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Tularemia, Biological Warfare, and the Battle for Stalingrad (1942-1943)
An editorial from Military Medicine, Vol. 166, No. 10, October 2001.
Guarantor: Eric Croddy. MA
During World War II both Soviet Red Army and German Wehrmacht forces suffered hundreds of thousands of casualties, many from infectious disease. In a recent book, Dr. Kenneth Alibek has suggested that the Soviet Red Army used tularemia (causative agent: Francisella tularensis) as a biological weapon during the battle of Stalingrad (1942-l943). Based on past clinical cases and the nature of the pathogen we propose that an outbreak resulting from natural causes is more likely.
One of the most fiercely fought engagements in the Eurasian theater during World War II was the siege of Stalingrad, which involved at least two German group armies and resulted in the loss of millions on both sides, dead, wounded or captured. Recently Dr. Kenneth Alibek has alleged that the Soviet Union used tularemia against German troops during this pivotal engagement, causing an epidemic that also affected Russian soldiers and civilians. From what we know of tularemia and its transmission, however, a natural outbreak at Stalingrad seems more likely.
In his 1999 book, Biohazard, Alibek (formerly known as Kanatjan Alibekov) describes in great detail the history and possibly ongoing work in the former Soviet Union/Russian biological weapons program. Much of what Alibek relates in his book, including the fact that the Soviet Union loaded a smallpox weapon on intercontinental missiles, is based on his experiences and knowledge gained while working for Biopreparat a very large, ostensibly civilian biotechnology concern established in 1973 for the development of biological weapons. It is unknown if research to offensive biological warfare (BW) continues in Russia.
Alibek is generally considered to be reliable, and he has briefed the U.S. intelligence community at great length regarding former Soviet BW capabilities. A former deputy director of the Soviet Russian Biopreparat. Alibek claims in his book that tularemia (caused by the bacterium Francisella tularensis) was deployed against Nazi troops during the battle for Stalingrad (August 1942 to February 1943). Alibek bases his allegation on the hundreds of thousands of tularemia infections that quickly arose at the beginning of the siege and the collaborative statements of an elderly lieutenant colonel in the Soviet Red Army. Alibek also reports a significantly high (70%) pulmonary involvement among those infected with tularemia from both sides, suggesting man-made air-borne dissemination.
Although no doubt exacerbated by wartime conditions at Stalingrad we believe that the tularemia epidemic of 1942-1943 was a natural outbreak. With regard to the high percentage of pleural involvement reported by Alibek (and others) one should note that even in the 1960s the mechanism of the disease process was not well understood nor was it certain if there was a primary pulmonary form of tularemia. The fact that a large percentage of tularemia infections were associated with pleural involvement--an outcome that could have been induced via other portals of entry--may not he very helpful in identifying the route of the initial infection.
Second the Rostov region alone already had 14,000 tularemia cases in January 1942, several months before the major Panzer assault on the city. With the large epizootic pool of F. tularensis among mice and water rats (and a severely if not completely disrupted hygiene and sanitation system), it probably required no help from Soviet bioweaponeers to create the conditions for an epidemic. One Soviet Red Army commander, Marshal K.K. Rokossovisky reflected in his memoirs on a counteroffensive in Stalingrad: "...just during these tense days, tularemia, a disease spread by mice suddenly emerged among our pilots. The number of infected pilots became so high, that it was necessary to take steps to save personal structure and aircrafts: The mice chewed all rubber and rubber insulation." Finally, postwar U.S. intelligence surveys of German biological weapons research does not indicate that the Wehrmacht suspected the Soviets of deliberate transmission of tularemia.
Tularemia, caused by the Gram-negative Intracellular bacterium F. tularensis, can be separated into two major biovars: in the United States, the F. tularensis biovar tularensis is most commonly found, whereas outside of the continental United States, especially in Scandinavia, the biovar palearctica is more prevalent and can be isolated from water, aquatic mammals, and mosquitoes. When inhaled as an aerosol, fewer than 50 F. tularensis bacteria can cause disease in humans. Because of this high infectivity, tularemia was investigated as a BW agent by both the United States and the former Soviet Union. Ingestion of bacteria, presumably a cause for at least a significant percentage of civilian tularemia cases during the siege of Stalingrad, requires as many as 1 billion organisms to cause disease. According to the literature, the severity of disease caused by the European-variant is somewhat milder than that of the biovar found in North America.
Although somewhat suspect because of the possible biases and political overtones, Soviet-era published epidemiological reviews of tularemia during the battle of Stalingrad help corroborate our view that a complete breakdown in public health infrastructure led to the epidemic. According to one Soviet retrospective: "Late in the fall of 1942, epicenters of the tularemia epizootic in the field mouse [lit: vole] were detected in the basin of the Don-delta. Concurrently, cases of tularemia were registered among the local population. More than 75% of the population was hit by tularemia in individual locations of the Stalingrad area.... As the health centers were practically out of order at this time, the entire burden of the treatment of the infected population was taken up by the military-medical front service."
One of these studies reports an even higher rate of pulmonary involvement in tularemia infections (95.2%) during the battle of Stalingrad caused by inhaled dust from infected straw. (The production of similar airborne fomites--as well as the predominance of the inhalation route of infection among certain populations--is consistent with other outbreaks that have occurred in Martha's Vineyard in the United States as well as in Finland and Sweden.) According to one Russian Journal article in 1980, the war disturbed normal agricultural activities of the population in the areas near the front. Crops remained unharvested and the grass uncut. Thus was created a large source of food for rodents, and in the fall of 1942 large numbers of mice, field mice, forest mice, shrews, and others appeared in the trenches and dugouts. The high prevalence of tularemia among Red Army soldiers was "associated with the use of hay for bedding in entrenchments, dig-outs, and trenches" and only got worse as infected rodents followed the soldiers into their hastily built military fortifications. However, In addition to inhalation exposures, many of the tularemia infections were also linked to "eating biscuits and other baked food touched by the rodents, using water from wells, which was infected by the bodies of the rodents that died as a result of tularemia." This same article also implicates mosquitoes as a disease vector in some cases of tularemia among civilian and military personnel.[l3] As seen in case studies from Finland and elsewhere, mosquitoes could have been a significant factor in the transmission of tularemia.
Interestingly, The Soviets reported that a live tularemia vaccine prepared by H.A. Gaiskii and B.Y. Elbert was tested at the Stalingrad front. (Sources conflict regarding whether or not large-scale tularemia vaccinations were administered for Soviet Red Army troops.) Although it showed some efficacy, the most effective countermeasures still involved standard pest control especially that of rodents. In the United States, a phenol-inactivated tularemia vaccine was developed in 1944, and an improved, acetone-based preparation was later used in 1945 that had fewer adverse reactions. During the now defunct U.S. BW program, tularemia was weaponized by freeze drying bacteria-laden slurry and muting it into a flue powder for aerosol delivery.
Tularemia does not have the name recognition nor the lethality of anthrax or smallpox. Still, F. tularensis poses a threat by its use as a weapon in terrorism or criminal malfeasance. Although a terrorist or state-sponsored attack using tularemia would be mitigated by modern antibiotics--prompt treatment is usually successful--the numbers of casualties could easily overwhelm existing capacity to treat both the sick and the "worried well."