and the Rural communicates the requirement to state authorities. Development Ministry play key roles in the provision The preparedness measures, of which surveillance of potable water, chlorination of water and water is the major functional component, is being quality monitoring. MHA/MoD/Ministry of Civil supported under IDSP The district level RRTs are . Aviation would support airlift of RRTs/clinical also trained, and the communication hub at the samples and logistics. The Armed Forces also have district level uses terrestrial and satellite linkages. the capacity for managing the aftermath of BW Under IDSP it is envisaged that by 2009 all the , and provide technical inputs for managing BT. districts would acquire such capabilities. 22
- 53. PRESENT STATUS AND CONTEXT All major outbreaks, man-made or natural, if However, there is poor networking and it needs to not detected early and contained, spread and soon be improved. 70% of health services are provided go beyond the coping ability of the district by the private sector but their presence is mainly administration, requiring support from the state/ in urban areas. Private hospitals are better centre. The primary health care system has to play organised and equipped. However, in mass a crucial role in detecting the early warning signs. casualty incidents, their utilisation leaves much to The village health functionaries [ASHA/Anganwadi be desired. The DM Act, 2005 provides enough worker/ANM/Multi-Purpose Worker (MPW)] interface powers for the DDMA to call for the services of with the community and are advantageously placed organisations which can contribute to effective to report public health events to the peripheral management of any disaster. public health services outlets such as sub-centres and PHCs. The functioning of the public health 2.4 Important Functional Areas system at the grass-root level is of paramount importance in picking up early signals and acting 2.4.1 Human Health Surveillance rapidly, as is the presence of a communication network for bi-directional flow of information. In biological disasters, surveillance is the key strategy to detect early warning signals and has to The district health setup includes hospital have components to include human, animal and facilities such as district hospitals, sub-district plant surveillance. Till 1999, when the National hospitals, CHCs and PHCs. Public health support Communicable Disease Surveillance programme is provided by the DHO and other officers related was launched, there was no organised system for to public health work such as the immunisation disease surveillance. It was expanded to cover officer and district officers for TB and malaria. The about 100 districts in three states. The lessons network of PHCs and the network of sub-centres learned were reviewed and MoH&FW initiated the is the backbone of the public health system through IDSP with World Bank support. which the public health measures are instituted— be it event-based, house-to-house surveillance, (A) Integrated Disease Surveillance Programme provision of safe drinking water through chlorination, vector control measures, mass Launched in 2004, the IDSP intends to detect chemoprophylaxis, sanitation measures, home care early warning signals of impending outbreaks and or referral of critical patients. The DHO/CMO help initiate an effective response in a timely manner. mobilises medical officers from the PHCs It is also expected to provide essential data to supported by health workers from the sub-centres monitor the progress of ongoing disease control for field work. The teams are constituted usually programmes and help allocate health resources on population norms, covering the entire affected more efficiently. It is a decentralised, state-based area. Reinforcements, if required, are arranged by surveillance programme, using an integrated the state governments from other districts, medical approach with rational use of resources for disease colleges and from central government institutions. control and prevention. Data collected under the IDSP also provides a rational basis for decision- 2.3.4 NGOs/Private Sector making and implementing public health interventions. NGOs play a major role in all disasters but are Specific objectives of the IDSP: largely conspicuous by their absence in biological disasters. At the district level, the district collector i) To establish a decentralised state-based would coordinate all the activities of NGOs. system of surveillance for communicable 23
- 54. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS and non-communicable diseases so that Training manuals for medical officers, health timely and effective public health action can workers and district level laboratory technicians be initiated in response to health challenges have been dispatched to the states. The financial in the country at the state and national and administrative component is also being levels. strengthened by training of accountants in financial management and training of data entry operators ii) To improve the efficiency of the existing in data management. surveillance activities of disease control programmes and facilitate sharing of Once fully implemented, syndromic reporting relevant information with the health would have the advantage of detecting possible administration, community and other unusual events. The call centre concept being stakeholders so as to detect disease trends implemented by the IDSP would help any medical over time and evaluate control strategies. professional or general public to inform the IDSP about any unusual event through a toll free number. The project is intended for surveillance of a The RRT in each district would investigate the limited number of health conditions and risk factors suspected situation. Till such time the information keeping in view the local vulnerabilities; integrate management system becomes fully operational, disease surveillance at the state and district levels; authentic baseline data may not be available and improve laboratory support; strengthen data quality; epidemic threshold levels cannot be determined. and, analyse and link them to action. The project envisages a transnational training programme, to involve communities and other stakeholders, 2.4.2 Epidemiological Assessment particularly the private sector. Integral to the IDSP is an IT network which aids the national electronic One of the major inputs for successful disease surveillance system. The strengthening of management of biological disasters is acquiring the laboratory network with standard biosafety the capability of rapid epidemiological assessment, practices would mean that selected district and identifying assessment tools such as mapping, use state level laboratories would have specific culture of Geographic Information System (GIS) and Global facilities. Positioning System (GPS), vulnerability assessment, risk analysis, and use of mathematical All the states/UTs are to be covered in a phased models. This would help in strategic decision- manner by 2009. For project implementation, making for public health interventions. ICMR is surveillance units have been set up at the central, using such tools in a limited way. GIS has also state and district levels. Surveillance committees been used to some extent in leprosy, immunisation, at the national, state and district levels would TB, and malaria programmes. monitor the project. Nine training institutes were identified to conduct training of the state and 2.4.3 Environmental Assessment district surveillance teams. Training modules have been developed for this purpose. Training of state/ Environmental assessment and strategic district surveillance teams has been completed for interventions are increasingly becoming a priority nine states in Phase-I. A total of 605 master trainers issue. Climate change is creating an enabling have been trained in 13 of the 14 Phase-II states. environment conducive for vector-borne and States are organising training programmes for zoonotic diseases. This is also due to the destruction medical officers, health workers, and laboratory of habitats of wild animals which increasingly technicians at the district and CHC/PHC levels. interface with the human population. Areas which 24
- 55. PRESENT STATUS AND CONTEXT require attention are water quality monitoring, food 2.4.5 Immunisation safety and security, vector control, animal health surveillance, sanitation and solid waste Vaccination if available against a biological management, and safe disposal of hazardous agent, can offer good protection to the ‘at-risk’ materials, including biomedical waste, etc. population. As a strategic measure, anthrax vaccine can also be given to personnel who are at high 2.4.4 Laboratory Support risk of exposure, e.g., hospital functionaries, Armed Forces personnel, first responders of NDRF, Prior to the appearance of avian influenza, the veterinarians and laboratory workers. These health sector had only one BSL-3 laboratory at NIV, practices are factored into preparedness measures. Pune. Now in addition, NICD, Delhi; Japanese Prime examples are the vaccine preparedness for Leprosy Mission for Asia (JALMA), Agra; and pandemic influenza and stockpiling anthrax and NICED, Kolkata (both ICMR institutions), have BSL- smallpox vaccines for a potential threat of 3 laboratories. Additional BSL-3 laboratories are bioterrerist attack with the smallpox virus. Anthrax being set up at the Regional Medical Research vaccine can also be administered post exposure Centre (RMRC), Dibrugarh (Assam); and King in combination with appropriate antibiotics such Institute of Preventive Medicine (KIPM), Chennai, as ciprofloxacin. Tamil Nadu, to complement the NICD/ICMR avian influenza network. BSL-3 laboratories are under 2.4.6 Chemoprophylaxis consideration for Central Research Institute (CRI), Kasauli; Haffkine Institute, Mumbai; and DRDE, Use of medication as a public health strategy Gwalior. The existing BSL-3 lab at NIV, Pune, has to prevent disease has been in practice. Stockpiling been upgraded to BSL-3+ and another BSL-4 of doxycycline for an attack of plague (natural or laboratory is being established by ICMR at Pune. terror strike), oseltamivir (Tamilflu) for avian flu and The MoA has one BSL-4 laboratory at the High rifampicin/ciprofloxacin for meningococcal Security Animal Disease Laboratory (HSADL) at meningitis are essential. With a strong Bhopal. The DADF is planning to instal four BSL-3 pharmaceutical manufacturing base, mobilisation laboratories for avian influenza and other emerging of millions of doses of chemoprophylactic agents diseases. The Centre for Molecular Biology has is possible in the Indian context at short notice. four BSL-3 laboratories and a BSL-4 laboratory is also under consideration. A portable laboratory has 2.4.7 Nutrition been developed by DRDO in collaboration with WHO and is available with NICD, Delhi, for such A factor accentuating the spread of disease in disaster situations. India is the poor nutritional standard of the population, especially children. Nutrition for Under IDSP, the laboratories within PHCs, preschool children is supported by the Integrated CHCs, district hospitals and medical colleges are Child Development Scheme, and for school going being upgraded to establish a national network of children under the midday meal programmes. laboratories. The National Laboratory Accreditation Board sets the minimum standards to be followed 2.4.8 Medical and Public Health Services by laboratories across the nation. Major issues remain regarding biosecurity, indigenous capability The network of PHCs and sub-centres is the of preparing diagnostic reagents and quality backbone of the public health system through assurance. which public health measures are instituted. The 25
- 56. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS primary health care systems interface with the capacity. In a crisis situation, there is further community and are advantageously placed to incapacitation due to tedious procurement detect early warning signs and report public health procedures. Inventory management/supply chain events. There are 23,109 PHCs providing management concepts are not followed. However, preventive, promotive and limited curative services. the Indian pharmaceutical sector is capable of The rural network of PHCs and sub-centres meeting enhanced requirements at times of such provides substantial help in biological disasters disasters. when field interventions are required. After the sporadic outbreak of avian influenza, The CHC (1/100,000 Population) is the grass- a central stockpile of PPE, ventilators, automatic root level functional hospital with 30 beds where analysers and oseltamivir has been maintained. basic specialties are envisaged. But a substantial number of CHCs do not have a full complement of NRHM (2005–12) strives to strengthen health basic specialties and the services are highly delivery at the grass-root level by placing a village skewed towards reproductive health. The district health worker, i.e., ASHA, in each village, supported hospitals, planned to provide secondary level care, by the village health and sanitation committee. The have on an average 200–250 beds but show wide PHC would have a medical officer and 24x7 inter- and intra-state variation. In some states, they services provided by nurses. The CHC would are suitable even for medical teaching/training. provide basic specialities, including 24x7 emergency services. The district hospitals are being In poorly performing states, 30–50% of the strengthened for health care delivery. Under the hospital beds are in rural hospitals, and are poorly health system projects funded by the World Bank, maintained. Even 60 years after independence, the the hospital systems at district and sub-district country cannot meet the standards set by the levels are being strengthened in terms of Mudaliar Committee in the 1950s—that of one bed infrastructure. Under the Pradhan Mantri’s per 1,000 population. Infectious diseases hospitals Swasthya Suraksha Yojna, tertiary care institutions and isolation facilities in the district hospitals, even are being strengthened. if existing, are the most neglected. Emergency support systems (including critical care support) 2.4.9 Information Technology and specialised capabilities for CBRN management in these hospitals are grossly IDSP is establishing linkages with all district inadequate/non-existent. Most district level and state headquarters, and all government hospitals, taluka hospitals and CHCs are not medical colleges on a Satellite Broadband Hybrid equipped to handle mass casualty incidents. Network. 84 sites have already been made active Emergency support systems (including critical care by the Indian Space Research Organisation and support) in these hospitals are grossly inadequate. the requisite equipment has been installed at all Another critical area in mass casualty events is the these sites. The network, on completion, will enable disposal of dead bodies. Even in the best of the 800 sites on a broadband network, 400 sites (out urban settings, these facilities are lacking. of these 800) will have dual connectivity with satellite and broadband. The National Informatics State-run hospitals have limited medical Centre (NIC) has been entrusted the task of setting supplies. Even in a normal situation, the patient up and managing of the information technology has to buy medicines. There is no stockpile of network. NIC is also establishing a ‘disease drugs, vaccines, PPE, and diagnostics for surge outbreak monitoring call centre’ that would receive 26
- 57. PRESENT STATUS AND CONTEXT disease outbreak related calls from across the 2.4.11 Community Participation country on a toll free number. The network is intended for distance learning, data transmission Presently, community participation is and video-conferencing as a part of tele-medicine inadequate in biological disasters due to the initiatives. intrinsic fear of community members of contracting the disease. However, communicating the risk, The reach of mobile telephony has changed strict following of infection control protocols and the face of telecommunication in India. Most encouragement from the government to NGOs and previously inaccessible areas are now covered by self-help groups, especially for instituting one or the other network. It is essential that there preventive measures, would ensure community be an efficient communication system, including participation. Containment of avian influenza in provision of satellite telephones, especially in Maharashtra, Gujarat and Madhya Pradesh saw inaccessible areas to support outbreak substantial involvement of the PRIs. This culture investigations and response. Establishment of has to be taken forward to involve other NGOs, Emergency Operations Centres (EOCs) at all state self-help groups, resident welfare associations, headquarters is under consideration by the vyapar mandals , etc. Areas where the district MoH&FW. authorities partner with these organisations can include health education, chlorination and water 2.4.10 Risk Communication and Creating quality monitoring, sanitation, vector control, drug Community Awareness distribution, documentation and data management during mass casualty incidences, disposal of dead The community will be greatly empowered if bodies, and provision of psycho-social care. the risk is communicated to the community. Our country has vast experience in the health sector 2.4.12 Mental Health Services and for instituting behavioural change through effective Psycho-social Care communication. Given the level of literacy in some states, communication strategies, to be successful, Disease outbreaks instil fear, cause anxiety and need planning, trained manpower, an affect a large population, and usually leave a trail understanding of communications protocols, of human agony that requires psycho-social messaging and the media, as also the ability to interventions. The country possesses rich manage the flow of information. The reach of visual experience and adequate expertise in providing and print media to a substantial section of the mental health services and psycho-social care, population ensures that messages in the context including training of manpower and service delivery. of biological disasters can be delivered to them The National Mental Health Programme has a instantaneously and further sustained through the community based approach delivering services audio/print media. Activities at the local level could through the District Mental Health Programme. include street plays, dramas, folk theatres, poster Successful community based innovative micro competitions, distribution of reading material, models at the grass-root level, incorporating school exhibitions, etc. It has been seen that contextual realities and cultural practices were creating awareness in the community not only adopted during major disasters such as the Orissa empowers them to act accordingly, but cyclone, Gujarat earthquake and more recently also alleviates fear and lessens the psychological during the Indian Ocean tsunami recovery and impact. rehabilitation process. 27
- 58. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS 2.4.13 Research and Development Tropical Diseases, Indian Veterinary Research Institute (IVRI), etc.], professional institutions and ICMR is the apex body for medical research in a large number of professionals, NGOs, regulatory India. DRDO also contributes to basic and applied bodies, experts, and stakeholders in the field of research in the biomedical field. ICMR and DRDO BDM participated in the deliberations. have established the capacity for basic and applied research in the area of molecular biology, During the workshop, the present status of the genomic studies, epidemiological, and health management of biological disasters, including BT, system research. Private establishments are in the country was discussed and important gaps excelling in the area of drugs and vaccines and were identified. The workshop also identified have established their global presence. priority areas for prevention, mitigation and preparedness of biological disasters and provided Areas requiring attention are—operational an outline of comprehensive guidelines to be research in forecasting, using trend analysis, formulated as a guide for the preparation of action mathematical modelling, GIS based modelling for plans by ministries/departments/states. molecular research on potential genetically engineered BT agents, genomic studies, specific A Core Group of Experts comprising major biomarkers, new treatment modalities and stakeholders as well as state representatives was advanced robotic tools. constituted under the chairmanship of Lt. Gen. (Dr.) J. R. Bhardwaj, PVSM, AVSM, VSM, PHS (Retd), 2.5 Genesis of National Disaster Member, NDMA to assist in preparing the Management Guidelines— Guidelines. Several meetings of the Core Group Management of Biological were held to review the draft versions of the Disasters Guidelines in consultation with concerned ministries, regulatory bodies and other stakeholders One of the important roles of NDMA is to issue to evolve a consensus on the various issues guidelines to ministries/departments and states to regarding the guidelines. During these evolve programmes and measures in their DM Plan deliberations, the core group felt that guidelines for holistic and coordinated management of for the management of plant and animal pathogens disasters as identified in the DM Act, 2005. should be taken up as a separate section in these guidelines. The various recommendations of the In this direction, a National Workshop on steering group and outcome of the workshop Biological and Chemical Disasters was convened proceedings—‘Pandemic Preparedness Beyond by NDMA at its headquarters in New Delhi between Health’, held in April 2008 were also incorporated 22–23 February 2007 as part of a nine-step in these Guidelines. participatory and consultative process to evolve the National Disaster Management Guidelines— Management of Biological Disasters. Stakeholders from various ministries/departments of GoI (Health, Home Affairs, Defence, and Agriculture), Interpol, R&D organisations/Institutes [ICMR, ICAR, CSIR, Bhabha Atomic Research Centre, NICD, DRDO, NIDM, All India Institute of Medical Sciences (AIIMS), Sir Dorabji Tata Centre for Research in 28
- 59. 3 Salient Gaps The extensive experience of dealing with biological sample transfer, biosecurity and epidemics in diverse conditions does instil biosafety of materials/laboratories. confidence in dealing with biological disasters. However, post-epidemic reviews of such situations, 3.2 Institutional Framework notably the Surat plague outbreak in 1994 and the subsequent one in Himachal Pradesh in 2001, the In the MoH&FW, public health needs to be SARS outbreak of 2003, the avian influenza outbreak accorded high priority with a separate Additional in 2006 and the Nipah outbreak in 2001 and 2007, DGHS for public health. In some states, there is a have emphasised the need to strengthen the separate department of public health. States that surveillance and public health delivery system in do not have such arrangements may also have to India. Current and emerging needs call for a take initiatives to establish such a department. The mechanism to address the health impact of climate apex institution, NICD, is not geared to address change, global warming, urbanisation, and the impact of environment changes, changing population growth, all of which may be the trigger communicable disease spectrum (emerging and and/or enabling factors for biological disasters. This re-emerging diseases), obligations under IHR chapter identifies the important gaps and scope (2005), and to make optimal use of newer for improvement in the legal, institutional and technologies. This would require a facelift in terms operational framework to institute preparedness of infrastructure and human resources. Similar and put forth robust response. public health institutions are conspicuous by their absence in most of the vulnerable states. Even the 3.1 Legal Framework best performing states do not have their own public health institution of eminence. The Epidemic Diseases Act was enacted in 1897 and needs to be repealed. This Act does not provide any power to the centre to intervene in 3.3 Operational Framework biological emergencies. It has to be substituted by an Act which takes care of the prevailing and 3.3.1 Policy and Plans foreseeable public health needs including emergencies such as BT attacks and use of At the national level, there is no policy on biological weapons by an adversary, cross-border biological disasters. The existing contingency plan issues, and international spread of diseases. It of MoH&FW is about 10 years old and needs should give enough powers to the central and state extensive revision. All components related to public governments and local authorities to act with health, namely apex institutions, field impunity, notify affected areas, restrict movement epidemiology, surveillance, teaching, training, or quarantine the affected area, enter any premises research, etc., need to be strengthened. The to take samples of suspected materials and seal preventive and social medicine departments of them. The Act should also establish controls over medical colleges which churn out postgraduates 29
- 60. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS in the speciality with focus on academics, need to there is no concept of an incident command system be oriented for public health management/ wherein the entire action is brought under the ambit administration. of an incident commander with support from the disciplines of logistics, finance, and technical For implementing IHR (2005), core capacity teams, etc. There is an urgent need for establishing needs to be developed for surveillance, border an incident command system in every district. control at ports and airports, quarantine facilities, etc. India needs to maintain a level of Unlike the Emergency Medical Relief Division epidemiological intelligence to keep a track on our (of DGHS) which coordinates and monitors all crisis adversaries’ biowarfare programmes. This applies situations, there is no such mechanism in the to terrorist outfits using available in-house facilities states. There is a need to establish EOCs in all to develop such weapons. A coordinated action state health departments with an identified nodal plan of the intelligence agencies, MoH&FW and person for coordinating a well orchestrated MoD needs to be put in place to gather intelligence response. and develop appropriate defence and deterrence strategies. One of the lessons learned during the plague outbreak in Surat in 1994 and avian influenza in In almost all the states, state policies, plans 2006 is the need to strengthen coordination with and guidelines are non-existent. Each state needs other sectors like animal health, home department, to have a public health institution which would communication, media, etc., on a continuous basis collect epidemiological intelligence, share for the management of outbreaks of this nature. information with the IDSP, provide for outbreak investigations and be capable of managing 3.3.3 Human Resources outbreaks. Within the state also it has been observed that interaction is lacking between the There is a shortage of medical and paramedical state health authorities and the local bodies, some staff at the district and sub-district levels. There is of which have enormous civic functions to perform, also an acute shortage of public health specialists, including public health. The limited capacities of epidemiologists, clinical microbiologists and the Mumbai Municipal Corporation were evident virologists. There have been limited efforts in the in the wake of floods in Mumbai in 2005, the Surat past to establish teaching/training institutions for Municipal Corporation fared no better during the these purposes. PHFI, NICD and ICMR are floods in 2006 and the plague outbreak in 1994. responsible for filling up these gaps. NICD has Under the DM Act, 2005, DDMA is the authority to started a masters course on Public Health. plan and execute the DM programme at the district However, more efforts are needed in this direction. level. In a substantial number of districts a DDMA is yet to be constituted. There have been limited efforts to train hospital managers in managing mass casualty incidents, 3.3.2 Command Control and Coordination and this was mainly from 1996 onwards through WHO projects. The emphasis was on the district At the operational level, Command and Control hospitals to have their own DM plans. (C&C) is identifiable clearly at the district level, where the district collector is vested with certain 3.3.4 Surveillance powers to requisition resources, notify a disease, inspect any premises, seek help from the Army, The IDSP does not reach the grass-root level state or centre, enforce quarantine, etc. However, and hence needs to be restructured. It should have 30
- 61. SALIENT GAPS international networkingwith generic or disease A need also exists for strengthening the specific networks (FluNet, Dengue Net, etc.) which networking of laboratories so that their expertise presently do not exist. This would facilitate global can be utilised quickly. During the plague outbreak monitoring of emerging and re-emerging diseases. in 1994, isolated strains had to be processed in Environmental surveillance and animal health international reference laboratories because of surveillance needs to be an integral part of the inadequate laboratory facilities. Since then a lot of IDSP Areas which require attention are water . progress has been made. Today, the country has quality monitoring, food safety and security, vector the capability of doing viral characterisation through control, zoonotic sanitation and solid waste genomic studies. Some laboratories under ICMR management, safe disposal of hazardous materials, are of international standards. The identification including biomedical waste, etc. and development of at least one central reference laboratory to the standards of a WHO reference The project should imbibe operational research laboratory for influenza or HIV, is essential. tools such as mapping, use of GIS and GPS, vulnerability assessment, risk analysis and use of 3.3.6 Primary Health Care mathematical models. Simple issues such as case definitions and epidemics, threshold levels need A network of sub-centres, PHCs and CHCs is to be established or adapted to suit Indian the backbone of primary health care which is requirements. As of now the system is not able to fundamental for detecting early warning signs of detect early warning signs and generate data from any impending outbreak in the community and which epidemiological intelligence can be instituting public health measures at the community extracted and used in decision-making. A reason level. At the village level, informed health workers for the spread of the Surat plague was the failure are needed to keep a watch on adverse health to detect early warning signs due to sudden events. NRHM is yet another valiant attempt at ecological changes that might have created a establishing an ASHA worker in each village. Two spillover of sylvatic plague into the domestic years into the project, ASHA workers are yet to environment, as had happened following the 1993 take root. earthquake in Maharashtra. Failing to establish village health workers, the 3.3.5 Laboratories sub-centres (one for 5,000 population) manned by MPWs/ANM are the existing first level of contact Biosafety laboratories are required for the between a health functionary and the community. prompt diagnosis of the agents for effective There are 142,655 sub-centres with about 2.1 lakh management of biological disasters. There is no health workers. There is almost 50% vacancy in BSL-4 laboratory in the human health sector. BSL- the position of male health workers. As BDM 3 laboratories are also limited. Major issues remain requires community based surveillance and case regarding biosecurity, indigenous capability of management, the health workers are the mainstay. preparing diagnostic reagents and quality Using the existing manpower would affect other assurance. There is need for using sophisticated functions assigned to them such as immunisation real time PCR methods for rapid diagnosis of and maternal health. A substantial number of CHCs biological agents through environmental sampling, do not have a full complement of basic specialties. particularly those that have the potential to be used For all PHCs and CHCs, the district hospital is the as agents of BT. Other areas that need to be first referral hospital for providing secondary care. strengthened include developing DNA probes, Most district level hospitals, taluka hospitals and sensors, markers, etc. CHCs are not equipped to handle mass casualty 31
- 62. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS incidents. Isolation facilities and critical care in the catchment areas of nuclear facilities). These facilities are lacking in them. In poorly performing hospitals have a significant scope for expansion states, 30–50% of their beds are in rural hospitals and advancement. All hospitals are required to which are poorly maintained. Specialised adopt procedures of quality accreditation. On the capabilities for CBRN management in these other hand, the country has world-class hospitals hospitals are grossly inadequate/do not exist. in the private sector. Their interface with the government and their utilisation in managing mass 3.3.7 Transportation casualty incidents need to be strengthened. As on date, all modes of transport are used in The major pillars for supporting effective mass the event of disasters, be it personal vehicles, casualty management that need to be trucks, tractors, tempos or even bullock carts. strengthened include pre-hospital care, pre- established incident command system, The major gaps are as follows: harmonisation of the concept of triage, communication network, transportation of mass i) Lack of an Integrated Ambulance Network casualties and upgradation of a medical setup to (IAN) and there is no ambulance system handle mass casualties. with advanced life-support facilities that is capable of working in biological disasters. 3.3.9 Stockpile of Drugs/Vaccines/ ii) Sub-optimal usage of resources in the Disinfectants/Insecticides/PPE private sector. iii) No accreditation/standard for ambulances State-run hospitals have limited medical in India. supplies. Even in normal situations, a patient has to buy medicines. There is no stockpile of drugs, 3.3.8 Hospital Facilities important vaccines like anthrax vaccine, PPE or diagnostics for surge capacity. In a crisis situation Health care facilities are mainly restricted to there is further incapacitation due to tedious urban areas and there is a palpable urban–rural procurement procedures. Inventory management/ divide as only 10.3% medical beds are available supply chain management concepts are not for 70% of the rural population. An estimate of the followed. Protection, detection, decontamination World Health Report indicates the requirement of equipment are not available with most first 80,000 beds every year for the next five years that responders. Decontamination, decorporation and can be fulfilled only with the proactive involvement CBRN treatment modalities are also grossly of private players in the medical field. inadequate. Government hospitals/medical college 3.3.10 Psycho-social Care hospitals in major cities and state capitals have, on an average, more than 500 beds. Such facilities There are some critical deficiencies in the are available, within 100–150 km in the better provision of psycho-social care. The routine training performing states. Even in these hospitals of medical undergraduates, nurses and health emergency departments/critical care facilities are workers for mental health services is grossly inadequate. However, surge capacity exists to inadequate. There is virtually no emphasis on the manage mass casualty incidents but they are not mental health aspects of disasters even in the equipped to handle CBRN disasters (except those routine postgraduate training in psychiatry. 32
- 63. SALIENT GAPS Although there have been efforts to provide communication materials and media plans are to community based psycho-social care during the be worked out in advance. early phases after a disaster, these services are usually withdrawn within a few weeks/months. The 3.3.13 Community Participation and the Role essence of any psycho-social care is the training of NGOs of community workers to meet the needs of the community and this needs to be built into the An empowered community contributes to system as a measure of all-time preparedness. community action which is of prime importance in managing biological disasters. NGOs have been 3.3.11 Training very active in mass casualty incidents such as earthquake, tsunami, fire, etc., however, this There is a need to create public health teaching voluntarism is missing when it comes to biological and training institutions in every state. Field disasters. Perhaps, the fear of acquiring the epidemiology training for public health disease keeps the community and the NGOs at professionals and training for field workers needs bay. to be augmented to make the field staff fully competent to support outbreak investigation and 3.3.14 Role of the Media response. There is need to identify and train RRTs in all the districts to respond to any threat of The role of the media is very important. They outbreak. The training programmes in BDM are are often not provided with the correct information, inadequate for doctors, nurses and paramedics. resulting in the spread of incorrect information The orientation of clinical doctors to the detection which adds to the panic. The media should be of suspected cases and detection of early warning used constructively to educate the community in signals of disease may help in instituting rapid recognising symptoms and reporting them early if response to an outbreak situation. This requires found. The cooperation of the community may be preparation of guidelines/standard treatment ensured through judicious handling of the media. protocols and wider dissemination of the same. Web based resource networks and knowledge 3.3.15 Documentation networks need to be created for easy access to all stakeholders. The areas of research and documentation need to be conceptualised and practiced all across the 3.3.12 Risk Communication nation. The practice of documenting disease outbreaks and its scientific analysis is lacking in During the plague outbreak in Surat, there was the country. There may be success stories which if a mass exodus of people from the affected areas. documented and analysed may become best The outbreak affected trade and tourism. Similarly, practices that can be adopted globally. during the avian influenza outbreak among poultry in 2006, people stopped eating chicken, leading 3.3.16 Financial Resources to a downturn in the poultry industry. Effective communication of the risks to the community DM has earmarked funds for emergency empowers them to mitigate the risk. The available response which the state can operate, namely the print and visual media need to be put to use for Calamity Relief Fund (CRF) and the National effective communication. Appropriate Calamity Contingency Fund (NCCF). However, the 33
- 64. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS disasters for which CRF and NCCF can be utilised be brought under the purview of CRF/NCCF. Also, are defined. Biological disasters do not fall into under the provisions of the DM Act, 2005, the this category. The states have no other funds which National Disaster Response Fund will be created, can be utilised for the containment of outbreaks. and adequate funds will also be earmarked for the This has to be corrected. Biological disasters must containment of biological disasters from this fund. 34
- 65. 4 Guidelines for Biological Disaster Management DM involves a planned and systematic 4.1 Legislative Framework approach towards understanding and solving problems in the wake of a disaster. Biological The policies, programmes and action plans disasters, be they natural or man-made, can be need to be supported by appropriate legal prevented or mitigated by proper planning and instruments, wherever necessary, for effective preparedness. The Guidelines will address all management of biological disasters. The important aspects of BDM, including prevention, mitigation, means to develop a robust though flexible legal preparedness, response, relief, rehabilitation and framework include: recovery. All important stakeholders including MoH&FW for natural biological disasters, MHA for 4.1.1 Legal Framework BT, MoD for BW, and MoA for animal health and i) It includes implementation of IHR (2005) agroterrorism, along with the community, medical which is needed for prevention, mitigation care, public health and veterinary professionals, and control of the spread of diseases etc., shall prepare themselves to achieve this internationally. objective. All concerned central ministries and departments of health in the states will prepare for ii) The legal instruments are required to the management of biological disasters based on support the operational framework for the Guidelines and will constitute the national managing prevailing and foreseeable public resource for management of mass casualty events health concerns such as BT attacks, use of arising out of biological disasters, including warfare biological weapons by adversaries and and terrorism. The nodal ministry shall also lay down cross-border issues. clear policies and plans including appropriate legal, iii) Enough power will be given to the central institutional and operational framework that government, state governments and local addresses all aspects of DM. The preparedness authorities to act with impunity, notify the and response plan is to be prepared at the affected area, restrict movements or centre, state and district levels with the role quarantine the affected area, enter any and responsibilities of various stakeholders premises to take samples of suspected clearly defined. Disaster plans will be prepared materials and seal them. by the nodal central ministries, state and iv) The Act will also establish controls over district authorities on the basis of the biological sample transfer, biosecurity and guidelines issued by the national and state biosafety of materials/laboratories. authorities. Sectoral coordination would ensure appropriate communication, command and For achieving the above objectives, the control. existing Acts, rules, regulations, etc., at various 35
- 66. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS levels will be reviewed and amended by the nodal MHA as the nodal ministry for handling it. ministry/state governments/local authorities, and The management structure needed to new Acts enacted and Rules laid down to achieve the expected results will be strengthen the management of biological disasters identified and strengthened. This may be at the centre, state and district levels. in the form of an appropriate crisis management structure, committees, task 4.1.2 Policy, Programmes, Plans and forces and technical expert groups within Standard Operating Procedures the ministry. iii) The public health division in DGHS needs The concerned ministries would evolve plans to be strengthened and the responsibility for prevention, mitigation, preparedness and for developing technical expertise should response to biological disasters based on the be vested with an officer of appropriate guidelines prepared by the national authorities. The seniority. programmes and plans to achieve the objectives set in the policy would be laid down with A public health institution of eminence, appropriate budgetary provisions. matching international standards needs to be created, for which the following measures are Health is a state subject. The primary required: responsibility of managing biological disasters vests with the state government. The central i) The existing apex institution, NICD, will be government would support the state in terms of strengthened to address the impact of guidance, technical expertise, and with human and environment changes, the changing material logistic support. All the states will develop communicable disease spectrum their own policies, plans and guidelines for (emerging and re-emerging diseases), BT managing biological disasters in accordance with and meeting obligations under IHR (2005). the national guidelines and those laid down by This would require a facelift in terms of SDMAs. infrastructure and human resource inputs. ii) All existing public health institutions 4.1.3 Institutional and Operational providing technical expertise in the area of Framework field epidemiology, surveillance, teaching, training, research, etc., need to be The MoH&FW would continue to be the nodal strengthened. For implementing IHR (2005), ministry for managing biological disasters. core capacity needs to be developed for surveillance, border control at ports and The institutional and operational framework airports, quarantine facilities, etc. includes: iii) Each state will strengthen its public health i) NCMC and NEC will coordinate all the infrastructure, including public health disasters including those of biological institutions which would collect origin. The secretaries of NDMA and all epidemiological intelligence, share important ministries, including the nodal information with IDSP provide for outbreak , ministry, will be members of these investigations and manage outbreaks. committees. iv) Hospitals will develop capabilities to attend ii) The intelligence and deterrence required for to mass casualties and public health handling BT calls for an appropriate role of emergencies with isolation facilities. In the 36
