Matsumoto , terrorist attack

The only reported incidents of nerve agent poisoning, where biomedical samples have been obtained, are those resulting from terrorist dissemination of sarin in Matsumoto (1994) and the Tokyo subway (1995), plus an assassination using VX, also in Japan (60). In contrast to the CW incidents involving sulfur mustard, many of the biomedical samples associated with these terrorist attacks were collected within hours of the event. 

Distribution, metabolism, and elimination of sarin in humans appear to resemble findings in animals. Minami and colleagues (1997, 1998) detected the sarin metabolite IMPA in urine of humans after the terrorist attack in Tokyo in 1995. They found peak levels of IMPA or methylphosphonic acid in urine 10-18 h after exposure. The levels of IMPA in urine correlated with the clinical symptoms. They also found evidence of distribution of sarin to the human brain in four of the 12 people who died after exposure. IMPA and MPA were detected in patients from the Matsumoto sarin exposure (Nakajima et al, 1998). 

The release of the nerve gas sarin by the Aum Shinrikyo cult in Matsumoto and Tokyo - in June 1994 and March 1995, respectively (see Chapter 13) - alerted the world to the very real chemical threat from terrorist groups. The determination and sophistication of subsequent terrorist attacks, the access such groups seem to have to the necessary funds, expertise and materials and their avowed intent to cause mass casualties and fatalities all emphasise that the possibility of a deliberate chemical release in a civilian setting can no longer be ignored. 

Spasm of the ciliary muscle may impair accommodation and is associated with severe headache. Long-lasting miosis, associated with eye pain, was a notable clinical sign in the Tokyo Subway (underground railway) terrorist attack with sarin and the same was true of the sarin attack at Matsumoto (Nohara and Segawa, 1996). 

In more recent times, the Aum Shinrikyo religious cult used sarin in two terrorist attacks in Japan. At Matsumoto, in 1994, overall 600 individuals reported acute signs and symptoms, 58 were admitted to hospital and seven people died (Morita et al., 1995). Following the release of sarin on the Tokyo underground in 1995, approximately 1000 individuals exhibited signs and symptoms and twelve people died (Nagao et al., 1997 IoM, 2000) (see Chapter 13). Not only were substantial numbers of members of the public directly affected, but in both situations, first responders and medical staff were also exposed to sarin as they attended those exhibiting marked... 

Nozaki et al. (1995) also reported on the treatment of a patient exposed to VX in an attempted murder by the same Aum Shinrikyo cult that released sarin in Matsumoto and the Tokyo subway terrorist attacks. Reportedly, VX was sprayed on the victim s back the man noted impaired vision and then experienced seizures and loss of consciousness. He arrived at the emergency room about 2 h after exposure semi-comatose... 

Large amounts of 0-isopropyl methylphosphonic acid were found in blood and nrine of victims of the terrorist attacks with sarin in Matsumoto and Tokyo. Until recently, it was assnmed that hydrolysis of phosphofluoridates in plasma and tissues of mammals proceeds exclusively by cleavage of the P F bond. For example, treatment of C( )P( )- P-soman with rat plasma or liver homogenate did not lead to any conversion of PMPA into the secondary hydrolysis product methylphosphonic acid (MPA). Ramachandran observed that the primary hydrolysis product of DF P, i.e., 0,0-diisopropyl P-phosphoric acid, is not metabolized after s.c. admiiustration to mice. Rather, the product was excreted unchanged into urine. However, Nakajima et al. reported that MPA was detected (in urine) until the third day after hospitalization of a victim of the terrorist attack with sarin in Matsumoto. This discrepancy needs further investigation. 

Thus, the way in which we use the lessons learned from this attack will affect our ability to deal adequately with future terrorist attacks using sarin, which could be even greater and more serious with respect to the number of victims. Can we really assume that only 12 of the approximately 5,500 victims died because the Japanese medical system was particularly well prepared for such an eventuality Probably not. It is more likely that the relatively small number of fatalities was due to the low concentration of sarin and the passive means of dispersing it. From tiiis perspective, the Matsumoto sarin attack one year earlier was more aggressive than the Tokyo subway sarin attack. In a trial after the Matsumoto incident, it was revealed tiiat a 70% concentration of sarin was actively volatilized using an electric heater and dispersed using an electric fan. A total of 7 victims died and 660 were injured and one victim died 14 years after sarin exposme. In other words, if the Tokyo subway sarin attack had been conducted using the same means as those employed in the Matsumoto sarin attack, the number of fatalities may have been 50 or 60. So humanity has not yet experienced the effects of a full-scale sarin attack in a major city. 

Although most toxicological studies were performed as animal studies, some data about humans exist, which were obtained from military volunteers exposed to nonlethal doses of sarin (NRC, 1982, 1985), accidentally intoxicated industrial workers (Duffy et al., 1979), and poisoned civilians affected by terrorist attacks in Tokyo in 1995, Matsumoto in 1994, and Osaka (Morita et al., 1995 Okumura et al., 1996 Tsuchihashi et al., 1998). For detailed data on these events, see the reports of the Committee on Health Effects Associated with Exposures During the Gulf War (2000). 

On 27 June 1994, the first successfiil terrorist attack on a civil population took place in the Japanese city of Matsumoto in the northern Japanese mountains. It was carried out by a cult (Aum Shinrikyo) that had managed to s)rnthesise sarin in a secret laboratory and released it at night from a van. The attack resulted in 600 casualties and seven fatalities. Five of these were found dead, and two were transported to the hospital where one died of respiratory failure and secondary cardiac arrest within 4 h and the other died many years later after having been in a vegetative state. Fifty-six persons were hospitalised in six hospitals. Respiratory failure was evident from the outset, and several casualties required intubation and ventilation. Generalised convulsions were noted in a number of cases. Not all the persons affected required hospital treatment, with some seeking medical evaluation later and other symptomatic cases which did not require medical care. 

The Matsumoto and Tokyo sarin incidents were the first examples of terrorist attacks in a civil setting using a military nerve agent. The sarin used had been synthesised in a secret laboratory and proved that such syntheses were within the capability of terrorist organisations. 

Terrorists have expressed an interest in nerve agents and have deployed them in attacks on unprotected civilians (Rotenberg and Newmark, 2003). A Japanese religious cult, Aum Shinrikyo, independently manufactured numerous chemical and biological agents. The first such attack with sarin occurred in Matsumoto in 1994 and the Tokyo subway in 1995. Thousands of people were affected and dozens of people died (Nagao et al, 1997 Ohtomi et al, 1996 Okumura et al, 1998 Yokoyama et al, 1998). In... 

Matsumoto (1994), 600 people were poisoned and hospitalized, and seven died (Morita et al, 1995 Nakajima et al, 1997 Yoshida, 1994). The attack in the Tokyo subway (1995) resulted in 5,500 people seeking hospital evaluation and 12 deaths (Bajgar, 2006). An interesting terroristic act was described by Tsuchihashi et al (2005) - a fatal intoxication with VX administered percutaneously. 

Security aspect. This review of AUM Shinrikyo s terrorist activity reveals a new threat to stability of democratic societies - chemical terrorism. Especially terrifying dimension of the problem is the fact that members of this fanatic cult used nerve gases three times against civilian population - sarin in Matsumoto and Tokyo in June, 1994 and in March, 1995, respectively, and VX in Tokyo in January, 1995. The two sarin attacks were especially dangerous, because they threatened the lives of hundreds of citizens. 

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