Transcript Bioterrorismpost - alistawatkins

Biomed
BCT
Bioterroism
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• The first well-documented use of smallpox
as a biological weapon was by British
troops in the French and Indian Wars. In
1763 two blankets and a handkerchief
laced with smallpox were given to the
Native Americans as gifts killing as many
as half of the population of the infected
tribes.
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Bioterroism: violent acts,
dangerous to human life that
appear to be intended:
• To intimidate or coerce a civilian
population
• To influence the policy of a government by
intimidation or coercion
• To affect the conduct of a government by
assassination or kidnapping
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Biological weapons are:
• Living microorganisms such as bacteria,
viruses, fungi, that can kill or incapacitate
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Classification
• The Centers for Disease Control and
Prevention (CDC) categorize biological
agents according to the risk they pose to
the public.
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Category A :
• Those that pose the highest risk (can be easily
disseminated and result in high mortality).
• Include bacteria and viruses that cause diseases such
as:
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anthrax,
botulism,
plague,
tularemia,
smallpox, and
viral hemorrhagic fever (such as hantavirus and ebola).
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Category B:
– pose a moderate risk to the public
– can be spread with some ease
– can cause a moderate degree of illness
– death rates due to these diseases are usually
low
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Other Types of
Agents
• In addition to biological agents, chemical
or radioactive agents may also be used as
weapons of bioterrorism.
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Chemical Agents
• The CDC classifies chemical agents
according to their target activity on the
skin, in the lungs, in the gastrointestinal
tract, and in the nervous system
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Radioactive agents
• Colorless, odorless, and invisible to the
eye.
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• Contamination of food, water, or objects
may disable or kill humans and animals
and be difficult to trace.
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Symptoms of Radiation
Exposure
• Symptoms of radiation exposure may
include:
• nausea, vomiting, diarrhea and, depending
on the extent of the exposure, bleeding
gums, nosebleeds, bruising, and hair loss.
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http://www.standeyo.com/News_Files/NBC/radiation.human.body.html
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The Pain of Exposure
• Exposure can be through ingestion,
inhalation, or contamination of an open
wound.
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Response to bioterroism agents:
• New Report: North Carolina Earns Grade
of 10 out of 10 on Disaster Preparedness
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Internal reporting requirements
(within a facility)
• Infectious control personnel
• Epidemiologist (local and state)
• Administration (health care facility and
health department)
• Office of public affairs in the health facility
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External contacts
(outside of facility)
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Local health department
State health department
FBI
CDC
Local police
EMS
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Examine the containment of
bioterroism agents
• Agents
• Containment of
agents
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BACTERIAL
• ANATHRAX
• PLAGUE
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Anthrax
Acute infectious disease caused
by bacillus anthracis.
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ANTHRAX
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Modes of transmission:
Inhalation of spores
Skin contact
Ingestion of contaminated food
Incubation period:
Pulmonary: 2-60 days
Cutaneous: 1-7 days
Gastrointestinal: 1-7 days
Transmission:
Anthrax is not airborne person to person. Direct contact with
infectious skin lesions can transmit infection.
• Prevention:
• Vaccine available-limited quantities.
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• Infections in humans:
• Skin contact – cutaneous, ingestiongastrointestinal, inhalation-pumonary
• Person-to-person transmission of
inhalation disease does not occur. *
• *direct exposure to vesicle secretions of
cutaneous anthrax can result in a
secondary infection.
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Gastrointestinal signs and
symptoms:
• Abdominal pain, nausea,
vomiting, fever
• Bloody diarrhea,
hematemesis
• Positive culture after 2-3
days
• Prognosis:
• If progression to toxemia
and sepsis, prognosis is
poor.
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Cutaneous signs and symptoms:
• Local skin involvement
with direct contact
• Commonly seen on head,
forearms, or hands
• Localized itching followed
by popular lesion that
turns vescular within 2-6
days – develops into
depressed black eschar
• Prognosis:
• Good if treated with
antibiotics.
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Pulmonary signs and symptoms:
• S/S
– Flu-like symptoms that may
briefly improve two to four
days after initial symptoms
– Abrupt onset of respiratory
failure
– Hemodynamic collapse
– Thoracic edema
• Widened mediastinum on xray
• Positive blood culture in 2-3
days of illness
• Prognosis:
• Good if treated early.
