Bioterrorism Agents: Plague

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Bioterrorism Agents Plague

• Lesson 1
• Introduction and Overview

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Objectives

• Identify plague bacterium
• Epidemiology
• Natural Occurrence

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Bio-Terror Threat

• Plague can cause large numbers of cases
• Could create panic
• Considered for use since 14th century

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Clinical Syndromes

• Bubonic
• Pneumonic
• Septicemic
• Plague Meningitis
• Pharyngeal

Safety Pin Y. Pestis in blood
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Bubonic Plague

• Infected flea bite
• Exposure through break in skin
• No person-to-person
• Untreated progresses to pneumonic

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Pneumonic Plague

• Inhalation of plague bacteria
• Disease progression
• Respiratory failure
• Shock
• Rapid death
• Person-to-person transmission

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Septicemic Plague

• Primary Form
• Direct inoculation in bloodstream
• Secondary Form
• Development of untreated pneumonic or bubonic
  plague

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EpidemiologyNatural Reservoirs

• Bites of infected flea
• Most common Oropsylla montana
• Blood meal from bacteremic animal
• Regurgitates into human/ animal host
• Common reservoirs
• Deer mice
• Ground squirrels

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EpidemiologyTransmission

• Bite of infected flea
• Respiratory droplets
• Direct contact (6 feet)
• Direct skin/mucous membrane less common
• BT event Respiratory droplets or aerosols

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Plague IncidenceUnited States,1970-2003

• Endemic to US
• Bubonic Most Common
• 83 Bubonic
• 2 Primary Pneumonic
• 15 Septicemic
• 5 to 15 cases per year
• Greatest Concentrations
• Arizona, Colorado, New Mexico, Utah

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Plague Case Fatality RatesUnited States, 1970 -
1977

• In US, 14 died
• Untreated 50 to 90
• Treated 15
• Deaths mostly from delays in diagnosis and
  treatment

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Plague IncidenceWorldwide, 1970 - 1998

• All inhabited continents, but Australia
• 1,500 to 3,000 cases annually
• Greatest Concentrations
• Asia, South America

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Plague Bioterrorism Scenario

• Most dangerous as aerosol
• Outbreak of pneumonic
• Possibly pharyngeal or ocular
• Report all suspect cases to public health
  immediately

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Review Questions PlagueLesson 1

• Overview

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Plague Review QuestionsLesson 1, Question 1

• Santa Fe, New Mexico hospital
• Treating suspect plague case
• Hearing of more cases in area
• When do you start to worry about bioterrorism?

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Plague Review QuestionsLesson 1, Question 1

• When do you start worrying about bioterrorism?
• Unrelated clusters
• Unusual rise in cases
• Both of the above
• None of the above

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Plague Review QuestionsLesson 1, Question 1

• When do you start worrying about bioterrorism?
• Answer - C. Both of the above
• Unrelated clusters
• Unusual rise in cases

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Plague Review QuestionsLesson 1, Question 2

• Abnormally large, tender lymph node
• Right arm
• Lab specimen for preliminary testing
• What organism causes plague?

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Plague Review QuestionsLesson 1, Question 2

• What organism causes plague?
• B. anthracis
• C. botulinum
• C. burnetii
• Y. pestis

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Plague Review QuestionsLesson 1, Question 2

• What organism causes plague?
• D. Y. pestis

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Plague Review QuestionsLesson 1, Question 3

• New Hampshire hospital
• Labs Unable to rule out plague
• Recent US travel
• Where in the US would you expect the patient to
  get plague?

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Plague Review QuestionsLesson 1, Question 3

• Where in the US would you expect the patient to
  get plague?
• Western US, Southwest
• Eastern US, Southeast
• Northern US, Northeast
• Southern US, Southwest

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Plague Review QuestionsLesson 1, Question 3

• Where in the US would you expect the patient to
  get plague?
• A. Western US, Southwest