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Transcript of Bioterroism1 Biomed BCT. Bioterroism2 3 The first well-documented use of smallpox as a biological...
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Bioterroism 1
BiomedBCT
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Bioterroism 2
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Bioterroism 3
• 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 4
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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Bioterroism 5
Biological weapons are:
• Living microorganisms such as bacteria, viruses, fungi, that can kill or incapacitate
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Bioterroism 6
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Bioterroism 7
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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Bioterroism 8
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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Bioterroism 9
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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Bioterroism 10
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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Bioterroism 11
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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Bioterroism 12
Radioactive agents
• Colorless, odorless, and invisible to the eye.
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Bioterroism 13
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Bioterroism 14
• Contamination of food, water, or objects may disable or kill humans and animals and be difficult to trace.
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Bioterroism 15
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Bioterroism 16
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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Bioterroism 17
The Pain of Exposure
• Exposure can be through ingestion, inhalation, or contamination of an open wound.
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Bioterroism 18
Response to bioterroism agents:
• New Report: North Carolina Earns Grade of 10 out of 10 on Disaster Preparedness
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Bioterroism 19
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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Bioterroism 20
External contacts (outside of facility)
• Local health department
• State health department
• FBI
• CDC
• Local police
• EMS
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Bioterroism 21
Examine the containment of bioterroism agents
• Agents• Containment of
agents
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Bioterroism 22
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Bioterroism 23
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Bioterroism 24
BACTERIAL
• ANATHRAX • PLAGUE
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Bioterroism 25
AnthraxAcute infectious disease caused
by bacillus anthracis.
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Bioterroism 26
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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Bioterroism 27
• 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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Bioterroism 28
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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Bioterroism 29
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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Bioterroism 30
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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Bioterroism 31
Anthrax
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Bioterroism 32
• 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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Bioterroism 33
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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Bioterroism 34
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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Bioterroism 35
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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Bioterroism 36
• 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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Bioterroism 37
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Bioterroism 38
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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Bioterroism 39
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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Bioterroism 40
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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Bioterroism 41
VIRAL
• SMALLPOX
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Bioterroism 42
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Bioterroism 43
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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Bioterroism 44
• 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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Bioterroism 45
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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Bioterroism 46
• 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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Bioterroism 47
Why were the British able to infect the American Indians with smallpox
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Bioterroism 48
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49
TOXINS
• BOTULISM • RICIN
Bioterrorism
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Bioterroism 50
Botulism
• Potent neurotoxin caused by an anaerobic bacillus- colstridium botulinum.
• Transmission:
• Contaminated food
• Inhalation
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Bioterroism 51
• Signs and symptoms:
• Gastrointestinal symptoms
• Drooping eyelids
• Weakened jaw clench
• Difficulty swallowing or speaking
• Blurred vision
• Respiratory distress
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Bioterroism 52
• 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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Bioterroism 54
• 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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Bioterroism 55
• Infections in Humans• Aerosol• Ingestion• Signs and Symptoms:•
18-24 hours• Weakness• Fever• Cough• Pulmonary edema
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Bioterroism 56
• 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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Bioterroism 57
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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Bioterrorism
58
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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Bioterroism 59
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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Bioterroism 60
• How would the bioterrorism agent, Ricin, be classified?
• a] Fungus
• b] Virus
• c] Toxin
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Bioterroism 61
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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Bioterroism 62
Isolation practices
• Standard precautions• Additional precautions
for smallpox and plague
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Bioterroism 63
• 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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Bioterroism 64
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Bioterroism 65
ER staff play an important role in:
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Bioterroism 66
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Bioterroism 67
Patient Placement
• Routine if small scale• Grouping affected
patients if large scale
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Bioterroism 68
• 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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Bioterroism 69
Patient transport
• Limited to movement that is essential
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Bioterroism 70
• 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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Bioterroism 71
• Cleaning, disinfection and sterilization of equipment and environment- follow standard precautions
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Bioterroism 72
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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Bioterroism 73
• 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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Bioterroism 74
Post - mortem care
• Notify pathology• Provide instructions to
funeral director
• Plague / Smallpox– cremation
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Bioterroism 75
• 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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Bioterroism 76
Hand washing technique
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Bioterroism 77
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Bioterroism 78
• When washing hands, what is the best water temperature to use?
• a Cold
• b Cool
• c Warm
• d Hot
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Bioterroism 79
• 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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Bioterroism 80
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Bioterroism 81