Transcript comp1_unit8b_lecture_slides

Component 1: Introduction to Health
Care and Public Health in the U.S.
1.8: Public Health Part II
1.8b: Public Health and Terrorism
Terrorism and Public Health
• The specter of terrorism continues to concern US
government and public
• Emergency Preparedness and Response – public health
programs
• Categories of Terrorism
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Bioterrorism
Agricultural terrorism
Chemical terrorism
Nuclear/radiation terrorism
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Bioterrorism
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Definition: intentional use of microorganisms or their derived products, to
produce death or disease in humans, animals, or plants
Classified as Overt (announced) or Covert (unannounced)
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Overt attacks - intended to create psychological (panic) damage along with physical damage,
as well as to encourage spread of an agent (exposed people fleeing an area take the agent
with them)
Covert attacks - intended to cause maximum damage before a response can be mounted.
Methods debated for detection for covert attacks include laboratory results and syndromic
surveillance.
In the United States, the history of bioterrorism is relatively short. Some of
the most notable events were:
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1984 Oregon. Considered by some to be the first incident of BT on US soil (others disagree,
citing examples such as the military’s apparently deliberate distribution of smallpoxcontaminated blankets to Native Americans in the 1700’s). The 1984 incident was discovered
by a small clinical laboratory, which noticed high numbers of Salmonella typhimurium results
and alerted public health officials. It was eventually determined that the central Oregon cult of
the Rajneeshees intentionally contaminated salad bars in The Dalles, resulting in 751 cases
of infection.
2001. Letters containing anthrax were mailed to various targets. Five people were killed.
2003 Greenville, SC, and 2004 Washington DC. Ricin letter incidents.
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Bioterrorism
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Bioterrorism agents are separated into three categories by CDC, depending
on their ease of transmission and severity of effect
Category A: Highest risk
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Category B: Next highest risk
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Easily transmitted from person to person
High death rates (mortality)
Could cause public panic
Require special public health preparedness response
Examples: Anthrax, Botulism, Pneumonic Plague, Smallpox, Tularemia, Ebola
Moderately easy to spread
Moderate illness rates, low death rates
Response would require specific enhancements of existing laboratory capacity and enhanced disease monitoring
systems
Examples: Ricin Toxin, Brucellosis, Q Fever, Typhus, food and waterborne pathogens
Category C: Third highest risk – emerging pathogens
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Easily available and spread
Potential for high illness (morbidity) and death (mortality) rates and major health impact
Examples: Nipah Virus, Hantaviruses, Yellow Fever, Multidrug-resistant Tuberculosis
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Public Health Preparedness and
Response
• Planning, monitoring, and education are three of the
main activities
• The Lab Response Network is an important part of public
health activities
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Lab Response Network – LRN
• LRN - national network of local, state and federal public health, food
testing, veterinary diagnostic, and environmental testing laboratories
• Provide response capacity for biological and chemical terrorism, as
well as other public health emergencies
• More than 150 biological and 62 chemical LRN labs
• Most are state public health labs, but veterinary, military, and
international labs are also important participants
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Agricultural terrorism
• Chemical and biological (unlike nuclear) weapons are
often manufactured from readily available raw materials,
raw materials that are usually in common use or found in
nature
• Agriculture, a building block of all civilizations, is an
attractive target
• Although there have been an unfortunately large number
of introductions of agricultural pests and pathogens
(example, chestnut blight, which effectively exterminated
the American chestnut tree), they have been caused by
accident, neglect, or ignorance - not terrorism
• The USDA Animal and Plant Inspection Service (APHIS)
attempts to prevent importation of agricultural hazards
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Chemical Terrorism
• As with other categories of terrorism, chemical terrorism
could result from covert or overt exposure of chemical
hazards to the population
• One system dealing with chemical hazards is the
Hazardous Substances Emergency Events Surveillance
(HSEES)
• Hazardous substance release information is gathered
from various sources including emergency response
systems, state fire marshals, and the National Response
Center
• 31 states as well as several territories and other
jurisdictions provide info for the Agency for Toxic
Substances and Disease Registry (ATSDR) national
database
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Chemical Emergencies
CDC categorizes hazardous chemicals by type of chemical and effects
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Biotoxins —poisons from plants or animals
Blister agents —chemicals that severely blister the eyes, respiratory tract, and skin
Blood agents —poisons that affect the body by being absorbed into the blood
Caustics (acids) —chemicals that burn or corrode people's skin, eyes, and mucus membranes
Choking/lung/pulmonary agents —chemicals that cause severe irritation or swelling of the respiratory
tract
Incapacitating agents —drugs that cause mental confusion or altered state of consciousness
Long-acting anticoagulants —poisons that prevent blood from clotting, which can lead to uncontrolled
bleeding
Metals —agents that consist of metallic poisons
Nerve agents —highly poisonous chemicals that prevent the nervous system from working properly
Organic solvents —agents that damage the tissues of living things by dissolving fats and oils
Riot control agents/tear gas —highly irritating agents often by individuals for protection (for example,
mace)
Toxic alcohols —poisonous alcohols that can damage the heart, kidneys and nervous system
Vomiting agents —chemicals that cause nausea and vomiting
http://www.bt.cdc.gov/chemical/
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Nuclear or Radiation
Terrorism
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Both the sun and the earth are sources of natural, background radiation
Man-made radiation occurs from sources such as TV sets, microwave
ovens, and X-rays
Nuclear terrorism threats are generally divided into
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Radiological Dispersion Devices (RDDs), also known as "dirty bombs“. A means
of dispersing radioactive materials
Radioactive contamination of drinking water or food supplies
Direct attacks on nuclear power plants or nuclear fuel reprocessing facilities
Use of nuclear weapons by countries
Locating radioactive sources in heavily populated areas
Public Health Preparedness and Response
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Education and information for the public
Education and information for health care providers
http://www.bt.cdc.gov/radiation/
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