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BiomedBCT

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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:

• 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.

• • 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)

• 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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AnthraxAcute infectious disease caused

by bacillus anthracis.

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ANTHRAX• 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, ingestion-gastrointestinal, 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 SeatDr. 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 • http://www.citypaper.com/news/story.asp?id=7379 • Plague satisfies all three

requirements. A historic terror, the disease decimated one-third 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

• A) Pneumonic• B) Bubonic• C) Septicemic

• The Wyoming Department of Health is investigating how a Boy Scout who visited northwest Wyoming became

infected with bubonic plague.

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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 • RICIN

Bioterrorism

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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•

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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