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Bioterrorism Awareness: Protection of Human and Animal Health

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... Agents/Diseases Anthrax Botulism Plague Smallpox Tularemia Viral hemorrhagic ... are Zoonotic Factors That Promote Transmission of Zoonoses Disease ... – PowerPoint PPT presentation

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Title: Bioterrorism Awareness: Protection of Human and Animal Health


1
Bioterrorism AwarenessProtection of Human and
Animal Health
  • Companion animal veterinarians

2
Why Are We Here?
  • September 11, 2001 changed many things
  • Worst terrorist act in U.S. history
  • More than 3,000 presumed dead
  • Occurred on American soil
  • Increased sense of vulnerability

3
Biological Attack
  • Bioterrorism attacks of 2001
  • Anthrax in postal system
  • 22 cases
  • 5 deaths
  • U.S. public health realm changed forever

4
Preparedness Responsibilities Veterinarians
  • Anticipate outbreaks on the local level
  • Collect and label samples
  • Know the agents
  • Know the typical signs of diseases
  • Animals and human
  • Know how to report suspected cases
  • Disseminate knowledge

5
Overview
  • Bioterrorism
  • Zoonoses and bioterrorism
  • Disease control and biosecurity
  • U.S. Government agencies involved
  • Bioterrorism agents/diseases
  • Your role and responsibility

6
Terrorism
  • Biological, chemical, or radiological agents
    targeting agriculture or its components
  • Livestock
  • Food supply
  • Crops
  • Industry
  • Workers
  • Conventional, radiological, nuclear,
    chemical,cyber
  • Typically direct human targeting

Biological agents targeting humans, animals, or
plants
7
Characteristics of a Biological Attack
  • Difficult to detect release
  • Dissemination may cover large area
  • Possible secondary spread
  • Recognition of agent may be delayed days to weeks
  • Difficulties in catching perpetrator

8
Infectious Disease Outbreak
Time (Days)
9
Clues Suggesting Biological Agent Release
  • Clustering of morbidity or mortality
  • Temporally or geographically
  • Large numbers of animals and/or people
  • Atypical symptoms
  • Normally healthy people affected
  • Unusual symptoms for area
  • Unusual age distribution
  • Disease occurring outside typical season

10
Many Agents are Zoonotic
  • Disease may be seen in animals before humans
  • Animals are sentinels
  • Pets, livestock,
    wildlife

11
Factors That Promote Transmission of Zoonoses
  • Frequent contact with domestic or wild animals
  • Overlap with wildlife habitat
  • Intensive livestock production
  • Poor animal sanitation
  • Poor personal hygiene
  • Poor animal health

12
Disease Control Client Education
  • Disinfect/clean up areas contaminated with animal
    waste
  • Livestock, pets, wildlife, rodents
  • Basic hygiene
  • Wash hands
  • Child supervision

13
Zoonoses ControlClient Education
  • Proper pet selection
  • Use caution at petting zoos
  • Cook food properly
  • Control strays
  • Communication with physician and veterinarian
  • Follow guidelines for immunocompromised people

14
Disease Control Veterinarians
  • Restrict animal movement, contact in hospital
  • Appropriate disinfection of hands, exam, waiting
    rooms, surgical suites
  • Regularly disinfect animal holding areas and
    adequately ventilate
  • Designated isolation area with posted protocols

15
U.S. Agencies
  • Dealing with terrorism

16
Public Health Security and Bioterrorism
Preparedness Response Act of 2002
  • June 12, 2002
  • Improve ability of the U.S. to prevent, prepare
    for, and respond to bioterrorism and other public
    health emergencies
  • 4.3 billion to various federal, state and local
    agencies
  • Upgrade facilities, enhance security, etc

17
Department of Homeland Security (DHS)
  • Established January, 2003
  • Mission
  • Prevent, protect, and respond to acts of
    terrorism on U.S. soil
  • Established four policy directorates
  • Responsibilities for coordinating HHS and USDA
  • Guard borders and airports, coordinate the
    response for future emergencies, analyze threats
    and intelligence, protect our critical
    infrastructure

