Bioterrorism Awareness: Protection of Human and Animal Health

1
Bioterrorism AwarenessProtection of Human and
Animal Health

• Food animal veterinarians

2
Why Are We Here?

• September 11, 2001 changed many things
• Worst terrorist act in U.S. history
• More than 3000 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
• Avoid petting zoos
• Cook food properly
• Control strays
• Communication with physician and veterinarian
• Follow guidelines for immunocompromised people

14
Biosecurity Educationfor the Producer

• Develop and implement a biosecurity plan
• Train employees to help maintain the plan
• Post signs restricting access to areas of the
  farm and control traffic flow

15
Biosecurity Educationfor the Producer

• Regulate visitors
• Keep visitors sanitary
• Clean clothing, boots
• Disposable plastic
  shoe/boot covers
• Implement insect, bird, and animal control
• Secure water, feed and nutrient sources

16
Biosecurity Educationfor the Producer

• Maintain healthy herd
• Vaccinate
• Proper hygiene for animals and handlers
• Purchase from reputable sources
• Quarantine newly purchased animals
• Separate sick animals

17
Biosecurity Veterinarians

• Disinfect your clothes, boots, equipment between
  farms
• Avoid vehicle contamination
• Follow biosecurity guidelines set forth by
  species specific associations

18
U.S. Agencies

• Dealing with terrorism

19
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
• 1.6 billion to state, local governments
• 300 million to CDC
• 1.15 billion to Secretary HHS
• 190 million for agriculture bioterrorism RD
• 160 million for water protection

20
Department of Homeland Security

• Homeland Security Act of 2002
• Mission
• Prevent, protect, and respond to acts of
  terrorism on U.S. soil
• Four divisions
• Border and Transportation Security
• Emergency Preparedness and Response
• Chemical, Biological, Radiological and Nuclear
  Countermeasures
• Information Analysis and Infrastructure
  Protection

21
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 first agencies to respond to anthrax
  incidents

22
Strategic National Stockpile

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

23
Insert Your States Info Here
24
Preparing Iowa

• Iowas Homeland Security www.iowahomelandsecurity.
  org
• Administered by Iowa Emergency Management
  Division
• Preparedness, mitigation, response and recovery
• Works with public and private partners
• Detection, protection, and prevention

25
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 Vet Info Network
• CFSPH training veterinarians to educate others

26
Category ABC Agent Overview
27
Classification

• Prepared by the CDCs Bioterrorism Preparedness
  and Response Office
• Category A highest priority
• Category B second highest priority
• Category C third highest priority

28
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

29
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.

30
Category A Agents/Diseases

• Anthrax
• Botulism
• Plague
• Smallpox
• Tularemia
• Viral Hemorrhagic fevers

31
Anthrax The Agent

• Bacteria Bacillus anthracis
• Forms spores
• Human disease
• Skin
• Intestinal
• Inhalational
• Animal disease
• Septicemia and rapid death

32
Anthrax The Bioweapon

• History
• Available easy to produce
• Spores infective
• Aerosolization
• Low lethal dose
• High mortality
• Person-to-person transmission rare

33
Anthrax The Response

• Vaccine
• Humans
• Animals
• Antibiotics
• Treatment
• Prophylaxis
• Disinfection
• Sporicidal agents, sterilization

34
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

35
Botulism The Bioweapon

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

36
Botulism The Response

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

37
Plague The Agent

• Yersinia pestis
• Gram neg, transmitted by fleabites, aerosol,
  direct contact
• Symptoms humans
• Bubonic, septicemia, pneumonic
• Symptoms animals
• Cat similar to human
• Dogs, livestock somewhat resistant

38
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

39
Plague The Response

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

40
Smallpox The Agent

• Variola virus, Orthopoxvirus
• Eradicated from the world in 1977
• Narrow host range humans only
• Transmission person-to-person, fomites
• Clinical signs
• Flu-like, progressive skin eruptions

41
Smallpox The Bioweapon

• Disease signals a bioterrorism event
• Large scale production
• Aerosolization, susceptible population
• Person to person and fomite transmission
• Fatality approximately 35

42
Smallpox The Response

• No specific treatment
• Vaccinia virus vaccination
• Vaccinia Immune Globulin
• Isolation of infected individuals
• Disinfection of environment, clothing etc. with
  various chemicals, boiling or autoclaving.