- 67. GUIDELINES FOR BIOLOGICAL DISASTER MANAGEMENT districts, DDMAs will provide the requisite 4.2.1 Vulnerability Analysis and Risk management structure for district DM, Assessment factoring in the requirements for managing biological disasters. Vulnerability analysis and risk assessment needs to be carried out at the macro and micro v) The strategic approach for management of levels for existing diseases with epidemic potential, biological disasters given in the preceding emerging and re-emerging diseases, and zoonotic points would only succeed with responsible diseases with potential to cause human diseases, participation of the government, private etc., so that appropriate preventive strategies and sector, NGOs and civil society. preparedness measures explained in the foregoing paragraphs are instituted appropriately. A sound infrastructure is necessary for medical countermeasures, creating awareness among the Important buildings and those housing vital public, raising human resources, logistic support installations need to be protected against biological and R&D for evolving novel technologies. agents wherever deemed necessary. This may be done through security surveillance, prevention, and 4.2 Prevention of Biological restricting the entry to authorised personnel only Disasters by proper screening, and installing High Efficiency Particulate Air (HEPA) filters in the ventilation Prevention and preparedness shall focus on systems to prevent infectious microbes from the assessment of biothreats, medical and public entering the circulating air inside critical buildings. health consequences, medical countermeasures and long-term strategies for mitigation. The Those exposed to biological agents may not important components of prevention and come to know of it till symptoms manifest because preparedness would include an epidemiological of the varied incubation period of these agents. A intelligence gathering mechanism to deter a BW/ high index of suspicion and awareness among the BT attack; a robust surveillance system that can community and health professionals will help in detect early warning signs, decipher the the early detection of diseases. epidemiological clues to determine whether it is an intentional attack; and capacity building for When exposure is suspected, the affected surveillance, laboratories, and hospital systems that persons shall be quarantined and put under can support outbreak detection, investigation and observation for any atypical or typical signs and management. A multi-sectoral approach will be symptoms appearing during the period of adopted involving MoH&FW, MHA, Ministry of observation. Health professionals who are Social Welfare, MoD and MoA. A biological disaster associated with such investigations will have response plan is to be evolved based on this adequate protection and adopt recognised strategic approach by the nodal ministry. universal precautions. It often may not be possible Preventive measures will be useful in reducing to evolve an EWS. However, sensitisation and vulnerability and in mitigating the post-disaster awareness will ensure early detection. consequences. Pre-exposure immunisation (preventive) of first responders against anthrax and It is pertinent to develop adequate counter- smallpox must be done to enable them to help terrorism measures against BT activities of terrorist victims post-exposure. The important means for groups by deterrents such as destruction of their prevention of biological disasters include the funding mechanisms and continuing surveillance following: at all levels. 37
- 68. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS 4.2.2 Environmental Management management programme. The important components of vector control programmes Disease outbreaks are mostly due to are: waterborne, airborne, vector-borne and zoonotic a. Environmental engineering work and diseases. Environmental monitoring can help generic integrated vector control substantially in preventing these outbreaks. measures. Integrated vector management also needs environmental engineering for elimination of b. Elimination of breeding places by breeding places, supported with biological and water management, draining of chemical interventions for vector control. Biological stagnant pools and not allowing water events with mass casualty potential may result in to collect by overturning receptacles, a large number of dead bodies requiring adequate etc. disposal procedures. The following measures will c. Biological vector control measures help in the prevention of biological disasters: such as use of Gambusia fish, is an i) Water supply important measure in vector control. A regular survey of all water resources, d. Outdoor fogging and control of vectors especially drinking water systems, will be by regular spraying of insecticides. carried out by periodic and repeated e. Keeping a watch on the rodent bacteriological culture for coliform population and detection of early microbes. In addition, proper maintenance warning signs such as sudden fall in of water supply and sewage pipeline will their numbers could preempt a plague go a long way in the prevention of biological epidemic. Protection against rodents disasters and epidemics of waterborne can be achieved by improving origin such as cholera, hepatitis, diarrhoea environmental sanitation, storing food and dysentery. in closed containers and early and safe ii) Personal hygiene disposal of solid wastes. Killing of rodents associated with diseases such Necessary awareness will be created in the as plague and leptospirosis would community about the importance of require the use of rodenticides like zinc personal hygiene, and measures to achieve phosphides, digging and filling up of this, including provision of washing, burrows, etc. cleaning and bathing facilities, and avoiding overcrowding in sleeping quarters, iv) Burial/disposal of the dead etc. Other activities include making Dead bodies resulting from biological temporary latrines, developing solid waste disasters increase risk of infection if not collection and disposal facilities, and health disposed off properly. Burial of a large education. number of dead bodies may cause water iii) Vector control contamination. With due consideration to the social, ethnic and religious issues Vector control is an important activity which involved, utmost care will be exercised in requires continuous and sustained efforts. the disposal of dead bodies. Cooperation of the community is very essential for a successful integrated vector 38
- 69. GUIDELINES FOR BIOLOGICAL DISASTER MANAGEMENT 4.2.3 Prevention of Post-disaster Epidemics with information shared at the various levels of the health care system. Information of epidemics can India needs to maintain the necessary level of be anticipated much in advance where epidemiological intelligence to pick up early epidemiologic assessment of surveillance data warning signals of emerging and re-emerging exists. diseases of epidemic/pandemic potential. This i) The existing Integrated Disease Surveillance would also require advance knowledge of the System will be rapidly expanded to cover activities of our adversaries in developing a the entire country. potential BW ensemble and its potential use during war and by terrorist outfits using available in-house ii) The state and district IDSP units will be facilities to develop such weapons. A coordinated trained to acquire the capabilities of using action plan of the intelligence agencies, MHA, standard case definition, regular data MoH&FW and MoD will be developed and put in collection and analysing data to detect early place to gather intelligence and develop warning signs and take actions to mitigate appropriate deterrence and defence strategies. any outbreak. i) The risk of epidemics are higher after any a. The state epidemiological cell under type of disaster, whether natural or man- DGHS will develop a simple format, made. These include waterborne diseases depending upon the level of such as diarrhoea/dysentery, typhoid and knowledge at each level on which data viral hepatitis, or vector-borne diseases will be collected daily. such as scabies and other skin diseases, b. Irrespective of the data collected, the louse-borne typhus and relapsing fever. basic principle of surveillance will ii) In certain natural disasters like floods, remain the same, i.e., use of standard earthquakes, etc., disturbance of the case definition, maintaining regularity environment increases the risk of rabies, of the reports and taking action on the snake bites and other zoonotic diseases. reports. Preventive measures will be taken to deal iii) The surveillance could be active, passive, with such eventualities by keeping reserves laboratory based or sentinel (collecting data of adequate stocks of anti-rabies vaccine from identified sentinel sites such as and anti-venom serum. hospitals or health centres), or a combination of all of these to suit public 4.2.4 Integrated Disease Surveillance health requirements. Systems iv) Surveillance at airports, ports and border The IDSP will be operationalised at all district crossings will be strengthened with levels to detect early warning signals for instituting appropriate controls. IDSP needs to network appropriate public health measures. The with international surveillance networks such surveillance team will monitor the probable sources, as GOARN, with support from WHO. modes of spread, and investigate the epidemics. Stringent inspection methodologies will also The surveillance programme will also be integrated be made. The list of biological agents for with the chain of laboratories of GoI including export control as identified by the Australia DRDO, ICMR, AFMS, and state governments/ Group is given as a ready reference on their private laboratories. There is an urgent requirement website (www.australiagroup.net/en/ of such systems to perform real-time monitoring biological_agents.html). 39
- 70. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS v) Detection and containment of an outbreak vi) Rapid Response Teams (RRTs): There will would entail four basic steps: be RRTs at the national, state and district a. Recognition and diagnosis by primary levels who would be trained under IDSP . health care practitioners: Medical If the disease is suspected to be of vector clinicians, including private borne origin the RRT would comprise of an practitioners, will report any unusual epidemiologist/public health specialist, incidence of infectious disease or physician, paediatrician, microbiologist (or syndrome (an undiagnosed cluster of trained pathologist), and entomologist. Any symptoms) with similar symptoms. outbreak at the district level will be Clinical laboratories would then investigated by the district RRT and attempt to identify the disease causing depending upon the report, the state/ agent from the patient’s blood, urine national RRT will be deployed. The RRT or other specimens. will be well-versed with the natural history of the disease as also in interpreting the b. Communication of surveillance epidemiological clues that would suggest information to public health authorities: an intentional outbreak. Physicians and infectious diseases specialists who detect any unusual vii) Confirmation of the specific type of pattern of disease incidents, such as microorganism(s) by the laboratory several patients with the same network. symptoms, shall report their viii) The emerging threats of Methicillin- observations to local or state public Resistant Staphyllococcus aureus (MRSA) health departments. will also be included in the surveillance c. Epidemiological analysis of the programme. surveillance data: Epidemiologists from the health department shall Confirming the type of microorganism causing interpret the surveillance data to make the disease and testing its sensitivity to different a tentative diagnosis and determine drugs is necessary for the management of the source of the outbreak, the mode biological disasters. Therefore, it may be necessary of transmission and the extent of to identify specific laboratories that are capable of exposure. They would then make supporting the integrated surveillance system. recommendations for appropriate treatment and public health measures Disasters such as floods, cyclones, tsunamis to contain the outbreak. The role of and earthquakes require active event based private care providers shall also be surveillance to be established for detection of early defined. warning signals. The existing state epidemiology d. Delivery of appropriate medical cell/IDSP unit will be equipped with such treatment and public health measures: surveillance systems if need be. MoH&FW will Infected individuals need to be depute RRTs, which will establish a post-disaster treated. Quarantine and vaccination of surveillance mechanism till such time recovery their contacts and possibly exposed takes place which can take four to six months. persons would be needed in situations Special attention will be given to disease/injury where secondary spread is surveillance, water quality monitoring and vector anticipated. surveillance. 40
- 71. GUIDELINES FOR BIOLOGICAL DISASTER MANAGEMENT 4.2.5 Pharmaceutical Interventions: Hemorrhagic Fevers (VHFs) spread readily Chemoprophylaxis, Immunisation and from person to person by respiratory Other Preventive Measures aerosols and require more than standard infection control precautions (gown, mask i) Health care workers will be equipped with with eye shield, gloves). Recognition of the gloves, impermeable gowns, N-95 masks clinical syndromes associated with various or powered air-purifying respirators. They biological disaster agents will be useful tools must clean their hands prior to donning PPE for physicians to identify early victims and for patient contact. After patient contact, recognise patterns of disease. In general, they must remove the gown, leg and shoe tularemia, plague and anthrax cause covering, gloves, clean hands immediately, respiratory pneumonia like illnesses. Plague then proceed to the removal of facial would most likely progress very rapidly to protective equipment (i.e., personal severe pneumonia with copious watery or respirators, face shields, and goggles) to purulent sputum production, hemoptysis, minimise exposure of their mucous respiratory insufficiency, sepsis and shock. membranes with potentially contaminated Inhalational anthrax would be differentiated hands. After the removal of all PPE they by its characteristic flu like symptoms, must clean their hands again. radiological findings of prominent All manufacturers of antibiotics, symmetric mediastinal widening and chemotherapeutics and anti-virals will be absence of bronchopneumonia. Also, listed and their installed capacity anthrax patients would be expected to ascertained. The centre/state governments develop fulminating, toxic, and fatal illness will ensure availability of all such drugs and despite antibiotic treatment. Milder forms anti-toxins that are needed to combat a of inhalational tularemia could be clinically biological disaster. State governments would indistinguishable from Q fever. Medical also enter into annual rate contracts for all personnel taking care of these patients will such essential drugs that are required for wear a HEPA mask in addition to standard managing biological disasters. Drugs that precautions pending the results of a can be used for mass chemoprophylaxis complete evaluation. Involvement of will be stocked. Medical stores/ meteorological expertise will be needed to organisations/depots will be identified in track aerosol clouds. each state that will follow scientific inventory iii) Recognition of the clinical syndromes management for keeping a minimum stock associated with viruses causing VHFs such of identified drugs and vaccines. Such as Filoviridae: Ebola and Marburg, centres will also stockpile requisite Arenaviridae: Lassa fever and New World quantities of PPE, laboratory reagents, Arena viruses, Bunyaviridae: Rift Valley diagnostics and other consumables. fever, Flaviviridae: yellow fever, Omsk ii) Aerosols are the most common method of hemorrhagic fever and KFD. Symptoms delivery for biological agents. This is include high fever, headache, malaise, because the most lethal biological agents arthralgias, myalgias, nausea, abdominal (anthrax, plague, smallpox and tularemia) pain, and non-bloody diarrhea; temperature are efficiently delivered by aerosol methods. >101°F (38.3°C) of >3 weeks duration; Of the potential biological disaster agents, severe illness, and no predisposing factors only plague, smallpox, and Viral for hemorrhagic manifestations; and at least 41
- 72. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS two of the following hemorrhagic symptoms: Zoonotic transmission of biological agents hemorrhagic or purple rash, epistaxis, to humans is another likely possibility. haematemesis, hemoptysis, blood in stools Brucelloisis, glanders and melioidosis affect in the absence of any other established domestic and wild animals which, like alternative diagnosis. humans, acquire the diseases from inhalation or contaminated injuries. Natural iv) Biotoxins generated from various microbial reservoirs for Q fever include sheep, cattle, agents have the potential to contaminate goats, cats, certain wild animals (including water and food and could be easily rodents), and ticks. Humans become implanted in large populations through this infected with F tularensis by various modes, mode. Therefore, it is necessary to have including bites by infective arthropods, sufficient checks at places where these handling infectious animal tissues or fluids, sources are located. There will be an direct contact with or ingestion of adequate on-site contingency plan to contaminated water, food or soil, and detect any escape and arrangements for inhalation of infective aerosols. Plague warning. occurs most commonly in humans when v) Chemotherapy: Doxycycline is considered they are infected by fleas. VHFs are an initial chemoprophylactic broad- transmitted to humans via contact with spectrum drug of choice in cases of infected animal reservoirs or arthropod respiratory illnesses due to strains of vectors. Adequate preventive measures Bacillus anthracis, Yersinia pestis, such as PPE will be adopted. Francisella tularensis, Coxiella burnetii and vii) Legitimate access to important research Brucellae. Other tetracyclines and and clinical material must be preserved. fluoroquinolones might also be considered. Prevention of unauthorised entry/exit of There is no approved anti-viral drug for the biological materials can be achieved by treatment of VHFs. However ribavirin will adopting adequate detection methods such be considered initially as an anti-viral agent as x-rays and other scanning methods to of choice in an outbreak due to VHFs. There identify microorganisms, plant pathogens is no effective post-exposure prophylaxis and toxins at international airports, ports, available in the form of vaccines or anti- etc. Suitable assessment of the personnel, viral drugs. Vaccinations are currently security, specific training and rigorous available for anthrax, tularemia, plague, Q adherence to pathogen protection fever and smallpox. Immune protection procedures are reasonable means of against ricin and staphylococcal toxins may enhancing biosecurity. All such measures be feasible in the near future. People must be established and maintained considered potentially exposed to VHFs and through regular risk and threat assessments, all persons in contact with the patients reviews and updating of procedures. diagnosed with VHF will be placed under Checks for compliance with these medical surveillance which will continue for procedures with clear instructions on roles, 21 days after the deemed potential responsibilities and remedial actions will be exposure of the patients. integral to biosafety programmes and vi) It is possible that more than one means of national standards for biosecurity. The delivery and several agents may be present subject is of prime importance and is dealt simultaneously in a biological disaster. with in detail, in Chapter 5. 42
- 73. GUIDELINES FOR BIOLOGICAL DISASTER MANAGEMENT viii) Immunisation/vaccination programmes reducing direct contact with patients. Social distancing measures such as closure of schools, India has a sizeable capability, built over offices and cinemas is recommended to prevent the years, for implementation of its universal the gathering of large numbers of people at one immunisation programme for six vaccine place. Further, there could be a ban on cultural preventable diseases. It is capable of mass events, melas, etc. Entry to railway stations and vaccination campaigns in disaster settings. airports could be restricted. There is evidence to Mass vaccination campaigns and suggest that social distancing measures, if properly prophylaxis programmes could be useful applied, can delay the onset of an epidemic, when indicated in diseases like tetanus, compress the epidemic curve and spread it over a measles, typhoid, cholera, viral hepatitis, longer time, thus reducing the overall health impact. etc. Appropriate influenza vaccination, Social distancing measures, if required to be depending on the causative strain, may be implemented in the context of an epidemic, may considered when the situation demands it. be voluntary or legally mandated. In either case, Such campaigns may be required in the public will be made aware of the action taken pandemic influenza and BT attacks using and its purpose. smallpox virus or for any other emerging bacterial or viral etiologies. MoH&FW will (B) Disease Containment by Isolation and lay down a clear vaccination policy, have a Quarantine Methodologies stockpile of vaccines, identify and train the vaccinators and have cold chain The spread of communicable diseases in many management. Capacity will be developed conditions can be controlled or prevented by in the pharmaceutical sector for creating a isolation and quarantine, thereby reducing direct viable high-tech infrastructure for vaccine contact with patients. Other preventive measures research and production. Immunisation are vector control, rodent and mosquito control, programmes under continuous monitoring and food and environmental control. It includes: : and reporting mechanisms will be an i) Isolation refers to isolating suspected cases effective preventive strategy. The details of in hospital settings. In the case of biological immunoprophylactic and chemoprophylactic disasters such as pandemic influenza which therapies to be administered during affects millions, home isolation may have epidemiological out-breaks and biological to be recommended to those who can be disasters are shown in Annexure-B treated at home. (Reference: http://www. usamriid.army.mil/ education/bluebook.html). ii) Quarantine refers to not only restricting the movements of exposed persons but also Specific immunisation programmes will be the healthy population beyond a defined initiated for laboratory personnel who are geographical area or unit/institution (airport likely to come in contact or work with and maritime quarantine) for a period in infectious agents. excess of the incubation period of the disease. Restrictions in the movement of 4.2.6 Non-pharmaceutical Interventions the affected population is an important (A) Social Distancing Measures method to contain communicable diseases. The status of the law and order mechanism Spread of communicable diseases in many of the state and district is an important factor conditions can be controlled or prevented by in helping health authorities in this regard. 43
- 74. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS The precautions to be undertaken while iii) It may be necessary to develop a system isolating patients of biological disasters are of inventory for effective contingency provided in Annexure-C. planning. Bacteria and toxins are frequently exchanged between countries for research 4.2.7 Biosafety and Biosecurity Measures and training programmes. Though there is a system of checks for bulk import, small Strict compliance with biosafety and amounts of organisms packed in small biosecurity provisions at all levels will deny the containers can easily be brought into the possibility of terrorists reaching facilities where such country. The existing system designed to microorganisms are stocked and available. This control these exchanges will be examined, will act as a second layer of defence and reduce strengthened and implemented properly. the possibility of any bioterrorist activity. The important components of biosafety and biosecurity Issues regarding biosafety and biosecurity measures are explained below. measures are dealt with in detail in Chapter 5. i) Microorganisms are handled extensively in medical, agricultural and veterinary fields 4.2.8 Protection of Important Buildings and and in research laboratories. They are also Offices used for the preparation of enzymes, sera and reagents which have commercial value Protection of important buildings against and are handled exclusively by commercial biological agents wherever deemed necessary, can manufacturers. Any contingency plan would, be done by preventing and restricting entry to therefore, remain incomplete unless all such authorised personnel only, by proper screening. organisations/institutions where they are Installing HEPA filters in the ventilation systems of handled are also brought within its purview. the air conditioning facilities will prevent infectious There must be a system for inventory control microbes from entering the air circulating inside in the laboratories dealing with bacteria, critical buildings. The post-exposure approach will viruses or toxins which can be a source of include effective decontamination and safety potential causative agents for biological procedures. disasters. Therefore, specific information about organisms and toxins handled in 4.3 Preparedness and Capacity different laboratories will be documented Development by the respective laboratories/organisations and secured. Preparedness will focus on assessment of ii) Within the laboratory, dangerous pathogens biothreats, medical and public health must be housed inside secure incubators, consequences, medical countermeasures and refrigerators or storage cabinets when not long-term strategies for mitigation. An important in use. For research and clinical aspect of medical preparedness in BDM includes laboratories, the laboratory supervisor will the integration of both government and private be responsible for establishing a method sectors. A sound infrastructure is necessary both for identifying authorised users of the for medical countermeasures and R&D for evolving laboratory and for establishing effective novel technologies. The important components of mechanisms for controlling access to the preparedness include planning, capacity building, laboratory and detection of unauthorised well-rehearsed hospital DM plans, training of individuals. doctors and paramedics, and upgradation of 44
- 75. GUIDELINES FOR BIOLOGICAL DISASTER MANAGEMENT medical infrastructure at various levels to reduce for the establishment of a well-focused and morbidity and mortality. A multi-sectoral approach functional organisation and the creation of a will be adopted to deal with any outbreak of supportive socio-political environment. Attention is infectious diseases—for this the involvement of to be given to the development of infrastructural MoH&FW, MHA, Ministry of Social Justice and facilities in terms of trained manpower, mobility, Empowerment, MoD and MoA is essential. A connectivity, knowledge enhancement and biological disaster response plan is to be evolved scientific up-gradation for all stakeholders on the basis of the national guidelines with due concerned with the management of biological participation of health officials, doctors, various disasters. Capacity development is an important private and government hospitals, and the public component of preparedness for the management at the national, state and district levels. There is of biological disasters which includes the following: need to establish institutes similar to NICD in each state of the country. Central and state government (A) Human Resource Development health departments also need to be equipped with i) The DHO will establish a centralised system state-of-the-art tools for rapid epidemiological for data collection from village to sub-centre investigation and control of any act of BT. The level by the village health guide, from sub- important components of preparedness are centre to PHC level, and from PHC to DHO discussed in the ensuing paragraphs. by the PHC in-charge. The development of a simple format to collect this information 4.3.1 Establishment of Command, Control from lower level, PHC, district, state and and Coordination Functions central level will also be made. The DHO, in consultation with the state At the operational level, C&C is clearly epidemiological cell, will develop a simple identifiable at the district level, where the district format for daily data collection, depending collector is vested with certain powers to requisition upon quantum of information available at resources, notify diseases, inspect any premises, each level. This format must be simple and seek help from the Army, state or centre, enforce informative. quarantine, etc. The incident command system needs to be encouraged and instituted so that the ii) Control rooms will be nominated/ overall action is brought under the ambit of an established at different levels in order to incident commander who will be supported by get all the relevant information and transmit logistics, finance, and technical teams etc. The it to the concerned official. The addresses Emergency Medical Relief Division (of DGHS) at and telephone numbers of the district the centre coordinates and monitors all crisis collector, DHO, hospitals, specialists from situations. Such a mechanism needs to be various medical disciplines like paediatrics, developed in the states also. EOCs will be anaesthesia, microbiology etc., and a list established in all the state health departments with of all stakeholders from the private sector an identified nodal person as Director (Emergency will be available in the control room. Medical Relief) for coordinating a well orchestrated iii) The shortfall of public health specialists, response. epidemiologists, clinical microbiologists and virologists will be fulfilled over a 4.3.2 Capacity Development stipulated period of time. Teaching/training institutions for these purposes will be Capacity development requires the all-round established. Till then PHFI, NICD and ICMR development of human resources and infrastructure will fill this gap to some extent. The 45
- 76. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS microbiology and preventive and social v) Selected hospitals will develop training medicine departments of medical colleges modules and standard clinical protocols for would orient their teaching/training towards specialised care, and will execute these public health management/administration. programmes for other hospitals. Table-top This calls for a review of the curriculum of exercises using different simulations will be public health teaching at the graduate and used for training at different levels followed postgraduate levels by the Medical Council by full-scale mock drills twice a year. of India. The immediate deficiency of vi) A district-wise resource list of all the specialists will be met by conducting short- laboratories and handlers who are working term training courses for medical officers. on various types of pathogenic organisms and toxins will be prepared. (B) Training and Education vii) BDM related topics will be covered in the i) The necessary training/refresher training will various continuing medical education be provided to medical officers, nurses, programmes and workshops of educational emergency medical technicians, institutions in the form of symposia, paramedics, drivers of ambulances, and exhibition/demonstrations, medical QRMTs/MFRs to handle disasters due to preparedness weeks, etc. The Dos and natural epidemics/BT. Don’ts for various natural and man-made ii) It is important that medical and public disasters are to be made as a part of health specialists are able to identify the community education programmes. epidemiological clues that differentiate a viii) Biological disaster related education shall natural outbreak from an intentional one. In be given in various vernacular languages. view of this, structured BT related education Simple exercise models for creating and web-based training will be given for awareness will also be formulated at the greater awareness and networking of district level. knowledge so that they are able to detect early warning signs and report the same to ix) Biological disaster plans will be rehearsed the authorities, treat unusual illnesses, and as a part of training every six months. undertake public health measures in time x) Knowledge of infectious diseases, to contain an epidemic in its early stage. epidemics and BT activities will be iii) Refresher training will be conducted for all incorporated in the school syllabi and also stakeholders at regular intervals. An at the undergraduate level in medical and adequate number of specialists will be veterinary colleges. made available at various levels for the management of cases resulting from an (C) Community Preparedness outbreak of any epidemic or due to a Community members including public and biological disaster. private health practitioners are usually the first iv) There is a need to evolve standardised responders, though they are not so effective due training modules for different medical to their limited knowledge of BDM. These people responders/community members for will be sensitised regarding the threat and impact capacity building in the area of disaster of potential biological disasters through public management and to create adequate awareness and media campaigns. The areas which training facilities for the same. need to be emphasised are: 46
- 77. GUIDELINES FOR BIOLOGICAL DISASTER MANAGEMENT i) Risk communication to the community phase, will be created after proper training and education. a. Community education/awareness about various disasters and c. NGOs and Private Voluntary development of Dos and Don’ts. Organisations (PVOs) will be involved in educating and sensitising the b. The public will be made aware of the community. basic need for safe food, water and sanitation. They will also be educated d. Supporting activities like street shows, about the importance of washing dramas, posters, distribution of hands, and basic hygiene and reading material, school exhibitions, cleanliness. The community will also electronic media, and publicity, etc., be given basic information about the will be undertaken. approach that health care providers will adopt during biological disasters. A legally mandated quarantine in a geographic area, isolation in hospitals, home quarantine of c. Toll-free numbers and a reward system contacts, and isolation management of less severe for providing vital information about cases at homes would only be possible with active any oncoming biological disaster by community participation. an early responder or the public will be helpful. (D) Documentation d. Definition of predisposing existing factors, endemicity of diseases, The experiences of various drills, the lessons various morbidity and mortality learnt from them, and best practices so developed indices. The availability of such data will be shared with all stakeholders/service will help in planning and executing providers. SOPs for their proper documentation and response plans. scientific analysis based upon the identified ii) Community participation indicators specific to biological disasters will be made. a. Providing support to public health (E) Research and Development services, preventive measures such as chlorination of water for controlling the possibility of epidemics, sanitation of It is essential to develop new research methods the area, disposal of the dead, and and technologies which will facilitate rapid simple non-pharmacological identification and characterisation of novel threat interventions will be mediated through agents. Research pertaining to the development various resident welfare associations, of new treatment modalities, specific biomarkers ASHA/ANM, village sanitation and advanced robotic tools needs overall review committees, and PRIs. and upgradation to meet global standards. Innovative technologies will enhance the ability to b. Community level social workers who respond quickly and effectively. This will require can help in rebuilding efforts, create targeted and balanced fundamental research, as counselling groups, define more well as applied research for technology vulnerable groups, take care of cultural development to acquire medical capabilities. and religious sensitivities, and also act as informers to local medical i) The recent development of genetic authorities during a biological disaster engineering techniques led to the 47
- 78. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS production of many types of bacteria and Delhi; NIV, Pune; DRDE, Gwalior; and viruses in research laboratories. In most IVRI, Mukteshwar. cases, detailed information about the d. Development of capacities to evaluate diseases caused by them is not known. Early the determinants for assessment of detection in such a situation becomes very threat based upon the research difficult. Examples of novel biological interventions undertaken. threats that could be produced through the use of genetic engineering technology e. Institutions under MoH&FW/ICMR shall include: acquire the capability for developing mathematical models/forecast a. Microorganisms resistant to antibiotics, models/secular trend models to standard vaccines and/or identify and assess biological threats therapeutics. They are also able to to the local community and develop elude standard diagnostic methods. indicators that govern their conversion b. Viral vectors such as adenovirus and into a high consequence scenario. vaccinia, as well as naked or plasmid f. The determinants of the threat level DNA can be engineered for the sole include information about the various purpose of delivering foreign genes biological organisms and toxins into new cells. produced as well as the population c. Innocuous microorganisms genetically under probable threat. The institutes altered to possess enhanced aerosol will develop mechanisms for the and environmental stability assessment of threat. characteristics which are able to iii) Operational research produce a toxin, poisonous substance, or endogenous bio-regulator. Operational research would focus on research models to estimate the probable ii) In view of the above biological threats, the public health consequences of various necessary interventions will be taken care threat scenarios and the specific medical of by establishing a national institute countermeasures that will be adopted, and responsible for biodefence research. The shall incorporate various assessment roles and responsibilities of this institute will criteria to assess existing preparedness, be: modes for its optimal utilisation, enhanced a. Integrate and take a directional requirements due to higher levels of approach to the study of infectious incidence and the development of short- disease outbreaks due to natural and and long-term mitigation strategies. The man-made biological disasters. mitigation strategies will then be taken up in a ‘mission mode approach’ for testing, b. Maintain a database of infectious evaluation and upgradation. agents and the newly emerging microbial pathogens of BW/BT iv) Long-term research importance. Long-term research would focus on novel c. Coordinate with the nodal institutions detection technologies, better ways to of the country identified as research manage biological agents and development centres by ICMR such as AIIMS, New of novel broad-spectrum antibiotics, Delhi; PGIMER, Chandigarh; NICD, vaccines, and laboratory diagnostics. 48
- 79. GUIDELINES FOR BIOLOGICAL DISASTER MANAGEMENT 4.3.3 Critical Infrastructure test for rapid detection and identification of the causative agent. The conventional The existing infrastructure of the health ministry, microbiological methods viz., culture and MoD and AFMS will be suitably upgraded to enable immuno-diagnosis or serology take a long it to support BDM activities. time (hours to days) and are too slow when rapid diagnosis is required to confirm early (A) Network of Laboratories warning signs. vi) The identified apex/regional biosafety A network of laboratories will be created/ laboratories will establish a mobile existing laboratories strengthened at the local, detection system relying on technologies state, regional and national levels to support IDSP such as bioluminescence and and to enhance diagnostic skills. The existing biofluorescence (detection of BW agents public health service and medical college through fast reacting bio reporter laboratories in both government and private sectors molecules). will be strengthened for confirmation of microorganisms, testing their sensitivity and other vii) There is a need to have national biodefence molecular level studies. Central ministries/ research centres where the latest molecular departments of health will focus on the following: and other diagnostic facilities will be available to identify such genetically i) Some institutes will be nominated as referral mutated microorganisms and also maintain laboratories including NICD, Delhi, and NIV, a national database of all such organisms. Pune, for investigation of viruses; National Meanwhile, one of the ICMR and DRDO Institute of Cholera and Enteric Diseases laboratories shall be designated for the (NICED), Calcutta, CRI, Kasauli and NICD, purpose. Delhi, for investigation of bacteria; and Indian Institute of Toxicology Research, viii) Provisions for adequate licensing and Lucknow for investigation of toxins. scrutiny and strict enforcement of biosecurity and biosafety will be ensured ii) Existing disease specific surveillance in food processing plants, storage laboratories (influenza surveillance network) warehouses, potable water reservoirs, and would also be strengthened to cater to research laboratories. investigation of diseases with suspected viral etiologies. ix) Efforts are required to upgrade diagnostic laboratories attached to medical institutions iii) All identified laboratories in the network need at the state level. Responsibilities of these to follow biosafety norms and be classified laboratories include the following: according to the biosafety level. As apex institutions, efforts will be made to have a a. Types of facilities and their levels of BSL-4 laboratory at NIV, Pune, and NICD. working. There will be at least one BSL-3 laboratory 1) District laboratories to diagnose to represent each region. pathogens and their drug iv) Manufacturing facilities for standard sensitivity. diagnostic reagents need to be identified 2) Medical college laboratories to and encouraged in the pharmaceutical sector. confirm diagnosis and provide v) In the context of BW/BT, the most important guidance in case of any doubt. step in biodefence strategy is to evolve a 49
- 80. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS 3) State referral laboratories: One b. In some states, the departments of laboratory in each state will be preventive medicine in medical identified by the respective state colleges may be upgraded to serve governments as a state referral this purpose. laboratory. Such a laboratory may c. This network will also be an integral be located in a medical college part of the IDSP These laboratories will . or if medical college does not have basic capabilities to collect and exist in the state, then in a dispatch samples to the referral government hospital. laboratory to isolate and detect 4) National referral laboratories: The microorganisms. For details, refer to responsibility of national referral the section on biosafety laboratories laboratories will be to help in in Chapter 5. investigation, isolation and characterisation of organisms and (B) Biomonitoring to provide guidance from time to i) The most important step in biodefence time. Depending upon the types strategy is the rapid detection and of organisms handled, there would identification of causative agents. Detection be different norms in terms of is the unspecific demonstration of increased location and capabilities. concentrations of microorganisms in a b. Other requirements of laboratories particular environment whereas 1) There is a requirement for sufficient identification is the species determination space with easy to clean walls, of the detected microorganisms. An attack ceilings and floors, adequate by BW agents is difficult to detect owing to illumination, bench tops the inherent intrinsic properties of the impervious to water and resistant organism, such as aerosolised transmission to disinfectants, acids, and of small-pox and other viruses causing alkaline or organic solvents. vesicular skin eruptions. Their early detection and identification is critical for 2) Safety systems to prevent fire and early implementation of specific electrical emergencies, countermeasures. Emergency shower and eye wash facilities, first aid rooms, proper ii) Detection systems for BW agents will have waste disposal facilities, the properties of rapidity, reliability, autoclaves, steriliser, incinerators, reproducibility, sensitivity and specificity so facilities for treating waste water as to quickly diagnose the correct etiological from laboratories are some other agent from complex environmental samples mandatory requirements. before their widespread dissemination. It x) Creating a chain of public health is essential to develop portable detectors laboratories with at least one such laboratory and other devices based upon the need in each district. This includes: assessment analysis. a. A referral system to be developed at iii) Molecular techniques are useful in the early the state and national level with detection and identification. Capacity advanced facilities for cultures and building is required to establish laboratories antibiotic sensitivity. having molecular facilities to detect BW 50
- 81. GUIDELINES FOR BIOLOGICAL DISASTER MANAGEMENT agents, especially Genetically Modified producing gene of a microorganism without Organisms (GMOs) which are difficult to culturing it. Polymerase Chain Reaction detect by routine conventional (PCR) can detect the presence of the microbiological techniques. Environmental specific nucleic acid (DNA/Ribonucleic acid samples (air, water, soil, etc.) may have low i.e., RNA) of the microorganism in 3–4 hours concentrations of the microorganisms and at extremely low concentrations. The may not be detectable to enable analysis. advantage with this method is that The most important recent development in identification can be made from non-living biodefence strategies is the on-line organisms. Loop mediated isothermal detection of possible BW agents through amplification technique for qualitative and fast reacting bio reporter molecules. quantitative detection of microorganisms is iv) Bioluminescence and biofluorescence: : the latest advancement in rapid and Various bioreporter molecules have been accurate identification of BW agents in field identified as signal generating systems. The conditions. Other variations and biochemical reaction of organisms modifications of PCR are the newer generates light which can be detected by methods for the detection and identification conventional photo detectors. of BW agents. Laboratory confirmation for the presence of an agent is generally given v) Biosensors: It is a type of probe in which on the basis of two or three supportive tests the biological component interacts with an in the absence of a culture of the organisms. analyte which is then detected by an The test will be able to differentiate the electronic component and translated into a organism from other closely related species. measurable electronic signal. It is a reliable The reliability of the rapid tests depends detection system for microbes with high upon its sensitivity to identify normal and selectivity and sensitivity. It can be of three genetically altered strains. The quality of types i.e., immunosensors, nucleic acid sample collection would also affect the sensors and laser sensors and can be used results of these tests. Other modern in the laboratory for detection. Biosensor techniques for rapid detection and direct technology is the driving force in the identification of the suspected BW agents development of various bio chips for the are flowcytometry, fluorescent activated cell detection of pesticides, allergens, gaseous sorter, gas chromatography, mass pollutants, and microorganisms in spectrometry, gas chromatography-mass environmental samples. spectrometry and liquid chromatography- vi) Bioprobes: These are based on the sensor mass spectrometry, which can detect monitor properties of biological entities. certain metabolites or chemical components Bees, beetles and other insects are being of organisms. used as sentinel species in collecting real time information about the presence of (C) Technical and Scientific Institutions toxins or similar threats. Biodetection can also be done through the development of Central/state/district authorities will identify and biorobots. define the technical institutions and laboratories vii) Molecular and other recent techniques: With engaged in various scientific, research and advances in molecular biology, it is now technical advancements in detection and possible to identify the specific disease identification of various microbiological agents (BT 51