Increased mortality rate if
treated after respiratory onset.
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Anthrax
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• What bioterrorism agent was sent through
the mail to federal agencies in Washington
D.C. in October, 2001?
• a] Cholera
• b] Anthrax
• c] Malaria
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Plague
• Plague is an acute bacterial disease caused
by yersinia pestis.
• Signs and Symptoms:
• Fever
• Cough
• Chest pain
• Hemoptysis
• Watery sputum
• Bronchopneumonia on x-ray
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Plague
• Bubonic plague : enlarged, tender lymph
nodes, fever, chills and prostration
• Septicemic plague: fever, chills,
prostration, abdominal pain, shock and
bleeding into skin and other organs
• Pneumonic plague: fever, chills, cough
and difficulty breathing; rapid shock and
death if not treated early
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TRANSMISSION
• Flea-borne, from infected rodents to
humans
• Direct contact with infected tissues or
fluids from handling sick or dead animals
• Respiratory droplets from cats and
humans with pneumonic plague
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• Mode of Transmission:
• Plague normally transmitted from an infected
flea
• Can be aerosol-probable use in bio terrorism
• Can be transmitted person to person
• Incubation period:
• Flea bite – 2-8 days
• Aerosol – 1-3 days
• Prognosis: Good if treated with antibiotics early.
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All of the following are ways that the
plague can be transmitted except:
• A) an infected flea
• B) aerosol
• C) food and or water
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The Hot Seat
Dr. Thomas Butler Had Very Good Reasons for Carrying Bubonic Plague
Aboard Passenger Flights--But That Didn't Stop The U.S. Government From
Ruining his Life
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http://www.citypaper.com/news/story.asp?id=7379
• Plague satisfies all three
requirements. A historic terror,
the disease decimated onethird of Europe's population in
the 14th century. Although
initial symptoms of plague are
similar to a cold (swollen
glands, fever, chills,
headache), if the disease
progresses, the bacteria can
cause internal hemorrhaging
and tissue necrosis. The dead
tissues eventually become
gangrenous, causing the victim
to turn black--hence the
disease's macabre nickname,
"Black Death."
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Which type of plague is
characterized by enlarge, tender
lymph nodes
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The Wyoming Department of Health is
investigating how a Boy Scout who
visited northwest Wyoming became
infected with bubonic plague.
• A) Pneumonic
• B) Bubonic
• C) Septicemic
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VIRAL
• SMALLPOX
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Smallpox
• Smallpox is an acute viral illness caused by the
variola virus.
• Mode of transmission:
– Airborne: droplets
– direct contact with infected bodily fluids or contaminated objects
such as bedding or clothing.
• Signs and symptoms:
• Flu like symptoms-fever, myalgia
• Skin lesions appear quickly progressing from macules to
papules to vesicles
• Rash scabs over in 1-2 weeks
• Rash occurs in all areas at once, not in crops
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• Incubation period:
• From 7 to17 days, average is 12 days
• Contagious when the rash is apparent and
remains infectious until scabs separate (approx.
3 weeks)
• Prognosis:
• Vaccine available and effective post-exposure
• Passive immunization is also available in the
form of vaccina- immune-globulin (VZIG)
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Smallpox has a high mortality rate.
• Smallpox (also called variola) is the only
disease that has been completely wiped
out throughout the world.
• Smallpox is also potentially one of the
most devastating biological weapons ever
conceived.
• The (WHO) officially declared smallpox
eradicated in 1980.
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• Current locations of smallpox virus:
Only two laboratories in the world are
known to house smallpox virus: the (CDC)
in Atlanta, Georgia, and the State
Research Center of Virology and
Biotechnology in Koltsovo, Russia.
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Why were the British able to infect
the American Indians with smallpox
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TOXINS
• BOTULISM
Bioterrorism
• RICIN
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Botulism
• Potent neurotoxin caused by an
anaerobic bacillus- colstridium
botulinum.
• Transmission:
• Contaminated food
• Inhalation
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Signs and symptoms:
Gastrointestinal symptoms
Drooping eyelids
Weakened jaw clench
Difficulty swallowing or speaking
Blurred vision
Respiratory distress
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• Incubation period:
• Neurological S/S for food borne botulism –
12-36 hours after ingestion
• Neurological S/S for inhalation botulism –
24-72 hours after exposure
• Prevention: Vaccine available
• Botulism cannot be transmitted person to
person.