18
Centers for Disease Control and Prevention
  • CDC's Mission
  • Promote health and quality of
    life by preventing and
    controlling disease, injury,
    and disability
  • Preparing for bioterrorism since 1998
  • One of the first agencies to respond to anthrax
    incidents of 2001

19
Strategic National Stockpile
  • 12-hour Push Package
  • Complete package of medical materials
  • Vendor Managed Inventory
  • Tailored to suspected agents

20
Insert Your States Info Here
21
Preparing Iowa
  • Iowas Homeland Security
  • Administered by Iowa Emergency Management
    Division
  • Works with public and private partners

www.iowahomelandsecurity.org
22
Preparing Iowa
  • Iowa Department of Public Health
    www.idph.state.ia.us/odedp
  • Iowa Department of Agriculture and Land
    Stewardship
  • Highly infectious animal disease program
  • IRVIN Iowa Rapid Veterinary Information Network
  • CFSPH training veterinarians to educate others

23
Category ABC Agent Overview
24
Classification
  • Prepared by the CDCs Bioterrorism Preparedness
    and Response Office
  • Category A Highest priority
  • Category B Second highest priority
  • Category C Third highest priority

25
Weaponization of Agents
  • Alter characteristics of a pathogen to make it a
    more effective weapon
  • Enhance transmission
  • Increase virulence
  • Resistant to antibiotics
  • Evade vaccine protection
  • Alter clinical signs

26
Note to presenter
  • As time allows select diseases you would like to
    review.
  • If you have limited time you should focus on the
    Category A agents.
  • The disease coverage is brief. If you would like
    more information on a disease, refer to the fact
    sheet or to the disease specific presentation.

27
Category A Agents/Diseases
  • Anthrax
  • Botulism
  • Plague
  • Smallpox
  • Tularemia
  • Viral hemorrhagic fevers

28
Anthrax The Agent
  • Bacteria Bacillus anthracis
  • Forms spores
  • Human disease
  • Skin
  • Intestinal
  • Pulmonary
  • Animal disease
  • Septicemia and rapid death

29
Anthrax The Bioweapon
  • History
  • Available easily produced
  • Spores infective
  • Aerosolization
  • Low lethal dose
  • High mortality
  • Person-to-person transmission rare

30
Anthrax The Response
  • Vaccine
  • Humans
  • Animals
  • Antibiotics
  • Treatment
  • Prophylaxis
  • Disinfection
  • Sporicidal agents, sterilization

31
Botulism The Agent
  • Clostridium botulinum Gram pos, spore-forming
    bacteria
  • 7 different neurotoxins
  • Types A-G
  • Clinical signs
  • Flaccid paralysis
  • Pigs, dogs, and cats
  • fairly resistant

32
Botulism The Bioweapon
  • Used by Aum Shinrikyo cult in Japan
  • Aerosolized
  • Easy to produce and transport
  • Potent and lethal
  • Most poisonous substance known

33
Botulism The Response
  • Toxoids for high risk people
  • Antitoxin available
  • Case-by-case basis
  • Botulinum toxins are easily inactivated with many
    disinfectants and heat

34
Plague The Agent
  • Yersinia pestis
  • Gram neg, transmitted by fleabites, aerosol,
    direct contact
  • Symptoms Humans
  • Bubonic, septicemic, pneumonic
  • Symptoms Animals
  • Cat Similar to human
  • Dogs, livestock Somewhat resistant

35
Plague The Bioweapon
  • WHO estimate
  • 50kg agent City population 5 million
  • 150,000 cases pneumonic plague
  • Potential mortality 100,000
  • Available
  • Person-to-person transmission
  • Pneumonic form 100 fatal if untreated

36
Plague The Response
  • Antibiotics generally effective if given early
  • Killed vaccine available
  • Isolation of sick individuals
  • Susceptible to a number of common disinfectants