- 82. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS causative agents), exotic pathogenic microbes and sufficiency in certain areas, especially for genetically modified agents. These institutes will security purposes against BT as well as act as professional guiding resource centres and threats arising out of the continuous function as referral centres. Some of the development of novel strains of laboratories will be designated as national referral microorganisms. laboratories. A suspected outbreak of any epidemic vi) All the activities will be in harmony with each or BT will be addressed to the designated other and at the various laboratories laboratory for proper and quick identification. Some identified at all levels. of the important functions of these identified laboratories include: vii) The institutes will develop models based on a ‘preventive strategy’ intended to reduce i) Identification and assessment of the vulnerability and to mitigate post-disaster biological threats to the local community consequences. The strategy will include and development of indicators to govern public health preparedness, long-term their conversion into a high consequence focus on novel detection technologies, scenario. The determinants of threat include newer ways to manage different kinds of information about the various biological biological agents and development of novel organisms and toxins produced as well as broad-spectrum antibiotics, vaccines and the population under the probable threat. biological system specific medical The institutes will develop a mechanism for countermeasures, for example, to manage assessment of the threat. the hemopoietic syndrome, etc. The ideal ii) These institutes will also develop research medical countermeasures for biological models to estimate the probable public agents will be highly effective for post- health consequences of a threat scenario exposure prophylaxis and early and the specific medical countermeasures symptomatic treatment with an excellent for each biological agent. safety profile. iii) The medical countermeasures that need to (D) Communication and Networking be adopted will incorporate the various assessment criteria to assess the existing Communication is a vital component of DM. preparedness, the modes for its optimal The existing communication systems are vulnerable utilisation, the enhanced requirement due to failure during disasters, thus it is important to to higher levels of incidence and the develop strategies to protect these systems and development of short- and long-term upgrade them and make them more resilient so mitigation strategies. that they can survive during disasters. The major iv) The mitigation strategies will then be taken guidelines include: up in the ‘mission mode approach’ for i) Emergency communications network: testing, evaluation and upgradation. Testing Establishment of control rooms at the will also be done through mock drills. district, state and central levels and v) Based upon the mitigation strategies, the inclusion of private practitioners in the short-term and long-term goals of network through the IDSP. There will be acquisition of various facilities, infrastructure terrestrial and satellite based hubs for fail- and development of newer counter acting safe communication both vertically and technologies will be defined. In addition, horizontally. there will be a need to achieve self- 52
- 83. GUIDELINES FOR BIOLOGICAL DISASTER MANAGEMENT ii) Health network: All hospitals will be interventions, sensitisation of the public connected with IAN and QRMTs. They will through the supporting role of the media, have an intra-hospital horizontal network. etc. Dedicated telephone numbers shall be vi) Role of international organisations: Under made available to hospitals. The network the IHR, WHO is the nodal agency that will shall also be integrated with police, fire and give information of any outbreak of disease other helpline services. in the neighbourhood. WHO also provides iii) Mobile tele-health: Mobile tele-health is technical advocacy on communicable another concept of tele-medicine that can disease alerts and response, provides be used for disasters by putting diagnostic technical experts, helps in capacity equipment and information communication development through training, and technology together on a vehicle to get laboratory support through WHO reference connectivity from the affected site to laboratories wherever required. Other advanced medical institutes where such organisations that provide technical connectivity already exists. Such systems expertise include CDC, OIE and FAO. may be placed in known disaster prone areas or could be moved at the onset of E) Public-private Partnership disasters. Such systems will be developed at the regional levels. The private sector has substantial infrastructure capabilities and is engaged in R&D for various iv) Communication through print and electronic products which is a part of biodefence research. media: The print and electronic media are Government technical agencies like DRDO and the first reporting agencies in any disaster, ICMR laboratories may collaborate with the private thus they need to be integrated into the sector for developing more efficient biodefence communication network so that correct tools such as vaccines. The private sector has the information can be disseminated to the potential to play a major role in the nation’s public. Normally there is panic in any preparedness by integrating its capacities with biological disaster situation. The media governmental organisations such as DRDE and strategy/plan for DM will address measures NICD. Some of the important recommendations to allay public anxiety and fears arising out include the following: of outbreaks in general and BT in particular. Correct information disseminated by the i) Adoption of international best practices will media is useful for educating the be encouraged in combating biological community at times of disasters. The media disasters. will be coordinated by an earmarked officer ii) International pharmaceutical agencies and of appropriate seniority. other technical laboratories that are v) NGOs as part of the BDM network: NGOs engaged in the field of research and and PVOs will be involved for community upgradation of specialised technologies for education and sensitisation. NGOs as of production of various vaccines like anthrax now have played a limited role in biological and smallpox and newer drugs, will be disasters as compared to hydrological or collaborated with for meeting the peak seismic disasters. They could play a role in requirements of vaccines and drugs during rumour surveillance, reporting of events, biological disasters. implementation of non-pharmaceutical 53
- 84. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS iii) Sourcing and procurement of preparedness will also entail specialised facilities countermeasures currently available with including chains of laboratories supported by manufacturing capacities in a ready state skilled human resource for collection and dispatch to enable their continuous supply. of samples. The major aspects of medical preparedness are explained in the ensuing iv) Developing a contemporary system based paragraphs. on PPP for stockpiling, distribution and cold chain system for sophisticated diagnostic kits, vaccines and antibiotics. 4.4.1 Hospital DM Plan v) Collaborations can be made to establish Hospital planning will include both internal infrastructure facilities required for response, hospital planning, and for hospitals being part of as mutually decided by the government and the regional plan for managing casualties due to the private sector. Possibilities will also be biological disasters. The major features will include explored for investments by the private the following: sector in the area of R&D, which can be i) Hospital disaster planning will consider the decided upon the need of government. possibility that a hospital might need to be evacuated or quarantined, or divert patients Private sector facilities are required to be to other facilities. included in district-level DM plans and collaborative strategies shall be evolved at the ii) The plan will be ‘all hazard’, simple to read district level for the utilisation of their manpower and understand, easily adaptable with and infrastructure. Private medical and paramedical normal medical practices and flexible staff must be made part of the resource. Community enough to tackle different levels and types based social workers can assist in first aid, psycho- of disasters. social care, distribution of food, water, and iii) The plan will include capacity development, organisation of community shelters under the development of infrastructure over a period overall supervision of elected representatives of of time and be able to identify resources the community. for expansion of beds during a crisis. iv) The plan will be based on the need 4.4 Medical Preparedness assessment analysis of mass casualty incidents. There will be a triage area and Medical preparedness will be based on the emergency treatment facilities for at least assessment of biothreat and the capabilities to 50 patients and critical care management handle, detect and characterise the microorganism. facilities for at least 10 patients. Specific preparedness will include pre- v) The quality of medical treatment of serious/ immunisation of hospital staff and first responders critical patients will not be compromised. who may come in contact with those exposed to The development plan will aim at the anthrax, smallpox or other agents. It further relates survival and recuperation of as many to activities for management of diseases caused patients as possible. by biological agents, EMR, quick evacuation of casualties, well-rehearsed hospital DM plans, vi) Hospitals will plan to recruit a sufficient training of doctors and paramedics and upgradation number of personnel, including doctors and of medical infrastructure at various levels which paramedical staff, to meet the patients’ will reduce morbidity and mortality. Medical needs for emergency care. 54
- 85. GUIDELINES FOR BIOLOGICAL DISASTER MANAGEMENT vii) It is essential that all hospital DM plans have xii) The registration and accreditation policy will the command structure clearly defined, make it mandatory to have a hospital DM which can be extrapolated to a disaster plan. scenario, with clear-cut job definitions when xiii) The existing infectious diseases hospitals an alert is sounded. Emergency services will be remodelled to manage diseases with provided must be integrated with other microorganisms that require a high degree departments of the hospital. of biosafety, security and infection control viii) The hospitals will submit data on their practices. There will be one such hospital capabilities to the district authorities and in each state capital. In addition, the district on the basis of the data analysis, the surge hospitals and medical colleges will have capacities will be decided by the district isolation wards to manage such patients. administration. Also, identified hospitals in vulnerable states will be strengthened for managing ix) There is no universal hospital DM plan CBRN disaster victims by putting in place which can be implemented by all hospitals decontamination systems, critical care in all situations. Therefore, on the basis of Intensive Care Units (ICUs) and isolation their specific considerations, each hospital wards with pressure control and lamellar will develop a disaster plan specific to itself. flow systems. The infectious control The plan shall be available with the district practices include the following: administration and tested twice a year by mock drills. a. When dealing with biological emergencies, the health workers x) The hospital DM plan will cater for the associated with the investigation of increased requirement of beds, such exposures will have adequate ambulances, medical officers, paramedics personal protection. and mobile medical teams during a disaster. The additional requirement of disease- b. Depending upon the risk, the level of related medical equipment, disaster-related protection will be scaled up from use stockpiling and inventory of emergency of surgical masks and gloves, to medicines will also be factored into the impermeable gowns, N-95 masks or hospital DM plan. The DM plan must be powered air-purifying respirators. They strengthened by associating the private will follow laid down SOPs for use of medical sector. PPE. Infection control practices will be followed at all health care facilities, xi) Although the number of private hospitals including laboratories. are increasing, they are not appropriately planned to manage casualties resulting from c. Of the potential biological disaster an outbreak of any epidemic or biological agents, only plague, smallpox and disaster. There is a need for networking VHFs are spread readily from person between public and private hospitals and to person by aerosols and require hospital DM plans need to be updated at more than standard infection control the district/state level through frequent precautions (gowns, masks with eye mock drills. Firm administrative policies will shields, and gloves). be in place for developing such plans at d. The suspected victims and those who the hospital level. have been in contact with them will 55
- 86. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS be advised to follow simple public spread the infection to other patients. health measures such as using masks/ Therefore, adequate number of handkerchief tied over the nose and isolation wards are required to be mouth, frequent washing of hands, planned with surge capacity to staying away from other people by at accommodate a large number of least a metre, etc. patients. If required, side rooms, seminar rooms, other halls can be xiv) Every hospital has two major facets, improvised for this purpose. administration and clinical care. Administrative activities involve setting the d. Security arrangements: Hospital hospital disaster plan into action and security staff will prepare SOPs to nominating a nodal medical officer in the prevent overcrowding of hospitals by plan who will be in charge of emergencies visitors, relatives, VIPs, and the media and trauma care. The nodal officer will be at the time of a disaster. Help of the responsible for getting updated information, district administration will be sought, initiating administrative action and if required. coordinating with the heads of various e. Identification of patients: The process clinical facilities. To handle biological will start at the time of giving first aid disasters, a hospital DM plan will have the and triage. A system of labelling and following facilities: identifying patients during spot a. Medical and paramedical staff: It is registration by giving a serial number important to train medical staff and to the patient and putting an paramedics properly in universal identification tag around the wrist can safety precautions, use of PPE, be done. In mass casualties, it can be communication, triage, barrier nursing, supplemented by giving colour coded and collection and dispatch of tags, such as red for serious patients, biological samples. A team of yellow for moderately serious patients, specialists must be made available to blue for those in need of observation handle infectious diseases affecting and black for the dead. various body systems and they will be f. Brought dead: All those brought in suitably immunised against agents dead and patients who die while such as anthrax and smallpox. receiving resuscitation will be b. Expansion of casualty area: If the segregated and shifted to the mortuary hospital casualty ward is unable to through a separate route. Temporary accommodate a large number of mortuary facilities will be created to casualties, provision will be made to cater for a mass casualty incidence. use the patients’ waiting hall, duly g. Diagnostic services: All laboratories reoriented, to receive the casualties. and radio diagnostic services will be Each major hospital will cater to at kept fully operational and utilised as least 50 additional patients at times and when required. These services will of disaster. be available within the emergency c. Isolation wards: Many biological treatment areas. agents cause infective diseases of h. Communication: Both extramural and various body systems which can intramural communication facilities will 56
- 87. GUIDELINES FOR BIOLOGICAL DISASTER MANAGEMENT be made available. These can be complete assessment of the situation and further augmented by the use of transmit information to the appropriate mobile phones. authorities. i. Medical supplies: Adequate supply of iii) Additional medical teams will be mobilised essential drugs and non-drug items to assist in handling the large number of will be made available for at least 50 casualties in the wake of a mass casualty patients in the emergency complex event. itself for immediate use. Additionally, iv) Adequate stock of medical stores, including hospital medical stores will have essential drugs, will be stocked and made adequate buffer stocks. available to the medical teams. j. Blood bank services: The services will v) The stocking of emergency medical stores cater for an adequate supply of safe shall be done by the state government. blood and its components. Voluntary Brick of medical stocks capable of treating blood donations will be encouraged 25/50/100 casualties will be kept ready to to fulfil the increased demand of move with the QRMTs at short notice. blood. vi) Drills will be conducted at regular intervals k. Other logistic support: Adequate, by mobile hospitals and mobile teams to uninterrupted supply of water and keep them in a functional mode at all times. electricity will be ensured for proper management of casualties. 4.4.3 Stockpile of Antibiotics and Vaccines The laying down of public health standards for hospitals and strengthening of CHCs across Government medical stores at the centre and the nation for basic specialities on 24x7 basis under states will stock sufficient quantities of essential NRHM by GoI are steps in the right direction to drugs, antibiotics and vaccines based on the risk strengthen medical care facilities in rural areas. assessment. State and local public health NRHM initiatives will be expedited to reach every authorities have to develop plans for distributing nook and corner of the country. and administering these materials. There is a need to have a supply of readily available anthrax, 4.4.2 Mobile Hospitals and Mobile Teams smallpox and other vaccines, which will be administered rapidly in the event of an outbreak to States will acquire and locate at least one contain the spread of the disease. All first mobile hospital at strategic locations. These responders will be vaccinated in an impending hospitals can be attached to earmarked hospitals disaster situation. for their use in non-disaster periods. These will be manned by trained manpower and perform the A regular review of the shelf life and adequacy following functions: of the available stock of vaccines and medicines is essential. The pharmaceutical industry in the i) To be mobilised to the disaster site for country will be kept updated with the threat management of cases at times of any perception of biological disasters and for possible epidemic outbreak or biological disaster. need for drugs and vaccines in the event of a major ii) Provide on-site medical treatment to disaster. A plan will be prepared to define the casualties as per triage and evacuation availability of antibiotics, anti-virals, vaccines, sera guidelines. The teams will also make a and other drugs from private pharmaceutical 57
- 88. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS companies who will be able to supply these items on the mental health aspects of disasters at short notice. even in the routine postgraduate training in psychiatry. There is a need for coordinated 4.4.4 Public Health Issues training services and monitoring at the district and state levels. i) The abrupt onset of large numbers of acutely ill persons, and rapid progression v) Most victims at the scene of a disaster suffer in a relatively high proportion of cases with from psycho-social problems. Some upper respiratory symptoms affecting, people, including relief workers, may among others, young healthy adults and develop post-traumatic stress disorders. children should alert medical professionals The plan will involve community level social and public health authorities. Such an workers who can help victims of psycho- occurence indicates a critical and social problems. unexpected public health event which can be the beginning of a biological disaster. 4.5 Emergency Medical and Public ii) A strong public health infrastructure with Health Response effective epidemiologic investigating capabilities, practical training programmes, 4.5.1 C&C for Medical and Public Health and preparedness plans is essential to Response prevent and control outbreaks of diseases, whether natural or man-made. A public C&C would follow a bottom-up approach. For relations officer will give information to the disasters manageable at the district level, C&C public, press, radio and other organisations will be activated at the Incident Command Post as per the health policy. Panic is a critical (ICP) and at the district. element in a disaster and, therefore, DM plans will address measures to allay public i) For biological disasters affecting many anxiety and fear arising out of BT. A districts, C&C will also be activated at the complete ban on the press or media is not state headquarters. For disasters affecting the right approach in such circumstances. a number of states, C&C will be at the The media is very useful for disseminating centre (in the nodal ministry) involving, if proper information and educating the required, the NCMC, the NDMA and NEC. community during a disaster. ii) The central RRTs will be activated by iii) Availability of safe food, clean water, and MoH&FW. NICD will be the nodal agency minimum standards of hygiene and for outbreak investigations. The sanitation will be ensured. Vulnerable coordination, logistics and monitoring will groups such as children, pregnant women, be supported by the Emergency Medical the aged and patients suffering from Relief division of MoH&FW. The response diseases like HIV/AIDS will be given special plan of the MoH&FW will be activated. The attention. control room in the C&C structure would, if required, function on 24x7 basis. iv) The routine training of medical undergraduates, nurses and health workers iii) Progress will be monitored by the nodal for mental health services is grossly ministry. For BT, the same modalities will inadequate. There is virtually no emphasis be activated by MHA. 58
- 89. GUIDELINES FOR BIOLOGICAL DISASTER MANAGEMENT iv) MoH&FW would support MHA’s activities of the incident commander (see Annexures and NICD would conduct the outbreak D-F). investigations. Faced with a BW situation, iii) There will be periodic mock drills for the MoD will be the nodal ministry and all checking response time and reducing it to actions as per the War Book will be put in a minimum. Periodic training and refresher place. training schedules will also be prepared. iv) The medical posts shall provide evacuation 4.5.2 Emergency Medical Response services, specialised health care, food, shelter, sanitation, etc. These will coordinate A biological disaster can lead to mass casualty with other functionaries involved in search, incidences, both intentional or otherwise. The rescue, helplines and information development of infectious diseases depends on dissemination, transport, communication, various factors such as type of agents, incubation power and water supply, and law and order. period, immune status of individuals, amount of infectious agent entering the body, etc. However, v) SOPs for providing hospital care and a a large number of cases arising in a short span of command control centre with the district time may require prompt establishment of medical collector as supreme head, will be laid down posts near the incident site. EMR at the site would and rehearsed using mock exercises. depend upon the quick and efficient response of vi) The nodes of communication will be RRTs/MFRs deputed from the district, reinforced dovetailed with emergency services of the by those from the state and the centre. They would district. Inter-hospital and inter-services triage the patient, provide basic life-support if communication will be established at all required at the site, and transport patients to the levels. nearest identified health facility along with vii) Mechanisms for checking the status of collection and dispatch of biological and coordination in planning, operations and environmental samples. If the incident command logistic management will be developed. system is implemented then the RRT/MFR will be integrated with the ICP and function under the overall directions of the incident commander. 4.5.3 Transportation of Patients Important components of an EMR plan are as follows: Occurrences of mass casualties are unlikely in the case of biological disasters. Development i) Pre-hospital care shall be established and of infectious diseases depends on various factors operationalised using a trained medical such as type of agent, incubation period, immune force. EMR at the site will depend upon status of the individual, amount of infectious agent the quick and efficient response of MFRs. entering the body, etc. Therefore, patients will arrive ii) MFRsmust be trained in the use of PPE and at hospitals sporadically, in an unpredictable in collection and dispatch of samples from manner, while many will go to private physicians. air, water, food and biological materials. The An exhaustive ambulance system, as required for standards for detection and basic life- other disasters, may not be needed here. However, support (airway maintenance, ventilation ambulances must have the provision for collection support, anti-shock treatment and of stool, vomitus, etc. Adequate intravenous fluid preparation for transportation) will also be and antibiotics must be made available in addition developed. EMR will be integrated with ICP to other emergency drugs, during transportation. and will function under the overall directions 59
- 90. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS 4.5.4 Treatment at Hospitals vi) Clinical suspicion and epidemiological investigation of such situations must be In case of an epidemic outbreak or bioterrorist supported by definitive diagnosis by high attack, the hospital DM plan will be activated. A quality laboratory tests. Laboratory specialised team or RRT consisting of clinician, diagnosis is the mainstay on which further epidemiologist, microbiologist and nurse will be response will be determined. made available for patient care in the hospital. vii) Establishing a diagnosis and detection The activation of a hospital DM plan includes some system and identifying causative agents will of the following important functions: be the most important response to a i) Patients requiring decontamination biological disaster. This procedure of (especially in the context of a BT attack identifying a disease agent in the using aerosols) will be decontaminated. environment is far more complex than Thereafter, they will be triaged and those identifying chemicals or toxins. The requiring critical care will be managed detection will be carried out by using accordingly. standard laboratory tests of suspected samples collected from the environment, ii) Patients requiring isolation will be kept in i.e., swabs and wipes from suspected isolation rooms/wards. The RRT shall assess surfaces, air samples, soil, food, and water. the patient load and if required, the hospital surge capacity will be increased. Those viii) Once the diagnosis has been confirmed by requiring treatment at referral centres will culture and antibiotic sensitivity of be transferred. Till such time definitive organisms, a bacterial infection will be diagnosis is not available, patients will be treated with appropriate antibiotics. In case provided empirical treatment based on of viral infections an anti-viral agent like presumptive diagnosis. cyclovir may be used. iii) Triage of patients will involve prioritisation ix) Administration of immunomodulators which based on the assessment by the clinical enhance the immunity of the body to fight team. Initially, diagnosis will be done on infection are useful for treating infections. clinical basis and treatment will be given x) Other supportive treatment like IV fluid, accordingly. vitamins and proper nutrition, along with iv) Supportive treatment will be given nursing care, will be ensured. immediately with the help of advanced equipment like ventilators for respiratory The hospitals would, throughout the crisis, paralysis caused by botulinum toxin. follow strict infection control practices. If the surge Samples of various body fluids like blood, capacity is exceeded, the services of private sera, urine, stool and sputum will be taken hospitals and nursing homes will be requisitioned. and dispatched to the laboratory for early Institutions such as the Indian Medical Association culture and identification, characterisation, and other professional bodies would also be and antibiotic sensitivity test of isolates. approached. v) Depending upon the type of infective disease involving various systems like 4.5.5 Domiciliary Care respiratory tract or gastrointestinal tract, the patient will be directed to different wards Not all patients will be needing hospital care. for isolation or quarantine. Those who can be treated at home will be given 60
- 91. GUIDELINES FOR BIOLOGICAL DISASTER MANAGEMENT necessary treatment as an outpatient and then Appropriate orders will be issued under the asked to report in case of deterioration of the enabling legal instrument to mandate isolation and symptoms. Institutions like IRCS are capable of quarantine. Central to the success of quarantine providing large numbers of trained volunteers and will be making available all essential services in their resources will be tapped. Equally important the quarantined area. A large number of police will be the involvement of NGOs for such and security personnel may have to be deployed purposes. for restricting the movement of people beyond the defined geographic area. The authorities at the 4.5.6 Public Health Response district level would also issue, if the situation so warrants, appropriate orders for implementing (A) Outbreak Investigation social distancing measures. The success of non- pharmaceutical interventions lies in the active An RRT will be deployed for outbreak cooperation of the civil society. Village committees, investigation. A standard case definition will be resident welfare associations and PRIs would followed, the guiding principle being to identify as supplement the efforts of the government in disease many suspect cases as possible. There will be containment. situations in which the RRT would have to lay down its own case definition. The suspect cases will be (C) Risk Communication identified and if the situation so warrants, all the contacts will be traced and kept under observation/ The risk will be conveyed to the community quarantine. Line listing of all cases and contacts through simple and precise messages. It might be will be prepared. The requisite clinical samples done using all available communication channels will be taken and transported to the nearest including word of mouth communication. To identified laboratories. disseminate information to a wider audience in a short span of time, print/visual media may be used. (B) Instituting Public Health Measures Effort will be made to prevent/reduce panic among the public and create awareness about adopting Surveillance mechanisms will be activated and, risk reduction/health seeking behaviour. if need be, active house-to-house surveillance will be followed, especially if the strategy is to stamp (D) Psycho-social Care out the disease in the formative stages of the epidemic. Pharmaceutical and non-pharmaceutical Biological disasters of rapid onset and high interventions appropriate to the situation will be mortality would create mass hysteria and panic implemented. Other public health measures among the public. It might induce mass exodus pertaining to drinking water, sanitation and vector from the affected area thereby spreading the control (depending upon the nature of the outbreak) disease further. The movement of such population shall be followed. Patients need to be provided into unaffected communities could result in strong appropriate treatment on outpatient basis or in resentment among communities not yet affected. identified hospitals, depending upon the severity Those families subjected to bereavement of there of the case. Public health units, primary health care near and dear ones would also reflect in higher points and hospitals need to follow standard psycho-social morbidity. MoH&FW through its infection control practices. For diseases amenable mental health institutions and NGOs would provide to immunisation, an appropriate immunisation adequate psycho-social care. strategy will be followed. 61
- 92. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS (E) Post-outbreak Surveillance appropriate authorities will be informed if help from international agencies is required. Even after the control of a natural/intentional outbreak, there would be heightened surveillance (I) Evaluation to detect fresh cases. The public will be informed to report fresh cases to the health authorities. There Once the outbreak has been contained, the might even be a reward system for those who report entire process will be reviewed. The gaps/ a fresh case, especially in situations where active bottlenecks in implementing the plan will be house-to-house or sentinel surveillance is not identified and addressed. The lessons learned and possible/sustainable in the longer run. There could the best practices adopted will be documented also be serological studies to assess immune for future reference. levels. Laboratories might also conduct laboratory based surveillance using a sampling framework. The success of the management of biological disasters, including BT, will depend upon the (F) Media coordinated response of fully prepared RRTs/MFRs, including medical teams of specialists backed up An identified person, knowledgeable about the by suitable communication, updated IDSP and an , event will be designated to address the media as adequate chain of laboratories and hospital care part of the district DM plan. As far as possible, the facilities. information sharing has to be transparent. The media would also have the obligation of reporting the event correctly and not sensationalising the 4.6 Management of Pandemics issue, so that it does not create panic among the public. Epidemics arising in one part of the world are nowadays rapidly disseminated to other areas due (G) Inter-sectoral Coordination to rapid transportation. The recent epidemic of SARS is one such instance. Infected individuals Response to a biological disaster might require (or even vectors) can travel to far removed parts of coordination between a number of departments, the would before they manifest clinical features. namely animal health sector, human health, home, Biological disasters, including BT, is a specific defence, intelligence, civil aviation, tourism, category of disaster that travels across borders by shipping, and transport. MoH&FW would virtue of human or logistic functions that seek coordinate between all these departments for international cooperation to mitigate its effects. appropriate actions that need to be taken by the This issue directly concerns international biosafety concerned departments. The identified task group and biosecurity norms. would meet on a regular basis till the crisis is over. The exchange of health intelligence has (H) Monitoring become important and international responsibilities often transcend national compulsions. IHR (2005) MoH&FW/MHA would closely monitor at the holds a member country to be duty bound to central level, any event that needs attention and improve its public health capabilities to prevent take it to its logical conclusion. All important and control the spread of any such disease within stakeholders, including NCMC and NDMA, will be the country and prevent it from spreading beyond kept informed of the situation. Daily situational its borders. The wide disparity between nations in reports will be sent to all concerned. The their capacity to tackle epidemics would mean that 62
- 93. GUIDELINES FOR BIOLOGICAL DISASTER MANAGEMENT competent medical teams from one nation would combat the threat. However, the capacity to identify need to work in another country, thereby raising and address exotic pathogens is required to be sovereignty issues. These matters have to be built. MoH&FW will prepare a comprehensive plan viewed in a global perspective. International based on the above guidelines, which will be agencies like WHO, FAO and OIE have a presence activated at the time of an alert, on the occurrence in all countries and coordinate such activities. of a pandemic. WHO has already developed and built an Pandemic preparedness is not restricted to the improved event management system to manage health sector alone. It has been extended to cover public health emergencies. It has also developed non-health stakeholders also, thereby requiring strategic operations at its Geneva headquarters overall preparedness measures. It is pertinent to and regional offices around the world, which are identify all the essential service providers and to available round-the-clock to manage emergencies. make adequate provisions for their business WHO has also been working with its partners to continuity during pandemic or biological disaster strengthen the GOARN, which brings together situations. The issues of advocacy and guidance, experts from around the world to respond to planning at each level, linkages between various disease outbreaks. The support to the international emergency functionaries, community awareness community is in the form of supply of specific to pandemic preparedness, multi-sectoral epidemiological information and action on acquired coordination and capacity development using PPP infections. The interface between national and will be developed in the plans. The mechanism for international agencies is normally well defined. regional level cooperation to address non-health issues will be developed. The ‘all hazard’ plans so A competent central office in the country under developed will be practiced through mock the aegis of the nodal ministry (MoH&FW) which exercises. To address this vital issue with respect has access to national-level data and is equipped to the existing scenario in the Southeast Asian to transmit relevant information to the stakeholders, region, NDMA had organised an international is needed. Surveillance of and remedial action conference in which various Indian experts and against threats need to be rapidly evolved to satisfy delegates from international agencies participated. both national and international needs. The deliberations during this conference have been developed as a comprehensive report—'Pandemic The ongoing surveillance for avian influenza is Preparedness beyond Health' (please visit an example of such interaction. The international www.ndma.gov.in for the same). The agency, in this case WHO, not only supports recommendations of these deliberations are to be designated national laboratories but also stockpiles considered while developing the plans and carrying appropriate prophylactic and therapeutic agents. out other preparedness measures. Thus, in the case of avian influenza (bird flu) stockpiles of oseltamivir and vaccine for combating 4.7 International Cooperation outbreaks are available for dispatch to affected regions. Nevertheless, national capability to International cooperation is a necessary anticipate, detect, mitigate and control exotic element in the management of pandemics. The pathogens needs to be in place. A properly various activities that will be undertaken to enhance functioning epidemiological mechanism capable harmony in the functioning of an international of immediately preparing an action plan for the regime in the management of biological disasters management of any emergency would effectively are as follows: 63
- 94. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS i) Establishment of an adequate mechanism assessment of different areas to enhance to enhance the level of interaction between the level of coordination between various the various state and non-state actors that national and global players. are required to work in tandem during such xi) The management of pandemics requires the events. pooling of medical logistics, trained human ii) The development of provisions for strict resources and other essentials at the compliance of existing international treaties/ international level. conventions at various levels xii) The management of pandemics also iii) A web-based forum for continuous requires a transparent and collaborative interaction of experts to develop necessary approach wherein the affected countries will strategic measures that need to be make a combined effort to mitigate the integrated with present global practices. impact. iv) A national web-based forum on the same Success in managing biological disasters lines also needs to be developed that would depends upon the level of coordination between interact with international forums for various stakeholders, their medical preparedness, exchange of information. knowledge, and awareness of their responsibilities. v) The forum will also conduct workshops, Such a process is highly complex at the seminars and conferences for direct international level and requires the initiation and interaction and exchange of ideas. coordination of pre-determined plans in the vi) The forum will also promote the official immediate phase. interaction of state actors to evolve new policies and programmes in the changing dynamics of any global threat of BT. vii) Interaction between various pharmaceutical companies, NGOs, state and non-state actors will allow the exchange of technologies that exist in other nations. viii) The stockpiling of various vaccines and essential drugs to combat newly emerging threats under the guidance of global health organisations will become cost-effective by regional level planning. This, in turn, will enhance the inherent capability of the member nations to respond to such attacks. ix) In order to achieve the development of deterrence against newly developing GMOs, international-level research collaboration is essential. x) Joint international mock exercises may be conducted, based on the vulnerability 64
- 95. 5 Guidelines for Safety and Security of Microbial Agents ‘A safe and healthful laboratory environment is technologies and practices that are implemented (also) the product of responsible institutional to prevent unintentional exposure to pathogens and leadership. National codes of practice foster and toxins and their accidental release. promote good institutional leadership in biosafety’ 5.1 Biological Containment Emmet Barkley, WHO Biological containment, which ensures that Disease diagnosis, human or animal sample infectious microorganisms remain in the laboratory, analysis, epidemiological studies, scientific is the principal feature that distinguishes research and pharmaceutical developments—all containment laboratories from basic laboratories. of these activities are carried out in biological A variety of overlapping integrated engineering laboratories in the government and private sectors. systems are installed in a containment laboratory Biological materials are handled worldwide in to prevent uncontrolled escape of infectious laboratories for numerous genuine, justifiable and microorganisms from the building, to safeguard legitimate purposes, where small and large volumes the health of the surrounding community, to prevent of live microorganisms are replicated, cellular unintentional spread of disease among man and components extracted and many other animals, by man to man, animal to animal, animal manipulations are undertaken for purposes ranging to man, and man to animal transfer, and to prevent from educational, scientific, medical and health- false laboratory reports due to cross contamination. related to mass commercial and/or industrial production. Among them, an unknown number of In addition to the engineering system, a positive facilities, large and small, work with dangerous attitude of employees towards biological safety, pathogens, or their products, every day. and their adherence to approved guidelines, are Technological advances have enabled an essential for total biocontainment. To summarise, increasing number of people to cultivate, study biological security is the end product of the and modify pathogenic organisms. This, interaction of the built facility with its management unfortunately, also permits dual use of the and operational philosophies and the environment technology. Under these circumstances it is in which it operates. necessary for legitimate laboratories dealing with pathogenic (or potentially pathogenic) microbes Recent developments in molecular biology, to ensure that there is no intentional removal of including recombinant DNA technologies, have agents. These measures are dealt with under the changed the age-old scenario of microbiology. term biosecurity. Biosafety is the term used to cover Incorporation of foreign genes in the host gene, laboratory activities designed to protect the utilising prokaryotic or eukaryotic cells might pose laboratory worker from infection by the organisms several problems of biosafety. An increasingly handled by him. Laboratory biosafety is the term important consideration in biotechnology research used to describe the containment principle, and applications is that workers in these fields 65