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Ricin
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• Ricin is a potent protein toxin derived
from Castor beans. Castor beans are
found easily all over the world and the
toxin is fairly easily produced. For this
reason ricin could be used as a
biological weapon with relative ease.
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Infections in Humans
Aerosol
Ingestion
Signs and Symptoms:
18-24 hours
Weakness
Fever
Cough
Pulmonary edema
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• 36-72 hours
• Severe respiratory distress
• Death from hypoxemia
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Incubation period:
• 8-18 hours
• Prognosis:
• Poor-no vaccine available
• Ricin does not spread easily person to
person.
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All of the following are considered
reason for Ricin being so dangerous
except
• A) plant grows everywhere, and is
poisonous
• B) there is no vaccine available, and can
be spread by inhalation or ingestion
• C) It causes paralysis of the muscles
causing the person to go into a coma
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Sarin
• Sarin and other nerve agents
may have been used in
chemical warfare during the
Iran-Iraq War in the 1980s.
• Sarin was used in two terrorist
attacks in Japan in 1994 and
1995.
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http://www.bt.cdc.gov/agent/sarin/basics/facts.asp
• Following release of sarin into the air, people
can be exposed through skin contact or eye
contact. They can also be exposed by breathing
air that contains sarin.
• Sarin mixes easily with water, so it could be
used to poison water. Following release of sarin
into water, people can be exposed by touching
or drinking water that contains sarin.
• Following contamination of food with sarin,
people can be exposed by eating the
contaminated food.
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• How would the bioterrorism agent, Ricin,
be classified?
• a] Fungus
• b] Virus
• c] Toxin
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Containment of bioterroism agents
• If patients have been
exposed and are
already ill, the
emphasis is not
decontamination but
rather respiratory
isolation of the patient
with employment of
standard precautions
until the agent is
known
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Isolation practices
• Standard precautions
• Additional precautions
for smallpox and
plague
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• How can the general public protect
themselves from bioterrorism agents?
• a] Follow standard precautions
• b] Avoid travel to Washington D.C. and
New York City
• c] Sterilize household items
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ER staff play an important role in:
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Patient Placement
• Routine if small scale
• Grouping affected
patients if large scale
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• How would a health care system manage victims
in a large scale bioterrorism attack?
• a Transport victims to various hospitals to
share the responsibility of giving care.
• b Group affected victims together in the same
facility
• c Open up a special isolation hospital for long
term care of victims
• d Provide routine patient care
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Patient transport
• Limited to movement
that is essential
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• An American man is in Spain on vacation and is
the victim of a bioterrorism attack. How should
he be treated?
• a He should be immediately transported back
to the USA for medical care.
• b He should be transported back to the USA
only if he is in critical condition.
• c He should be treated in Spain until he is
noninfectious.
• d He should be transferred to the closest
American military hospital.
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• Cleaning, disinfection
and sterilization of
equipment and
environment- follow
standard precautions
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Discharge management
• Discharge when noninfectious
• Home care if large numbers of persons
exposed with instruction on barrier
precautions, hand washing, waste
management, cleaning and disinfection of
environment and patient care items.
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• A large scale bioterrorism attack has occurred
and the director of the health department has
determined that those victims who are least
symptomatic can be cared for at home. What will
need to be done to prepare for home care?
• a Instruction on barrier precautions,
handwashing, and cleaning
• b Isolation signs will need to be posted around
the outside of the house
• c No special actions are needed
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Post - mortem care
• Notify pathology
• Provide instructions to
funeral director
• Plague / Smallpox
– cremation
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• A patient has died from a bioterrorist attack.
Would a funeral director be told the cause of
death?
• a Yes, because special post-mortem
precautions must be taken.
• b No. Disclosure of cause of death would
violate HIPPA rules.
• c] No, because the director might refuse the
patient.
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Hand washing technique
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• When washing hands, what is the best
water temperature to use?
• a Cold
• b Cool
• c Warm
• d Hot
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• An early example of a biological agent
being used to kill, was when the British
used blankets infected with what organism
to infect American Indians?
• A) ebola
• B) anthrax
• C) Smallpox
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