37
Smallpox The Agent
  • Variola virus, Orthopoxvirus
  • Eradicated from the world in 1977
  • Narrow host range Humans only
  • Transmission Person-to-person, fomites, aerosols
  • Clinical signs
  • Flu-like, progressive skin eruptions

38
Smallpox The Bioweapon
  • Used historically
  • Disease signals a bioterrorism event
  • Susceptible population
  • Easy to produce large scale
  • Aerosolization
  • Secondary spread
  • Person-to-person
  • Fomites
  • Mortality approximately 30

39
Smallpox The Response
  • No specific treatment
  • Vaccinia virus vaccination
  • Vaccinia Immune Globulin
  • Isolation of infected individuals
  • Ring vaccination program
  • Disinfection of environment, clothing with
    various chemicals, boiling or autoclaving

40
Tularemia The Agent
  • Francisella tularensis
  • Transmitted by ingestion, inhalation, vectors,
    direct contact through skin
  • Six clinical forms in humans

Ulceroglandular
Glandular
41
Tularemia The Agent
  • Sheep, young pigs, horses, dogs, cats
  • Sudden fever, lethargy, stiffness, prostration,
    and death
  • Wildlife
  • Usually find dead
  • Rabbits behave strangely
  • Cattle, older pigs resistant

42
Tularemia The Bioweapon
  • Stable
  • Aerosolized
  • Low infective dose via inhalation
  • Case fatality 30-60 (untreated )
  • WHO estimation 1970
  • 50 kg agent City population 5 million
  • 250,000 ill
  • 19,000 deaths

43
Tularemia The Response
  • Person-to-person transmission not documented
  • Antibiotics effective if early or prophylactic
  • Vaccine
  • For high risk individuals
  • Unknown efficacy
  • against inhalational
  • tularemia

44
Viral Hemorrhagic FeversThe Agents
  • Ebola, Marburg, Lassa, Machupo
  • Human clinical presentation
  • Early Fever, fatigue
  • Severe Bleed from internal organs, body orifices
  • Progression to shock seizures
  • Animals Only non-human primates susceptible

Vincent Massey
45
VHF The Bioweapons
  • Aerosolized
  • Not readily available, require specialized
    production
  • Person-to-person and nosocomial transmission
    occur
  • Untreated fatality rate variable
  • Humans 25-90
  • Non-human primates 50-100

46
VHF The Response
  • Intensive supportive care
  • Ribavirin has shown some efficacy
  • Susceptible to bleach solutions, phenolic
    disinfectants, and UV light

47
Category B Agents/Diseases
  • Brucellosis
  • Glanders
  • Melioidosis
  • Psittacosis
  • Q Fever
  • Typhus fever
  • Viral encephalitis
  • Toxins
  • Food Safety Threats
  • Water Safety Threats

48
Brucellosis The Agent
  • Gram-negative bacteria
  • Ingestion, inhalation, or direct contact
  • Clinical signs
  • Humans Cyclic fever and
  • flu-like symptoms
  • Animals Reproductive signs

49
Brucellosis The Agent
50
Brucellosis The Bioweapon
  • History
  • Highly infectious
  • Easily aerosolized
  • Stable
  • Prolonged incubation period
  • May make diagnosis difficult
  • Person-to-person unlikely

51
Brucellosis The Response
  • Long term antibiotics generally effective
  • Vaccinate calves, no human vaccine
  • Eliminate reservoir
  • Standard precaution to avoid
    exposure
  • Thorough disinfection

52
Glanders The Agent
  • Burkholderia mallei Gram-negative
  • Transmission by ingestion,
    inhalation, or direct contact
  • Animal-to-human transmission is
    inefficient
  • Clinical signs
  • Humans horses Cutaneous and pulmonary lesions,
    rapidly fatal illness