- 96. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS (molecular biology) are not necessarily trained in 5.2.3 Risk Group-III: High individual risk and microbiological techniques, including safe handling low community risk of pathogens. A pathogen that usually produces serious 5.2 Classification of Microorganisms human/animal diseases but does not ordinarily spread from one infected individual to other. Microorganisms are classified on the basis of the risks levels that their handling entails. This is 5.2.4 Risk Group-IV: High individual risk and different when human/animal/plant specimens, high community risk GMOs, environmental isolates and experimental animal samples are dealt with. Each of these Agents that usually produce serious human or categories requires specific guidelines. The animal diseases and may be readily transmitted scheme for risk based classification of from one individual to another directly or indirectly. microorganisms is intended to provide a method They need stringent conditions for their for defining the minimal safety conditions that are containment. Precautions are needed when necessary when using these agents. It designates entomological experiments are conducted in the five classes of hazardous agents such as Risk same laboratory areas. Group I, II, III, IV and V. Each country should draw up a classification by risk group of the agents 5.2.5 Risk Group: Special category encountered in that country. The organisms not encountered in the country may be considered as Foreign human/animal pathogens that are not special category (Risk Group V). The following present in a country and need stringent classification is in conformity with the classification containment facilities for handling. of human and animal pathogens. 5.3 Biologics 5.2.1 Risk Group-I: Low individual and community risk Biologics derived by recombinant DNA techniques or developed from hybridomas may be This group includes agents of no or minimal classified into three broad categories based on hazard under ordinary conditions of handling, that the biological characteristics of the new product can be used safely in the laboratory without special and the safety concerns they present. apparatus or equipment and using techniques generally acceptable for non-pathogenic materials. 5.3.1 Category-I 5.2.2 Risk Group-II: Moderate individual risk This category includes inactivated recombinant and limited community risk DNA-derived vaccines, bacterins, bacterin-toxoids, virus subunits or bacterial subunits. These This class includes agents that may produce nonviable or killed products pose no infectious diseases of varying degrees of severity resulting risks. from accidental inoculation or infection or other means of cutaneous penetration. Effective 5.3.2 Category-II treatment and preventive measures are available and the risk of spread is limited. These agents can This category includes products which have usually be adequately and safely contained by been modified by the addition of one or more ordinary laboratory techniques. genes. Precaution must be taken to ensure that 66
- 97. GUIDELINES FOR SAFETY AND SECURITY OF MICROBIAL AGENTS the deletion or addition of genetic materials does microorganisms of Risk Groups I, II, III and IV. These not impart increased virulence, pathogenicity and laboratories are designated as BSL 1, 2, 3 and 4. enhanced survival period of these organisms, than The descriptions of BSL 1–4 are parallel to those those found in natural or wild type forms. The of P 1–4 in the National Institute of Health, USA, genetic information added or deleted must specify guidelines for research involving DNA technology characterised DNA segments, including base pair and are consistent with the general criteria used in analysis, amino acid sequence, restriction enzyme assigning agents to classes 1–4 in the classification sites, as well as phenotypic characterisation of the of pathogens on the basis of risks. altered organisms. 5.4.1 Biosafety Level-1 (BSL-1) 5.3.3 Category-III Such a laboratory is suitable for handling Risk This category includes live vectors which carry Group-I organisms and is referred to as a basic foreign genes that code for immunising antigens laboratory. Undergraduate and teaching and/or immuno-stimulants. Live vectors may carry laboratories come under this category. The more than one recombinant derived foreign genes laboratory is not separated from the general traffic since they can carry large numbers of new genetic in the building. The work is generally carried out information. They are also efficient for infecting on open bench-tops without the use of primary and immunising target animals. Currently used live containment equipment. However, good laboratory vectors are vaccinia and other pox viruses, bovine practices and techniques should be followed while papilloma virus, adenoviruses, simian virus-40 and handling organisms. yeasts. 5.4.2 Biosafety Level-2 (BSL-2) 5.4 Laboratory Biosafety This category of laboratory is suitable for Animal experimentation with pathogens carrying out work on Risk Group-II organisms. The requires facilities to ensure appropriate levels of level of biosafety is similar to that of BSL-I. Besides environmental quality, safety and care. Laboratory following good laboratory practices and animal facilities are extensions of the laboratory techniques, some additional aspects like closing and in some institutions are integral to and the doors when work is in progress and adherence inseparable from the laboratory. Biosafety levels to a biosafety manual should be adopted. Safety recommended for working with infectious agents equipment like biological safety cabinets (Class I in vivo and in vitro are comparable. or II) or other protective devices should be used when the procedures involved could create The three basic elements of containing aerosols. microorganisms in a laboratory are laboratory practices and techniques, safety equipment 5.4.3 Biosafety Level-3 (BSL-3) (primary containment barrier) and facility design (secondary containment barrier). Incorporation of BSL-3 laboratories are suitable for undertaking these elements into a laboratory is required for safe work with Risk Group-III organisms. The laboratories handling of human and animal pathogens, under this category include clinical, diagnostic, including recombinant organisms of various risk research or production facilities where infectious groups. These form the basis for classification of agents, which may cause serious/lethal diseases, laboratories. Four BSLs, in ascending order, are are used. Laboratory workers have special training described for laboratories dealing with in carrying out the work and are supervised by 67
- 98. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS scientists. Infectious materials are handled in generation, cross contamination and accidental biological safety cabinets (Class I, or II). The infection of the workers. In addition, the two-person laboratory has special design features of negative rule should apply, whereby no individual works air pressure with restricted access zones, sealed alone within the laboratory. A system shall be set penetrations and directional air flow. up for reporting laboratory accidents and exposures, employee absenteeism and medical Enforcement of biosafety guidelines, including surveillance of laboratory associated illnesses. decontamination of materials in the laboratory, are critical elements in the handling of pathogens. The All the procedures within the facility will be safety equipment used in this category of laboratory carried out in Class III biological safety cabinets or are biosafety cabinets (Class I, II, III) or a in Class I and II biological safety cabinets in combination of personal protective or physical conjunction with a ventilated life-support system. containment devices, e.g., clothing, masks, gloves, respirators, centrifuge safety cups, sealed The BSL-4 laboratory has specific design centrifuge rotors and animal isolators. For BSL-3 features. It should be such that organisms handled laboratories, the design features should be such in the laboratory do not escape into the environment that the infectious agents handled in the laboratory through man, material, air or water (effluent). To should not escape into the environment. The achieve this, the laboratory should be under laboratory is separated from unrestricted traffic graded negative air pressure and should have within the building. Physical separation of the arrangements for sterilisation of outgoing materials laboratory from access corridors will be provided by autoclaving (both steam and ethylene oxide), by clothing changes, showers, air locks and other formalin fumigation (air locks), surface access facilities. Table tops shall be impervious to decontamination (dunk tank), effluent treatment water and resistant to acid, alkali, solvents and (steam sterilisation) and air filtration system with heat. A sink will be located near the laboratory exit HEPA filters. which is elbow or foot operated. Exhaust air filtered through the HEPA filters of biosafety cabinets will When pathogens of high-risk groups having be discharged directly to the outside or through a zoonotic importance are handled, the personnel building exhaust system having thimble will wear a one-piece positive pressure suit which connections. is ventilated by a life-support system. A specially designed suit area shall be provided in the 5.4.4 Biosafety Level-4 (BSL-4) laboratory facility. Entry to this area shall be through an air lock fitted with airtight doors. A chemical BSL-4 laboratories are suitable for carrying out shower should be provided to decontaminate the work with Risk Groups-IV and V (exotic) pathogens surface of the suit before the worker leaves the area. which pose serious threats to the human and animal population. Personnel working in the laboratory Normally, the requirements for biosafety and have specific training in procedures of handling biosecurity are congruent. However, it is worthwhile high-risk pathogens and understand the function noting that such laboratories may be performing of various biosafety equipment and design of the clandestine research in which case these two laboratory. A safety department will formulate the activities will be in conflict. In any case, each biosafety rules and regulations, which will be institution will: followed strictly. Good laboratory practices must i) Recognise that laboratory security is related be followed to ensure safe handling of organisms to but differs from laboratory safety. at the workplace to avoid spillage, aerosol 68
- 99. GUIDELINES FOR SAFETY AND SECURITY OF MICROBIAL AGENTS ii) Control access to areas where biologic samples, cellular components and genetic agents or toxins are used and stored. elements. This is done in order to raise awareness of the need to secure collections of VBM. Through iii) Know who is in the laboratory area. microbiological risk assessments performed as an iv) Know what materials are being brought into integral part of an institution’s biosafety the laboratory area. programme, information is gathered regarding the v) Know what materials are being removed type of organisms available at a given facility, their from the laboratory area. physical location, the personnel who require access to them, and the identification of those responsible vi) Have an emergency plan. for them. Laboratory biosecurity risk assessment vii) Have a protocol for reporting incidents. should further help establish whether this biological material is valuable and warrants tighter security 5.5 Microorganism Handling provisions for its protection, that presently may be Instructions insufficient through recommended biosafety practices. This approach underlines the need to Microorganisms should always be handled in recognise and address the ongoing responsibility appropriate facilities. Thus, it will be wrong to of countries and institutions to ensure a safe and handle a Category III organism in a BSL-2 facility. secure laboratory environment. This is probably not possible in the country at present since an adequate number of containment 5.5.1 Laboratory Biosecurity Measures facilities do not exist. A dilemma arises when samples from outbreaks are being studied. In these It will be based on a comprehensive programme cases it will be prudent to handle the samples at of accountability for VBMs that includes: the highest containment level appropriate to the i) Regularly updated inventories with storage suspected infective agent. Once the aetiological locations. agent is identified it will be handled in the appropriate facility. ii) Identification and selection of personnel with access. The purpose of this part of the document is to iii) The planned use of VBM. define the scope and applicability of ‘laboratory iv) Clearance and approval processes. biosafety’ recommendations, narrowing them strictly to human, veterinary and agricultural v) Documentation of internal and external laboratory environments. The operational premise transfers within and between facilities. for supporting national laboratory biosecurity plans vi) Inactivation and/or disposal of the and regulations generally focuses on dangerous unwanted/surplus material. pathogens and toxins. In this document, the scope of laboratory biosecurity is broadened by 5.5.2 Institutional Laboratory Biosecurity addressing the safekeeping of all Valuable Protocols Biological Materials (VBM), including not only pathogens and toxins, but also scientifically, These protocols should include how to handle historically and economically important biological breaches or near-breaches in laboratory biosecurity, materials such as collections and reference strains, including: pathogens and toxins, vaccines and other i) Incident notification. pharmaceutical products, food products, GMOs, non-pathogenic microorganisms, extraterrestrial ii) Reporting protocols. 69
- 100. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS iii) Investigation reports. Specific accountability procedures for VBMs require the establishment of effective control iv) Recommendations and remedies. procedures to track and document the inventory, v) Oversight and guidance through the use, manipulation, development, production, biosafety committee. transfer and destruction of these materials. The objective of these procedures is to know which The protocols should also include how to materials exist in a laboratory, where they are handle discrepancies in inventory results, and located, and who has the responsibility for them describe the specific training to be given, and the at any given point in time. To achieve this, minimal training that personnel must be required management should define: to follow. The involvement, roles and responsibilities i) Which materials (or forms of materials) are of public health and security authorities in the event subject to material accountability measures. of a security breach should also be clearly defined. ii) Which records should be kept, by whom, 5.6 Countering Biorisks where, in what form and for how long. iii) Who has access to the records and how 5.6.1 Accountability for VBM access is documented. iv) How to manage the materials through While it is difficult to mitigate the operating procedures associated with them consequences of theft of VBM, i.e., possible (e.g., where they can be stored and used, misuse, diversion, etc., after they have left a given how they are identified, how inventory is facility, it is easier to minimise the probability of maintained and regularly reviewed, and how such an event happening, by establishing destruction is confirmed and documented). appropriate controls to protect VBM from unauthorised access or loss. Unauthorised access v) Which accountability procedures will be is the result of inappropriate or insufficient control used (e.g., manual log book, electronic measures to guarantee selective access. Losses tables, etc.). of VBM often result from poor laboratory practices vi) Which documentation/reports are required. and poor administrative controls to protect and vii) Who has responsibility for keeping track of account for these materials. It is important to VBMs. establish practical, realistic steps that can be taken to track and safeguard VBM. Indeed, viii) Who should clear and approve the planned comprehensive documentation and description of experiments and the procedures to be VBM retained in a facility may represent confidential followed. information, as much as records and ix) Who should be informed of and review the documentation of access to restricted areas. planned transfer of VBMs to another However, such documentation may prove useful, laboratory. for example, to help discharge a facility from possible allegations. For useful reference, it is 5.6.2 Transport of Materials recommended that such records be collected, maintained and retained for some time before they The use and storage of VBM should be limited are eventually destroyed. to clearly identified areas. The only VBM permitted outside a restricted area should be those that are 70
- 101. GUIDELINES FOR SAFETY AND SECURITY OF MICROBIAL AGENTS being moved from one location to another for access. Just as training is essential for good specific, authorised reasons. Transport security biosafety practices, it is also essential to train for endeavours to provide a measure of security during good biosecurity practices, particularly in the movement of biological materials outside of emergency situations. Hence, regular training of the access-controlled areas in which they are kept all personnel on security policies and procedures until they arrive at their destination. Transport helps ensure correct implementation. A national security applies to biological materials within a system of periodically validated certification of single institution and also between institutions. personnel will be desirable. Internal material transport security includes reasonable documentation, accountability and Laboratory biosecurity describes both a control over VBM moving between secured areas process and an objective that is a key requirement of a facility, as well as internal delivery associated for public health and welfare. It requires with shipping and receiving processes. External consideration of the reason for developing transport security should ensure appropriate regulations, what the objects of the regulations are, authorisation and communication between facilities how regulations are written, who develops before, during and after external transport, which regulations, and who pays for their development may involve a commercial transportation system. and application. It includes the generation and The recommendations of the UN Model Regulations sharing of scientific knowledge, and involves for the Transport of Dangerous Goods provides bioethical considerations such as transparency of countries with a framework for the development of decision-making, public participation, confidence national and international transport regulations and and trust, and responsibility and vigilance in include provisions addressing the security of protecting society. Effective laboratory biosecurity dangerous goods, including infectious substances, is a societal value that underwrites public during transport by all modes. Based on these confidence in biological science. recommendations, each country has to evolve its own regulations appropriate to its national situation. 5.6.4 Training 5.6.3 Elements of a Laboratory Biosecurity Laboratory biosecurity training, complementary Plan to laboratory biosafety training and commensurate with the roles, responsibilities and authorities of Laboratory biosecurity should specifically staff, should be provided to all those working at a address the policies and procedures associated facility, including maintenance and cleaning with physical biosecurity, staff security, personnel, staff involved in ensuring the security transportation security, material control and of the laboratory facility and to external first information security. It should also include responders. Such training should help understand emergency response protocols that address the need for protection of VBM and equipment security related issues, such as specific instructions and rationale for the laboratory biosecurity concerning situations when outside responders may measures adopted, and should include a review be called (fire brigade, emergency medical of relevant national policies and institution-specific personnel or security personnel), including the procedures. Training should provide for protection, protocol to follow once on site and the scope of assurance and continuity of operations. Procedures authority of all the parties involved. It is important describing the security roles, responsibilities and for the laboratory security plan to anticipate the authority of personnel in the event of emergencies most likely situations that would require exceptional or security breaches should also be provided during 71
- 102. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS training, as well as details of security risks judged be essential as both the hosts and pathogens will not significant enough to warrant protection be subject to similar life processes and also interact measures. The biorisk management plan should with each other. An overseeing National Committee ensure that laboratory personnel and external for Microbial Activities needs to be set up to partners (police, fire brigade, medical emergency coordinate the field and gradually build up the personnel) participate actively in laboratory laboratory infrastructure to develop the national biosecurity drills and exercises, conducted at capacity to deal with the issues. The ability to regular intervals, to revise emergency procedures handle biological disasters, be they natural or man- and prepare personnel for emergencies. made, could be built into the system. Personnel management will be crucial for the success of the Training should also provide guidance on the activity and will be a mandate for the committee. implementation of codes of conduct and should Some of the international guidelines that could form help laboratory workers understand and discuss the basis for the development of the national ethical issues. Training should also include the guidelines are: development of communication skills among partners, improvement of productive collaboration, (A) Laboratory Biosafety and endorsement of confidentiality or of i) WHO – Laboratory Biosafety Manual (LBM), communication of pertinent information to and from 3rd Edition. employees and other relevant parties. Training should not be a one-time event—it should be (B) Laboratory Biosecurity offered regularly and taken recurrently. It should represent an opportunity for employees to refresh i) WHO – LBM, 3rd Edition. their memories and to learn about new ii) WHO – Biorisk Management. Laboratory developments and advances in different areas. biosecurity. Training is also important in providing occasions iii) Organisation for Economic Cooperation and for discussion and bonding among staff members, Development (OECD) — Security and in strengthening of team spirit among members Requirements for Biological Resource of an institution. Centres. 5.6.5 National Code of Practice for C) Transport of Infectious Substances Biosecurity and Biosafety i) UN Recommendations on the Transport of A national code of practice for biosecurity and Dangerous Goods: Model Regulations. biosafety needs to be prepared and promulgated. ii) International Civil Aviation Organisation Based on such a code of practice, accreditation Requirements/International Air Transport of laboratories with respect to the handling of Association Standards. microbial material will be undertaken at the national level. Only accredited laboratories will be permitted to undertake outbreak investigations, epidemiological analysis and vaccine research. A network of such laboratories is required for a country of India’s size. The network for human (medical), veterinary and agricultural infections would probably have to be independent, but points of contact will 72
- 103. 6 Guidelines for Management of Livestock Disasters Agriculture and allied sectors account for about significant improvement in the livestock sector 24% of India’s Gross Domestic Product (GDP). Of complying with the rules of international trade in this, animal husbandry and dairy accounts for about animals and its products. In our country not only 25% and fisheries a shade over 4%. Livestock also do livestock provide milk, meat, draught power, provide gainful employment to the rural poor and transport, manure, hides, wool, etc., but animals women. These figures actually represent a steady also provide a relatively safe investment option and flow of essential food products, draught animal give the owner social security. power, manure, employment, income and export earnings. Distribution of livestock wealth in India 6.1 Losses to the Animal Husbandry is more egalitarian, compared to land. Hence, from Sector due to Biological the equity and livelihood perspectives, it is Disasters considered an important component in poverty alleviation programmes. 6.1.1 Losses due to Natural Disasters In sheer numbers, India is second in cattle and Natural disasters have negative economic first in buffalo population of 185 million and 98 consequences in the livestock sector, particularly million respectively, second in goat with 124 in developing countries. Droughts, earthquakes, million, third in sheep with 61 million and seventh floods, ice storms, wildfires, cyclones, tsunamis, in poultry with 489 million. The livestock sector etc., create havoc with human and livestock produced approximately 98 million tonnes of milk, population. These lead to a negative impact on 44 billion eggs, 48.5 million kg of wool, and 6 the infrastructure of our country by reducing an million tonnes of meat in 2004–05. The total export important source of income in rural areas and earnings from livestock, poultry and related hindering the distribution of foods and goods. products was US $ 1080.82 million in 2003–04, out of which the leather sector accounted for 6.1.2 Losses due to Infectious Diseases in 54.24% and meat and its products accounted for Animals 35.78%. The fisheries sector’s contribution is no less impressive, either, with 6.4 million tonnes of With increasing globalisation, the persistence fish production during the same period. of Trans-boundary Animal Diseases (TADs) anywhere in the world poses a serious risk to the The livestock revolution provides a significant world’s animal, agriculture and food security and opportunity for livestock farmers in the poorer jeopardises international trade. Furthermore, regions to partake in economic activity and may animal production and marketing under formal provide a way for many of them to escape poverty. trade schemes tends to institutionalise and protect However, for this to occur there is need for an systems that are increasingly demanding in both increase in the quantity and quality of animal quality and sanitary product innocuity. Recent products for trade at the local level and for a animal health emergencies, including Foot and 73
- 104. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS Mouth Disease (FMD) and bird flu have highlighted has already invaded the country on two occasions the vulnerability of the livestock sector to serious in successive years, 2006 and 2007. Through high damage by epidemic diseases and its reliance on alacrity and timely intervention, it has been possible efficient animal health services and practices at both times to control this dreaded infection with all levels. The significance of animal diseases potential for a human pandemic, within a relatively (including zoonoses) on human health and welfare short period of time. India has also been successful is also being increasingly recognised. in the past in eradicating another dreaded infection of the equine species, i.e., South African horse At both local and international levels, the sickness, which invaded the country in the early presence of animal diseases has a significant 1960s and is still present in the list of TADs. The negative impact on opportunities for trade. In remaining TADs, e.g., vesicular stomatitis, African developed countries, trends in the livestock industry swine fever and transmissible gastro-enteritis have seen an increase in scales of operation, a continue to be a threat to Indian livestock as well reduction in the number of holdings, and a as scores of other microbial infections with potential substantial increase of the importance of livestock for quick spread and mass mortality. Added to the and livestock product markets, and higher threat potential to livestock population is the frequency and speed of movement of animals and zoonotic dimension of several animal diseases animal products. As a consequence, the such as anthrax, brucellosis, West Nile fever, TB, introduction of infectious diseases to susceptible Japanese encephalitis, bird flu, rabies, etc. animals causes increasingly heavy losses in both developed and developing countries. Although the 6.3 Consequences of Losses in the small holding pattern of livestock rearing in India Animal Husbandry Sector offers relative advantages over the intensive farming system in minimising losses due to TADs, the loss Be it animal disease or a natural disaster, the absorption capacity, as in other non-industrialised consequences of loss of livestock in large numbers nations, is less. are predictable. These are primarily: i) Food scarcity due to shortage of animal 6.2 Potential Threat from Exotic and origin food, e.g., milk, meat and eggs. Existing Infectious Diseases ii) Economic crisis due to escalation of food prices (the value of milk output in India is Among the eight to ten globally recognised, equal to the combined value of paddy and most harmful TADs which can inflict enormous wheat produced). losses on livestock of a country or region in a short iii) Environmental contamination leading to span of time, five are existing in the country, e.g., epidemics due to massive animal mortality. FMD, PPR, Newcastle disease, hog cholera and bluetongue. Of these, there are official control iv) Loss of valuable germ-plasm and programmes against the first four to minimise losses biodiversity. to livestock. India has been successful recently in v) Loss of employment starting from primary eradicating rinderpest, another dreaded trans- producers, down the food processing and boundary infection which used to devastate cattle marketing chain. and other ruminants for centuries. Although it was exotic until recently, Highly Pathogenic Avian vi) Loss of traction power, shortage of manure. Influenza (HPAI), commonly referred to as bird flu, vii) Emotional shock to animal owners. 74
- 105. GUIDELINES FOR MANAGEMENT OF LIVESTOCK DISASTERS 6.4 Present Status and Context and the species of livestock/type of product to be imported. Central and state governments, voluntary ii) State Laws: agencies and international organisations are working towards reducing the impact of disasters At state level each state enforces either its and minimising the loss of animal life and own animal disease control Act or in case production on account of natural disasters and the state does not have an Act, the Act of a infectious diseases. These efforts are mainly neighbouring state is enforced for directed in developing shelter and providing for prevention and control of infectious prophylaxis and treatment, and feed and fodder diseases. Some of the state Acts are for disaster impact reduction. The issues of . enumerated below: compensation due to loss in livestock following a. The Goa, Daman & Diu Diseases of natural calamities are generally handled by the Animals Act, 1974. revenue departments of state governments on the b. The Gujarat Diseases of Animals basis of the estimation of losses made by the (Control) Act, 1963. animal husbandry departments. A compensation mechanism for losses due to infectious diseases c. The Himachal Pradesh Livestock and does not exist, unless covered under some Birds Diseases Act, 1968 and insurance scheme. Himachal Pradesh Livestock and Birds Diseases, Rules, 1971. 6.4.1 Legislative and Regulatory d. The Jammu and Kashmir Animal Framework Diseases (Control) Act Svt. 2006, (1949). e. The Madhya Pradesh Cattle Diseases (A) National Act, 1934 and Madhya Bharat Animal Contagious Diseases Act, 1959. The veterinary services are backed by suitable f. The Bombay Animal Contagious central and state legislations. Diseases (Control) Act, 1948. i) National Legislation: g. The Orissa Animal Contagious a. The Indian Veterinary Council Act, 1984 Diseases Act, 1949. regulates veterinary practices in the h. The Punjab Livestock and Birds Diseases country. Act, 1948 and Punjab Contagious b. The Livestock Importation Diseases of Animals Rules, 1953. (Amendment) Act, 2001 provides i. The Rajasthan Animal Diseases Act, modalities of International Animal 1959 and Rajasthan Animal Diseases Health Certification. Rules 1960. c. The Livestock Importation Act, 1898, j. The Bengal Diseases of Animals Act, 1944. as amended in 2001, regulates entry of livestock and livestock products. k. The Andhra Pradesh Cattle Diseases Act, 1866; Andhra Pradesh Cattle These importations are allowed subject to Diseases (Extension and Amendment) fulfillment of health/quarantine requirements Act, 1961; Bye Laws made under specified by the GoI that are developed depending Andhra Pradesh Cattle Diseases Act, upon the disease status of the exporting country 1866. 75
- 106. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS l. The Karnataka Animal Diseases (B) International Control Act, 1961: Karnataka Diseases (Control) Rules, 1967. Several of the UN organisations as well as inter- governmental organisations provide the framework m. The Madras Rinderpest Act, 1940. for development of the animal husbandry sector in n. The Madras Cattle Diseases Act, 1866. member countries, including marketing, o. The Kerala Prevention and Control of international trade, food safety and regional Animal Diseases Act, 1967. cooperation. These are: i) Food and Agriculture Organization (FAO) Note: The UTs of Andaman and Nicobar FAO is primarily responsible for the Islands and Lakshadweep do not have any animal establishment of guidelines and disease legislation. However, in the Andaman and recommendations on good agricultural Nicobar Islands and Lakshadweep islands the practices for the management of animal respective directors of animal husbandry have diseases and zoonoses. It is involved in the powers related to the control and elimination of development of programmes and infectious diseases of livestock. coordination of activities with other relevant organisations for the effective prevention The various state Acts provide that if an animal and progressive control of important animal is believed to be affected with a scheduled disease, diseases, including the promotion of the owner should report the fact to the nearest collection and analysis of information on the veterinary practitioner. The Acts also provide for national distribution and impact of these isolation of infected animals, disposal of carcasses diseases, and provision of relevant and infected material by burial or burning, technical assistance, particularly to disinfection of premises and vehicles, banning of developing countries. cattle fairs and markets or congregation of animals during any outbreak. Non-compliance with the ii) World Organisation for Animal Health provisions of the law is deemed a cognisable The need to fight animal diseases at the offence and punishable with fine or imprisonment, global level led to the creation of the Office or both. With a view to preventing the transmission International des Epizooties (OIE) through of infection to disease free areas, the Acts provide an international agreement signed on 25 that animals should move to such areas only January, 1924. In May 2003, the Office through prescribed routes and before entering the became the World Organisation for Animal area, animals should be held for observation in a Health but kept its historical acronym OIE. temporary quarantine station where, if necessary, OIE is the inter-governmental organisation they should be vaccinated and marked. The state responsible for improving animal health Acts also provide for safeguarding eradicated or worldwide. It is recognised as a reference disease-free areas from where a particular disease organisation by the WTO and as of May has been eliminated, by regulating the entry of 2007, had a total of 169 Member Countries livestock into such an area and observing such and Territories. OIE maintains permanent precautions as may be necessary to maintain the relations with 35 other international and ‘eradicated’ or ‘free’ status against a particular regional organisations and has regional and disease. Thus, there are adequate legal provisions sub-regional offices in every continent. in all the states of India for the prevention and control of animal diseases. 76
- 107. GUIDELINES FOR MANAGEMENT OF LIVESTOCK DISASTERS The organisation is placed under the traffic and trade. IHR (2005) is legally authority and control of an International binding on all WHO member states. Committee consisting of delegates iv) Codex Alimentarius Commission (CAC) designated by the governments of all member countries. The day-to-day The CAC was established in 1963 by FAO operations of OIE is managed at its and WHO to develop food standards, headquarters in Paris and placed under the guidelines and related texts such as codes responsibility of a Director General elected of practice under the Joint FAO/WHO Food by the International Committee. The Standards Programme. The main purpose headquarters implements the resolutions of this programme is to protect the passed by the International Committee, health of consumers, ensure fair trade which have been developed with the practices in the food trade, and promote support of Commissions elected by the coordination of all food standards work delegates. undertaken by international governments and NGOs. The Codex Alimentarius system OIE is primarily responsible for the presents a unique opportunity for all establishment of standards, guidelines and countries to join the international recommendations relevant to animal community in formulating and harmonising diseases and zoonoses in accordance with food standards and ensuring their global its Statutes and as defined in the WTO- implementation. It also allows them a role Sanitary and Phyto-Sanitary (SPS) in the development of codes governing Agreement (refer to Chapter 7). Its mandate hygienic processing practices and includes development and updating of recommendations relating to compliance international science-based reference with those standards. standards and validation of diagnostic tests published in the Terrestrial Animal Health V) The Global Framework for Progressive Code, Aquatic Animal Health Code, Manual Control of Trans-boundary Animal Diseases of Diagnostic Tests and Vaccines for (GF-TADs) Terrestrial Animals, and Manual of This is a joint FAO/OIE initiative which Diagnostic Tests for Aquatic Animals. The combines the strengths of both OIE list of infectious diseases of terrestrial organisations to achieve agreed common animals is provided in Annexure-G. objectives. GF-TADs is a facilitating iii) International Health Regulation (IHR) mechanism which will endeavour to empower regional alliances in the The revised IHR that was adopted by the fight against TADs, to provide for World Health Assembly in 2005 is an capacity building and to assist in international legal instrument that came into establishing programmes for the specific force on 15 June 2007, replacing the earlier control of certain TADs based on regional IHR. The purpose and scope of IHR (2005) priorities. is to prevent, protect against, control and provide a public health response to the The overall objective of GF-TADs is to limit international spread of disease in ways that the ravages of animal diseases on the are commensurate with and restricted to livelihoods of livestock-dependent people public health risks, and which avoid around the world and to promote safe and unnecessary interference with international healthy trade through strengthening local 77
- 108. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT UIDELINES FOR MANAGEMENT G OF BIOLOGICAL DISASTERS OF LIVESTOCK DISASTERS and national capabilities. FMD was containment, based on official OIE data, identified as the principal animal disease ground information stemming from field of global concern in all the consultations projects, collaborators, consultancy carried out during the preparation of this missions or personal contacts and provides programme. In order to obtain the necessary analyses of the situation, disseminated information for the promotion of early through bulletins, electronic messages and prevention and early reaction, close other reports. interaction among national animal health WHO has developed an outbreak tracking services for achieving a sound regional and verification system for human diseases, understanding of disease occurrence is which, for zoonotic diseases such as Rift required. GF-TADs will rely on the action of Valley fever, brucellosis, TB, rabies and countries’ veterinary services and those of food-borne diseases, will be shared with regional, specialised animal health OIE and FAO in GF-TADs. organisations. Since international animal health monitoring is able to single out geographical dynamics of disease 6.4.2 Prevention and Preparedness: National occurrence only when countries report the Scenario presence of diseases, GF-TADs intends to contribute to the strengthening of national Animal husbandry and veterinary services is a structures and mechanisms to fulfil such state subject and falls within the purview of the reporting functions effectively. state government. As a consequence each state vi) Existing International Warning Systems for government and UT has its own department of Diseases animal husbandry and veterinary services. Veterinary services are provided at state veterinary OIE has an information system that includes hospitals, dispensaries and mobile veterinary the dissemination of early warning clinics which are staffed by veterinary graduates messages whenever epidemiologically holding a degree in veterinary science and animal significant events are officially reported to husbandry recognised by the Veterinary Council its Central Bureau, within hours of their of India (VCI) and State Veterinary Councils. receipt. This alert system is aimed at Prevention of animal diseases, control and decision-makers, enabling them to take surveillance is also an important function of the necessary preventive measures as quickly state veterinary services. as possible. In order to improve transparency and animal Subjects such as animal quarantine, prevention health information quality, OIE has also set of inter-state transmission of diseases, regulatory up an animal health information search and measures for quality of biologicals and drugs, verification system for non-official import of biologicals, livestock, livestock products information from various sources on the and control of diseases of national importance are existence of outbreaks of diseases that have the responsibilities of the central government. not yet been officially notified to the OIE. FAO, through the emergency prevention The DADF of the MoA handles the central system priority programme established in animal health services. The central government 1994, developed an early warning and formulates schemes and policies for the control response system aimed at disease and eradication of diseases in the country. 78
- 109. GUIDELINES FOR MANAGEMENT OF LIVESTOCK DISASTERS India has about 47,000 registered veterinary the emergency. At the state level, a similar practitioners engaged in different activities. More committee, i.e., the state animal disease than 70% of the registered veterinary practitioners emergency committee is activated. All important are in the state government services. The country stakeholders, including specialists in the subject has 8,720 veterinary hospitals and polyclinics, are members of these committees. 17,820 veterinary dispensaries, and 25,433 Veterinary Aid Centres (VACs) and mobile veterinary (B) Sub-national Veterinary Services clinics totalling 51,973 centres. In addition, there are border posts which besides their border duties The provision of veterinary services falls within also work as disease reporting posts. Thus the total the purview of the state governments. Veterinary number of disease reporting posts is 52,390. These services are provided at state veterinary hospitals disease reporting units form the backbone of the and dispensaries, and mobile veterinary clinics. disease surveillance system and have an effective Immunisation against prevalent endemic animal coverage. There are 51,973 animal disease diseases, animal disease reporting, surveillance reporting units in 641,169 villages in India. 86,073 and controlling disease outbreaks are important veterinary personnel (24,767 veterinary graduates functions of the state veterinary service. Delivery and 61,306 veterinary field assistants) look after of veterinary services at state level is done both by the animal health aspects. Thus, for animal disease field and laboratory services of each state and UT. surveillance, disease reporting and veterinary cover, on an average one disease reporting post caters There is an inbuilt disease surveillance system to the needs of 12.33 villages, 5,464 bovines (cattle in the country. Administratively, each state and buffaloes) and 3,499 sheep and goats. comprises of several districts. Each district is However, in the event of any disaster, these services divided into tehsils/talukas, which are further are often found wanting. divided into villages. A village is the smallest administrative unit at the grass-root level. (A) National Veterinary Services There is a well-knit infrastructure of The provision of these services is the government veterinary services units at each level. responsibility of the DADF of the MoA. Subjects Broadly, state headquarters and large district towns such as animal quarantine, providing health have veterinary polyclinics, each district regulatory measures for import/export of livestock headquarter has a veterinary hospital and each and livestock products, animal feeds, etc., and tehsil headquarter has a veterinary dispensary. prevention of inter-state transmission of animal Veterinary assistant surgeons/veterinary officers diseases and control of diseases of national who are veterinary graduates head all these importance are the responsibilities of the central institutions. At the village level, veterinary services government. are provided by VACs. Each VAC caters to the needs of about 5–10 villages. VACs are headed The central government has a special by veterinary field assistants who are non-graduate, responsibility for safeguarding against any new para-veterinary personnel. They are given one to disease threatening to enter the country. In the two years of training after matriculation in state- event of an emergency in the livestock sector, the run government veterinary training schools. They DADF activates its National Animal Disease impart preliminary veterinary services to farmers Emergency Committee (NADEC) to monitor, and administer preventive vaccination to livestock evaluate and issue necessary guidelines to handle against prevalent infectious diseases. 79