43
Tularemia The Agent

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

44
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

45
Tularemia The Bioweapon

• WHO estimation 1970
• 50 kg agent city population 5 million
• 250,000 ill
• 19,000 deaths
• Stable
• Aerosolized
• Low infective dose via inhalation
• Mortality 21-49 if untreated

46
Tularemia The Response

• Person to person transmission not documented
• Antibiotics effective if early or prophylactic
• Vaccine
• For high risk individuals
• Unknown efficacy
• against inhalation
• tularemia

47
Viral Hemorrhagic FeversThe Agents

• Ebola, Marburg, Lassa, and 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
48
VHF The Bioweapons

• Aerosolized
• Not readily available, require specialized
  production
• Person-to-person and nosocomial transmission
  occur
• Untreated fatality rate estimated to be 50-90

49
VHF The Response

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

50
Category B Agents/Diseases

• Brucellosis
• Glanders
• Melioidosis
• Psittacosis
• Q Fever

• Typhus fever
• Viral encephalitis
• Toxins
• Food Safety Threats
• Water Safety Threats

51
Brucellosis The Agent

• Gram negative bacteria
• Ingestion, inhalation, or direct contact
• Clinical signs
• Humans cyclic fever and flu-like symptoms
• Animals reproductive signs

52
Brucellosis The Agent
53
Brucellosis The Bioweapon

• History
• Aerosolization, highly infectious
• Stable when lyophilized
• Case fatality rate 0.5
• Person to person unlikely
• Incubation is variable making diagnosis difficult

54
Brucellosis The Response

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

55
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 pulmonary lesions,
  rapidly fatal illness

56
Glanders The Bioweapon

• History
• WWI Russian horses
• WWII Chinese civilians, horses, POWs
• Easy to reproduce, lyophilized
• Aerosolized, highly infectious
• Mortality high in chronic form
• 50-70
• Person to person transmission - rare

57
Glanders The Response

• No vaccine
• Antibiotic therapy likely effective
• Destroyed by various chemicals

58
Melioidosis The Agent

• Burkholderia pseudomallei Gram negative
• Transmission contact, ingestion, inhalation
• Clinical signs humans, sheep, goats, and pigs
• Asymptomatic to pneumonia, lung wound
  abscesses

59
Melioidosis The Bioweapon

• Easy to produce
• Available
• Aerosolization
• Mortality high 90
• Person-to-person transmission unlikely

60
Melioidosis The Response

• Long term, multiple antibiotics effective
• Vaccines available not in U.S.
• Easily destroyed by disinfectants

61
Psittacosis The Agent

• Chlamydophila psittaci
• Occurs worldwide
• Reportable in U.S.
• Clinical disease
• Humans and birds ranges from asymptomatic to
  systemic illness with severe pneumonia

62
Psittacosis The Bioweapon

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

63
Psittacosis The Response

• Antibiotics generally effective
• Decontamination with most disinfectants

64
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

65
Q Fever The Bioweapon

• History
• Easily accessible, resistant
• Highly infectious
• Aerosolization
• Low mortality

66
Q Fever The Response

• Antibiotic therapy may limit complications
• Vaccine developed, not available in U.S.
• Variable susceptibility to disinfectants

67
Typhus Fever The Agent

• Rickettsia prowazekii a rickettsial organism
• Endemic in Eastern Europe, Middle East, and parts
  of Africa

• Transmitted by excreta of human body louse
• Clinical signs humans
• Fever, headache, macular eruptions, and petechial
  rash
• Not seen in domestic animals

J. Kalisch
68
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
69
Typhus Fever The Response

• Antibiotics are generally effective
• Vaccine, not commercially available

70
Viral Encephalitis The Agent

• The alphaviruses EEE, WEE, and VEE
• Transmitted via mosquito
• Clinical signs
• Birds are asymptomatic carriers, act as sentinels

• Humans, horses, donkeys, mules often
  asymptomatic to flu-like
• Encephalitis in small proportions

71
Viral EncephalitisThe Bioweapon

• Easy to produce
• Aerosolization
• High rate of infection
• Person-to-person transmission possible

72
Viral EncephalitisThe Response

• Supportive care
• Vaccine
• Equine
• Human high risk

• Virus unstable in environment

73
Toxins The Agents

• Staphylococcal enterotoxin B (SEB)
• Ricin toxin from castor plant
• Clostridium perfringens epsilon toxin

74
SEB The Agent

• Staphylococcal enterotoxin B (SEB)
• A common cause of food poisoning
• Clinical signs humans
• Fever, chills, headache, myalgia
• Non-productive cough if inhaled
• GI signs if swallowed
• Animals likely similar to human

75
Ricin The Agent

• Ricin toxin from bean of castor plant
• Available worldwide
• Clinical signs
• Acute onset of fever,
• chest tightness, cough,
• dyspnea, nausea