53
Glanders The Bioweapon
  • History
  • WWI Russian horses
  • WWII Chinese civilians, horses, POWs
  • Easy to produce
  • Aerosolized, highly infectious
  • Mortality high in chronic form
  • 50-70
  • Person to person transmission Rare

54
Glanders The Response
  • No vaccine
  • Antibiotic therapy likely effective
  • Destroyed by various chemicals

55
Melioidosis The Agent
  • Burkholderia pseudomallei Gram-negative
  • Transmission Contact, ingestion, inhalation
  • Clinical signs Humans, sheep, goats, and pigs
  • Asymptomatic to pneumonia, lung and wound
    abscesses

56
Melioidosis The Bioweapon
  • Easy to produce
  • Available
  • Aerosolization
  • High mortality 90
  • Person-to-person (rare)
  • Animal-to-person (rare)

57
Melioidosis The Response
  • Long-term, multiple antibiotics effective
  • Vaccines available Not in U.S.
  • Easily destroyed by disinfectants

58
Psittacosis The Agent
  • Chlamydophila psittaci
  • Gram-negative
  • Occurs worldwide
  • Reportable in U.S.
  • Clinical disease in humans and birds
  • Asymptomatic
  • Systemic illness with severe pneumonia

59
Psittacosis The Bioweapon
  • Easily obtained
  • Aerosolized
  • Stable in the environment
  • Person-to-person transmission rare
  • Low mortality

60
Psittacosis The Response
  • Antibiotics generally effective
  • Decontamination possible with most disinfectants

61
Q Fever The Agent
  • Coxiella burnetii
  • Transmission Inhalation, direct
    contact, ingestion, ticks
  • Disease symptoms
  • Humans
  • Acute Flu-like pneumonia hepatitis
  • Chronic Endocarditis, osteomyelitis
  • Animals Most asymptomatic
  • Sheep, cattle and goats Abortions

62
Q Fever The Bioweapon
  • History
  • Easily accessible
  • Environmentally
  • resistant
  • Highly infectious
  • Aerosolization
  • Travel ½ mile by wind
  • Low mortality- chronic morbidity

63
Q Fever The Response
  • Often self-limiting disease
  • Antibiotic therapy may limit complications
  • Vaccine developed, not available in U.S.
  • Variable susceptibility to disinfectants

64
Typhus Fever The Agent
  • Rickettsia prowazekii Rickettsial organism
  • Endemic in Eastern Europe, Middle East, and parts
    of Africa
  • Transmitted in feces of human
    body louse
  • Clinical signs Humans
  • Fever, headache, macular
  • eruptions, and petechial rash
  • Not seen in domestic animals

J. Kalisch
65
Typhus Fever The Bioweapon
  • WHO estimation 1970
  • 50 kg agent 5 million people in city
  • 125,000 ill
  • 8,000 deaths
  • Available
  • Can be aerosolized in
    lice feces

U.S. Typhus Commission
66
Typhus Fever The Response
  • Antibiotics are generally effective
  • Vaccine, not commercially available

67
Viral Encephalitis The Agent
  • The Alphaviruses EEE, WEE, and VEE
  • Transmitted via mosquito
  • Clinical signs
  • Humans, horses, donkeys,
  • mules Often asymptomatic
  • to flu-like
  • Encephalitis in small proportions
  • Birds are asymptomatic carriers, act as sentinels

68
Viral EncephalitisThe Bioweapon
  • Easy to produce
  • Aerosolization
  • High rate of infection
  • Person-to-person transmission possible

69
Viral EncephalitisThe Response
  • Supportive care
  • Vaccine
  • Equine
  • Human High risk
  • Virus unstable in environment

70
Category C
  • Nipah virus
  • Hantavirus

71
Nipah Virus The Agent
  • Paramyxovirus
  • Fruit bat reservoir
  • Clinical signs
  • Humans Encephalitis
  • Pigs Respiratory, neurological
  • Dogs and cats Distemper