- 110. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS A VAC is the first disease information unit at (C) Animal Disease Management the grass-root level. Under the provisions of state disease control acts, a livestock owner or any other In order to control diseases in economically government or private personnel functioning in the important livestock and to undertake the obligatory area having knowledge about the onset of an functions related to animal health in the country, infectious disease in livestock is supposed to inform GoI is implementing a scheme for livestock health the VAC. The VACs communicate disease outbreak and disease control with the following components: information to the veterinary dispensary/hospital, i) Assistance to States for Control of Animal which in turn passes on the information to the Diseases (ASCAD) district veterinary officer and which further flows to Under this component, assistance is the director of veterinary services. The state director provided to state governments/UTs for the sends a monthly report to GoI. Reporting of disease control of economically important diseases as per the OIE list of diseases is presently an affecting livestock and poultry by way of important function of this disease surveillance immunisation, strengthening of existing system. state veterinary biological production units, strengthening of existing state disease There are 250 disease investigation diagnostic laboratories, holding workshops/ laboratories in India for providing disease seminars and in-service training to diagnostics services. Many states have disease veterinarians and para-veterinarians. The investigation laboratories at the district level. Each programme is being implemented on a state has a state-level laboratory which is well 75:25 sharing basis between the centre and equipped and has specialist staff in various the states, however, 100% assistance is disciplines of animal health. provided for training and seminars/ workshops. The states are at liberty to Beside the state disease investigation choose the diseases for immunisation as per the prevalence and importance of the laboratories there is one central and five referral disease in their state/region. Besides this, regional disease diagnostics laboratories funded by the DADF. Each state agriculture university/ the programmes envisage collection of information on the incidence of various live- veterinary college also has disease diagnostic stock and poultry diseases from states/UTs facilities. At the national level, the IVRI, and specially its Centre for Animal Disease Research and and compile the same for the whole country. Diagnostics based at Izatnagar (Bareilly) and the ii) National Project on Rinderpest Eradication Disease Diagnostic Laboratory of the National Dairy (NPRE) Development Board (NDDB) at Anand, Gujarat, are The objective of this scheme is to highly specialised laboratories providing disease strengthen veterinary services and eradicate diagnostic services. In order to monitor ingress of Rinderpest and Contagious Bovine Pleuro- exotic diseases, a state-of-the-art laboratory exists Pneumonia (CBPP) and to obtain freedom at HSADL, Bhopal with BSL-4 standards. By and from these infections following the path large, all state-level laboratories, regional prescribed by OIE. The country has gained diagnostic laboratories, laboratories of ICAR/NDDB the status of ‘Freedom from Rinderpest and and HSADL are capable of diagnosing animal CBPP Infections’. However, surveillance is diseases. still carried on. 80
- 111. GUIDELINES FOR MANAGEMENT OF LIVESTOCK DISASTERS iii) Foot and Mouth Disease Control Programme each at Mumbai, Kolkata, Delhi and (FMD-CP) Chennai, have been established. These stations are equipped to deal with all To prevent economic losses due to FMD imports into the country. and develop herd immunity in cloven-footed animals, FMD-CP is being implemented in vi) Functions of AQCS in India: 54 specified districts of the country since a. Quarantine/testing of imported 2003–04 as part of the Tenth Plan with 100% livestock and livestock products. central funding for cost of vaccines, maintenance of cold chain and other b. Export certification of livestock/ logistic support to undertake vaccination. livestock products as per the The state governments are providing other requirements of the importing country infrastructure and manpower for the and as prescribed in the Terrestrial programme. Six-monthly vaccination drives Animal Health Code, OIE. are carried out in the identified districts. c. Implementation of various provisions The programme has considerably reduced of the Livestock Importation Act, 1898 losses due to this infection in the areas (as amended in 2001). where it is being implemented. (vii) National Veterinary Biological Products iv) Professional Efficiency Development (PED) Quality Control Centre (Institute of Animal The objective of this scheme is to regulate Health) veterinary practice and maintain a register In order to ensure the quality of veterinary of veterinary practitioners as per the biologicals used in the country for the provisions of the Indian Veterinary Council prevention and control of infectious Act, 1984 (IVC Act). In order to upgrade the diseases, GoI has established the National skill of veterinarians, a Continuing Veterinary Veterinary Biological Products Quality Education Programme has been initiated. Control Centre at Baghpat, Uttar Pradesh, Under the Central Sector Scheme of the which is expected to start functioning soon. Directorate of Animal Health, schemes for The institute has the following objectives: Animal Quarantine and Certification a. To recommend licensing of Services, Disease Diagnostic Laboratories manufacturers of veterinary vaccines, (central/regional laboratories) and the biologicals, drugs, diagnostics and National Veterinary Biological Products other animal health preparations in the Quality Control Centre (Institute of Animal country. Health) are functioning. b. To establish standard preparations for v) Animal Quarantine and Certification use as reference materials in biological Services (AQCS) assays. While efforts have been made to ensure c. To ensure quality assurance of the better livestock health in the country, veterinary biologicals both produced simultaneous efforts are equally necessary indigenously and through imports. to prevent entry of any disease into the country from outside through the import of (vii) Livestock Insurance Scheme livestock and livestock products. With this Apart from the regular health schemes, the objective in view, four AQCS Stations, one Livestock Insurance Scheme has also been 81
- 112. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS formulated with the twin objectives of inadequate. In the event of increased demand to providing a protection mechanism to meet the ideal standards of livestock health farmers and cattle rearers against any management, production facilities will be found eventual loss of their animals due to death wanting in terms of capacity and also in terms of and to demonstrate the benefit of the good manufacturing practices with the state- insurance of livestock to the people and controlled units. popularise it with the ultimate goal of attaining qualitative improvement in 6.5 Challenges livestock and their products. This centrally sponsored scheme has been implemented DM in livestock, be it due to infectious diseases on a pilot basis in 2005–06 and 2006–07 or natural calamities, is inadequately addressed during the Tenth Five-Year Plan in 100 in the country. The professional and other selected districts. Under the scheme, stakeholders dealing with livestock are not crossbred and high yielding cattle and adequately trained in this vital aspect of livestock buffaloes are being insured at their current management. The course curricula of veterinary market price. and animal sciences do not adequately address this. Infectious disease control in livestock, 6.4.3 Research and Development in particularly the existing ones, is well covered during Livestock Health training in universities. The capacity for timely detection of an exotic disease which has the The development of therapeutics and potential of becoming a disaster, and its prophylactics against animal health problems, as subsequent management so that it can be well as developing best practices for disease minimised, will require to be built up. A case in management, disease epidemiology and point is the recent incursion of bird flu into the surveillance for diseases are done primarily by a country. Vital time were lost in its first experience highly specialised laboratory under specialised in the country where the disease was initially animal science institutions like ICAR. Besides these confused with another existing disease in poultry institutions, state agricultural and veterinary with almost similar clinical manifestations. Through universities, NDDB and several private sector a series of training programmes, people have been establishments are also involved in the trained to handle a possible emergency in case of development of vaccines or diagnostics for livestock any further occurrence of bird flu. However, diseases. simultaneous occurrences in several places in the country could still seriously stretch resources. It is 6.4.4 Production of Veterinary Biologicals and essential that adequate stress be given to quality Pharmaceuticals manpower development in the management of disease-related emergencies in livestock. Vaccines are manufactured both in the private sector as well as in the state-run biological 6.5.1 Existing Gaps in Animal Disaster production centres. The quality aspects of the Management manufacturing plants are regulated by the Drug Controller of India under MoH&FW. Compared to The following gaps could thus be identified in the number of livestock and poultry, as well as the the management of disasters in livestock, be it number of diseases that are prevalent in the due to natural calamities, diseases or an act of country, the infrastructure for such production is war: 82
- 113. GUIDELINES FOR MANAGEMENT OF LIVESTOCK DISASTERS i) Inadequate trained manpower for DM: The v) Inadequate inter-state disease and existing livestock health management setup emergency disease reporting system: The at both the state and central levels consists existing routine and paper-based disease of veterinary professionals trained in routine reporting system is both time-consuming management of animal diseases. There is and ineffective in managing disease control a need to train veterinary professionals in and containment. The existing system the comprehensive management of animal should be replaced with a wide area emergencies of disastrous proportions. A network-based disease reporting system separate force of trained volunteers should throughout the country. also be raised at the state and district levels vi) Lack of policy in border areas regarding to assist veterinary professionals in the movement of livestock in and around managing animal emergencies. neighbouring countries where the borders ii) Inadequate training facility for staff in the are porous: The existing quarantine management of disasters: At present, the facilities, especially along the international training given to veterinary professionals is borders with Nepal, Bhutan, Myanmar and primarily in routine diseases management. Bangladesh are grossly inadequate in Training objectives are confined to the preventing the spread of TADs. The various management of endemic diseases only, no security forces guarding these borders could organised training is provided in the be utilised by giving them the necessary management of large-scale epidemics/ policy backup, training and infrastructure. pandemics such as bird flu, etc. In view of vii) Inadequate preparedness for animal DM at emerging animal pandemics such as bird the district and state levels: Presently, flu, FMD, etc., there is an urgent need to animal health emergencies are not catered institutionalise specialised training in the for in DM plans in many states and districts. management of large-scale animal As a policy guideline, inclusion of emergencies. contingency measures for managing animal iii) Inadequate biosecured laboratories for emergencies should be made mandatory. handling dangerous pathogens: Presently viii) Lack of a national policy for the there is only one laboratory at HSADL, rehabilitation of the animal husbandry sector Bhopal, with BSL-4 standards. The recent after a disaster: Post-disaster rehabilitation experience with the bird flu outbreak of both disaster-struck animals as well as revealed the inadequacy to cater for an farmers is of paramount importance due to epidemic/pandemic. There is a need to the obvious health and economic establish more regional laboratories of BSL- implications. There is a need to lay down 4 level to cater to emerging contingencies. policies for systematic and organised iv) Lack of mobile veterinary laboratories/clinics management of rehabilitation efforts. to work at the emergency site: In case of epidemics occurring in remote and isolated 6.6 Guidelines for the Management places, on-the-spot primary diagnosis is a of Livestock Disasters crucial aspect of emergency measures. Valuable time wasted in getting the 6.6.1 Risk and Vulnerability Assessment diagnosis done at far-off laboratories can be saved with the availability of mobile Disasters that could lead to an emergency diagnosis laboratories in the districts. situation in the animal husbandry sector may arise 83
- 114. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS primarily due to the following four categories of d. Public health problems. risks: iii) Earthquake i) Natural disasters: Flood, drought, cyclone, a. Injured livestock lead to problems of tsunami, earthquake, etc. their maintenance. ii) Infectious diseases: Zoonotic and non- b. Death or desperation of the owners zoonotic. leads to neglect of the livestock iii) Fodder poisoning. thereby increasing the indirect losses. iv) Miscellaneous: War (conventional war, BW The above factors will be used to define the or BT). steps of risk and vulnerability assessment. The major recommendations for district/state authorities (A) Natural Disasters include: India is vulnerable to most types of natural i) Development of ‘multi-hazard’ risk and disasters and its vulnerability varies from region to vulnerability mapping of the districts. region and a large part of the country is exposed ii) Development of demographic maps of areas to these natural hazards which often turn into with dense/scarce population of livestock. disasters, causing a significant disruption of the social and economic life of communities arising iii) Other factors that compound/reduce the from the loss of life and property, including contained risk, including variable climatic livestock. The risk factors required to be included conditions and availability of medical in the risk assessment analysis with respect to a logistics. group of natural disasters are listed below: i) Cyclic Drought and Famine (B) Infectious Diseases a. Breeding capacity. Emergency animal diseases are not always the b. Fertility. same as exotic or foreign animal diseases. Outbreaks of infectious diseases are of many types: c. Pregnancy and lactation. i) Any unusual outbreak of an endemic disease d. Population drift due to in exponential frequency causing significant - heavy economic losses change in the epidemiological pattern of - scarcity of feed and fodder that particular disease. ii) Tsunami, heavy snowfall and rain, flood ii) The appearance of a previously unknown disease in a particular region. a. High mortality rate among livestock due to drowning (generally they are iii) Animal health emergencies caused due to not set free to move to highland areas, non-disease events, for example, a major making them vulnerable to the chemical residue problem in livestock or a situation). food safety problem such as hemorrhagic uraemic syndrome in humans caused by b. Unavailability of clean drinking water. the contamination of animal products by c. Outbreak of diseases due to improper verotoxic strains of E. coli. disposal of carcasses. 84
- 115. GUIDELINES FOR MANAGEMENT OF LIVESTOCK DISASTERS iv) Deliberate introduction of exotic the above approach, the following activities will microorganisms in a targeted region. be undertaken: i) Listing of the various poisonous materials, A risk analysis will enumerate the mitigation including braken fern, Lantana camara, strategy to be outlined for the prevention of such parthenium, rati (Abrus prectorus), dhatura livestock diseases: (thorn apple), kaner (oleandar); cyanogenic i) Mitigation measures will be developed, plants like immature maize, sorghum based on the risk assessment analysis, to banchari, cereal affected with egrot, India control the spread of such diseases. pea; nitrate and nitrite containing plants, etc.; and the measures to prevent the ii) Mapping will be done of infectious diseases availability of such materials to livestock. endemic to the area and level of prevalence in the past. ii) Exotic/cross breeds are more susceptible to damage under drought conditions than iii) Surveillance mechanisms will be set up to indigenous breeds. Livestock owners will detect exotic microorganisms to prevent be made aware of how to take proper care outbreaks and high priority diseases that of these exotic/cross breeds. may lead to national emergencies. iii) Certain areas will be demarcated for fodder iv) Large-scale epidemics which may occur production, especially of Crassulacean Acid due to the introduction of a new disease or Metabolism (CAM) varieties of plants, infectious agent or uncontrolled movement particularly in desert areas. Pastures should of animals resulting in mixing of the also be developed for migratory sheep and susceptible and infected population, have goat and clean grain made available for to be checked. pigs and poultry. v) Genetic mutation in an otherwise innocuous infectious agent, climatic changes or (D) Trans-boundary Animal Diseases disruption of the environment necessitate changes in husbandry and DM practices. TADs are a major cause of economic losses to Routine monitoring/surveillance of field the livestock industry and are those infectious flocks will be undertaken, particularly in diseases which could spread fast and have the seasons which are conducive to such potential to cause considerable mortality or losses epidemics. in productivity. TADs have the capability to seriously vi) The vaccination status of all livestock will affect earnings from export of livestock or its be periodically checked. products. (C) Fodder Poisoning A TAD epidemic such as avian influenza (bird flu) or FMD has the same characteristics as other Nitrate accumulation in plants leads to nitrate/ natural disasters—it is often a sudden and nitrite poisoning which is a potential danger to unexpected event, has the potential to cause major grazing animals with pigs being most susceptible, socio-economic consequences of national followed by cattle, sheep and horses. In order to dimensions and even threaten food security, may keep a check on such cases, awareness among endanger human life, and requires a rapid national- the local community must be created so that they level response. The following diseases are of take proper care of their animals and prevent them immense importance from both animal husbandry from eating poisonous toxic materials. Based on and public health perspectives: 85
- 116. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS i) Non-zoonotic diseases India and could possibly play havoc with the national economy as well as public health are FMD, a. FMD* rinderpest, PPR and avian influenza (H5N1). b. Peste des Petits Ruminants (PPR)* c. Rinderpest The major recommendations to contain these endemic diseases which have epidemic potential d. Vesicular stomatitis are as follows: e. African Swine Fever (ASF) i) Strict quarantine inspection and testing will f. Classical Swine Fever (CSF)* be undertaken for any form of imported g. Contagious Bovine Pleuropneumonia germplasm prior to release. (CBPP) ii) In case of avian influenza, special care will ii) Diseases with known zoonotic potential be taken during the migratory season to prevent mixing of wild and domestic a. Anthrax* population of birds. b. Bovine Spongiform Encephalopathy (BSE) Exotic animal diseases have managed to enter c. Brucellosis (B. melitensis)* India a number of times causing severe loss to the livestock industry. A risk analysis will monitor the d. Crimean Congo hemorrhagic fever emergence and re-emergence pattern of exotic e. Ebola virus diseases: f. Food-borne diseases i) HPAI emerged in two instances though it has been stamped out of indigenous g. Highly Pathogenic Avian Influenza territory. (HPAI)* ii) Exotic diseases like bluetongue in sheep, h. Japanese encephalitis* infectious bovine rhinotracheitis in cattle, i. Marburg hemorrhagic fever PPR in sheep and goat or infectious bursal j. New World screwworm disease in poultry have now become endemic in the country. Effective vaccines k. Nipah virus are available in our country to manage l. Old World screwworm these livestock diseases. m. Q fever iii) Exotic diseases prevailing in other n. Rabies* countries which have a higher vulnerability potential of re-emergence in Indian o. Sheep pox*/goat pox* livestock, for example rinderpest, which is p. Tularemia still prevalent in some parts of Africa and is one of the most dreadful infections of q. Venezuelan equine encephalomyelitis cattle until recent times. r. West Nile virus iv) Presently, Indian livestock is vaccinated (* indicates presence of the disease in India) against serotypes ‘O’, ‘A’ and ‘Asia 1’, but is highly vulnerable to world serotypes ‘C’, Almost all the diseases mentioned above have ‘SAT 1’, ‘SAT2’ and ‘SAT 3’ and the the potential to assume epidemic proportions, yet antigenic variants of existing serotypes that a few important ones that have been endemic in require constant surveillance. 86
- 117. GUIDELINES FOR MANAGEMENT OF LIVESTOCK DISASTERS The risk management practices based on these iii) Ensuring the availability of emergency kits prevailing risk factors will include: with farmers and people living in the vicinity of known hazardous factories/nuclear i) Check on the unhindered movement of laboratories, etc. animals across the states; incursion of any new infectious disease that could cause serious losses of livestock. 6.6.2 Capacity Development ii) Diseases like HPAI with an inherent zoonotic A large number of farmers in rural India suffer potential will be kept under constant loss of livestock due to various diseases. It is surveillance. essential to prevent and mitigate such losses by iii) Risk maps will have trend maps with capacity development in the following areas: periodic shift patterns, time intervals of re- i) Immediate relief in terms of emergency aid emergence and consequence through Veterinary Assistance Teams (VATs), management analysis of increase/reduction temporary makeshift shelters and in the overall risk due to the introduction of emergency provision for water and feed exotic breeds. packages. A disaster often impacts the iv) Human disease surveillance data and surroundings, altering the landscape’s probabilities of shift from livestock to character, feel, smell, look and layout. It is humans or vice versa will be mapped to important to provide an alternative shelter, define the areas that require adoption of clean and uncontaminated water and appropriate mitigation strategies. ensure that damaged grain and mouldy hay or feed or forage that may have been (E) Miscellaneous Causes contaminated by chemicals or pesticides is not consumed by them. India may have remained blissfully unaware of ii) Infrastructure for disposal of dead animals: the losses in livestock due to the Bhopal gas Burial/disposal methods of animal tragedy or the consequences of arsenic or other carcasses and other products (tissues) of toxic elements that may not only cause acute loss animal origin will continue to be an of livestock but are also potentially hazardous for important and necessary concern. The public health as livestock produce is directly related purpose of a ‘secure’ burial is to physically to the human food chain. The impact of major isolate wastes from the environment and to accident hazard units such as nuclear reactors and prevent contamination of water and air. At hazardous waste dumping sites are examples of the village level, some suitable land should slow and impending livestock disaster situations. be identified beforehand, for any emerging The major recommendations include: contingency. Ideally, incineration facilities i) Development of risk management plans for for proper disposal of animal carcasses are incident site contamination levels and essential as specific disease control ecological studies to define the routing of measures during epidemics. the various toxins to livestock. iii) Infrastructure for containment of epidemics: ii) Regular health surveys of the livestock of Any attempt to contain an emerging these regions by an assigned authority, pandemic virus at its source is a demanding based on mutually agreed mechanisms and resource-intensive operation. The between the public and private sectors. feasibility of rapid containment depends on 87
- 118. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS the number of contacts of the initial cases coordination with relief and rescue and the ability of government authorities to efforts of government and ensure basic infrastructure and essential humanitarian agencies so as to avoid services to the affected population. The the mismanagement that often infrastructure for various services including hampers relief operations following shelter, power, water, sanitation, food, natural disasters. security, and communications will be c. Awareness programme on accidental developed to maintain strict infection and man-made chemical/biological control in isolation/quarantine facilities. disasters: A well-organised training Training of first responders for proper culling programme of veterinary professionals of birds by animal husbandry teams is as well as administrative officials in essential to prevent the spread of bird flu. livestock emergency management is iv) Organised rehabilitation packages for the need of the hour. A brief module in livestock livelihood: A programme that the form of a workshop should be delivers a comprehensive package of organised to apprise the concerned combined services including restocking, parties of the emerging threat shelter construction and income-raising perceptions and their activities; water and sanitation countermeasures. The training interventions; health, nutrition and facilities available with KVKs as well psychological stress amelioration with as agriculture universities should be education and disaster preparedness, will utilised. be undertaken. d. Enhancement of the capabilities of a. Building infrastructure for disease emergency field and laboratory forecasting: Disease surveillance veterinary services, especially for should utilise modern computing and specific high-priority livestock disease communication technology to convert emergencies. Accurate and timely data into useable information quickly laboratory analysis is critical for and effectively. Accurate and efficient identifying, tracking and limiting data transfer with rapid notification to threats to livestock health. The national key partners and constituents is critical network of animal health laboratories for effectively addressing the threat of will be strengthened for a more emerging diseases. efficient livestock health system and augmentation of its capacity to b. Training of farmers on mitigation of respond effectively to livestock health disaster losses: Villagers (livestock disasters. farmers, including women) should be given intensive DM training. This will include preparation for post- 6.6.3 Inter-departmental Support earthquake, flood, cyclone and fire Several essential government services, other situations. The objective of the than MoA, will be invaluable during crisis to programme is to help build, within a mitigate impact on the animal husbandry sector. short period of time, a mechanism that These include, inter alia: can respond to natural calamities and facilitate early recovery. Outcomes of i) Defence forces (notably the Army and Air the training should include better Force) which can provide support for such 88
- 119. GUIDELINES FOR MANAGEMENT OF LIVESTOCK DISASTERS activities, including transportation of preparedness planning. This would include, personnel and equipment to disaster or inter alia, the National Veterinary disease outbreak sites, particularly when Association, livestock industry groups, these are inaccessible to normal vehicles; national/state authorities and Departments provision of food and shelter; protection of of Finance, Health and Wildlife. disease control staff in areas with security problems and provision of communication 6.6.4 Livestock Management during facilities between national and local disease Disasters control headquarters and field operations. ii) Veterinary professionals of the Army and The following preparations are essential for various forces guarding the border, viz., management of animals during disasters: Assam Rifles, Border Security Force (BSF), i) Development of flood, cyclone and other Indo-Tibet Border Police (ITBP) and natural calamity warning systems. In Sashastra Seema Bal (SSB) will be trained principle, an EWS would make it possible and co-opted in the containment of TADs. to avoid many adverse economic and iii) Police or security forces for assistance in human costs that arise due to the the application of necessary disease control destruction of livestock resources every year. measures such as enforcement of Reliable forecasting would also allow state quarantine and livestock movement, control governments to undertake more efficient measures, and protection of staff if relief interventions. Other tools that may necessary. provide early warning signals include field iv) Public works department, for provision of monitoring and remote sensing systems. earth-moving and disinfectant-spraying Ideally, field monitoring should provide equipment, and expertise in the disposal monthly flows of information on the of slaughtered livestock in eradication availability of water and the general state campaigns. of crop and livestock production. Useful production parameters include marketing v) National or state emergency services for trends, particularly the balance of trade logistics support and communications. between livestock and grain foods, and Defence forces and various paramilitary anthropomorphic measures such as the forces will be equipped and entrusted to mean arm circumference of children under provide necessary logistics and five. Remote sensing, which relies on communication backup in case of imagery satellites, is a valuable tool when emergency. used in conjunction with field monitoring. vi) Revenue Department services for These tools will be integrated to develop compensation against losses. A uniform an effective EWS. policy for compensation that has necessary ii) Establishment of fodder banks at the village legislative backing will be entrusted to the level for storage of fodder in the form of Revenue Department to ensure bales and blocks for feeding animals during implementation. drought and other natural calamities is an vii) Liaison with, and involvement of, relevant integral part of disaster mitigation. The persons and organisations outside the fodder bank must be established at a secure government animal health services who also highland that may not be easily affected have a role in animal health emergency by a natural calamity. A few fodder banks 89
- 120. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS will be developed as closed facilities to programme provides for the intentional prevent them from getting contaminated. removal of animals from a region before they die. iii) Supply of feed ingredients at nominal cost from the Food Corporation of India: Most viii) Treatment and vaccination of animals grain rations for cattle and sheep provide against contagious diseases in flood enough protein to maintain a satisfactory affected areas. Routine prophylactic 10–12% level. But when we feed livestock vaccination of livestock in flood-prone area in emergency situations—mostly low-protein significantly reduces the severity of the materials such as ground ear corn, grain post-disaster outbreak of any endemic straws or grass straws—a protein diseases. Since animals affected by floods supplement is needed. Adequate reserves are prone to pick up infectious diseases, as per the availability of resources will be vaccination and veterinary camps will be developed. set up to treat and immunise livestock iv) Conservation of monsoon grasses in the against various diseases. The creation of a form of hay and silage during the flush community based animal health care season greatly help in supplementing delivery system may significantly reduce shortage of fodder during emergencies livestock deaths in a region. Vaccination such as drought or flood. The objective is programmes and primary animal health care to preserve forage resources for the dry will prevent some of the drastic losses season (hot regions) or for winter (temperate associated with the onset of rains. regions) in order to ensure continuous, ix) Provision of compensation on account of regular feed for livestock. It is an important distressed sale of animals and economic disaster mitigation strategy. losses to farmers due to death or injury of v) Development of existing degraded grazing livestock. Compensation for animals and lands by perennial grasses and legumes. other property affected by an emergency As a majority of the population in drought- due to an animal disease outbreak is an prone areas depends on land-based integral part of the strategy for eradicating activities like crop farming and animal or controlling disease. A legislation that husbandry, the core task for development provides the power to destroy livestock and will be to promote rational utilisation of land property, and ultimately determines the for supplementing fodder requirements process by which compensation is to be during emergencies. paid, will be enacted and implemented by the respective legislative bodies. vi) Provision of free movement of animals for grazing from affected states to the unaffected reduces pressure on pastures 6.6.5 Disposal of Dead Animals during and also facilitates early rehabilitation of Disasters the affected livestock. In emergency situations, the presence of livestock can Carcasses can be a hazard to the environment exacerbate conflict when refugees with and other animals and require special handling. animals compete for reduced forage and To minimise soil or water contamination and the water resources. To prevent this, what is risk of spreading diseases, guidelines for proper technically known as emergency de- carcass disposal must be followed. Disposal stocking programme, will be instituted. This options include calling a licensed collector to 90
- 121. GUIDELINES FOR MANAGEMENT OF LIVESTOCK DISASTERS remove dead stock or burial in an approved animal iv) A comprehensive strategy for recovery disposal pit. Alternatives include incineration and actions to bring back normalcy, including burial. Burial avoids air contamination associated assistance for repairs and other losses will with burning carcasses and is economical. Since be identified in DM plans. the heat in the pile eliminates most pathogens, Safety is an important aspect of a response burial can also improve the biosecurity of farming plan and every action plan will enumerate operations. different responding activities to be undertaken for the effective management A plan for the disposal of dead livestock should of livestock disasters. The response plan address selection of the most appropriate site in will be rehearsed to remove the plausible each village or cluster of villages for burial or anomalies in actions. burning, disinfection process, provision of costs for burial or burning, material and equipment required for burial and burning, etc. A prototype 6.6.7 Steps for Prevention, Mitigation and guideline for disposal of livestock is provided for Preparedness reference (Annexure-H). DM plans at all levels will include the following important measures: 6.6.6 Strategy for Emergency Management i) Public awareness about natural disasters i) There will be efforts to prevent an that different regions and the country are emergency, reduce the likelihood of its most likely to experience and their occurrence or reduce the damaging effects consequences on the livestock sector. of unavoidable hazards long before an ii) Provisions to establish adequate facilities emergency occurs. Flood and fire insurance to predict and warn about the disasters policies for farms are important mitigation periodically, including forecasting disease activities. outbreaks. This could only be achieved by ii) It is pertinent to develop plans regarding a well networked surveillance mechanism what to do, where to go, or who to call for that proactively monitors emerging help before an event occurs—actions that infections and epidemics. will improve chances of successfully iii) Development and implementation of dealing with an emergency. These include relevant policies, procedures and legislation preparedness measures such as posting for management of disasters in the animal emergency telephone numbers, holding husbandry sector. The livestock health disaster drills and installing warning infrastructure in India, modelled to provide systems. routine veterinary cover, needs iii) Efforts need to be made to respond safely reorganisation in view of emerging to an emergency by converting epidemics/challenges. The existing animal preparedness plans into action. Seeking husbandry policies will be revisited and if shelter from a cyclone or moving out of the required, modified to cater to changing buildings during an earthquake are both realities. response activities. The GoI Action Plan for iv) Mobilise the necessary resources, e.g., management of the outbreak of bird flu is access to feed, water, health care, sanitation an example of the effective handling of an and shelter, which are all short-term outbreak of livestock disaster in the country. measures. In the long term, resettlement 91
- 122. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS programmes, psycho-social, economic and xii) Development of active disease surveillance legal needs (e.g., counselling, and epidemiological analysis capabilities documentation, insurance) are required to and emergency reporting systems. be undertaken. xiii) A computer-based national grid of v) Another long-term strategy is required to surveillance and disease reporting should readjust the livestock production system in be developed for timely detection and the country from a biosecurity point of view containment of any emergent epidemic. so that in the event of the entry of any new, xiv) An intelligence cell—Central Bureau of dangerous pathogen, the losses could be Health Intelligence under DGHS should be minimised by segregation. raised to assist the proposed National vi) Initiation of PPP in livestock emergency Animal Disaster Emergency Planning management, especially in the field of Committee (NADEPC). vaccine production, will go a long way in xv) Immunisation of all persons who are likely combating animal health emergencies of to handle diseased animals such as anthrax infectious origin. Similar partnership in feed infected cattle and animals. manufacturing as well as livestock production will minimise the losses due to other livestock emergencies. 6.6.8 Research and Development vii) Commissioning of risk assessments on The need for strategic research to mitigate risks high-priority disease threats and of biological disasters in livestock—a vital subsequent identification of those diseases component of the human food chain—is in no way whose occurrence would constitute a different from risks to humans. The world is slowly national emergency. moving towards the ‘one health: animal health and viii) Appointment of drafting teams for the public health’ concept, as it has been seen that preparation, monitoring and approval of most newly emerging human epidemics in the last contingency plans. Implementation of decade in various parts of the world had originated simulation exercises to test and modify in livestock or other animals and birds. Therefore, animal health emergency plans and the requirements of R&D efforts for livestock DM preparedness are also necessary. are similar these discussed in Chapter 4. Research institutions of ICAR, defence organisations, ICMR, ix) Assessment of resource needs and planning DBT and CSIR will identify areas of potential threat for their provision during animal health and disasters in livestock and fisheries and readjust emergencies. their research priorities to address these concerns x) Central/state governments will develop/ to be in readiness for any eventuality. establish an adequate number of R&D and biosafety laboratories in a phased manner for dealing with animal pathogens. xi) A dedicated establishment, preferably under DADF, may be entrusted with the overall monitoring of the national state of preparedness for animal health emergencies. 92
- 123. 7 Guidelines for Management of Agroterrorism The agricultural sector comprising of crop Agroterrorists could release damaging insects, plants and animals are susceptible to a large viruses, bacteria, fungi or other microbes as number of diseases and pests in nature, some of bioweapons that are mainly aimed at wiping out which assume epidemic proportions due to the crops or farm animals. They also could attempt to appearance of more severe or virulent strains/races/ poison processed foods. Although the biotypes of the pests in a given area under certain consequences of an agroterrorism attack are favourable conditions, causing huge economic substantial, relatively little attention has been losses. The present chapter, mainly focuses on the focused on this threat worldwide. Agricultural and disease/pest outbreaks in the agrarian sector which food industries—the most important industries in are deliberately brought about by malafide the world are most vulnerable to disruption. It is intentions. The key difference between natural also an easy way to cause huge damage when epidemics and those that are deliberately induced compared to other terrorist attacks, and the is an element of vigilance that needs special capabilities that terrorists would need for such an attention by intelligence agencies for the attack are not considerable. The incidences of management of agroterrorism. agroterrorism in Colorado during WW II, attacks on Cuban crops, the citrus tanker disease in Florida Agroterrorism is clearly not aimed at agriculture and deliberate attacks in Sri Lanka are some of per se but at crippling the economy. Indeed, the cited examples. agroterrorism certainly has a number of advantages for the perpetrator over the more anticipated forms 7.1 Dangers from Exotic Pests of BW aimed directly at humans. The agents are generally not hazardous to man and so can be In the past, a number of plant and animal produced and carried with minimal risk. The diseases and pests have been introduced through technical and operational challenges are reduced, import of seeds/planting materials/livestock and since the pathogens rapidly reproduce and are livestock products and many of them have become easily disseminated—such as by walking in a field established and continue to cause economic losses with contaminated shoes, hiring a crop duster to every year. In the case of crops, the important infect wheat fields, wiping a cow’s nose with an diseases include bunchy top in banana, potato infected handkerchief. All these actions could easily wart, downy mildew in sunflower, chickpea blight, go unnoticed yet be sufficient to spread disease. San Jose scale in apple, coffee berry borer, the Moreover, the trend of planting monocultures invasive weed Lantana camara and more recently having a high degree of genetic homogeneity, the the biotype ‘B’ of whitefly Bemisia tabaci (most concentration of a single crop in one region and efficient vector of the tomato leaf curl virus). The the intensive rearing of animals all aid in the spread diseases affecting animals include infectious of disease. The targets are vulnerable and the bovine rhinotracheitis, PPR, blue tongue, equine security levels low. 93
- 124. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS infectious anaemia, infectious bursal disease, reo the incidence of berry borer damage as high as and adeno viruses, etc. 60–70% in a few badly managed plantations in Byrambada area of Kodagu District. Late harvesting The banana bunchy top disease was recorded also aggravated the buildup of berry borer for the first time in 1943 in Kottayam District in the population. Recently, the incidence of berry borer erstwhile princely State of Travancore (now Kerala). has been reported from the coffee growing areas The disease was believed to have come from Sri of lower Palani Hills. Lanka (then Ceylon). An eradication programme initiated in the 1950s met with little success as the The damage potential of dangerous pests and virus spread through the aphid vector, viz., diseases which have not yet been reported from Pentalonia nigronervosa. Subsequently, the disease India is high especially if misused or mishandled. spread to Assam, Kerala, Orissa, Tamil Nadu and These can cause immense harm to human beings West Bengal. The central government issued a and ecosystems on a large scale, which is an issue domestic quarantine notification in 1959 prohibiting of great concern. Thus, the agricultural economy transportation of banana planting material from the is vulnerable to serious threats from exotic pests. above states to any other state/UT. However, in the absence of effective implementation of domestic Diseases that have the potential to be used as regulatory measures, the disease continued to bioweapons are listed below: spread to other states and its incidence was reported from most banana-growing areas of the (A) Bacterial and Fungal Pathogens country. Of late, the banana bunchy top disease i) Bacterial wilt and ring rot in potato has completely wiped out the hill banana cultivation ( Clavibacter michiganensis sub sp. in the lower Palani Hills area of Tamil Nadu. sepedonicus). The coffee berry borer (Hypothenemus hampei) ii) Fire blight in apple and pear ( Erwinia was first reported in the Gudalur area of Nilgiris amylovora). District in Tamil Nadu in 1990. The pest was iii) Black pod in cocoa ( Phytophthora believed to have been introduced through infested megakarya). coffee beans brought by Sri Lankan repatriates settled in Gudalur area. Surveys carried out in 1992 iv) Powdery rust in coffee (Hemelia coffeicola). have revealed incidence of the pest in coffee v) Sudden death in oak ( Phytophthora growing areas of Wyanad District of Kerala and ramorum). Kodagu (Coorg) District of Karnataka. The central vi) South American leaf blight in rubber government issued a notification in 1992 prohibiting (Microcyclus ulei). the movement of coffee beans (seeds) and planting material from Nilgiris, Wyanad and Kodagu vii) Vascular wilt in oil palm ( Fusarium Districts. With the removal of restrictions on the oxysporum f sp. elaedis). pooling of coffee by the Coffee Board and viii) Soybean downy mildew ( Peronospora introduction of the free sale quota, the pest manshurica). continued to spread to newer areas due to ix) Blue mold in tobacco (P hyocyami sub sp. . unrestricted movement of infested berries to curing tabacina). places located outside these three districts. The infested area was about 10,000 ha in 1993 and x) Tropical rust in maize (Physopella zeae). 94
