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BIOTERRORISM

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BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James s Hospital. 9/11 Changes Move to high risk Biological Threat, specialist public ... – PowerPoint PPT presentation

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Title: BIOTERRORISM


1
BIOTERRORISM
  • Dr. E. McNamara
  • Public Health Lab. HSE, Dublin.
  • St. Jamess Hospital.

2
9/11 Changes
  • Move to high risk
  • Biological Threat, specialist public arena
  • Newsworthy
  • Rare/eradicated infections
  • Low clinical experience

3
Autumn 2001 USA
  • 5 letters, finely milled anthrax spores
  • 11 pulmonary anthrax (5 died)
  • 7 cutaneous anthrax
  • All sent from Trenton, New Jersey, 1 person
  • American origin, B. anthracis
  • Criminal Act Terrorist

4
Lessons Learned
  • No one prepared
  • Easy to produce contagious material
  • Easy to spread, (except aerosolization)
  • Small numbers affected, major concern
  • Copy cat phenomenon Hoaxes
  • Lab. techniques for diagnosis
  • Major disruption
  • Use of prophylactic antibiotics

5
Benefits
  • Co-operation internationally
  • WHO
  • CDC
  • EU
  • National preparedness Plans
  • Multidisciplinary
  • Government
  • Admininstrative
  • Emergency services
  • Medical
  • Scientific

6
History Biological Warfare
  • Water wells contaminated with corpses
  • Siege Caffa, Crimea 1346, used plague corpses
  • British, gave Smallpox contaminated blankets as
    presents to Native Americans

7
Modern History Biological Warfare
  • Germany WWI
  • sold anthrax infected horses
  • WWI-II
  • Many countries started biological programme
  • WWII Not Used
  • UK 5 million anthrax cattle-cakes
  • USA Botulinum
  • Canada Plague
  • Germany Salmonella
  • Japan POW/Chinese trials

8
Post WWII
  • USA
  • 3400 people 1969, BTWC
  • Allegation
  • Korean War
  • Cuba
  • Misinformation, FBI to Soviets
  • Soviets
  • 1920 1969, BTWC signed
  • 1975 Enlarged, Biopreparat
  • 60,000 people
  • 40-50 facilities
  • 50 agents

9
Post WWII contd.
  • 1979 Sverdlovks, Anthrax, 69 died
  • 1980 1990 Defections
  • 1990 Yelsin cessation?
  • Iraq 1974?, S. Africa 1980-1993
  • 10 12 trying to acquire, evidence?

10
Preparing for Biological Attacks
  • Enhance surveillance
  • Resource laboratories
  • Communication systems
  • Bioterrorism education
  • Stockpile vaccines and drugs
  • Molecular surveillance microbial strains
  • Support development diagnostic tests
  • Support research Rx. and vaccines
  • CDC April 2000

11
Biological Agents
  • Category A
  • Easily dessiminated
  • High mortality
  • Public panic
  • Require special preparedness
  • Category B
  • Moderately easy to dessiminate
  • Low mortality
  • Need enhanced Dx./surveillance
  • Category C
  • Emerging pathogens

12
Anthrax, B. anthracis
  • Zoonotic, spore forming rod
  • Soil reservoir, years
  • Affects large domestic and wild herbivoires
  • Worldwide
  • Humans
  • Contact with infected animals/products
  • Skin cutaneous
  • GIT/resp. inhalation
  • 2000 cases, cutaneous / year
  • 5 cases USA, 1 case UK
  • No cases Ireland for 25 years

13
Anthrax contd.
  • Bioterrorist threat inhalation spores
  • No person person spread ! (cutaneous?)
  • Cutaneous
  • Skin inoculation
  • Painless swelling
  • Papular vescle ulcer
  • Black eschar
  • Toxaemia
  • Mortality with Rx., lt 1.
  • GIT
  • Ingest contaminated meat
  • Pain, diarrhoea, haematemesis, septicaemia
  • Mortality gt 50

14
Anthrax contd.
  • Dx. (Confirm reference laboratory)
  • Hazard Group 3 CL3
  • Non motile, GPB, Aerobic
  • Central / Terminal spores
  • Nonhaemolytic
  • Sensitivity tests
  • Rx. Penicillin / Ciprofloxacin
  • Post exposure prophylaxis Ciprofloxacin
  • Infection Contol standard precautions

15
Biological Agents
  • Category A
  • Easily dessiminated
  • High mortality
  • Public panic
  • Require special preparedness
  • Category B
  • Moderately easy to dessiminate
  • Low mortality
  • Need enhanced Dx./surveillance
  • Category C
  • Emerging pathogens

16
Anthrax, B. anthracis
  • Zoonotic, spore forming rod
  • Soil reservoir, years
  • Affects large domestic and wild herbivoires
  • Worldwide
  • Humans
  • Contact with infected animals/products
  • Skin cutaneous
  • GIT/resp. inhalation
  • 2000 cases, cutaneous / year
  • 5 cases USA, 1 case UK
  • No cases Ireland for 25 years

17
Anthrax contd.
  • Bioterrorist threat inhalation spores
  • No person person spread ! (cutaneous?)
  • Cutaneous
  • Skin inoculation
  • Painless swelling
  • Papular vescle ulcer
  • Black eschar
  • Toxaemia
  • Mortality with Rx., lt 1.
  • GIT
  • Ingest contaminated meat
  • Pain, diarrhoea, haematemesis, septicaemia
  • Mortality gt 50