72
Nipah Virus The Bioweapon
  • Aerosolization potential
  • Wide host range
  • No person-to-person transmission expected
  • High morbidity and mortality

73
Nipah Virus The Response
  • Avoid contact with all infected animals and
    fluids
  • Vaccine being researched
  • Call authorities immediately

74
Hantavirus The Agent
  • Bunyaviridae family
  • Asymptomatic reservoir Rodents
  • Transmission Inhalation,
  • ingestion, direct contact
  • Human clinical signs
  • Fever, myalgia, headache
  • Hantavirus Pulmonary Syndrome
  • Hemorrhagic Fever with Renal Syndrome
  • Not seen in domestic animals

75
Hantavirus The Bioweapon
  • Aerosolized
  • Hospitalization
  • Unexpected disease in the U.S.
  • HFRS limited to Asia/Europe to date

76
Hantavirus The Response
  • Supportive care
  • Limit exposure to rodent excrement
  • Wear gloves, face mask
  • Virus is deactivated with bleach

77
Other Important Diseases
  • Transmissible Spongiform Encephalopathy (TSE)
  • Rift Valley Fever
  • Hendra Virus
  • West Nile Virus
  • Foot and Mouth Disease
  • Monkeypox

78
Transmissible Spongiform Encephalopathy The Agent
  • Prions
  • Proteinaceous infectious particles
  • Mutated proteins
  • Very long incubation period
  • Neurological signs in all species
  • No treatment available

79
Bovine Spongiform Encephalopathy
  • Mad cow disease
  • Incubation 2 to 8 years
  • 1995, United Kingdom
  • vCJD
  • People exposed to BSE
  • Before bovine offal ban in 1989
  • Active U.S. surveillance since 1990

80
TSE The Response
  • Very resistant
  • Heat, sterilization and disinfectants
  • Early identification not possible
  • Lack of host immune response
  • Long incubation period
  • No effective treatment or vaccine
  • Surveillance program
  • Import restrictions

81
Rift Valley Fever The Agent
  • Phlebovirus in family Bunyaviridae
  • Transmission Mosquito, inhalation, contact with
    infected body fluids
  • Clinical signs
  • Humans Flu-like, fever, headache
  • Severe disease Retinitis, hemorrhagic
    fever
  • Animals Abortions, death in neonates

82
Rift Valley Fever The Bioweapon
  • WHO estimate 1970
  • 50 kg of virus aerosolized
  • 35,000 incapacitated
  • 400 deaths (1 mortality)
  • Stable at most temperatures
  • Inactivated by various chemicals

83
Rift Valley Fever The Response
  • Vaccinate ruminants in endemic areas
  • Control mosquitoes
  • Avoid contact with infected tissues blood
  • Wear protective clothing
  • No person-to-person transmission

84
Hendra Virus The Agent
  • Newly discovered
  • Australia
  • Fruit bats
  • Transmission Urine, body fluids
  • Incubation 6-18 days
  • Humans
  • Flu-like illness, respiratory failure
  • Horses, cats
  • Acute respiratory signs, nasal discharge, fever,
    encephalitis, sudden death

85
Hendra Virus The Response
  • Little is known about disease
  • Highest level of security to work with the agent
  • Potentially serious consequences
  • High mortality rate
  • Lack of treatment

86
West Nile Virus The Agent
  • Flavivirus
  • Transmission
  • Mosquitoes Culex species
  • Blood transfusion, organ donation, breast feeding
  • Animals Horses, birds, mammals, and reptiles
  • Humans
  • Duration 3-6 days
  • 80 have no signs
  • 20 develop West Nile Fever

87
West Nile Virus Public Health Significance
  • Human illness in U.S. in 2003
  • 9,100 cases, 222 deaths
  • Horses illness in U.S. in 2003
  • 4,554 cases
  • 40 of ill result in death
  • Method of introduction to U.S. unknown
  • data current as of 1/30/04