- 125. GUIDELINES FOR MANAGEMENT OF AGROTERRORISM (B) Virus, Viroid and Phytoplasma South Asia; rice tungro spherical virus whose Indian i) Barley stripe mosaic virus. isolate is different from Southeast Asian isolates; cotton leaf curl virus which causes severe damage ii) Coconut cadang-cadang (Viroid). in Pakistan but has limited distribution in India; iii) Palm lethal yellowing (Phytoplasma). groundnut bud necrosis virus having a wide host range; banana bunchy top virus with five identified (C) Plant Parasitic Nematodes strains; and tobacco streak virus, citrus tristeza virus and mungbean yellow mosaic virus which i) Pine wood nematode ( Bursaphelenchus have reported several strains. The pathogens xylophilus). causing serious diseases where variability has been ii) Red ring nematode in coconut reported are cereal rusts caused by Puccinia (Rhadinaphelenchus cocophilus). triticina (whose spores are airborne of which a number of virulent pathotypes are known), rice blast (D) Insect Pests (Pyricularia oryzae, where a high degree of i) Mediterranean fruit fly (Ceratitis capitata). variability has been reported), Bulkholderia solanacearum (whose race 2 is not known in India) ii) Cotton boll weevil (Anthonomus grandis). and Xanthomonas campestris pv malvacearum (of iii) Russian wheat aphid (Diuraphis noxia). which the most virulent pathovar in Africa, XcmN, is not known in India). The insects where biotypes 7.2 Basic Features of an Organism have been reported include Bemisia tabaci (a highly to be used as a Bioweapon in the polyphagous pest which attacks more than 600 Agrarian Sector host plant species has 16 known biotypes); brown plant hopper (Nilaparvata lugens, where biotypes For an organism to be used as a bioweapon, from India differ from those in other Asian countries); it should possess certain basic characteristics. rice gall midge (Orseolia oryzae, has six biotypes These include high adaptability to a wide range of known from India) and red flour beetle (Tribolium ecological conditions and easy amenability for castaneum, whose strains show variability in the mass production and discrete packaging with no level of pesticide resistance). Several races have special requirements of storage, etc. The organism also been reported for nematodes like Meloidogyne should also have a strong competitiveness, high incognita, M. javanica/M. arenaria and Heterodera rate of propagation to be able to spread far and avenae. wide with minimum inoculum, and also have the ability to propagate persistently. The organism 7.4 Present Status and Context should also affect a key crop grown over large areas so as to cause significant losses to the target The economy of India is largely linked to the country or to an important agro-industry. growth of agriculture as it is a predominantly agrarian country. Indian agriculture has made rapid 7.3 Dangers from Indigenous Pests progress in taking the annual foodgrain production from 51 million tonnes in the early 1950s to 200 Apart from the threat of exotic destructive million tonnes at the turn of the century, thereby agricultural pests, their strains/isolates/biotypes making the country self-reliant in food production. reported also have a potential for use as However, the liberalisation of world trade in bioweapons comprising viruses such as rice tungro agriculture since the establishment of WTO in 1995 bacilliform virus with four variables isolated from has brought in many challenges apart from opening 95
- 126. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS up new vistas for growth and diversification of like cowpea mottle virus on Vigna unguiculata from agriculture. We need to sustain food security along the Philippines and Alfalfa mosaic virus on Vigna with economic and environmental security. unguiculata from Nigeria. Under the present scenario of liberalised trade 7.4.1 Legislative and Regulatory Framework in agriculture, there is an increasing likelihood of a number of serious exotic pests gaining entry and The legislative and regulatory framework at the establishment through bulk imports. Among these national and international level for the management are moko wilt in banana, which has seriously of agroterrorism activities are discussed in the threatened banana cultivation in Central and South following sections. America. Further, lethal yellowing of coconut is another dreadful disease which was responsible (A) National for the loss of more than half a million coconut i) Destructive Insects and Pests Act, 1914 palms in Jamaica, which was worst affected and The quarantine law was enacted for the first created havoc in the Caribbean region. Cadang- time in India in 1914 as the Destructive cadang is another destructive disease in coconut Insects and Pests (DIP) Act. A gazette reported from Philippines and Guam. The red ring notification entitled ‘Rules for Regulating the nematode causes serious losses to coconut and Import of Plants etc., into India’ was other palms in tropical America. The South published in 1936. Over the years, the DIP American leaf blight in rubber is another disease Act has been revised and amended several of quarantine concern which, so far, is not known times. However, it was further amended to to have occurred in Southeast Asia, but is still a meet the emerging scenario of liberalised serious concern to rubber producing countries in trade under WTO. this region. Coffee berry disease is of sufficient concern to India and has caused serious losses in The DIP Act (1914) provides for the coffee production in African countries. Further, two following: destructive pathogens of cocoa, viz., swollen shoot a. It prohibits or regulates the import into virus and witches’ broom though not known to have India or any part thereof or any specific occurred yet in India, are of sufficient concern to place therein or any article or class of cocoa production in the country. Likewise there articles. are many pests that attack plants against, which we need to safeguard our country. b. It also prohibits or regulates the export from a state or the transport from one It may be mentioned that a number of state to another state in India of any destructive pests/diseases have recently been plants and plant materials, diseases intercepted in quarantine, which highlights the risk or insects, likely to cause infection or of introduction of these pests/diseases through infestation. indiscriminate imports. The interceptions in plants c. It authorises the state government to include insects like Anthonomus grandis on make rules for the detention, Gossypium sp from USA, Ephestia elutella on inspection, disinfection or destruction Triticum aestivum from Italy, nematodes like of any pest or class of pests or of any Ditylenchus dipsaci in Allium cepa from England, article or class of articles, in respect Heterodera schachtii in Beta vulgaris from of which the central government has Germany; pathogens like Peronospora manshurica issued notifications. in Glycine spp from several countries and viruses 96
- 127. GUIDELINES FOR MANAGEMENT OF AGROTERRORISM In 1984, a notification was issued under the c. Import of soil, earth, sand, compost, DIP Act, namely Plants, Fruits and Seeds plant debris accompanying seeds/ (Regulation of Import into India). The order, planting materials is not permitted. popularly known as the PFS Order, was Besides, hay, straw or any other revised in 1989 after the announcement of material of plant origin are not to be the New Policy on Seed Development by used as packing material. GoI in 1988, proposing major modifications d. Special conditions for import of plants, for smooth quarantine functioning. The new seeds for sowing, planting and policy covered the import of seeds, planting consumption mentioned under materials of wheat, paddy, coarse cereals, Schedule II (Clause 4) of the Order. oil seeds, pulses, vegetables, flowers, ii) Plant Quarantine (Regulation of Import into ornamentals and fruit crops. While India) Order, 2003. liberalising imports, care has been taken to ensure that there is absolutely no With liberalised trade under the WTO compromise on plant quarantine Agreements, there has been a pressing requirements. Though there are several need for complying with international phyto- requirements under the PFS Order, 1989, sanitary regulations. Therefore, to fill in the the most important are: gaps in the existing PFS Order, viz., regulating the import of germplasm/GMOs/ a. No consignment would be imported transgenic plant material; live insects/fungi into India without a valid import permit including biocontrol agents etc.; and to fulfil issued by the concerned competent India’s obligations under the international authority: (a) for bulk consignments the Agreements, the Plant Quarantine (PQ) import permit issued by the Plant (Regulation of Import into India) Order, 2003 Protection Advisor to GoI; (b) for came into force from 1 January 2004. Under importing germplasm of agri- this Order, the need for incorporation of horticultural crops, the Director of the additional/special declarations for freedom National Bureau of Plant Genetic of imported commodities from quarantine Resources (NBPGR) is authorised by and alien pests on the basis of standardised GoI to issue import permits, both for Pests Risk Analysis, particularly for seed/ government institutions as well as planting materials, is also taken care of. private seed companies; (c) for forest plants, the Forest Research Institute, Under the PQ Order, 2003, the scope of Dehradun; and (d) for the remaining plant quarantine activities has been plants of economic and general widened with the incorporation of additional interest, the Botanical Survey of India, definitions. The salient features of the Order Kolkata. No consignment will be are: imported unless accompanied by an a. Pest Risk Analysis (PRA) has been official phyto-sanitary certificate issued made a precondition for imports. by an official agency of the exporting b. Prohibition has been imposed on the country. import of commodities with weeds/ b. Seeds/planting materials requiring alien species contamination as per isolation growing under detention, to Schedule VIII; and restriction on the be grown in an approved post-entry import of packaging material of plant quarantine facility. origin, unless treated. 97
- 128. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS c. Provisions have been included for under Schedule VI of the PQ Order, 2003, regulating the import of soil, peat and after vetting by DPPQS. sphagnum moss; germplasm/GMOs/ iii) Environment Protection Act (EPA), 1986 transgenic material for research; live insects/microbial cultures and In the UN Conference on the Human biocontrol agents and timber and Environment held at Stockholm in 1972, in wooden logs. which India participated, it was urged that all countries should take appropriate steps d. Agricultural imports have been for protection and improvement of the classified as (a) Prohibited plant human environment. Consequently, the EPA species (Schedule IV); (b) Restricted was enacted in 1986 to protect and improve species where import is permitted only the environment and prevent hazards to by authorised institutions (Schedule V); human beings, other living creatures, plants (c) Restricted species permitted only and property. with additional declarations of freedom from quarantine/regulated pests and The Environment (Protection) Rules, 1989 subject to specified treatment came later for the purpose of protecting and certifications (Schedule VI) and ; (d) improving the quality of the environment Plant material imported for and preventing and abating environmental consumption/industrial processing pollution. In its various schedules, relevant permitted with normal Phyto-sanitary provisions have been made for the Certificate (Schedule VII). management and handling of hazardous wastes; rules for manufacture, storage and e. Additional declarations have been import of hazardous chemicals; and rules specified in the Order for import of 400 for the manufacture, use, import/export and agricultural commodities, specifically storage of hazardous microorganisms, listing 600 quarantine pests and 61 genetically engineered organisms or cells. weed species (now 31 as per It empowers the central government to Amendment III of the PQ Order, 2003). prohibit or restrict the handling of hazardous f. Notified points of entry have been substances, including their export and increased to 130 from the existing 59. import in different areas either in qualitative g. Certification fee and inspection or quantitative terms because of its potential charges have been rationalised. to cause damage to the environment, human beings, other living creatures, plants and So far, 10 amendments of the PQ Order, property. Both living modified organisms 2003, have been notified to WTO revising (LMOs) and invasive alien species are definitions, clarifications regarding specific covered under EPA, however, it does not queries raised by quarantine authorities of state in clear terms the modality for various countries, with revised lists of crops restriction and prohibition of these potential under Schedules IV, V, VI, and VII. The threats to the environment. revised list under Schedule VI and VII now include 411 and 284 crops/commodities, iv) Biological Diversity Act, 2002 respectively (www.plantquarantineindia.org). The Biodiversity Act primarily addresses the Besides, NBPGR has also conducted a PRA issue of access to genetic resources and for 95 species which have been notified associated knowledge of foreign 98
- 129. GUIDELINES FOR MANAGEMENT OF AGROTERRORISM individuals, institutions or companies, and of the above-mentioned regulations. There equitable sharing of benefits arising out of are six statutory bodies involved: the use of these resources and knowledge a. Recombinant DNA Advisory to the country and the people. In order to Committee under DBT to recommend safeguard the interests of the people of appropriate safety regulations in India the proposed exceptions are: recombination research, use and a. Free access to biological resources for applications. use within India for any purpose other b. The Institutional Biosafety Committee than commercial use. to prepare site-specific plans for the b. Use of biological resources by vaids use of genetically engineered and hakims. microorganisms. c. Free access to the Indian citizens to c. Review Committee on Genetic use biological resources within the Manipulation under DBT to oversee all country for research purposes. research and field trials on LMOs. d. Collaborative research through d. The Genetic Engineering Approval government sponsored or government Committee under MoEF to consider approved institutions subject to the proposals related to the release of overall policy guidelines and approval genetically engineered organisms into of the central government. the environment. There is need to take care of the provisions e. The State Biotechnology Coordination of the PQ Order, 2003 while dealing with Committee to inspect, investigate and the ‘Regulation of Access to Biological take punitive action in case of Diversity’—prepare a list of pests which have violations of safety and control a wide host range to predict their impact on measures in the handling of genetically biodiversity and have a mechanism for in- engineered organisms. country movement of disease-free material, f. The District Level Committee to including those for research. monitor safety regulations in v) GM Crops installations engaged in the use of genetically modified organisms and Genetic engineering tools and recombinant their applications in the environment. DNA technology have led to the development of transgenic or genetically vi) Disaster Management Act, 2005 modified crops with a novel combination Refer to Chapter 2 of this document. of genetic materials. (B) International Biosafety framework in India: i) Agreement on the Application of Sanitary The GM crops developed through and Phyto-sanitary Measures biotechnological applications are passed through a stringent regulatory framework This Agreement, commonly known as SPS before its approval by the GoI. The Ministry Agreement of WTO of which India is a of Environment and Forests (MoEF) and DBT signatory member, concerns the application are the nodal agencies for implementation of food safety, animal and plant health 99
- 130. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS regulations. It recognises the government’s sanitary standards and it has set up an rights to take sanitary and phyto-sanitary import conditions database. Further, measures but stipulates that they must be Biosecurity Australia is actively involved in based on science, should be applied only negotiations with trading partners and to the extent necessary to protect human, international fora to maintain, gain or animal and plant life or health and should improve access to export markets for live not arbitrarily or unjustifiably discriminate animals and their genetic material, plants, between members where identical or similar and plant products. conditions prevail. The Agreement aims to Similarly, New Zealand’s Ministry of overcome health-related impediments of Agriculture and Forestry has established plants and animals to market access by Plants Biosecurity, which has implemented encouraging the ‘establishment, recognition an integrated biosecurity system for and application of common sanitary and imported agricultural/horticultural products. phyto-sanitary measures by different The New Zealand Ministry of Agriculture and Members’. Forestry Biosecurity Authority is responsible SPS measures are defined as any measure for the development and implementation of applied to protect animal or plant life or plant import health standards and its health from risks arising from the entry, officials have been closely associated with establishment or spread of pests and the development of international standards diseases; to protect human or animal life on phyto-sanitary measures. or health from risks arising from additives, Canada also has established an contaminants, toxins or disease causing independent self-sustaining Canadian Food organisms in food, beverages or foodstuffs; Inspection Agency, an umbrella organisation and to protect human life or health from for implementation of SPS measures related risks arising from diseases carried by to animal and plant products. Uruguay and animals. There are three standard-setting Chile have established self-sustaining international organisations whose activities agricultural quarantine inspection services are considered to be particularly relevant for enforcing SPS measures totally in line to its objectives: FAO/WHO, CAC, OIE, and with the WTO-SPS Agreement and forged the international and regional organisations strong economic integration among operating within the framework of the Argentina, Brazil, Bolivia and Paraguay. International Plant Protection Convention (IPPC). The European Union has forged strong economic integration and adopted common ii) Global Developments in the wake of SPS plant health directives to protect the Agreement of WTO interests of the member countries. The Recently, the Department of Agriculture, Animal and Plant Health Inspection Service Fisheries and Forestry of the (APHIS) is an independent service Commonwealth of Australia established established under the United States Biosecurity Australia for conducting import Department of Agriculture (USDA) which is risk analyses as per the Australian responsible for implementing SPS Quarantine Inspection Service’s Import Risk measures. A list of national standards on Analysis Process. Biosecurity Australia is phyto-sanitary measures is provided in responsible for the development of phyto- Annexure-I. 100
- 131. GUIDELINES FOR MANAGEMENT OF AGROTERRORISM iii) Major challenges under the WTO-SPS The Convention had three main goals, viz., Agreement for developing countries conservation of biodiversity, sustainable use In the wake of implementation of the WTO- of the components of biodiversity, and SPS Agreement, developing countries have sharing the benefits arising from the to face the following challenges: commercial and other utilisation of genetic resources in a fair and equitable way. The a. Review and updating of phyto-sanitary Convention was comprehensive in its goals legislation and regulations to give and dealt with an issue so vital to humanity’s effect to the international agreement future that it stands as a landmark in and establish a nodal point for international law. It recognises for the first enquiries and information exchange, time that the conservation of biological including a notification procedure. diversity was ‘a common concern of b. Establishment of national standards on humankind’ and is an integral part of the SPS measures in line with international development process. The Agreement standards to undertake pest risk covers all ecosystems, species and genetic analysis and identify pest-free areas resources. It links traditional conservation and scientifically justify the high level efforts to the economic goal of using of protection in the absence of pest biological resources sustainably. It sets risk assessment. principles for fair and equitable sharing of c. Recognition of the equivalence of the benefits arising from the use of genetic specific measures through bilateral or resources, especially those destined for multilateral agreements. commercial use. It also covers the rapidly expanding field of biotechnology, d. Strengthening of backup research in addressing technology development and quarantine for diagnosis and treatment. transfer, benefit-sharing and biosafety. The e. Capacity building in terms of Convention is legally binding and the infrastructure and expertise. signatory member countries are obliged to implement its provisions. iv) Biological and Toxin Weapons Convention Refer to Chapter 4 of this document. Article 8 (h) of CBD, 1992 emphasises on preventing the introduction and eradication v) Convention on Biological Diversity (CBD) or control of those invasive alien species In 1992, the largest ever meeting of world which threaten other species, habitats or leaders took place at the UN Conference ecosystems. These alien species are on Environment and Development in Rio de recognised as the second largest threat to Janeiro, Brazil. A historic set of agreements biological diversity and natural resources, were signed at this ‘Earth Summit’, including after habitat destruction. Article 8 (g) of the CBD, the first global agreement on the Convention directs the members to establish conservation and sustainable use of or maintain means to regulate, manage or biological diversity. The biodiversity treaty control the risks associated with the use gained rapid and widespread acceptance. and release of LMOs which are likely to Over 150 governments signed the have adverse environmental impacts on the document at the Rio conference, and since conservation and sustainable use of then more than 175 countries have ratified biological diversity, also taking into account the Agreement. the risks to human health and, specifically, 101
- 132. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS focusing on transboundary movements. ICAR has established several research centres Recognising the potential risk arising from in order to meet the agricultural research and LMOs, Article 19.3 of CBD provides for the education needs of the country. It is actively safe transfer, handling and use of LMOs. . pursuing HRD in the field of agricultural sciences After several meetings the parties adopted by setting up numerous agricultural universities the International Protocol on Biosafety in across the country. The Technology Intervention January 2000. Programmes form an integral part of ICAR’s agenda, making KVKs responsible for training, research and 7.4.2 National Organisation demonstration of improved technologies. ICAR, through its various institutes, carries out research Indian Council of Agricultural Research work on the detection and management of both indigenous and exotic pests and diseases of ICAR is an autonomous apex body responsible livestock, plants, animals and fisheries, and for the organisation and management of research undertakes quarantine processing of plant and education in the fields of agriculture, animal germplasm and research material, including that sciences and fisheries. To fulfil its mission, ICAR of transgenics, at NBPGR. HSADL, Bhopal, has aims to achieve the following mandate: the facilities to work with exotic disease-causing microbes under high containment conditions. i) To plan, undertake, aid, promote and coordinate research and education, extension in agriculture, horticulture, 7.4.3 International Organisations plantation crops, animal sciences, fisheries, (A) World Trade Organization agroforestry, home science and allied sciences. WTO, established on 1 January 1995, is the ii) To act as a clearing house for research and legal and institutional foundation of the multilateral general information relating to agriculture, trading system. It is the platform on which trade animal husbandry, fisheries, agroforestry, regulations among countries evolve through home science and allied sciences through collective debate and negotiation and which in turn its publications and information system, and have a broad scope in terms of commercial activity instituting and promoting transfer of and trade policies for all the member countries. technology programmes. The WTO Agreement contains more than 60 iii) To look into the problems relating to broader agreements in 29 individual legal texts covering areas of rural development concerning everything from services to government agriculture, including post-harvest procurement, rules of origin and intellectual technology, by developing cooperative property (http://www.wto.org). Of these, the programmes with other organisations such Agreement on the Application of Sanitary and as the Indian Council of Social Science Phyto-sanitary (SPS) measures is in fact the one Research, CSIR, Bhabha Atomic Research which is going to have major implications on Centre, Agricultural and Processed Food biosecurity in trade. It covers measures to be Products Export Development Authority, the adopted by countries to protect human health from Ministry of Food Processing Industries, diseases; human or animal life from food-borne MHA, state agricultural universities and risks; and animals and plants from pests and central research institutes. diseases. The specific aims of SPS measures are 102
- 133. GUIDELINES FOR MANAGEMENT OF AGROTERRORISM to ensure food safety and to prevent the spread of sanitary Measures and networks with all regional diseases among animals and plants. plant protection organisations at the global level. FAO has a biosecurity portal which is a storehouse In order to achieve these targets, international of knowledge and information on all aspects of standards need to be developed for which WTO animal and plant diseases and gives information has assigned the responsibilities as follows: on the various Technical Cooperation Projects undertaken in the developing world. It also i) For food safety: CAC, Vienna, a subsidiary promotes or sponsors various training organ of FAO, and WHO has been programmes on issues related to pest risk analysis, authorised for all matters related to food EWS, etc. safety evaluation and harmonisation. ii) For animal health and zoonosis: OIE, Paris, 7.4.4 Prevention and Preparedness: National develops the standards, guidelines and Context recommendations. iii) For plant health: IPPC at FAO, Rome, is the DPPQS under the Department of Agriculture source for International Standards for the and Cooperation of MoA has a network of 29 PQ Phyto-sanitary Measures affecting trade. stations at various international airports, seaports and land frontiers to check bulk imports of grains, These three organisations are often referred to seeds and other planting materials for the presence as the ‘Three Sisters’ who are observers and of diseases and pests that may be associated with contributors to the SPS committee meetings. They these materials. Though a few of these stations also serve as experts who advise WTO dispute are well equipped, in general they lack trained settlement panels. manpower and infrastructure to handle imported materials effectively and quickly. As far as The main purpose of WTO is to promote free quarantine of imported research material trade flow, serve as a forum for trade negotiations (germplasm, transgenic planting material) is and serve as a dispute settlement body, based concerned, it is undertaken by ICAR at NBPGR, upon the principles of non-discrimination, equal which has both the expertise and the laboratory treatment and predictability. Agriculture was and post-entry quarantine facilities (including a brought under the purview of multilateral trade containment facility of CL-4 level) to do the job negotiations and this has led to apprehensions effectively. among the people that implementation of the provisions of the agreement will have an adverse (A) Legislation effect on domestic agricultural production, exports and imports. The new PQ (Regulation of Import into India) Order, 2003 is an attempt to comply with the various (B) Food and Agricultural Organization provisions of the SPS Agreement of WTO of which India is a signatory. The new PQ Order has however FAO is an organ of the UN which has a number evoked many queries from the European of programmes on plant and animal biosecurity. Commission, US Department of Agriculture (USDA), IPPC, as mentioned earlier, has its secretariat in Canada, and other developed countries. The PQ FAO and takes care of plant biosecurity issues. order is being looked into for suitable amendments IPPC develops international standards on phyto- to promote trade and not to use quarantine sanitary measures through a Commission on Phyto- measures as a technical barrier to trade. 103
- 134. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS (B) Recent Developments in Strengthening Plant (C) Recent Attention given to Technical Issues Quarantine Facilities i) Steps are now being taken to conduct PRA on priority commodities of export/import, Keeping in view the significant role played by though still in an ad hoc manner. phyto-sanitary services in the safe conduct of global trade in agriculture, MoA has established modern ii) The database on endemic pests is being pest diagnostic laboratory facilities with high-tech developed at Regional PQ Station, scientific equipment at five regional centres at Chennai, and the database on pests of Amritsar, Chennai, Kolkata, Mumbai and New Delhi quarantine significance to India are being under the FAO-United Nations Development developed at NBPGR, New Delhi. These Programme (UNDP) Project. The Project was will be complimentary and serve as a aimed at developing and strengthening plant backbone of information for developing quarantine facilities at major ports through capacity PRA. building and HRD. Further, under this project, iii) Amendments to the revised PQ Order, 2003 various expert consultations were organised in are being brought about, keeping in view drafting PQ legislation; training programmes/ the global demands for facilitating trade. workshops in pest risk analysis and surveillance; preparation of operational manuals; setting up of iv) A task force on phyto-sanitary capacity laboratory diagnostic facilities; designing of glass building has been recently set up to look house facilities; quality systems and auditing; etc. into the immediate and long-term training needs at different levels. Besides, a PQ website, www. plant quarantine v) Steps are also being taken to establish a india.org was designed and hosted under the PQ authority which would make the system above-mentioned project. The PQ website provides more dynamic from the operational and information about contact points, plant quarantine financial aspects. setup, PQ Act and regulations, New Seed Policy guidelines, quarantine procedures for issuance of permit, import clearance, post-entry quarantine 7.5 Guidelines for Biological Disaster inspection and export inspection and certification Management—Agroterrorism of agriculture commodities. But it needs to be upgraded in a dynamic mode. Also, a suitable 7.5.1 Legislative and Regulatory Framework software package was developed for creating a database on endemic pests of prioritised Quarantine legislations are in place and have commodities. Quality Systems-International been revised. Specific regulatory measures will be Standards Organisation (ISO) 9002 certification has developed to deal with agroterrorism. It should been implemented for quarantine screening and include strong legislative and administrative laboratory testing of import/export plants and plant policies for import/export processes related to material at the Regional PQ Station, Chennai. This application of SPS measures; to implement survey involved preparation of quality policy manual/ and control, including emergency actions against quality procedures manual for documentation of pests; to search, seize, inspect, treat or destroy the procedures being practiced and periodical infected/infested material; to enact or enforce SPS review and auditing to ensure these procedures regulations; to negotiate, establish and comply with are being followed through corrective and bilateral agreements; and to allow and perform preventive actions. auditing and monitoring of SPS activities. 104
- 135. GUIDELINES FOR MANAGEMENT OF AGROTERRORISM 7.5.2 Risk and Vulnerability Assessment a mechanism for early detection of the disease. This again highlights the Mechanisms to assess the risk of attack on importance of integrated pest surveillance agricultural crops/storage godowns will be defined with the component of early detection as and developed based on threat analysis. one of its mandates. ii) At the field level, this would involve proper As far as imports are concerned, steps are education and awareness programmes for being taken to gear up pest risk analysis for the villages to ward off intentional attacks imported commodities, but it is still in process. An by suspected agroterrorists on their crops/ organised system dedicated to carry out pest risk animals/livestock and also to equip them analysis against identified quarantine pests will be with the emergency curative measures to established. This requires an independent unit for be taken in such a situation. risk analysis with trained manpower and computer and internet facilities. iii) DDMAs will ensure that there is enough stock of disinfectants and vaccines for (A) Integrated Pest Surveillance System animals; and chemicals, biopesticides and biocontrol agents to save crops from any i) An effective integrated pest surveillance suspected attack. system and organisation devoted to performing field inspection and pest survey iv) For imports, the quarantine network will be activities for the detection, delimitation or strengthened especially at land frontiers of monitoring of established pests, as well as the country through which agroterrorists can a system and organisation devoted to the easily bring in exotic pests in a clandestine detection of new pests will be introduced. manner. ii) Specific systems will be required for 7.5.4 Preparedness identification, establishment and maintenance of pest-free areas according (A) Emergency Control and Treatment to international standards. i) An EOC will be established as a national hub for incident operations support, (B) Intelligence Gathering and Secured communications, and information Dissemination of Information dissemination pertaining to the management of animal and plant incidents The agriculture departments of the district/state and all similar hazards. The EOC will agricultural machinery will work out the modalities integrate and provide overall monitoring at the local/regional levels for intelligence gathering and operations support and serve as the and secured dissemination of information. Such primary point of coordination during processes will be developed knowing the fact that agricultural health emergencies. the stakeholders are generally farmers, a majority ii) The EOC has to be used in both routine of whom have small land holdings and need to be protected from any unforeseen calamity to avoid and emergency situations. When an emergency situation is not underway, the chaos at all levels. Centre’s facilities will be used to monitor and report on international and domestic 7.5.3 Prevention and Early Detection surveillance of pest pathogens and disease i) The first step to ward off ultimate harm from conditions of concern and to conduct an agroterrorist attack in the field is to have advanced training. 105
- 136. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS iii) The EOC will have advanced security ii) Post-entry quarantine facilities for materials features such as a secured room with known to carry latent infections of pests will infrared motion sensors and cameras, sound also be developed and maintained. masking and a secure phone line. The iii) An antisera bank of exotic viruses, a communication capabilities will include database on sequences of virus specific video teleconferencing, advanced primers and also a repository of seeds of computer interfaces, GIS mapping and a indicator hosts will be developed for strong multimedia component. specialised detection and identification of iv) A system and organisation for performance viruses of exotic origin. of quarantine treatments, including iv) Professionals will be trained to identify new emergency pest control activities for new pests or strains unknown to a particular region. pest introductions, will be defined. 7.5.6 Documentation (B) Development of National Standards on Phyto- sanitary Measures i) SDMAs and DDMAs will ensure the The establishment of national standards on development of a proper documentation of phyto-sanitary measures in line with international pest surveillance data of the state, and standards is of critical concern to meet the stiff methods for early detection of diseases and challenges under international agreements. pests, including exotic diseases not known Currently, there are 27 such international standards. to occur in the region. They will undertake Therefore, it is necessary to review the 21 national management of options and emergency standards (Annexure-I). operations, including contact points, etc., in case of any agroterrorist activity. Also, certain new standards will be developed ii) The documentation must be available in the on priority a for the following: regional/local language also as the i) Guidelines for aluminum phosphide stakeholders generally do not have a high fumigation. literacy profile. ii) Guidelines for surveillance, consignments 7.5.7 Research and Development in transit, pest reporting, sampling and diagnostic protocols. (A) Academic and Scientific Research Institutions iii) SOPs and manuals will be developed for operational purposes. The designated institutions will be directed by the respective authorities/departments/ministries to 7.5.5 Capacity Development undertake the following activities: i) The quarantine stations at sea ports, airports i) Generation of comprehensive and land frontiers will be upgraded in terms epidemiological data on important pests/ of facilities and expertise for detection and diseases to determine their tolerance limits. identification of exotic pests and salvaging This would also help in developing pest risk of the infected/infested material by analysis. developing suitable disinfestation protocols. 106
- 137. GUIDELINES FOR MANAGEMENT OF AGROTERRORISM ii) Development of sensitive detection and of SPS measures to ensure their consistent salvaging techniques to detect low levels application or justification in maintaining such of infections as the quarantine samples measure or modification to the changed situation need to be subjected to various techniques will be put in place by the departments of for detection of a variety of pests. This is agriculture, both central and state. more challenging in the case of small samples of germplasm as besides being (C) Linkages with National Programmes sensitive, the technique also needs to be non-destructive. At present, the staff of DPPQS works in isolation and is not really getting the benefits of the various iii) Development of suitable alternatives to research organisations of ICAR and state methyl bromide, a widely used quarantine agricultural universities for the detection and fumigant which is being phased out identification of pests and for control strategies. because of to its adverse environmental An active linkage will be developed between the impacts. This is now designated as an All India Coordinated Research Projects and ozone-depleting substance and a potential activities of DPPQS in order to have comprehensive health hazard to various organisms in the survey and surveillance programmes. After the Montreal Protocol (1987). India has ratified National Agricultural Technology Project ended, the Montreal Protocol and is legally ICAR started the National Agricultural Innovation committed to phase out the use of methyl Project in 2007 with assistance from the World bromide except for pre-shipment and Bank. In this research, projects in the fields of quarantine purposes, by 2015. agronomy, soil science, horticulture, plant iv) Development of molecular techniques for breeding, extension, etc., are submitted by state the detection of races/biotypes/strains will agriculture universities and national institutes, and also be intensified as they are also approved by the Project Implementation Unit in considered pests under the IPPC definition Krishi Anusandhan Bhavan II in Pusa, New Delhi. of pests. These detection techniques should be sensitive enough to detect even low levels/concentrations of pests. v) Studies on factors affecting the likelihood of survival of pests under different conditions of transport, mode of dispersal, distribution of hosts/alternate hosts at the destination, potential for establishment, reproductive strategy and method of pest survival, potential vectors and natural enemies of the pest in the area, etc., will be urgently undertaken to authentically prepare a PRA during exchange. (B) Accreditation of Laboratories An auditing system to monitor the implementation and evaluation of the effectiveness 107
- 138. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS 8 Implementation of the Guidelines The National Guidelines on BDM have been structured and coordinated. The following factors formulated as part of an integrated national 'all are considered critical for ensuring a seamless and hazard' approach for the management of disasters. harmonious functioning of all concerned The prime aim is to reduce the occurrence and stakeholders during the management of biological mitigate to the lowest level possible the effects of disasters: biological disasters affecting mankind, livestock i) Institutionalisation of programmes and and crops, and the associated risks posed to activities at the ministerial/department level. health, life and environment. It is ensured that all aspects of preparedness required are covered for ii) Identification of the various stakeholders/ prevention, mitigation and quick and efficient agencies/institutions with precise roles, response, including measures pertaining to relief, responsibilities, a clear chain of command recovery and rehabilitation. The BDM approach and work relationships. aims to institutionalise the implementation of iii) Rationalisation and augmentation of the initiatives and activities covering the entire existing regulatory framework and continuum of the disaster management cycle. The infrastructure. objective is to develop a national community that iv) Matching infrastructure, capacity is informed, resilient and prepared to face disasters development and response mechanisms for with minimal loss of life while ensuring adequate overall preparedness. care for the survivors. Therefore, it will be the endeavour of the central and state governments v) Improved inter-ministerial and inter-agency and local authorities to ensure its implementation communication, coordination and in an efficient, coordinated and focused manner. networking at all levels. This can be accomplished by forging reciprocal relationships as envisaged by the institutional MoH&FW, as the nodal ministry, will foresee mechanism set up through the DM Act, 2005, viz., the implementation of the guidelines at the national the NDMA, SDMAs and DDMAs. level. The other stakeholders in biological emergency management are MoD, MoR, MoL&E, The primary responsibility of preparedness and MoA, DADF at the central level; ministries/ response shall continue to remain with the state departments of health of the states/UTs; scientific and district authorities. Further capacity and technical institutions, academic institutions in enhancement and reinforcement of the system, agriculture, life sciences, zoological sciences, whenever required, will be provided by the central animal husbandry, medical, biomedical and and state governments. Initiatives like PPP will be paramedical field; and professional bodies, encouraged for further revamping the system. In corporate sector, NGOs and the general community. order to optimise the use of resources while ensuring effectiveness and promptness, the Implementation of the Guidelines will begin response to biological disasters will be highly with the formulation of a biological disaster 108