18
Anthrax contd.
  • Dx. (Confirm reference laboratory)
  • Hazard Group 3 CL3
  • Non motile, GPB, Aerobic
  • Central / Terminal spores
  • Nonhaemolytic
  • Sensitivity tests
  • Rx. Penicillin / Ciprofloxacin
  • Post exposure prophylaxis Ciprofloxacin
  • Infection Contol standard precautions

19
Inhalation Anthrax
  • Bioterrorist agent
  • Mortality 90
  • Incubation 1 60 days
  • Initial Phase (hrs days)
  • Non-specific symptoms
  • Non-specific clincial signs Dx. test
  • Recover / Progress to fulminant
  • Fulminant Phase
  • Septicaemia / Toxaemia
  • Dyspnoea with CXR mediastenal widening
  • 50 haemorrhagic menigitis and death
  • Mortality increased with short incubation

20
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21
Small Pox
  • Human, DNA variola virus
  • 2 Forms
  • Variola major, mortality 30 (3 vaccinated)
  • Variola minor, mortality 1
  • Airborne spread, contact
  • Secondary attack rate 50 (unvaccinated)
  • Last death 1978 UK.
  • WHO 1980, eradicated.

22
Small Pox contd.
  • Incubation 12-14 days, rash further 2-4 days
  • Fever, headache, myalgia, abdominal pain and
    vomiting
  • Delirium 15
  • Rash, centrifugal, face and extremities
  • Copious virus on mucosal lesions
  • Secondary bacterial pneumonia (mortality gt 50)
  • Haemorrhagic Small Pox (95 mortality)
  • Differental Chicken Pox.

23
Small Pox contd.
  • Dx.
  • Hazard Group 4
  • EM (Herpes Pox) - CL3
  • PCR (differentites Pox viruses) CL4
  • Culture CL4
  • Public Health Emergency International
  • Case Standard, contact and airborne precautions
  • Isolate negative pressure, HEPA extract
  • PPE. Decontamination protocol
  • Immune HCW (vaccinated)
  • Rx. supportive
  • Contact/Exposed
  • Quarantine for 18 days - monitor temperature
  • Infectious form onset of fever

24
Small Pox Vaccine
  • Face face contacts
  • HCW (core, prepardness)
  • Designated emergency personnel
  • Vaccine
  • Live vaccinia virus (not variola)
  • Vaccine site, infectious until scab heals
  • Newer vaccine development
  • S/E
  • Efficancy

25
Small Pox Vaccine contd.
  • CI atopic dermatitis, pregnant,
    immunocompromised
  • S/E
  • Fever headache, rigors, vastles
  • Generalised vaccinia (GV)
  • Eczema vaccinatum (EV)
  • Progressive vaccinia (PV)
  • Post vaccinial CNS (PVE)
  • Incident 1968
  • Life threatening 52 / million
  • Deaths 1.5 / million

26
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27
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28
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29
Cl. Botulinum
  • Botulinum neurotoxin most potent
  • Contaminated food, canned products
  • Wound botulism, contaminated soil, IVDA
  • Bioterrorism agent
  • Aerosolisation inhalation
  • Contaminate food ingestion
  • Large numbers with acute flaccid paralysis

30
Cl. Botulinum contd.
  • Incubation
  • 2hrs 8 days, Foodborne
  • 1hr 5 days, Aerosol
  • Foodborne
  • VD, diplopia, dysarthria, weakness
  • Ptosis, facial palsy, ?gag Hypotonic
  • Inhalation
  • Dysplagia, nystagmins, ?speech, ?gait
  • Terminal
  • Progressive muscular paralysis
  • Mortality 5 (with Rx.)

31
Cl. Botulinum contd.
  • Differential Dx.
  • Guillain-BarrĂ©
  • Myastheria gravis
  • Stoke
  • CNS despressants

32
Cl. Botulinum contd.
  • Dx.
  • Detect botulinum toxin
  • Culture
  • Rx.
  • Antitoxin
  • Supportive
  • Infection Control standard precautions

33
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34
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35
Plague
  • Yersinia pestis HG3
  • GNCB, 02
  • Aerosol, flea vector, person-person
  • 3 Forms
  • Bubonic 90
  • Septicaemic 10
  • Pneumonic 1
  • Bioterrorist agent
  • Aerosol pneumonic
  • Fleas bubonic, septicaemic

36
Bubonic Plague
  • Incubation 1-8 days
  • Fever, rigors, headache
  • Buboes painful lymph nodes
  • 15 develop pneumonic plague
  • Mortality 12

37
Septicaemic Plague
  • Primary, or secondary to bubonic
  • Rigors, abdominal pain, VD
  • Purpura, DIC, necrosis
  • Mortality 30

38
Pneumonic Plague
  • Highest bioterrorism risk
  • Primary or secondary from haematogenous
  • Incubation 1-3 days
  • Pneumonic symptoms
  • Respiratory failure and shock
  • Mortality - ?with rx. 8

39
Plague
  • Dx.
  • Culture
  • Rx.
  • Gentamicin, Streptomycin IV
  • Ciprofloxacin, Doxycycline P.O.
  • Infection Control
  • Standard and droplet, single room, surgical mask
  • Contacts
  • Prophylaxis Ciprofloxacin 72 hrs.

40
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41
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42
Tularaemia
  • F. tularensis
  • Non-motile, aerobic, GNCB, zoonosis, rabbits,
    deerfly
  • HG3
  • Worldwide
  • Low inoculum 10 CFU
  • Ulceroglandular
  • Typhoidal
  • Mortality 35-60 (untreated)
  • Inhalation
  • Infection Control standard (no person-person)
  • Rx. Gentamicin/Streptomycin 10 days
  • Contacts prophylaxis

43
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Tularaemia
44
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Tularaemia
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