88
Spread of WNV in the U.S. 1999-2002
89
West Nile Virus The Response
  • Treatment Supportive care
  • Vaccine available for horses, not humans
  • Source elimination
  • Mosquito larval habitats
  • Personal protection
  • Reduce time outdoors
  • Wear long pants and sleeves
  • Use mosquito repellent

90
Foot and Mouth Disease FMD
  • Picornavirus
  • Transmission Direct contact, aerosol, fomites
  • Species Cloven-hooved animals (not horses)
  • Signs Fever, vesicles, salivation, lameness
  • Extremely rare, mild symptoms in people

91
FMD Agroterrorism Threat
  • Most important livestock disease in the world
  • U.S. agriculture as a target
  • One sixth of the U.S. domestic product is tied to
    agriculture
  • Immunologically naive population
  • Vulnerabilities
  • Increased travel, poor biosecurity

92
FMD The Response
  • USDA upgrading safeguarding measures
  • Strict biosecurity
  • Notify authorities immediately
  • Response and recovery plans
  • Quarantine
  • Depopulation
  • Disinfection
  • Vaccination complex decision

93
Monkeypox The Agent
  • Orthopoxvirus, related to smallpox
  • Transmission
  • Reservoir may be African squirrel
  • Bites, aerosol, direct contact
  • Zoonotic, animal-to-animal, person-to-person
  • Animals Fever, rash, pustules conjunctivitis
  • Humans Flu-like, rash, pustules, lymphadenopathy

94
Monkeypox Public Health Significance
  • 2003 U.S. Outbreak
  • Zoonotic disease
  • 6 Midwestern states
  • Animal illness
  • Suspect cases 93
  • Confirmed cases 10
  • Human illness
  • Suspect cases 72
  • Confirmed cases 37
  • All had contact with infected prairie dogs
  • Potential bioweapon

95
Monkeypox The Response
  • Treatment supportive care
  • Smallpox vaccination
  • Moderately protective (85 of cases)
  • 30 individuals in 2003, no adverse events
  • Infection Control
  • EPA registered detergent disinfectant
  • 0.5 sodium hypochlorite (bleach)
  • Embargo
  • Euthanasia of animals
  • Quarantine for 6 weeks

96
The Veterinarians Responsibility
97
Opportunities for the Veterinary Profession
  • Integrate into the public health system
  • Be aware, contribute, assist in development of
    surveillance programs
  • Report trends in disease and clinical signs
  • Be involved with emergency response plans at all
    levels

98
The Veterinarians Responsibility
  • Guardian of animal and public health
  • Sharpen awareness of potential bioterrorism
  • Alert officials early
  • You are the expert
  • Provide leadership and input to clients and
    community

99
What to do if bioterrorism is suspected
  • Stay informed and remain calm
  • Response is event specific
  • Response is everyone's responsibility
  • Follow the advice of public health officials
  • Follow federal and state guidelines
  • Movement restrictions may be necessary

100
Contacts
  • Phone numbers to know
  • State Veterinarian
  • State Public Health Veterinarian
  • APHIS- Area Veterinarian in Charge
  • Public Health Officials

101
Summary
  • Bioterrorism is a real threat
  • Public health infrastructure is being
    strengthened
  • Many bioterrorism agents are zoonotic
  • Awareness education is an important component of
    preparedness and protection

102
Summary
  • Prevention, recognition, and response involves
    everyone
  • Report any suspicious activity, unexplained
    behavior or death loss in your clients herd or
    flock
  • You play a critical role

103
Conclusion
  • The best prescription,
  • is knowledge.
  • Dr. C. Everett Koop
  • Former U.S. Surgeon General

104
Acknowledgments
Development of this presentation was funded by a
grant from the Centers for Disease Control and
Prevention to the Center for Food Security and
Public Health at Iowa State University.
105
Acknowledgments
Author Reviewers
Glenda Dvorak, DVM, MS, MPH Radford Davis, DVM,
MPH Gayle Brown, DVM, PhD Jean Gladon, BS
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