- 139. IMPLEMENTATION OF THE GUIDELINES preparedness plan as part of an ‘all hazard’ DM national calamities, they should also cater for plan in all districts, states/UTs and central developing additional capacities besides meeting ministries. The enabling phase will be used to build their own requirements, in their preparedness plan. necessary capacity, taking into consideration the existing elements such as techno-legal regimes, The plan will be simple, realistic, functional, stakeholder initiatives, emergency plans, gaps, flexible, concise, holistic and comprehensive, priorities based on vulnerabilities and risk encompassing networking of medical, laboratory assessment. The existing DM plans at various and public health components. The plan would levels will be further revamped/strengthened to lay special emphasis on the most vulnerable address biological disaster preparedness. The groups/communities to enable and empower them central ministries/departments, states/UTs and to respond and recover from the effects of biological districts will prepare and implement DM plans at disasters. all levels that address the strategic, operational and administrative aspects through an institutional, The National Plan needs to include: legal and operational framework. i) Measures to be taken for minimisation/ reduction of biological disasters (leading These Guidelines have set modest goals and to zero tolerance), or mitigation of their objectives of biological disaster preparedness to effects (leading to avoidable morbidity and be achieved by mustering all stakeholders through mortality). an inclusive and participative approach. All concerned ministries of GoI, the state governments, ii) Measures to be taken for integration of UT administrations and district authorities will mitigation procedures in the development allocate appropriate financial and other resources, plans. including dedicated manpower and targeted iii) Measures to be taken for preparedness and capacity development, for successful capacity development to effectively implementation of the Guidelines. A list of important respond to any threatening mass casualty websites is given in Annexure-J. situation. iv) Roles and responsibilities of the nodal 8.1 Implementation of the Guidelines ministry, different ministries or departments of the GoI, institutions, community and 8.1.1 Preparation of the Action Plan NGOs in respect of the measures specified in clauses i), ii), and iii) above. Implementation of the Guidelines at the national level will begin with the preparation of a The action plan will spell out detailed work detailed action plan (involving programmes and areas, activities and agencies responsible, and activities) by MoH&FW that will promote coherence indicate targets and time frames for implementation among different BDM practices and strengthen and be continually reviewed and updated. The mass casualty management capacities at various identified tasks, to the extent possible, will be levels. Line ministries such as MoD, MoR, MoL&E, standardised to have SOPs and resource inventory, MHA, and MoA, etc., will also prepare their etc. The action plan should have an inbuilt respective preparedness plans as part of ‘all mechanism to coordinate with other ministries and hazard’ DM plans and action plan. In view of the NEC. The plan will also specify indicators of expected role of these important line ministries in progress to enable their monitoring and review management of mass casualties in the event of within the ministry and by the National Authority. 109
- 140. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS The plan would be sent to NDMA through NEC for of the monitoring mechanism to be employed for approval. undertaking a transparent, objective and independent review of the National Disaster The ministries/agencies concerned, in turn, will: Management Guidelines—Management of Biological Disasters will be worked out. A separate i) Issue guidance on the implementation of group of experts may be earmarked for evaluation the plans to all stakeholders. to get an objective, third-party feedback on the ii) Obtain periodic reports from the effectiveness of the activities based upon the stakeholders on the progress of Guidelines. implementation of the DM plans. iii) Evaluate the progress of implementation of The important issues while preparing the action the plans against the time frames and take plan include: corrective action, wherever needed. i) Adopting a single window approach for iv) Disseminate the status of progress and conducting and documenting the activities issue further guidance on implementation outlined in the guidelines in each of the of the plans to stakeholders. stakeholder ministries, departments, state governments, agencies and v) Report the progress of implementation of organisations. the plans to the nodal ministry. ii) Laying down the roles and responsibilities MoH&FW will keep the National Authority of all stakeholders at the state and district apprised of the progress on a regular basis. levels for managing biological disasters and Similarly, concerned state authorities/departments to assist them in terms of the required will develop their state-level DM plans and dovetail resources. it with the national plan and keep the National iii) Developing detailed documents on how to Authority and SDMA informed. The state ensure implementation of each of the departments/authorities concerned will implement activities envisaged in the Guidelines so and review the execution of the DM plans at the as to attain a synergy among various district and local levels along the above lines. activities and ensure coordination. iv) Ascertaining medical preparedness 8.1.2 Implementation and Coordination at the measures, including capacity development National Level to effectively respond to intentional and non- intentional incidences of biological Planning, execution, monitoring and evaluation disasters. are four facets of the comprehensive implementation of the Guidelines. If desired, the v) Incorporating measures for the prevention nodal ministry can co-opt an expert nominated by of biological disasters, or the mitigation of the National Authority during the planning stage their effects by integration of mitigation so that the desired results are achieved through measures in the development plans. the action plan. The consultative approach vi) Coordinating with line ministries such as increases ownership of the stakeholders in the MoD, MoR, civil aviation and ESIC networks solution process by bringing clarity to the roles for maintaining their resources and ensuring and responsibilities with regard to various these are available during biological preparedness activities. Detailed documentation emergencies. 110
- 141. IMPLEMENTATION OF THE GUIDELINES vii) Ensuring professional expertise for the experts for planning, implementation and dissemination, monitoring and successful monitoring, the state DDMAs will formulate suitable and sustainable implementation of the mechanisms for their active involvement at various various plans at all levels. levels. viii) Ensuring that the skills and expertise of The India Disaster Resource Network database professionals are periodically updated will be strengthened by the states by continual corresponding to global best practices updating, enhancement and integration with the according to the spirit of the emergency respective DM plans. The activities are to be taken medical management framework for BDM. up in project mode with a specifically earmarked budget (both plan and non-plan) for each activity. The national plans would lay emphasis on The approach followed will emphasise identified critical gaps in managing biological preparedness and disaster-specific risk reduction disasters and would strengthen the government measures, including technical and non-technical hospitals and assist the states in putting up mitigation measures that are environment and requisite infrastructure, including specialised technology friendly and sensitive to the special capabilities, for managing mass casualties arising requirements of the vulnerable groups and out of biological disasters. This may include self- communities. contained mobile hospitals that can be airlifted or transported by road, rail or waterways to the disaster affected area, especially if the health 8.1.4 District Level to Community Level facilities at local levels themselves are affected. A Preparedness Plan and Appropriate coordinated and synergistic partnership with the Linkages with State Support Systems private sector, NGOs and Red Cross will help in providing critical resources during response A number of weaknesses have been identified operations and assist in restoring essential services. with regard to awareness generation, response time and actions like evacuation, medical assistance 8.1.3 Institutional Mechanisms and and other timely actions for detection, early Coordination at the State and District warning, vaccination, quarantine, evacuation, Level medical management activities and public health issues. This is specially observed in the district The state/UT governments may adopt in their DM plans and has been found to be a weak link in plan the measures indicated in para 8.1.2 above, emergency management. The central and state as applicable. The respective state/UT/district governments will evolve mechanisms through mock authorities will develop the biological disaster exercises, awareness programmes, training preparedness plans based upon the BDM programmes, etc., with a view to sensitise and Guidelines as a part of ‘all hazard’ DM plans. The prepare the officers concerned for initiating prompt measures indicated at the national level may be and effective response during such emergencies. adopted to ensure effective implementation by regular monitoring at the state level by the The CMO of the district will be in charge of concerned authorities. The state will also allocate the overall medical management of both resources and provide necessary finances for government and private set-ups during disaster efficient implementation of the plans. Since most events. Prior arrangements will be worked out with activities under the Guidelines are community- the private sector to ensure that all these resources centric and require the association of professional can be adopted in disaster situations. He will be 111
- 142. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS responsible for preparing the district BDM plan as ii) Specific allocations will be made for part of the district DM plans based on the BDM carrying out disaster preparedness and Guidelines. mitigation efforts in the annual as well as development plans. Disaster resilience is the ability of the iii) On the basis of the multi-hazard vulnerability community to anticipate disasters and react quickly status of the particular area, the ‘all hazard’ and effectively when they strike. The process of DM plan will have requisite inbuilt mitigation building resilience will be made through awareness mechanisms, including earthquake- generation, organising health and sanitation fairs, resistant structures for hospital buildings involving them in mock exercises to give direction and other health care management to their actions, PPP and development of local institutions in the government and private capacities by education and training programmes. sectors. iv) The developmental plans will have suitable 8.2 Financial Arrangements for techno-financial measures for establishing Implementation an effective health care system for the hospitals to ensure preparedness and After any disaster, central and state overall management. governments provide funds for immediate relief and rehabilitation to address the immediate needs of v) The concerned ministries/departments will the affected population in terms of food, water, initiate mitigation projects for upgradation shelter and medicine. Different disasters in the past of existing infrastructure to meet the have revealed that expenditure on response, relief, enhanced requirement of risk reduction and recovery and rehabilitation far exceeds the risk management. expenditure on prevention, mitigation and vi) Private stakeholder will allocate sufficient preparedness. With the paradigm shift in the funds for the purpose of disaster-specific government’s focus on activities during the pre- prevention/mitigation and medical disaster phase, adequate funds will be allocated preparedness measures for BDM. for prevention/mitigation, preparedness and vii) Wherever necessary and feasible, the capacity development rather than concentrating central ministries and departments and only on management at the time of a disaster. The urban local bodies in the states may initiate basic principle of ‘return on investment’ may not discussions with corporate sector be applicable in the immediate context but the undertakings to support disaster-specific long-term impact will be highly beneficial. Thus, risk reduction practices and establishment financial strategies will be worked out such that of medical set-up to deal with all disasters necessary finances are in place and flow of funds as part of PPP and corporate social are organised on a priority basis by identification responsibility. of necessary functions in all the phases of preparedness, prevention/mitigation, response, Central and state governments will facilitate relief, recovery and rehabilitation. Important the development and design of appropriate risk- activities in this respect include: avoidance, risk-sharing and risk-transfer i) Central ministries/departments and the state mechanisms in consultation with financial governments will mainstream DM efforts in institutions, insurance companies and reinsurance their development plans. agencies. The insurance sector will be encouraged 112
- 143. IMPLEMENTATION OF THE GUIDELINES to promote medical insurance mechanisms agencies. Precise schedules for structural covering BDM aspects in the future. A national measures will, however, be evolved in the BDM strategy for risk transfer through insurance, using management action plan that will follow at the the experiences of micro-level initiatives in some central ministries/state level duly taking into account states and global best practices will be developed the availability of financial, technical and to reduce the financial burden of the government. managerial resources. In case of compelling Detailed mechanisms for insurance are required circumstances warranting a change, consultation to be evolved during the response, relief and with NDMA will be undertaken, well in advance, rehabilitation phases. for adjustment on a case-to-case basis. All identified activities under the action plan for preparedness in BDM management will be 8.3 Implementation Model prepared as part of the ‘all hazard’ management plan, listed below, for implementation. The institutional and operational framework, including hospital infrastructure available with the (A) Short-term Plan (0–3 Years) state and district health authorities in the government sector, needs further revamping and i) Regulatory framework. strengthening. The private sector health care a. Dovetailing of existing Acts, Rules and institutions should also form an important medical Regulations with the DM Act, 2005. resource for the management of mass casualties during biological disasters. As on date, none of b. Enactment/amendment of any Act, the major hospitals in the government/private sector Rule and Regulation, if necessary, for are fully equipped and geared for managing mass better implementation of all health casualties, particularly victims of natural outbreaks, programmes across the country for epidemics and BT activities. The implementation disaster management. plan has to be drawn up at each level setting a c. Implementation of IHR, CBD and WHO target in terms of time line, and reviewed each guidelines through international year and at every level to evaluate the degree of cooperation. achievement, reasons for shortfall, and corrective ii) Prevention. action for timely implementation. The experience gained in the initial phase of the implementation a. Strengthening of integrated is of immense value, to be utilised not only to make surveillance systems based on mid-term corrections but also to frame long-term epidemiological surveys, detection policies and guidelines after comprehensive review and investigations of disease of the effectiveness of DM plans undertaken in the outbreaks. short term. b. Establishment of EWS. c. Coordination between public health, 8.3.1 Suggested Broad Time Frame for the medical care and intelligence Implementation of National Guidelines agencies to prevent BT. d. Rapid health assessment and The time lines proposed for the implementation provision of laboratory support. of various activities in the Guidelines are considered both important and desirable, especially in case e. Institution of public health measures of those non-structural measures for which no to deal with emergencies as an clearances are required from central or other outcome of biological disasters. 113
- 144. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS f. Immunisation of first responders and - Development of human adequate stockpiling of necessary resources for monitoring and vaccines. management of delayed health effects, mental health and iii) Preparedness. psycho-social care. a. Identifying infrastructure needs for formulating mitigation plans. 3) Education and training. b. Equipping MFRs/QRMTs with all - Inclusion of knowledge of BDM material logistics and backup support. in the educational curricula of stakeholders. c. Upgrading of earmarked hospitals for CBRN management. - Knowledge management. d. Communication and networking - Proper education and training system with appropriate intra-hospital of personnel using information and inter-linkages with state networking systems by holding ambulance/transport services, state continuing medical education police departments and other programmes and workshops. emergency services. j. Community preparedness. e. Mobile tele-health services. 1) Community awareness f. Laying down minimum standards for programmes for first aid. water, food, shelter, sanitation and hygiene. 2) Dos and Don’ts to mitigate the effects of medical emergencies g. Organising community awareness due to the effect of biological programmes for first aid, general triage agents. and Dos and Don’ts to mitigate the effects of biological emergencies and 3) Define roles as a part of the define their role as a part of the community DM plan. community DM plan. k. Hospital preparedness. h. Sensitise and define the role of public, 1) Hospital DM plans. private and corporate sectors for their active participation. 2) Developing tools to augment surge capacities to respond to any i. Capacity development. mass casualty event following a 1) Knowledge management. biological disaster. - Sensitising and defining the 3) Identifying, stockpiling, supply role of public, private and chain and inventory management corporate sectors for their of drugs, equipment and active participation. consumables, including vaccines 2) Human resource development. and other agents for protection, detection and medical - Strengthening of NDRF, MFRs, management. medical professionals, paramedics and other l. Specialised health care and laboratory emergency responders. facilities. 114
- 145. IMPLEMENTATION OF THE GUIDELINES 1) Upgradation of existing and supplies such as vaccines, establishment of new biosafety antibiotics, etc. laboratories and high containment facilities. (C) Long-term Plan (0–8 Years) m. Scientific and technical institutions for The long-term action plan will address the following applied research and training. important issues: 1) Post-disaster medical i) Knowledge of BDM as a part of ‘all hazard’ documentation procedures and training programmes should be addressed in epidemiological surveys. the present curriculum of science and medical undergraduate and postgraduate courses. 2) Regular updation on certain issues by adopting activities in R&D ii) Establishing of national stockpile of vaccines, modes initially by pilot studies. antibiotics and other medical logistics. iii) Initiating relevant postgraduate courses. (B) Medium-term Plan (0–5 Years) iv) Training programmes in the areas of i) Prevention. emergency medicine and BDM as a part of a. Strengthening of IDSP and EWS at ‘all hazard’ training programmes will be regional levels. conducted for hospital administrators, specialists, medical officers, nurses and b. Incorporation of disaster-specific risk other health care workers. reduction measures. v) Public health emergencies with the potential ii) Preparedness. of causing mass casualties due to covert a. Institutionalisation of advanced EMR attacks of biological agents would also be system (networking ambulance addressed in the plan by setting up services with hospitals). integrated surveillance systems, rapid iii) Capacity development. health assessment, investigation of outbreak, providing laboratory support and a. Strengthening of scientific and instituting public health measures. technical institutions for knowledge management and applied research vi) Provision for quality medical care. and training in CBRN management. vii) Strengthening of the existing institutional b. Continuation and updation of HRD framework and its integration with the activities. activities of NDMA, state authority/SDMA, district administration/DDMA and other c. Developing community resilience. stakeholders for effective implementation. d. Hospital preparedness. viii) Implementing a financial strategy for 1) Testing of various elements of the allocation of funds for different national/ emergency plan through table top state/district-level mitigation projects. exercises and mock drills. ix) Establishing an information networking 2) Specialised health care and system with appropriate linkages with state laboratory facilities. ambulance/transport services, state police 3) Ensuring stockpile of medical departments and other emergency services. countermeasures and medical The states will ensure proper education and 115
- 146. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS training of the personnel using this To conclude, the present system of information networking system. preparedness and arrangements for mass casualty management in a biological disaster are x) Training of NDRF, MFRs, paramedics and required to function in a more coordinated and other emergency responders. Identification proactive manner. MoH&FW, state governments/ and recognition of training institutions for district administration, will enhance their training of medical officers, paramedics and capacities with the help of the private sector. The MFRs for emergency medicine and DM. existing DM plans at various levels will be further xi) Development of post-disaster medical revamped/strengthened to address the documentation procedures and management of mass casualties due to biological epidemiological surveys. disasters. 116
- 147. 9 Summary of Action Points The present chapter provides a summary of natural disasters or biological threats associated all the guidelines mentioned in Chapters 4–7 for with a particular region will be undertaken by the the management of biological emergencies. The DM authority at each level. Based on this, the IDSP important action points are discussed in the will be upgraded and strengthened. Facilities and following pages. amenities will be developed to cover all issues of environmental management like water supply, 1. Legislative framework personal hygiene, vector control, burial/disposal of the dead and the risk of occurrence of zoonotic Legislative framework includes the disorders. establishment of a legal, institutional and operational framework which clearly defines the The existing IDSP programme will be policy, programmes, plans, SOPs, and institutional expanded and state/district IDSP units will be and operational framework. Its role will be to equipped with trained personnel for data collection, implement IHR (2005) and other legal mechanisms, standard case definition, and its integration with mechanisms to manage BT activities, cross-border the information received from GOARN, WHO. These issues, provisions to quarantine the areas affected personnel will also be trained for dissemination of by epidemics or pandemics and various aspects appropriate information to the public health of transportation of biological samples, biosafety authorities, epidemiological analysis and and biosecurity aspects and upgradation of existing confirmation of the microorganism involved using infrastructure supported by various technical the integrated laboratory network followed by experts. deployment of RRTs. Pre-exposure (preventive) immunisation of first responders against anthrax Policies and guidelines issued by NDMA will and smallpox must be practiced. . be the basis for developing DM plans by various stakeholders and service providers both in the The nodal health ministry (i.e., MoH&FW) and government (nodal and line ministries, state other line ministries and departments of health, government and district administration) and private state/district administrations will undertake set-up at each level. The response to various necessary preventive measures in DM and biological disasters will be coordinated by NDMA/ developmental plans. NEC/NCMC, SDMAs and DDMAs. (para 4.2.1–4.2.4) (para 4.1) 3. Pharmaceutical and non- 2. Capacity development for the pharmaceutical interventions and prevention of biological disasters biosafety/biosecurity measures The activities related to vulnerability and risk Tools will be developed to monitor the status analysis of various epidemics in the aftermath of of available pharmaceutical interventions including 117
- 148. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS antibiotics, chemotherapeutics and anti-virals, and 5. Capacity development of human listing of essential drugs that may be required to resource, training and education, manage biological emergencies. On-site community, standardised documentation contingency planning will be done to contain procedures and R&D biotoxins within the laboratory premises. Various immunisation and vaccination programmes will be The roles of various health and non-health undertaken and the existing arrangements will be professionals at various levels in the management strengthened. of a biological crisis will be defined. Control rooms to support the field responders will be set up. These Mechanisms to employ various non- professionals will be trained through refresher pharmaceutical interventions like social distancing courses to fill the prevailing gaps. measures, and isolation and quarantine techniques will be adopted at various levels. The various training modules will be developed/standardised and implemented at each A database of the inventories of various level by district/state authorities and nodal/line laboratories handling hazardous microorganisms, ministries. will be developed to ensure the implementation of various biosafety and biosecurity measures at Educational institutions will organise symposia, these institutions. Provisions of biosecurity exhibition/demonstrations, medical preparedness applicable to imported articles to prevent any mass weeks and will also provide education on disaster casualty event of biological origin, will be undertaken. medicine in the concerned vernacular languages. Various aspects of the management of infectious The nodal ministry (i.e., MoH&FW) and line diseases related to BT will also be disseminated ministries will undertake various pharmaceutical through educational programmes. and non-pharmaceutical interventions in their DM and development plans. Similarly, state/district Various provisions will be made according to authorities will also develop capacities at their the SOPs laid down by the ministries/departments respective levels. concerned. (para 4.2.5–4.2.8) Community awareness about the delivery of 4. Preparedness: establishment of services in various civic amenities will be command, control and coordination strengthened so that appropriate knowledge is functions developed and provided to the stakeholders in such a manner that it does not spread panic. This A well-orchestrated medical response to is intended to enhance participation of the biological disasters will only be possible by having community in all phases of the DM cycle and be a command and control function at the district level resilient enough to tackle biological emergencies. with the district collector as commander. The CMO All the practices and training schedules will be will be the main coordinator for management of coupled with mock exercises followed by biological emergencies. documentation and evaluation of lessons learnt to improve the existing system. NDMA/NEC will coordinate at the central level while SDMA/DDMAs will coordinate the various The aspect of community preparedness will functions at their respective levels. be included in the DM plans developed at each (para 4.3.1) 118
- 149. SUMMARY OF ACTION POINTS level by respective authorities and ministries media channels, networking of NGOs and concerned using the PPP mode. international organisations will be undertaken in the immediate phase. The overall development of R&D will cater for biodefence and operational infrastructure will also cater for PPP models in the research with models to develop checks on various various programmes and plans. public health consequences, thereby evaluating various mitigation strategies after testing them at Nodal and line ministries at the central level numerous stages. These will lay the foundation for and departments of health, SDMAs/DDMAs at the long-term research interventions to be undertaken state/district level will identify the various to mitigate the impact of such emergencies. requirements of critical infrastructure to be developed with PPP models to mitigate the impact MoH&FW, MoD and MHA will develop various of biological disasters. research strategies in conjunction with ICMR, CSIR, (para 4.3.3) DRDO and other research organisations with adequate funding for these projects. NDMA will 7. Medical preparedness for act as a facilitator, and advisory and monitoring management of biological disasters body to ensure the implementation of identified tasks at the national level. Various activities like hospital disaster (para 4.3.2) management planning (para 4.4.1), upgradation of earmarked hospitals, development of mobile 6. Development of critical hospitals and mobile medical teams supported by infrastructure for management of adequate medical logistics including essential biological emergencies medicines, antibiotics, vaccines, PPEs, etc., will be undertaken on priority basis at each level. The development of a laboratory network including national/state level referral laboratories, and A disaster-resilient public health infrastructure district level diagnostic laboratories with medical must include an effective inbuilt mechanism to colleges to confirm diagnosis under a single keep a check on the early warning signs of an integrated framework is a felt need of the day. On outbreak, make available safe food, water, personal a similar basis, a chain of public health laboratories hygiene facilities and also have the capacity to will also be developed and networked with IDSP . provide psycho-social care. The roles of various stakeholders/service providers like MoH&FW as The critical infrastructure will also be supported nodal ministry, other line ministries having health by biomonitoring techniques based on advanced care facilities and departments of health at the molecular and biochemical techniques. To capture state/district levels will provide an integrated these capabilities at one place, the various framework to manage public health emergencies. scientific and technical institutions will be identified and upgraded based on their needs analysis. The The various response protocols—including main focus of these institutions will be to develop emergency medical response by instituting the ICP various models based on the preventive strategy. under the overall directions of the incident commander, transportation of patients and Upgradation of the existing emergency treatment at the hospitals—will be developed and communication network, health network, including practiced through regular mock drills in a simulated IAN and mobile tele-health, print and electronic environment. 119
- 150. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS State/district health departments will have the state levels within the country. These two levels of basic responsibility and fulfil the structural and non- functioning require to be in synergy with each other. structural requirements in their respective development and DM plans. In addition, the nodal The management of pandemics is a cross- ministry will incorporate the cross-cutting issues cutting issue and specific preparedness plans will to be implemented throughout the country through be developed to contain these disasters within the national programmes identified in their DM plans. lowest possible limits of spread under the overall (para 4.4.) guidance of IHR (2005). A properly functioning epidemiological mechanism, will be used to 8. Institution of mechanism for prepare an action plan for the management of avian public health response flu, and similar incidences to effectively combat the inherent risks. Various international best The response mechanism will include outbreak practices will be tested and incorporated in the investigation by RRTs, standard case definition, DM plans by the nodal and line ministries to prevent surveillance, follow up, collection of biological the spread of biological disasters across samples and transportation to the nearest international boundaries. laboratories for analysis. The various (para 4.6) pharmaceutical and non-pharmaceutical interventions so required will be instituted 10. Developing a mechanism for immediately. Provision of risk communication and enhancing international cooperation modes to provide psycho-social care, media management, inter-sectoral coordination followed During the preparedness phase, various by continuous monitoring and evaluation of the interactive forums will be developed to evaluate standard case, are some of the principle activities the common problems and identify viable solutions that would be integrated in district DM plans for for prompt and effective management of biological managing biological disasters of multiple origin. emergencies. The mechanism for international cooperation will include both resource sharing, The district DM plan for BDM will be the basic stockpiling of medical logistics at the regional level, functional unit which will be in coherence with state/ joint international mock exercises and knowledge national DM plans to ensure prompt and effective management systems. response in the aftermath of biological disasters. (para 4.5) Various mitigation strategies addressing international cooperation will be identified in the 9. Establishment of provisions for DM plans at each level by DDMAs, SDMAs and management of pandemics the nodal/line ministries concerned. (para 4.7) Biological disasters are different from other types of emergencies and can cross borders, 11. Preparedness for biological causing various concerns in terms of global containment of microbial agents surveillance, monitoring of human and logistic functioning across the borders, health intelligence, Provisions that ensure the containment of guidelines framed by WHO, optimal utilisation of infectious microorganisms within the laboratory, will information available with GOARN and resources be developed in the DM plans. Various aspects of available with member states at the global level. biosafety and biosecurity will also be developed Similar concerns are applicable at multiple district/ in the DM plans. 120
- 151. SUMMARY OF ACTION POINTS SOPs for biosafety and biosecurity will be 14. Development of counter biorisk developed by the respective laboratories in measures accordance with the National Code of Practice for Biosecurity and Biosafety. The existing and newly emerging biorisks will (para 5.1) be addressed through the accountability criteria 12. Classification of microorganisms in relation to VBM, secured system of transportation and biologics of such materials, development of laboratory biosecurity plans, training of human resources and provision of all logistics/facilities and development/ The scheme for risk-based classification of strict implementation of the National Code of microorganisms is intended to provide a method Practice for Biosecurity and Biosafety. These will for defining the minimal safety conditions that are be incorporated into the respective BDM plans. necessary when using these agents. It designates five classes of hazardous agents such as Risk These aspects will be developed and Groups I, II, III, IV, and V. Each country should draw integrated as SOPs in the district/state DM plans. up a classification for risk groups of the agents At the national level, global best practices will be encountered in that country. incorporated in the DM plans, if needed. (para 5.6) The nodal ministry through its laboratories and surveillance system will collect, classify and make available the requisite data at a secure national 15. Risk and vulnerability portal. assessment of livestock (para 5.2–5.3) The various risks posed to livestock during natural disasters, i.e., spread of infectious diseases, 13. Biosafety laboratories and fodder poisoning, TADs, various types of wars microorganism handling instructions including conventional wars, BW or BT will be analysed to develop a comprehensive mitigation Existing BSLs will be upgraded and new ones strategy. developed at various levels based on the need and threat assessment. The differences between Relevant studies will be undertaken at each the requirements of various levels will be an level by the respective authority/ministry/ important factor of consideration while doing need department concerned. assessment analysis. SOPs of the functioning of (para 6.6.1) such laboratories will also be laid down and strictly monitored. Instructions on the handling of microorganisms will also be laid down. 16. Capacity development: management of livestock The nodal ministry along with line ministries and health departments of state governments will This includes the development of VATs, assess the existing situation and undertake infrastructure for disposal of carcasses, containment development of such critical structures through of epidemics; temporary shelters, organised developmental plans. Upgradation of existing rehabilitation package for livestock livelihood, laboratories will be carried out, if needed. awareness programmes and preparedness for (para 5.4–5.5) emergency field and laboratory veterinary services. SOPs will be laid down to enhance inter- 121
- 152. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS departmental support and strengthen the weak Preventive measures for early detection of linkages. agroterrorism activities will also be outlined. Various provisions will be developed at each level by the Capacity development will be undertaken at respective departments/ministries or authorities. the district/state/national levels by the ministries/ (para 7.5.1–7.5.3) departments concerned as a part of their respective DM plans. 19. Preparedness for management (para 6.6.2–6.6.3) of agroterrorism activities 17. Preparedness for livestock The preparedness measures include provisions management during disasters for emergency control and treatment, development of national standards on phyto-sanitary measures Various mitigation activities, including and other related activities. development of EWS, establishment of fodder banks, availability of low cost feed ingredients, It includes various capacity building measures conservation of monsoon grasses, development of including SOPs for documentation. It is pertinent existing degraded grazing lands, free movement to evolve newer R&D activities to mitigate the of animals for grazing, treatment and vaccination impact of such situations and strengthen support of animals, and strategy for compensation on mechanisms such as accreditation of laboratories account of loss and disposal of dead animals and development of linkages of local level initiatives during disasters will be planned/undertaken. A with national/state programmes. comprehensive strategy for emergency manage- (para 7.5.4–7.5.7) ment will be developed and steps for prevention, mitigation and preparedness for management of 20. Development of an ‘all hazard’ livestock during disasters will be laid down. The implementation strategy various R&D activities to mitigate the impact on livestock during disasters will be undertaken. The strategy outlines the requirements for (para 6.6.4–6.6.8) development of a BDM action plan by the nodal ministry, measures to implement and coordinate 18. Establishment of legislative and various activities at the national level, and regulatory framework and early institutional framework and coordination at the detection facilities based on risk state/district levels. Adequate strategy will be management practices evolved to develop linkages and state support systems. Necessary financial arrangements will be The existing quarantine legislations will be made for implementation of all the plans developed revisited and modified, if needed. Strict at the district/state/national levels. An implement- enforcement of SPS measures and the related ation model with suggested broad time frames as activities thereof at all levels, will be ensured. Risk short- medium- and long-term plans for 0–3, 0–5 and assessment of plausible attacks on agricultural 0–8 years, respectively have been recommended. fields and adequate measures for pest risk analysis (para 8.1–8.3) with trained manpower and equipment will be developed. It includes the development of the It is the responsibility of the various integrated pest surveillance system, intelligence stakeholders/service providers to identify various gathering and secured dissemination of information aspects of BDM activities under different plans at for a comprehensive risk management framework. different levels. 122
- 153. Annexures Annexure-A Refers to Chapter 1, Page 03 Characteristics of Biological Warfare Agents 123
- 154. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS Source: Medical Management of Biological Casualties handbook, Sixth edition, April 2005; USAMRIID, Fort Detrick Frederick, Maryland 124
- 155. ANNEXURES Annexure-B Refers to Chapter 4, Page 43 Vaccines, Prophylaxis, and Therapeutics for Biological Warfare Agents ANTHRAX VACCINE/TOXOID DEVELOPMENT TM Emergent BioThrax Anthrax Vaccine (AVA) Recombinant protective antigen (A) (rPA) vaccine Preexposure : licensed for adults 18-65yr old, 0.5 mL SC @ 0, 2, 4 wk, 6, 12, 18 mo then annual boosters : Postexposure Under INDvise Contingency Use Protocol for volunteer anthrax vaccination SC@ 0, 2, 4 wk in combination with approved and labeled antibiotics IND Pediatric Annex for postexposure use. CHEMOPROPHYLAXIS DEVELOPMENT (A) Ciprofloxacin : 500 mg PO bid (adults), 15mg/kg (up to 500mg/dose) Anthrax Immune (A) Globulin (AIG) PO bid (peds) , or (A) Doxycycline : 100 mg PO bid (adults), 2.2mg/kg (up to 100mg/dose) PO (A) bid (peds < 45kg) or (if strain susceptible): (A) Penicillin G procaine: 1,200,000U q 12 hr (adults) , 25,000U/kg (A) (maximum 1,200,000 unit) q 12 hr (peds) , or Penicillin V Potassium: 500 mg q 6 hr (adults), or Amoxicillin: 500mg PO q 8 hr (adults and children>40kg), 15mg/kg q 8 hr (children<40kg), (IND) Plus, AVA (postexposure) 1. Fully immunized (completed 6 shot primary series and up-to-date on annual boosters, or 3 doses within past 6 mo): continue antibiotics for at least 30 days. (IND). 2 Unimmunized: 3 doses of AVA 0.5cc SQ at 0, 2, 4 weeks . Continue antibiotics for at rd least 7-14 days after 3 dose. 3 No AVA used: continue antibiotics for at least 60 days CHEMOTHERAPY Inhalational, Gastrointestinal, or SystemicCutaneous Disease: Anthrax Immune Globulin (AIG) (A) Ciprofloxacin : 400 mg IV 1 12 h initially then by mouth (adult) (A) 15 mg/kg/dose (up to 400mg/dose) q 12 h (peds) , or (A) Doxycycline: 200 mg IV, then 100 mg IV q 12 h (adults) (A) 2.2mg/kg (100mg/dose max) q 12 h (peds < 45kg) , or (if strain susceptible), Contd 125
- 156. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS (A) Penicillin G Procaine: 4 million units IV q 4 h (adults) (A) 50,000U/kg (up to 4M U) IV q 6h (peds) PLUS, One or two additional antibiotics with activity against anthrax. (e.g. clindamycin plus rifampin may be a good empiric choice, pending susceptibilities). Potential additional antibiotics include one or more of the following: clindamycin, rifampin, gentamicin, macrolides, vancomycin, imipenem, and chloramphenicol. Convert from IV to oral therapy when the patient is stable, to complete at least 60 days of antibiotics. Meningitis: Add Rifampin 20mg/kg IV qd or Vancomycin 1g IVq12h COMMENTS In 2002 the American Committee on immunization Practices (ACIP) AIG is serum from recommended making anthrax vaccine available in a 3-dose regimen (0, 2, 4 human AVA weeks) in combination with antimicrobial postexposure prophylaxis under an IND recipients with high application for unvaccinated persons at risk for inhalational anthrax. anti-PA titers. Penicillins should be used for anthrax treatment or prophylaxis only if the strain is demonstrated to be PCN-susceptible. According to CDC recommendations, amoxicillin prophylaxis is appropriate only after 14-21 days of fluoroquinolone or doxycycline and only for populations with contraindications to the other drugs (children, pregnancy) Oral dosing (versus the preferred IV) may be necessary for treatment of systemic disease in a mass casualty situation. Cutaneous Anthrax: Antibiotics for cutaneous disease (without systemic complaints) resulting from a BW attack involving BW aerosols are the same as for postexposure prophylaxis. Cutaneous anthrax acquired from natural exposure could be treated with 7-10 days of antibiotics. Brucellosis VACCINE/TOXOID None CHEMOPROPHYLAXIS Can try one of the treatment regimens for 3-6 weeks, for example: (A) Doxycycline : 200mg po qd (adults) , plus Rifampin: 600mg PO qd CHEMOTHERAPY Inhalational, Gastrointestinal, or SystemicCutaneous Disease (A) Significant infection: Doxycycline: 100mg PO bid for 4-6 wks (adults) , 2.2 mg/kg PO bid (peds), (A) (A) plus Streptomycin 1g IM qd for first 3 wks (adults) , or Doxycycline + Gentamicin (if streptomycin not available) Less severe disease: (A) Doxycycline 100mg PO bid for 4-6 wks (adults) , plus (A) Rifampin 600-900 mg/day PO qd for 4-6 wks (adults) , 15-20mg/kg (up to 600-900mg) qd or divided bid (peds) Others used with success: TMP/SMX 8-12mg/kg/d divided qid, plus Rifampin (may be preferred therapy during pregnancy or in children <8yrs), Or Ofloxacin + Rifampin Long-term (up to 6 mo) therapy for meningoencephalitis, endocarditis: Rifampin + a tetracycline + an aminoglycoside (first 3 weeks) COMMENTS Ideal chemoprophylaxis is unknown. Chemoprophylaxis not recommended after natural exposure. Avoid monotherapy (high relapse). Relapse common for treatments less than 4-6 weeks. 126 Contd