76
Epsilon Toxin The Agent

• Clostridium perfringens type B and D
• Increases intestinal and vascular permeability,
  and liver damage
• Clinical signs
• Calves diarrhea, abdominal pain, listlessness,
  neurologic
• Sheep, goats watery to bloody diarrhea,
  neurologic
• Humans little information

77
Toxins The Bioweapon

• History
• Aerosolized SEB, Ricin
• Available worldwide
• Easy to produce, stable
• Many species affected
• No person-to-person transmission

78
Toxins The Response

• Supportive
• No vaccines currently available for SEB or Ricin
• Vaccines for animals for clostridial disease
• Toxins are inactivated with common disinfectants

79
Food Safety Threats

• Campylobacter species
• Salmonella species
• E. coli 0157H7
• Viruses, parasites, chemicals, toxins
• Ingestion of contaminated food
• Gastrointestinal upset

80
Food Safety Threats The Bioweapon

• 1984, The Dalles, Oregon
• Bagwan Shree Rajneesh cult
• Contaminated salad bars
• Salmonella typhimurium
• Goal incapacitate voters
• 751 people ill

81
Food Safety Threats The Response

• Constant vigilance to improve food safety
• Food irradiation at processing plants
• Wash hands and utensils frequently
• Proper cooking temperature and storage

82
Water Safety Threats

• 53 of US drinking water is from ground water
• Cryptosporidium parvum- protozoa
• Vibrio cholerae- bacteria

83
Cryptosporidium The Agent

• Cryptosporidium parvum- protozoa
• Transmission inhalation, ingestion
• Clinical signs humans, calves, others
• Acute gastroenteritis
• Dogs, cats, horses, pigs resistant

84
Vibrio cholerae The Agent

• Vibrio cholerae- Gram negative bacteria
• Transmission fecal-oral, contaminated shellfish
• Clinical signs, humans
• Acute, mild diarrhea
• 5 severe disease
• Animals are resistant to disease

85
Water Safety Public Health Significance

• 1993 Municipal water supply contaminated in
  Milwaukee
• Cryptosporidum parvum
• 40,000 ill
• 1997 Decorative water fountain at the Minnesota
  Zoo
• 369 cases
• Mostly young children

86
Water Safety Threats The Response

• Government has laws to protect our water supply
• Treatment facilities are equipped and will likely
  inactivate most organisms

• Chlorination, filtration, ozone
• Dilution factor

87
Category C

• Nipah virus
• Hantavirus

88
Nipah Virus The Agent

• Paramyxovirus
• Fruit bats
• Clinical signs
• Humans encephalitis
• Pigs respiratory neurological
• Dogs and cats distemper

89
Nipah Virus The Bioweapon

• Aerosolization potential
• Wide host range
• No person to person transmission expected
• High morbidity and mortality

90
Nipah Virus The Response

• Avoid contact with all infected animals and
  fluids
• Vaccine undergoing research
• Call authorities immediately

91
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

92
Hantavirus The Bioweapon

• Aerosolized
• Hospitalization
• Hemorrhagic Fever with Renal Syndrome not the
  clinical form expected in U.S.

93
Hantavirus The Response

• Supportive care
• Limit exposure to rodent excrement
• Virus is deactivated with bleach

94
Other Important Diseases

• Transmissible Spongiform Encephalopathy
• Rift Valley Fever
• Hendra Virus
• West Nile Virus
• Foot and Mouth Disease

95
Transmissible Spongiform Encephalopathy The Agent

• Prions
• Proteinaceous infectious particles
• Mutated proteins
• Very long incubation period
• Neurological signs in all species
• No treatment available

96
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
• No reported cases

97
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

98
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

99
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

100
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

101
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

102
Hendra Virus The Response

• Little is known about disease
• Biolevel-4
• Potentially serious consequences
• High mortality rate
• Lack of treatment

103
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

104
West Nile Virus Public Health Significance

• Human illness in US in 2002
• 4156 cases, 284 deaths
• Horses illness in US in 2002
• 14,717 cases
• 40 of ill result in death
• Method of introduction to U.S. unknown
• data current as of 5/28/03

105
Map courtesy of CDC
106
West Nile Virus The Response

• Treatment supportive care
• Vaccine available for horses, not humans
• Source elimination
• Eliminate larval habitats
• Personal protection
• Reduce time outdoors
• Wear long pants and sleeves
• Use mosquito repellent

107
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

108
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

109
FMD The Response

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

110
The Veterinarians Responsibility
111
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

112
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

113
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

114
Contacts

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

115
Summary

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

116
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

117
Conclusion

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

118
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.

Authors Danelle Bickett-Weddle, DVM Jamie
Snow, DVM Reviewers Radford G. Davis, DVM, MPH
Gayle B. Brown, DVM, PhD