- 157. ANNEXURES Glanders & Meliodosis VACCINE/TOXOID None CHEMOPROPHYLAXIS Cantry one of the treatment regimens for 3-6 weeks, for example: (A) Doxycycline : 200mg po qd (adults) , plus Rifampin: 600mg PO qd CHEMOTHERAPY Severe Disease: ceftazidime (40mg/kg IV q 8hrs), or imipenem (15mg/kg IV q 6hr max 4 g/day), or meropenem (25mg/kg IV q 8hr, max 6g/day), plus, TMP/SMX (TMP 8 mg/kg/day IV in four divided doses) Continue IV therapy for at least 14 days and until patient clinically improved, then switch to oral maintenance therapy (see “mild disease” below) for 4-6 months. Melioidosis with septic shock: Consider addition of G-CSF 30ug/day IV for 10 days. Mild Disease: Historic: PO doxycycline and TMP/SMX for at least 20 weeks, plus PO chloramphenicol for the first 8 weeks. Alternative: doxycycline (100 mg po bid) plus TMP/SMX (4 mg/kg/day in two divided doses) for 20 weeks. COMMENTS Little is known about optimum therapy for glanders, as this disease has been rare in the modern antibiotic era. For this reason, most experts feel initial therapy of glanders should be based on proven therapy for the similar disease, melioidosis. One potential difference in the two organisms is that natural strains of B. mallei respond to aminoglycosides and macrolides, while B. pseudomallei does not; thus, these classes of antibiotics may be beneficial in treatment of glanders, but not melioidosis. Severe Disease: If ceftazidime or a carbapenem are not available, ampicillin/sulbactam or other intravenous beta-lactam/beta-lactamase inhibitor combinations may represent viable, albeit less-proven alternatives. Mild Disease: Amoxicillin/clavulanate may be an alternative to Doxycycline plus TMP/SMX, especially in pregnancy or for children <8yr old. Plague VACCINE/TOXOID DEVELOPMENT Recombinant F1-V Antigen Vaccines, DoD & UK CHEMOPROPHYLAXIS Ciprofloxacin: 500 mg PO bid x 7 d (adults), 20mg/kg (up to 500mg) PO bid (peds), or Doxycycline: 100 mg PO q 12 h x 7 d (adults), 2.2 mg/kg (up to 100mg) PO bid (peds), or Tetracycline: 500 mg PO qid x 7 d (adults) CHEMOTHERAPY (A) Streptomycin: 1g q 12hr IM (adults) , 15mg/kg/d div q 12hr IM (up to 2 FDA-approved (A) therapeutics g/day)(peds) , or Gentamicin: 5 mg/kg IM or IV qd or 2 mg/kg loading dose followed by 1.7 mg/kg IM or IV (adults), 2.5 mg/kg IM or IV q8h (peds). Alternatives: Doxycycline: 200 mg IV once then 100 mg IV bid until clinically (A) improved, then 100 mg PO bid for total of 10-14 d (adults) , or Ciprofloxacin: 400mg IV q 12 h until clinically improved then 750 mg PO bid for total 10-14 d, or Chloramphenicol: 25 mg/kg IV, then 15 mg/kg qid x 14 d. Contd 127
- 158. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS A minimum of 10 days of therapy is recommended (treat for at least 3-4 days after clinical recovery). Oral dosing (versus the preferred IV) may be necessary in a mass casualty situation. Meningitis: add Chloramphenicol 25mg/kg IV, then 15mg/kg IV qid. COMMENTS Greer inactivated vaccine (FDA licensed) is no longer available. Streptomycin is not widely available in the US and therefore is of limited utility. Although not licensed for use in treating plague, gentamicin is the consensus choice for parenteral therapy by many authorities. Reduce dosage in renal failure. Chloramphenicol is contraindicated in children less than 2 yrs. While Chloramphenicol is potentially an alternative for post-exposure prophylaxis (25mg/kg PO qid), oral formulations are available only outside the US. Alternate therapy or prophylaxis for susceptible strains: trimethoprim- sulfamethoxazole Other fluoroquinolones or tetracyclines may represent viable alternatives to ciprofloxacin or doxycycline, respectively. Q Fever VACCINE/TOXOID Inactivated Whole Cell Vaccine (IND): TM (Preexposure) DoD Laboratory Use Protocol using Australian Qvax vaccine in at-risk laboratory personnel. CHEMOPROPHYLAXIS Doxycycline: 100 mg PO bid x 5 d (adults), 2.2mg/kg PO bid (peds), or Tetracycline: 500 mg PO qid x 5d (adults) Start postexposure prophylaxis 8-12 d post-exposure. CHEMOTHERAPY (A) Acute Q-fever: Doxycycline: 100 mg IV or PO q 12 h x at least 14 d (adults) , 2.2 mg/kg PO q 12 h (peds), or Tetracycline: 500 mg PO q 6 hr x at least 14 d Alternatives: Quinolones (eg ciprofloxacin), or TMP-SMX, or Macrolides (eg clarithromycin or azithromycin) for 14-21 days. Patients with underlying cardiac valvular defects: Doxycycline plus Hydroxychloroquine 200mg PO tid for 12 months Chronic Q Fever: Doxycycline plus quinolones for 4 years, or Doxycycline plus hydroxychloroquine for 1.5-3 years. COMMENTS Q-Fever vaccine manufactured in 1970. Significant side effects if administered inappropriately; sterile abscesses if prior exposure/skin testing required prior to vaccination. Time to develop immunity – 5 weeks. Initiation of postexposure prophylaxis within 7 days of exposure merely delays incubation period of disease. Tetracyclines are preferred antibiotic for treatment of acute Q fever except in: 1. Meningoencephalitis: fluoroquinolones may penetrate CSF better than tetracyclines 2. Children < 8yrs (doxycycline relatively contraindicated): TMP/SMX or macrolides (especially clarithromycin or azithromycin). 3. Pregnancy: TMP/SMX 160mg/800mg PO bid for duration of pregnancy. If evidence of continued disease at parturition, use tetracycline or quinolone for 2-3 weeks. T l i Contd 128
- 159. ANNEXURES Tularemia VACCINE/TOXOID (IND) Live attenuated vaccine (Preexposure) DoD Laboratory Use Protocol for vaccine. Single 0.1ml dose via scarification in at-risk researchers. CHEMOPROPHYLAXIS Ciprofloxacin: 500 mg PO q 12 h for 14 d, 20mg/kg (up to 500mg) PO bid (peds), or Doxycycline: 100 mg PO bid x 14 d (adults), 2.2mg/kg (up to 100mg) PO bid (peds<45kg), or Tetracycline: 500 mg PO qid x 14 d (adults) CHEMOTHERAPY (A) (A) Streptomycin: 1g IM q12 h days x at least 10 days (adults) , 15mg/kg (up to 2g/day) IM q12h (peds) , or Gentamicin: 5 mg/kg IM or IV qd, or 2 mg/kg loading dose followed by 1.7 mg/kg IM or IV q 8 h x at least (A) 10 days (adults) , 2.5mg/kg IM or IV q 8 h (peds), or Alternatives: Ciprofloxacin 400 mg IV q 12 h for at least 10d (adults), 15mg/kg (up to 400mg) IV q 12 h (peds), or (A) Doxycycline: 200 mg IV, then 100 mg IV q 12 h x 14-21 d (adults) , 2.2mg/kg (up to 100mg) IV q 12 h (peds<45kg), or Chloramphenicol: 25mg/kg IV q 6 h x 14-21 d, or (A) Tetracycline: 500 mg PO qid x 14-21 d (adults) COMMENTS Vaccine manufactured in 1964. Streptomycin is not widely available in the US and therefore is of limited utility. Gentamicin, although not approved for treatment of tularemia likely represents a suitable alternative. Adjust gentamicin dose for renal failure Treatment with streptomycin, gentamicin, or ciprofloxacin should be continued for 10 days; doxycycline and chloramphenicol are associated with high relapse rates with course shorter than 14-21 days. IM or IV doxycycline, ciprofloxacin, or chloramphenicol can be switched to oral antibiotic to complete course when patient clinically improved. Chloramphenicol is contraindicated in children less than 2 yrs. While Chloramphenicol is potentially an alternative for post-exposure prophylaxis (25mg/kg PO qid), oral formulations are available only outside the US. Botulinum Toxins VACCINE/TOXOID DEVELOPMENT (IND) Pentavalent Toxoid Vaccine (Preexposure use only) DoD rBONT Heptavalent Vaccine HBIG, DoD pentavalent human botulism immune globulin, types A- (IND). E IND for pre-exposure prophylaxis for high risk individuals only. CHEMOPROPHYLAXIS (IND) DoD equine antitoxins In general, botulinum antitoxin is not used prophylactic ally. Under special circumstances, if the evidence of exposure is clear in a group of individuals, some of whom have well defined neurological findings consistent with botulism, treatment can be contemplated in those without neurological signs. Contd 129
- 160. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS defined neurological findings consistent with botulism, treatment can be contemplated in those without neurological signs. CHEMOTHERAPY CDC trivalent equine antitoxin for serotypes A, B and E. A and Monoclonal antibodies B are licensed and E is a CDC IND Product. TM BabyBig , California Health Department, types A and B (A) Human lyophilized IgG HE-BAT, DoD heptavalent equine botulism antitoxin, types A- (IND) G HFabBAT, DoD de-speciated heptavalent equine botulism (IND) antitoxin, types A-G COMMENTS Pentavalent Toxoid Vaccine failed potency testing for Serotypes D and E. FDA has concerns about all of the other Serotypes potency. Must initiate series 13 weeks before potential exposure for optimum protection. Skin test for hypersensitivity before equine antitoxin administration. Ricin Toxin VACCINE/TOXOID DEVELOPMENT COMMENTS Inhalation: supportive therapy Availability of ricin vaccine contingent upon transition of G-I: gastric lavage, candidate to advanced development and upon availability of superactivated charcoal, funds. cathartics. Staphylococcus Enterotoxins VACCINE/TOXOID DEVELOPMENT DoD recombinant SEB Vaccine CHEMOPROPHYLAXIS CHEMOTHERAPY COMMENTS Supportive care including assisted ventilation for inhalation exposure. Currently insufficient funding for JVAP development to IND product. Encephalitis Viruses VACCINE/TOXOID DEVELOPMENT (A) JE live attenuated vaccine VEE (V3526) Vaccine. (IND) VEE Live Attenuated Vaccine (DoD Laboratory Use Protocol for Preexposure) TC-83 strain, for initial immunizations Contd 130
- 161. ANNEXURES (IND) VEE Inactivated Vaccine (DoD Laboratory Use Protocol for Preexposure) C-84 strain, for booster immunizations (IND) EEE Inactivated Vaccine (DoD Laboratory Use Protocol for Preexposure) (IND) WEE Inactivated Vaccine (DoD Laboratory Use Protocol for Preexposure) CHEMOPROPHYLAXIS None CHEMOTHERAPY No specific therapy. Supportive care only. COMMENTS VEE TC-83 vaccine manufactured in 1965. Live, attenuated vaccine, with significant side effects. 25%-35% or recipients require 2-3 days bed rest. Time to develop immunity – 8 weeks. VEE TC-83 reactogenic in 20%. No seroconversion in 20%. Only effective against subtypes 1A, 1B, and 1C. VEE C-84 vaccine used for non-responders to VEE TC-83. Must be given prior to EEE or WEE (if administered subsequent, antibody response decreases from 81% to 67%). EEE vaccine manufactured in 1989. Antibody response is poor, requires 3- dose primary (one month) and 1-2 boosters (one month apart). Primary series yields antibody response in 77%; 5%-10% of non-responders after boosts. Time to immunity – 3 months. WEE vaccine manufactured in 1991. Antibody response is poor, requires 3- dose primary (one month) and 3-4 boosters (one month apart). Primary series antibody response in 29%, 66% after four boosts. Time to develop immunity – six months. EEE and WEE inactivated vaccines are poorly immunogenic. Multiple immunizations are required. Hemorrhagic Fever Viruses VACCINE/TOXOID DEVELOPMENT (A) Yellow Fever live attenuated 17D vaccine Adenovirus vectored Ebola Vaccine (IND) Ebola DNA vaccine AHF vaccine (x-protection for BHF) (IND) RVF inactivated vaccine (DoD IND for high-risk laboratory workers) CHEMOPROPHYLAXIS Lassa fever and CCHF: Ribavirin 500mg PO q 6 hr for 7 days (Not FDA approved for this use) CHEMOTHERAPY Ribavirin (CCHF/Lassa/KHF): 30 mg/kg (up to 2g) IV initial dose; then 16 Passive antibody for mg/kg (up to 1g) AHF, BHF, Lassa fever, (IND) IV q 6 h x 4 d; then 8 mg/kg (up to 500mg) IV q 8 h x 6 d (adults) and CCHF. Mass Casualty Situation (Arenavirus, Bunyavirus, or VHF of unknown etiology. Not FDA-approved or IND) Ribavirin: 2000mg PO; then 600mg PO bid (if > 75kg), or 400mg PO in am and 600mg PO in PM (if < 75kg) for 10 days (adults), 30mg/kg then 15mg/kg divided bid for 10 days (peds) COMMENTS Aggressive supportive care and management of hypotension and Ebola DNA vaccine in coagulopathy very important. human trials at NIH Human antibody used with apparent beneficial effect in uncontrolled human trials of AHF. 131 Contd
- 162. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS Human experience with postexposure ribaririn use for VHF exposure is limited to a few cases exposed to CCHF and Lassa. Any use for this purpose should be ideally under IND. Consensus statement in JAMA from 2002 suggests using Ribavirin to treat clinically apparent hemorrhagic fever virus infection of unknown etiology using doses from CCHF/Lassa/KHF IND. Sm allpo x V AC CINE/TOXOID D EVE LOP M ENT TM (A) W yeth Dryvax (1:1) (P reexposure) A ttenuated Vaccinia V accines : (IN D ) A cam bis Modified Vaccinia Aventis Pasteur Sm allpox Vaccine (A PS V) (P reexposure) A nkara (MV A) VaxGen LC16m 8 strain Cell Culture derived Vaccines (all N YCB OH strain): (IND ) - Dynport Vaccine (Preexposure) - Acam bis/Acam bis-Baxter Vaccines (ACA M1000 and A CAM 2000) (IND ) (Preexposure) CHE M OPROPH YLAXIS TM (IN D) W yeth Dryvax (1:1) (P ostex posure) D oD IN D for A PSV (1:5) Use of Sm allpox Vaccine in R esponse to Bioterrorism : C ontingency Use TM (IN D) W yeth Dryvax (1:5 dilution) TM CDC IND . If Dryvax (1:5) used up, not available, or need both vaccines, then use: (IND ) AP SV (1:5 dilution) CHE M OTHE RAPY (IN D) Cidofovir for treatm ent of sm allpox : Oral form ulations of - Probenecid 2g P O 3 h prior to cidofovir infusion. c idofovir derivatives - infuse 1L NS 1 h prior to c idofovir infusion - Cidofovir 5m g/k g IV over 1 hr M onoclonal V accinia - repeat probenecid 1g PO 2 h and again 8 h after cidofovir infusion Im m une Globulins com pleted. For Select Vaccine A dv erse reactions (Eczema vacc inatum , vaccinia necrosum , oc ular vaccinia w/o keratitis, severe generalized vaccinia): 1. V IG IV (Vaccinia Imm une Globulin – intravenous form ulation). 100m g/kg IV infusion. 2. V IG-IM (Vaccinia Im m une Globulin – intram usc ular form ulation). 0.6m l/k g IM . 3. C idofovir 5m g/k g IV infusion (as above). COMM ENTS TM Dryvax - W yeth calf lym ph vaccinia vaccine 100 dos e v ials undiluted: 1 dose by scarification. Greater than 97% tak e after one dos e w ithin 14 days of adm inistration. TM Dryvax is effective (either preventing or attenuating resulting dis ease) up to at least 4 days post exposure. TM Dryvax (1:1) FD A license approved 25 Oct 2002. AP SV is als o k nown as the S alk Institute (TS I) vaccine, a frozen, liquid form ulation using the NYC BOH vaccine strain via calf-lym ph production also TM used in the Dryvax Pre and post exposure vaccination recommended if > 3 years s inc e last vaccine. Recom m endations for use of sm allpox vaccine in respons e to bioterrorism are periodic ally undated b y the Centers for Diseas e C ontrol and P revention (CDC), and the m os t recent recom mendations can be found at http:w ww.cdc.gov. 132 Source: Medical Management of Biological Casualties handbook, Sixth edition, April 2005; USAMRIID Fort Detrick Frederick, Maryland
- 163. ANNEXURES Annexure-C Refers to Chapter 4, Page 44 Patient Isolation Precautions Standard Precautions • Wash hands after patient contact. • Wear gloves while touching blood, body fluids, secretions, excretions and contaminated items. • Wear a mask and eye protection, or a face shield during procedures likely to generate splashes or sprays of blood, body fluids, secretions or excretions. • Proper handling of patient-care equipment and linen in a manner that prevents the transfer of microorganisms to people or equipment. Use proper precautions while handling a mouthpiece or other ventilation device as an alternative to mouth-to-mouth resuscitation. Standard precautions are employed in the care of all patients Airborne Precautions Standard Precautions plus: • Place the patient in a private room that has monitored negative air pressure, a minimum of six air changes/hour, and appropriate filtration of air before it is discharged from the room. • Wear respiratory protection when entering the room. • Limit movement and transport of the patient. Place a mask on the patient, if the patient needs to be moved. Conventional Diseases requiring Airborne Precautions: Measles, Varicella, Pulmonary TB. Biothreat Diseases requiring Airborne Precautions: Smallpox. Droplet Precautions Standard Precaution plus: • Place the patient in a private room or cohort them with someone with the same infection. If not feasible, maintain at least three feet between patients. • Wear a mask when working within three feet of the patient. • Limit movement and transport of the patient. Place a mask on the patient, if the patient needs to be moved. Conventional Diseases requiring Droplet Precautions: Invasive Haemophilus influenzae and meningococcal disease, drug-resistant pneumococcal disease, diphtheria, pertussis, mycoplasma, Group A Beta Hemolytic Streptococcus, influenza, mumps, rubella, parvovirus. 133
- 164. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS Biothreat Diseases Requiring Droplet Precautions: Pneumonic Plague Contact Precautions Standard Precautions plus: • Place the patient in a private room or cohort them with someone with the same infection if possible. • Wear gloves when entering the room. Change gloves after contact with infective material. • Wear a gown when entering the room if contact with patient is anticipated or if the patient has diarrhea, a colostomy or wound drainage not covered by a dressing. • Limit the movement or transport of the patient from the room. • Ensure that patient-care items, bedside equipment, and frequently touched surfaces receive daily cleaning. • Dedicate use of noncritical patient-care equipment (such as stethoscopes) to a single patient, or cohort of patients with the same pathogen. If not feasible, adequate disinfection between patients is necessary. Conventional Diseases requiring Contact Precautions: Methicillin Resistant Staphylococcus aureus, Vancomycin Resistant Enterococcus, Clostridium difficile, Respiratory Syncytial Virus, parainfluenza, enteroviruses, enteric infections in the incontinent host, skin infections (Staphylococcal Scalded Skin Syndrome, Herpex Simplex Virus, impetigo, lice, scabies), hemorrhagic conjunctivitis. Biothreat Diseases requiring Contact Precautions: VHFs. For more information, see: Garner JS. Guidelines for Infection Control Practices in Hospitals. Infect Control Hosp Epidemiol 1996;17:53-80. 134
- 165. ANNEXURES Annexure-D Refers to Chapter 4, Page 59 Laboratory Identification of Biological Warfare Agents 135
- 166. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS * Toxin gene detected — only works if cellular debris including genes present as contaminant. Purified toxin does not contain detectable genes. ELISA — enzyme-linked immunosorbent assays. FA — indirect or direct immunofluorescence assays. Std. Micro./serology — standard microbiological techniques available, including electron microscopy. Not all assays are available in field laboratories. X — Advisable. 136
- 167. ANNEXURES Annexure-E Refers to Chapter 4, Page 59 Specimens for Laboratory Diagnosis 1 Within 18–24 hours of exposure 2 Fluorescent antibody test on infected lymph node smears. Gram stain has little value. 3 Virus isolation from blood or throat swabs in appropriate containment. 4 C. burnetii can persist for days in blood and resists desiccation. Ethylene Di-amine Tetra Acetic Acid anticoagulated blood preferred. Culturing should not be done except in BSL-3 containment. 137
- 168. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS Annexure-F Refers to Chapter 4, Page 59 Medical Sample Collection for Biological Threat Agents This guide helps to determine which clinical samples to collect from individuals exposed to aerosolised biological threat agents or environmental samples from suspect sites. Proper collection of specimens from patients is dependent on the time frame following exposure. Sample collection is described for ‘Early post-exposure’, ‘Clinical’, and ‘Convalescent/Terminal/Postmortem’ time frames. These time frames are not rigid and will vary according to the concentration of the agent used, the agent strain, and predisposing health factors of the patient. • Early post-exposure: when it is known that an individual has been exposed to a bioagent aerosol, aggressively attempt to obtain samples as indicated. • Clinical: samples from those individuals presenting with clinical symptoms. • Convalescent/Terminal/Postmortem: samples taken during convalescence, the terminal stages of infection or toxicosis or postmortem during autopsy. Shipping Samples: Most specimens sent rapidly (less than 24 h) to analytical labs require only blue or wet ice or refrigeration at 2° to 8°C. However, if the time span increases beyond 24 h, contact the USAMRIID ‘Hot-Line’ (1-888-USA-RIID) for other shipping requirements such as shipment on dry-ice or in liquid nitrogen. Blood samples: Several choices are offered based on availability of the blood collection tubes. Do not send blood in all the tubes listed, but merely choose one. Tiger-top tubes that have been centrifuged are preferred over red-top clot tubes with serum removed from the clot, but the latter will suffice. Blood culture bottles are also preferred over citrated blood for bacterial cultures. Pathology samples: Routinely include liver, lung, spleen, and regional or mesenteric lymph nodes. Additional samples requested are as follows: brain tissue for encephalomyelitis cases (mortality is rare) and the adrenal gland for Ebola (good to have but not absolutely required). Bacteria and Rickettsia Convalescent/Early post-exposure Clinical Terminal/Postmortem Anthrax Bacillus anthracis 24 to 72 h 3 to 10 days 0 – 24 h Serum (TT, RT) for toxin assays Serum (TT, RT) for toxin assays Nasal and throat swabs, Blood (E, C, H) for PCR. Blood Blood (BC, C) for culture. induced respiratory secretions (BC, C) for culture Pathology samples for culture, FA, and PCR Plague Yersinia pestis 24 – 72 h >6 days 0 – 24 h Blood (BC, C) and bloody sputum Serum (TT, RT) for IgM later for Nasal swabs, sputum, induced for culture and FA (C), F-1 Antigen IgG. Pathology samples respiratory secretions for assays (TT, RT), PCR (E, C, H) culture, FA, and PCR 138
- 169. ANNEXURES Tularemia Francisella tularensis 24 – 72 h >6 days 0 – 24 h Blood (BC, C) for culture Serum (TT, RT) for IgM and Nasal swabs, sputum, induced Blood (E, C, H) for PCR later IgG, agglutination titers. respiratory secretions for Sputum for FA & PCR Pathology Samples culture, FA and PCR BC: Blood culture bottle E: EDTA (3-ml) TT: Tiger-top (5 – 10 ml) C: Citrated blood (3-ml) H: Heparin (3-ml) RT: Red top if no TT Bacteria and Rickettsia Convalescent/Early post-exposure Clinical Terminal/Postmortem Glanders Burkholderia mallei 24 – 72 h >6 days 0 – 24 h Blood (BC, C) for culture Blood (BC, C) and tissues for culture. Nasal swabs, sputum, induced Blood (E, C, H) for PCR Serum (TT, RT) for immunoassays. respiratory secretions for culture Sputum & drainage from Pathology samples. and PCR. skin lesions for PCR & culture. Brucellosis Brucella abortus, suis, & melitensis 24 – 72 h >6 days 0 – 24 h Blood (BC, C) for culture. Blood (BC, C) and tissues for culture. Nasal swabs, sputum, induced Blood (E, C, H) for PCR. Serum (TT, RT) for immunoassays. respiratory secretions for culture Pathology samples and PCR. Q-Fever Coxiella burnetii 2 to 5 days >6 days 0 – 24 h Blood (BC, C) for culture in Blood (BC, C) for culture in eggs or Nasal swabs, sputum, induced eggs or mouse inoculation mouse inoculation respiratory secretions for culture Blood (E, C, H) for PCR. Pathology samples. and PCR. BC: Blood culture bottle E: EDTA (3-ml) TT: Tiger-top (5 - 10 ml) C: Citrated blood (3-ml) H: Heparin (3-ml) RT: Red top if no TT 139
- 170. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS Toxins Convalescent/Early post-exposure Clinical Terminal/Postmortem Botulism Botulinum toxin from Clostridium 24 to 72 h >6 days botulinum Nasal swabs, respiratory Usually no IgM or IgG 0 – 24 h secretions for PCR Pathology samples (liver and Nasal swabs, induced respiratory (contaminating bacterial DNA) spleen for toxin detection) secretions for PCR (contaminating and toxin assays. bacterial DNA) and toxin assays. Serum (TT, RT) for toxin assays Ricin Intoxication Ricin toxin from Castor beans 36 to 48 h >6 days 0 – 24 h Serum (TT, RT) for toxin assay Serum (TT, RT) for IgM and Nasal swabs, induced respiratory Tissues for immunohisto-logical IgG in survivors secretions for PCR (contaminating stain in pathology samples. castor bean DNA) and toxin assays. Serum (TT) for toxin assays Staph enterotoxicosis Staphylococcus Enterotoxin B 2-6h >6 days 0–3h Urine for immunoassays Nasal Serum for IgM and IgG Nasal swabs, induced respiratory swabs, induced respiratory Note: Only paired antibody secretions for PCR (contaminating secretions for PCR samples will be of value for IgG bacterial DNA) and toxin assays. (contaminating bacterial DNA) assays…must adults have Serum (TT, RT) for toxin assays and toxin assays. antibodies to staph Serum (TT, RT) for toxin assays enterotoxins. T-2 toxicosis 0 – 24 h postexposure 1 to 5 days >6 days postexposure Nasal & throat swabs, induced Serum (TT, RT), tissue for toxin Urine for detection of toxin respiratory secretions for detection metabolites immunoassays, HPLC/ mass spectrometry (HPLC/MS). BC: Blood culture bottle E: EDTA (3-ml) TT: Tiger-top (5 - 10 ml) C: Citrated blood (3-ml) H: Heparin (3-ml) RT: Red top if no TT 140
- 171. ANNEXURES Viruses Convalescent/Early post-exposure Clinical Terminal/Postmortem Equine Encephalomyelitis VEE, EEE and W EE viruses 24 to 72 h >6 days 0 – 24 h Serum & Throat swabs for Serum (TT, RT) for IgM Nasal swabs & induced culture (TT, RT), RT-PCR (E, Pathology samples plus brain respiratory secretions for RT- C, H, TT, RT) and Antigen PCR and viral culture ELISA (TT, RT), CSF, Throat swabs up to 5 days Ebola 0 – 24 h 2 to 5 days >6 days Nasal swabs & induced Serum (TT, RT) for viral Serum (TT, RT) for viral culture. respiratory secretions for RT- culture Pathology samples plus adrenal PCR and viral culture gland. Pox (Smallpox, monkeypox) Orthopoxvirus 2 to 5 days >6 days 0 – 24 h Serum (TT, RT) for viral Serum (TT, RT) for viral culture. Nasal swabs & induced culture Drainage from skin lesions/ respiratory secretions for scrapings for microscopy, EM, PCR and viral culture viral culture, PCR. Pathology samples BC: Blood culture bottle E: EDTA (3-ml)H: Heparin (3- TT: Tiger-top (5 - 10 ml) C: Citrated blood (3-ml) ml) RT: Red top if no TT Environmental samples can be collected to determine the nature of a bioaerosol either during, shortly after, or well after an attack. The first two along with early post-exposure clinical samples can help identify the agent in time to initiate prophylactic treatment. Samples taken well after an attack may allow identification of the agent used. While the information will most likely be too late for useful prophylactic treatment, this information along with other information may be used in the prosecution of war crimes or other criminal proceedings. This is not strictly a medical responsibility. However, the sample collection concerns are the same as for during or shortly after a bioaerosol attack and medical personnel may be the only personnel with the requisite training. If time and conditions permit, planning and risk assessments should be performed. 141
- 172. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS Like in any hazmat situation a clean line and exit and entry strategy should be designed. Obviously, if one is under attack and in the middle of the bioaerosol, there can be no clean line. Depending on the situation, personnel protective equipment should be donned. The standard Gas Mask is effective against bioaerosols. If it is possible to have a clean line then a three person team is recommended, with one clean and two dirty. The former would help decontaminate the latter. Because the samples may be used in a criminal prosecution, what, where, when, how, etc., of the sample collection should be documented both in writing and with pictures. Consider using waterproof disposable cameras and waterproof notepads,as these items also need to be decontaminated. The types of samples taken can be extremely variable. Some of the possible samples are: • Aerosol Collections in Buffer Solutions • Soil • Swabs • Dry Powders • Container of Unknown Substance • Vegetation • Food/Water • Body Fluids or Tissues What is collected will depend on the situation. Aerosol collection during an attack would be ideal, assuming you have an aerosol collector. Otherwise anything that appears to be contaminated can either be sampled by swabbing the item with swabs if available, or absorbent paper or cloth. The item itself could be collected if not too large. In the case of well after the attack, collection samples of dead animals or people can be taken in a manner similar to samples that are taken during an autopsy. All samples should ideally be double bagged in ziploc bags (the inner bag decontaminated with dilute bleach before placing in the second bag) labelled with the time and place of collection along with any other pertinent data. If ziploc bags are not available, use whatever expedient packaging is available which appears to reduce the chance of sample contamination and infection of personnel handling the sample. Note: This above chart has been downloaded from Medical Management of Biological Casualties handbook, Sixth edition, April 2005; USAMRIID, Fort Detrick Frederick, Maryland. This may be suitably modified under the guidance of a microbiologist. 142
- 173. ANNEXURES Annexure-G Refers to Chapter 6, Page 77 OIE List of Infectious Terrestrial Animal Diseases 1. The following diseases are included within the category of multiple species diseases: • Anthrax • Aujeszky’s disease • Bluetongue • Brucellosis (Brucella abortus) • Brucellosis (Brucella melitensis) • Brucellosis (Brucella suis) • Crimean Congo haemorrhagic fever • Echinococcosis/hydatidosis • Foot and mouth disease (FMD) • Heartwater • Japanese encephalitis • Leptospirosis • New world screwworm (Cochliomyia hominivorax) • Old world screwworm (Chrysomya bezziana) • Paratuberculosis • Q fever • Rabies • Rift Valley fever • Rinderpest • Trichinellosis • Tularemia • Vesicular stomatitis • West Nile fever 2. The following diseases are included within the category of cattle diseases: • Bovine anaplasmosis • Bovine babesiosis • Bovine genital campylobacteriosis • Bovine spongiform encephalopathy (BSE) • Bovine TB • Bovine viral diarrhoea • Contagious Bovine Pleuro Pneumonia (CBPP) • Enzootic bovine leukosis 143
- 174. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS • Haemorrhagic septicaemia • Infectious bovine rhinotracheitis/infectious pustular vulvovaginitis • Lumpy skin disease • Malignant catarrhal fever (Wildebeest only) • Theileriosis • Trichomonosis • Trypanosomosis (tsetse transmitted) 3. The following diseases are included within the category of sheep and goat diseases: • Caprine arthritis/encephalitis • Contagious agalactia • Contagious caprine pleuropneumonia • Enzootic abortion of ewes (ovine chlamydiosis) • Maedi-visna • Nairobi sheep disease • Ovine epididymitis (Brucella ovis) • Peste des petits ruminants • Salmonellosis (S. abortusovis) • Scrapie • Sheep pox and goat pox 4. The following diseases are included within the category of equine diseases: • African horse sickness • Contagious equine metritis • Dourine • Equine encephalomyelitis (Eastern) • Equine encephalomyelitis (Western) • Equine infectious anaemia • Equine influenza • Equine piroplasmosis • Equine rhinopneumonitis • Equine viral arteritis • Glanders • Surra (Trypanosoma evansi) • Venezuelan equine encephalomyelitis 5. The following diseases are included within the category of swine diseases: • African swine fever • Classical swine fever • Nipah virus encephalitis 144
- 175. ANNEXURES • Porcine cysticercosis • Porcine reproductive and respiratory syndrome • Swine vesicular disease • Transmissible gastroenteritis 6. The following diseases are included within the category of avian diseases: • Avian chlamydiosis • Avian infectious bronchitis • Avian infectious laryngotracheitis • Avian mycoplasmosis (Mycoplasma gallisepticum) • Avian mycoplasmosis (Mycoplasma synoviae) • Duck virus hepatitis • Fowl cholera • Fowl typhoid • HPAI in birds and low pathogenicity notifiable avian influenza in poultry • Infectious bursal disease (Gumboro disease) • Marek’s disease • Newcastle disease • Pullorum disease • Turkey rhinotracheitis 7. The following diseases are included within the category of lagomorph diseases: • Myxomatosis • Rabbit haemorrhagic disease 8. The following diseases are included within the category of bee diseases: • Acarapisosis of honey bees • American foulbrood of honey bees • European foulbrood of honey bees • Small hive beetle infestation (Aethina tumida) • Tropilaelaps infestation of honey bees • Varroosis of honey bees 9. The following diseases are included within the category of other diseases: • Camelpox • Leishmaniosis 145
- 176. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS Annexure-H Refers to Chapter 6, Page 91 Disposal of Animal Carcasses: A Prototype 1. If death was caused by a highly infectious disease • Clean and disinfect the area after the carcass is removed. • Wear protective clothing when handling deadstock and thoroughly disinfect or dispose of clothing before handling live animals. • Properly dispose of contaminated bedding, milk, manure, or feed. • Check with the State Veterinarian about disposal options. Burial may not be legal. Special methods of incineration or burial may be used in cases of highly infectious diseases. • Limit the access of the deadstock collector and his vehicle to areas well away from other animals, their feed and water supply, grazing areas, or walkways. The standard site requirements for disposal of dead animals are: • 6 feet above bedrock, 4 feet above seasonal high ground water. • 2 feet of soil on top, final cover. • Greater than 100 feet from property lines. • Greater than 300 feet from water supplies. 2. Composting deadstock If you compost your deadstock, follow the steps listed below: A. Decide what method you will use. Burial methods include static piles, turned windrows, turned bins, and contained systems. Information on the first three methods is available on several websites listed under ‘Resources on deadstock disposal.’ • Static piles with minimum dimensions of 4 feet long, by 4 feet wide, by 4 feet deep are by far the simplest to use. • Turned windrows may be an option for farmers already composting manure in windrows. • Turned bin systems are more common for handling swine and poultry mortalities. • The eco-pod is a contained system developed by Ag-Bag, which has been used to compost swine and poultry mortalities. B. Select an appropriate site. • Well-drained with all-season accessibility. • At least 3 feet above seasonal high ground water levels. • At least 100 (preferably 200) feet from surface waterways, sinkholes, seasonal seeps, or ponds. • At least 150 feet from roads or property lines—think about which way the wind blows. • Outside any Class I groundwater, wetland or buffer, or Source Protection Area contact—NRCS for verification. 146
- 177. ANNEXURES C. Select anduse effective carbon sources. • Use materials such as wood chips, wood shavings, coarse sawdust, chopped straw or dry heavily bedded horse or heifer manure as bulking materials. Co-compost materials for the base and cover must allow air to enter the pile. • If the bulking materials are not very absorbent, cover them with a 6-inch layer of sawdust to prevent fluids from leaching from the pile. • Cover the carcass 2 feet deep with high-carbon materials such as old silage, dry bedding (other than paper), sawdust, or compost from an old pile. • Plan on a 12’ x 12’ base for an adult dairy animal. The base should be at least 2 feet deep and should allow 2 feet on all sides around the carcass. • When composting smaller carcasses, place them in layers separated by 2 feet of material. D. Prepare the carcass. • After placing the carcass on the base, lance the rumen of adult cattle. Explosive release of gasses may uncover the pile releasing odours and attracting scavengers. E. Protect the site from scavengers. • Adequate depth of materials on top of the carcass should minimise odours and the risk of scavengers disturbing the pile. • Scavengers may be deterred by the temperatures within the pile, but, if not, an inexpensive fence of upside down hog wire may be adequate to avoid problems. F. Monitor the process. • Keep a log of temperature, carcass weight, and co-compost materials when each pile is started. Weather and starting materials will affect the process. • Measure pile temperature with a compost thermometer 6 to 8 inches from the top of the pile and deep within to check for proper heating. Check daily for the first week or two. Pile temperature should reach 65oC for 3 consecutive days to eliminate common pathogens. • Record events or problems such as scavenging, odours, or liquid leaking from the pile. Wait. Most large carcasses will be fully degraded within 4-6 months. Smaller carcasses take less time. Turning the pile after 3 months can accelerate the process. 147
- 178. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS Annexure-I Refers to Chapter 7, Page 100 and 106 List of National Standards on Phyto-sanitary Measures New standards/guidelines need to be developed on a priority basis for aluminum phosphide fumigation; surveillance; consignments in transit; pest reporting; and, sampling and diagnostic protocols. SOPs and manuals for the above must also be developed for the operational aspects. 148
- 179. ANNEXURES Annexure-J Refers to Chapter 8, Page 109 Important Websites Ministry/Institute/Agency Website Ministry of Home Affairs http://mha.nic.in/ Ministry of Health and Family Welfare http://mohfw.nic.in/ Ministry of Agriculture http://agricoop.nic.in/ Ministry of Defence http://mod.nic.in/ National Disaster Management Authority www.ndma.gov.in Council of Scientific and Industrial Research http://www.csir.res.in/ Defence Research Development Organisation http://www.drdo.org/ Department of Biotechnology www.dbtindia.nic.in National Institute of Virology www.icmr.nic.in/pinstitute/niv.htm National Institute of Communicable Diseases www.nicd.org Indian Veterinary Research Institute www.ivri.nic.in World Health Organization www.who.int Indian Council of Agricultural Research www.icar.org.in United Nations Children’s Fund www.unicef.org National Institute of Cholera and Enteric Diseases www.niced.org Public Health Foundation of India www.phfi.org National Institute of Epidemiology www.icmr.nic.in/pinstitute/nie.htm Vector Control Research Centre www.pon.nic.in/vcrc/ International Health Regulations www.who.int/csr/ihr/en/ Centers for Disease Control and Prevention www.cdc.gov National Bureau of Plant Genetic Resources www.nbpgr.ernet.in Disaster Management Institute www.dmibpl.org Armed Forces Medical Services www.indianarmy.gov.in/dgafms/index.htm The Australia Group www.australiagroup.net/en/biological_agents.html 149
- 180. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS Core Group for Management of Biological Disasters 1 Lt Gen (Dr.) Janak Raj Bhardwaj, Member, NDMA Chairman PVSM AVSM VSM PHS (Retd) New Delhi MD DCP PhD FICP FAMS FRC Path (London) 2 Maj Gen J.K. Bansal, VSM CBRN Coordinator, Coordinator NDMA, New Delhi 3 Lt Gen (Dr.) D. Raghunath Principal Executive, Member PVSM, AVSM (Retd) Sir Dorabji Tata Center for Research in Tropical Diseases, Bangalore 4 Dr. P. Ravindran Director, Emergency Member Medical Relief, MoH&FW, New Delhi 5 Dr. Shashi Khare Head, Department of Member Microbiology, NICD, New Delhi 6 Dr. S.J. Gandhi Dy. Director (Epidemic), Member Directorate of Health Services, Ahmedabad 7 Dr. R.K. Khetarpal Head, Plant Quarantine Member Division, NBPGR, ICAR, MoA, New Delhi 8 Col A.K. Sahni Senior Advisor and Member Head, Microbiology and Virology Department, Base Hospital, Delhi Cantt. 9 Mr. A.B. Mathur Joint Secretary, Member Cabinet Secretariat New Delhi 10 Dr. S.K. Bandopadhyay Commissioner, Member Department of Animal Husbandry, MoA, New Delhi 11 Mr. Murali Kumar NDM II, MHA, New Delhi Member 12 Mr. Arun Sahdeo Consultant, NIDM, Member New Delhi 150
- 181. ACKNOWLEDGEMENTS Steering Committee 1 Lt Gen Shankar Prasad, Vasant Vihar, New Delhi Member PVSM, VSM (Retd) 2 Dr. A.N. Sinha (Retd) Ex-Director, Emergency Member Medical Relief, MoH&FW, New Delhi 3 Dr. Narender Kumar Director of Personnel, Member DRDO Bhawan, MoD New Delhi 4 Dr. R.L. Ichhpujani Additional Director and Member National Project Officer, NICD, New Delhi 5 Dr. B. Pattanaik Project Director, FMD, Member IVRI, Nainital 6 Brig R.K. Gupta, 278, Vasant Enclave, Member AMC (Retd) Munirka, New Delhi 7 Dr. A.K. Sinha Veterinary Officer, Member Director General, SSB, New Delhi 8 Mr. S.D. Singh, IPS Senior Superintendent Member of Police, Jammu Significant Contributors Agarwal G.S. Dr., Scientist E, DRDE Gwalior Aggarwal A.K. Dr., Dy. Medical Commissioner, ESIC Head Office, New Delhi Aggarwal Rakesh. Supdt. of Police, Central Bureau of Investigation, CGO Complex, New Delhi Ahmad Muzaffar Dr., Director, Dte. of Health Services, Old Secretariat, Srinagar, Kashmir Akhtar Suhel Dr., Commissioner, Govt. of Manipur, Imphal Alam S.L., Scientist D, DRDE, Gwalior Amrohi Rajesh Kr. Dr., SMO, 6th Bn ITBP P Sec 26, Panchkula, Haryana , .O. Arora Rajesh Dr., Sceintist D, Institute of Nuclear Medicine and Allied Sciences, Delhi Baciu Adrian, Coordinator, Interpol’s Bioterrorism Prevention Programme, Lyon, France 151
- 182. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS Bakshi C.M., DIG, Central Reserve Police Force, Pune,Talegaon, Pune Bakshi Sanchita Dr., Director of Health Services, Govt. of West Bengal, Kolkata Bharti S. R., Dy Comdt, Central Industrial Security Force, Arakonam, Tamil Nadu Bhaskar N. Lakshmi Dr., Sr. Resident Nizam Institute of Medical Sciences (NIMS) Hospital, Hyderabad Bhati S. G. IPS, DIG (Intellegence), Police Bhawan, Gandhinagar, Gujarat Bhatia S. S. Lt Col, Research Pool Officer, DGMS (ARMY), L-Block, New Delhi Biswas N.R. Prof., Deptt. of Pharmocology, AIIMS, New Delhi Chattopadhyay Joydeep Dr., CMO, 106, Bn NDRF: BSF, KOLKATA Chawla Raman Dr., SRO, (Man-made Disasters and Medical Preparedness), NDMA, New Delhi Chokeda Deepak Major, 4011 Fd Amb, C/O 56 Apo Dash Dipak, Sr. Correspondent, Times of India, New Delhi Desai Rajnanda Dr., Dy. Director, Medical Dte. of Health Services , Panaji, Goa Dhar G. Theva Neethi, Additional Secretary (R&R), Pondicherry Flora S.J. Scientist F, DRDE, Gwalior Ganguly N. K. Prof., Ex-DG, ICMR, Delhi Gupta Amit Dr., Asst. Professor, Surgery, AIIMS, New Delhi Gupta Kavita Dr., ICAR, New Delhi Hojai Dhruba Dr., Director of Health Services, Assam, Guwahati Jangpangi P.S., Addl. Secy, Government of Uttarakhand, Dehradun Kamboj D.V. Dr., Scientist D, DRDE, Gwalior Kapur Rohit Lt Col, Dte. Gen. Medical Services (Army) Room No.111 L Block , New Delhi Kapur Sanjeev, Chief Operating Officer, Jain Studios, New Delhi Kashyap R. C. Air Com, Medical Dte, Air HQ, R K Puram, New Delhi Kaul R. Technical Officer B, DRDE, Gwalior Kaul S. K. Lt Gen, Commandant, Armed Forces Medical College, Pune Kaushik.M.P Dr., Associate Director, DRDE, Gwalior . Khadwal Raman, Commandant, Dte. Gen., ITBP Lodi Road, New Delhi , Kumar Das Abhaya Major, AMC, 320 Field Ambulance, C/o 99 APO Kumar Dheeraj Capt Dr., Medical Officer, Base Hospital, New Delhi Kumar Manoj, Cameraman, Jagran, Noida 152
- 183. ACKNOWLEDGEMENTS Kumar Om Dr.,Scientist E., DRDE, Gwalior Kumar Rahul Brig, Deputy Director General (NBC Warfare), Army HQ, New Delhi Kumar S Dr., Prinicipal and Dean, MS Ramaiah Medical College, Bangalore Kumar Sanjay Srivastav, Second In Command, 106 BN NDRF: BSF, Kolkata Kumar Subodh Dr., Scientist D, DRDE, Gwalior Laumas Sanjiv Brig, DACIDS, Min Of Def., South Block, New Delhi Lidder S.B.S. Brig (Retd.), Ex-Commander, Faculty of NBC Protection, College of Military Engg., Pune Mandki Nawal Singh, Commissioner, Bhoo Abhilekh, Raipur, Chattisgarh Manja K.S. Dr., Ex-Director of Personnel, DRDO, New Delhi Meshram G.P Scientist F, DRDE, Gwalior ., Mitrabasu Dr., INMAS, New Delhi Modi Y.C., Jt. Dir., CBI, CGO Complex, New Delhi Naidu G.S. Dr., Deputy Director (Public Health), Dte. of Health, New Saram, Pondicherry Nimesh G. Desai Prof., Head, Dept. of Psychiatry and Medical Suptd., Institute of Human Behaviour and Allied Sciences, Delhi Oberoi M.M. Dr., DIG/AC-III, CBI CGO Complex, New Delhi Padhl G.C. Dr., C.M.O. (SG), NDRF(A) CISF Surakshya comp., Dist. Vellore (TN) Parashar B.D. Dr., Scientist F, DRDE, Gwalior Pariat W.M.S., Relief Commissioner, Main Secretariat Building, Shillong, Meghalaya Parida M.M. Dr., Scientist E, DRDE, Gwalior Pipersenia V.K., Principal Secretary, Assam Secretariat, Dispur Prakash S. Dr., Director, Stali Institute of Health & Family Welfare, Magadi Road, Bangalore Prakash Sri Dr., Associate Director, DRDE, Gwalior Prasad G.S.C.N.V., Dr., Dy. Medical Supritendent, Nizam Institute of Medical Sciences (NIMS), Hyderabad Puri S.K. Brig (Retd.), Dean, Institute of Health Management Research, Jaipur Rai G.P Dr., Scientist F, DRDE, Gwalior . Rajenderan C. Dr., M.D., Poision Center, GGH & MMC, Chennai Rao P.V.L. Dr., Scientist F, DRDE, Gwalior Rathore C.B.S., DIG, CRPF, Gandhinagar, Gujarat 153
- 184. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS Rawat D. S., CO O/o Director General, SSB, Force Hqr, East Block-V, R.K.Puram, New Delhi Rawat K.S., Sr. Field Officer, Force Hqs., SSB, RK Puram, New Delhi Sachdeva T.S. Col., Director, Perspective Planning (NBC Medicine), Army HQ, New Delhi Saha S.S. Dr., Director, Health Services, Delhi Govt., F-17 Karkardooma, East Delhi Salhan R.N. Dr., Addl. DG, MoH&FW, Nirman Bhavan, New Delhi Salunke Subhash Dr., Regional Advisor EHA, WHO-SEARO, Indraprastha Estate, New Delhi Santosh Kumar Prof., NIDM, Delhi Satayanarayanan S., Senior Staff Correspondent, Dyal Singh Library, 1 D.D.U. Marg, New Delhi Saxena Amit, Scientist B, DRDE, Gwalior Sayana R.C.S. Dr., D.G. (Medical Health),107, Chandra Nagar, Dehradun Sekar Vijaya S., Dy. Director, Tamil Nadu Fire Service, North Western Region, Vellore, Tamil Nadu Sekhose V. Dr., Principal Director, Health & FW, Government of Nagaland, Kohima Sellamuthu, M.K., IAS, Joint Commissioner (LR) Deptt of Revenue Admn., DM&M, O/o RC Selvam D.T. Dr., Scientist D, DRDE, Gwalior Selvaraj S. Alphonse Dr., Joint Director, Public Health, Chennai, Tamil Nadu Shankar Ravi Dr., INMAS, New Delhi Sharan Anand M., Additional Resident Commissioner, Harayana Bhawan, New Delhi Sharma Anurag, IG & Director, National Industrial Security Academy, Hakimpet, Hyderabad Sharma Deepak, PPS, NDMA, Centaur Hotel, New Delhi Sharma K. Dr., C. Dy. Director, Himachal Pradesh, Shimla, Himachal Pradesh Sharma Mudit Wg Cdr, Air Force Station, Arjangarh, New Delhi Sharma N.K. Dr., DGHS, O/o DGHS Sharma R.C., Chief Fire Officer, Delhi Fire Services, Delhi Sharma R.K. Dr., Joint Director and Head, CBRN Defence, INMAS, DRDO, Delhi Singh Asar Pal, Liaison Officer, Lakshadweep, Kasturbha Gandhi Marg, New Delhi Singh J.N., Gen. Secy., Aware World, C-181, Pandav Nagar, New Delhi Singh Kamlesh K.R., Correspondent, Jain Studios, New Delhi Singh Lokendra Dr., Scientist F, DRDE, Gwalior Singh P.K., Officer, Secretariat (Man-made Disasters and Medical Preparedness) NDMA, New Delhi 154
- 185. ACKNOWLEDGEMENTS Sohal S.P Dr.,Jt. Director, Health Services, O/o Director, Health Services, Government of Punjab, .S. Chandigarh Sood Rubaab, Disaster Mgmt. Cosultant, NDMA, Centaur Hotel, New Delhi Srivastava Shishir, Media Special Correspondent, Jagran, Noida Sudan Preeti, IAS, Commissioner, Disaster Management, Andhra Pradesh Secretariat, Hyderabad Sundaram Arasu Dr., Programme Director, Disaster Mgmt. Cell, Anna Institute of Management, Chennai Swain N. Gp Capt, DMS (O&P), Air HQ, R.K.Puram, New Delhi Tandon Sarvesh Dr., Asstt Prof., Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, New Delhi Tripude R. Dr., Scientist D, DRDE, Gwalior Tuteja Urmil Dr., Scientist F, DRDE, Gwalior Veer V. Dr., Scientist F, DRDE, Gwalior Vijayaraghavan R. Dr., DRDE, Gwalior Wangdi C.C., Addl. Secretary, Land Revenue & Disaster Management Dept., Govt. of Sikkim, Gangtok Yadav R.K., Station Officer, DFS Nehru Place Fire Stn., New Delhi Yaden Michael, Addl. Director, Civil Defence, Nagaland Yaduvanshi Raajiv, IAS, Commissioner & Secy. (Revenue), Government of Goa, Panaji 155
- 186. NATIONAL DISASTER MANAGEMENTGUIDELINES: MANAGEMENT OF BIOLOGICAL DISASTERS Contact Us For more information on these Guidelines for Management of Biological Disasters Please contact: Lt Gen (Dr.) J.R. Bhardwaj PVSM, AVSM, VSM, PHS (Retd) MD DCP PhD FICP FAMS FRC Path (London) Member, National Disaster Management Authority Centaur Hotel, (Near IGI Airport) New Delhi-110 037 Tel: (011) 25655004 Fax: (011) 25655028 Email: [email protected]; [email protected] Web: www.ndma.gov.in 156