Preparing%20for%20and%20Responding%20to%20Bioterrorism:%20Information%20for%20the%20Public%20Health%20Workforce

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Preparing for and Responding to Bioterrorism
Information for the Public Health Workforce
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Acknowledgements
This presentation, and the accompanying
instructors manual, were prepared by Jennifer
Brennan Braden, MD, MPH, at the Northwest Center
for Public Health Practice in Seattle, WA, for
the purpose of educating public health employees
in the general aspects of bioterrorism
preparedness and response. Instructors are
encouraged to freely use all or portions of the
material for its intended purpose. The
following people and organizations provided
information and/or support in the development of
this curriculum. A complete list of resources
can be found in the accompanying instructors
guide.
Patrick OCarroll, MD, MPH Project Coordinator
Centers for Disease Control and Prevention
Judith Yarrow Design and Editing Health Policy
and Analysis University of WA Washington State
Department of Health
Jeff Duchin, MD Jane Koehler, DVM,
MPH Communicable Disease Control, Epidemiology
and Immunization Section Public Health - Seattle
and King County Ed Walker, MD University of
WA Department of Psychiatry
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Diseases of Bioterrorist Potential Overview
CDC, AFIP
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Diseases of Bioterrorist Potential Learning
Objectives

• Develop an awareness of the potential agents that
  might be used in a bioterrorism event
• Identify contagious agents
• Describe the types of illness caused by the
  agents
• Identify agents that might require public health
  to provide immunizations or antibiotics to
  exposed persons
• Describe how to respond if a suspicious package
  or substance is received

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Biological Agents of Highest Concern Category A
Agents

• Smallpox (Variola major)
• Anthrax (Bacillus anthracis)
• Plague (Yersinia pestis)
• Tularemia (Francisella tularensis)
• Botulism (Botulinum toxin)
• Viral hemorrhagic fevers (Filoviruses
  Arenaviruses)

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Biological Agents of 2nd Highest ConcernCategory
B Agents

• Q-fever (Coxiella burnetti)
• Brucellosis (Brucella species)
• Glanders (Burkholderia mallei)
• Venezuelan, Western and Eastern encephalomyelitis
  (Alphaviruses)
• Ricin toxin from Ricinus communis (castor bean)
• Epsilon toxin from Clostridium perfringens
• Staphlococcus enterotoxin B

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Biological Agents of 2nd Highest ConcernFood- or
Waterborne Category B Agents

• Salmonella species
• Shigella dysenteriae
• Escherichia coli 0157H7
• Vibrio cholera
• Cryptosporidium parvum

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Types of Illnesses These Agents Can Cause

• Flu-like illness (fever, sweats, nausea)
• Cough and/or pneumonia
• Skin ulcers (anthrax, tularemia, plague)
• Rashes (smallpox, ebola)
• Paralysis (botulism)
• Diarrhea vomiting (food- and water-borne
  agents)
• Headache, confusion

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Contagious Agents(Person-to-Person Transmission)

• Smallpox
• Plague pneumonia
• Some viral hemorrhagic fevers (e.g., ebola)
• Food- and water-borne agents (e.g., salmonella
  shigella)

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Agents That May Require Antibiotics or
Immunization to Prevent Disease

• Antibiotics
• Anthrax
• Plague
• Tularemia
• Q Fever
• Brucellosis

• Immunization
• Smallpox
• Anthrax

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DecontaminationCategory A Critical Agents

• Decontamination of exposed persons
• Showering or washing thoroughly with soap and
  water adequate for most bleach not necessary
• Decontamination of facilities and equipment
• May not be necessary for surfaces contaminated by
  agents with short survival time (i.e., plague,
  botulism)
• Other agents may require bleach solution,
  sporicidal chemicals, incineration, and/or
  autoclaving

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Infection Control Category A Critical Agents

• Infection control
• Standard precautions all cases
• Airborne contact precautions smallpox and
  viral hemorrhagic fevers
• Droplet precautions pneumonic plague

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Infection ControlStandard Precautions

• Standard Precautions all cases
• Disposable, non-sterile gloves
• Hand washing after glove removal
• Disposable gown or apron, faceshield if splashing
  anticipated
• Change protective gear between cases

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Infection Control Contact Precautions

• Standard precautions plus
• Wear gloves and gown, change after contact with
  infectious material
• Dedicate non-critical patient care items (e.g.,
  stethoscope) to a single patient or disinfect
  between patients

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Infection Control Droplet and Airborne
Precautions

• Droplet Precautions
• Standard Precautions plus
• Wear mask when w/in 6 ft of patient

• Airborne Precautions
• Standard Precautions plus
• Patient in negative air pressure room
• Wear respiratory protection (such as a HEPA
  filter mask)

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Mail SafetyRecognizing Suspicious Packages

• Protruding wires or aluminum foil
• Excessive security material such as masking tape,
  string, etc.
• Visual distractions
• Ticking sound
• Marked with restrictive endorsements
  ("Personal,"Confidential)
• City or state in the postmark does not match the
  return address

• Excessive postage
• Handwritten or poorly typed addresses
• Incorrect titles
• Title, but no name
• Misspellings of common words
• Oily stains, discolorations, or odor
• No return address
• Excessive weight
• Lopsided or uneven envelope

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Mail Safety Handling Suspicious Packages or
Letters with a Threatening Message

• Do not shake or empty contents
• PLACE the envelope or package in a plastic bag or
  other type of container to prevent leakage of
  contents
• LEAVE the room and CLOSE the door or section off
  the area to prevent others from entering
• WASH your hands with soap and water
• Contact local law enforcement

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Hoaxes and Evaluation of Suspicious Powders

• If a suspicious substance is received
• Cover substance (do not try to clean up any
  spilled contents)
• Leave the room and close the door
• Turn off air conditioning system
• Wash hands with soap water
• Report to local law enforcement (call 911)
• Notify building security

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Hoaxes and Evaluation of Suspicious Powders,
cont.

• Additional steps to take if exposed to a
  suspicious powder or substance
• Remove contaminated clothing place in plastic
  bag or other sealed container
• Shower with soap water (bleach is not
  necessary)
• Make a list of all people exposed or in the same
  room/area as the substance

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Summary of Key Points

• Most of the biological agents of concern produce
  an initial non-specific or flu-like illness.
• Standard precautions should be used with all
  patients following a bioterrorism incident.
• Additional precautions are required with a few
  biological agents, where person-to-person
  transmission is possible.

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Summary of Key Points

• Notify building security and local law
  enforcement if a suspicious package or substance
  is received.
• If exposed to a suspicious substance, remove
  contaminated clothing, and wash with soap and
  water.

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Resources

• Centers for Disease Control Prevention
• Bioterrorism Web page
• CDC Office of Health and Safety Information
  System (personal protective equipment)
• USAMRIID -- includes link to on-line version of
  Medical Management of Biological Casualties
  Handbook
• Johns Hopkins Center for Civilian Biodefense
  Studies

http//www.bt.cdc.gov/
http//www.cdc.gov/od/ohs/
http//www.usamriid.army.mil/
http//www.hopkins-biodefense.org
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Resources

• Office of the Surgeon General Medical Nuclear,
  Biological and Chemical Information
• St. Louis University Center for the Study of
  Bioterrorism and Emerging Infections
• Public Health - Seattle King County

http//www.nbc-med.org
http//bioterrorism.slu.edu
http//www.metrokc.gov/health
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Resources

• Washington State Department of Health
• Communicable Disease Epidemiology
• [phone] OR
• [phone] (24 hour emergency)
• Association for Professionals in Infection
  Control
• MMWR Rec Rep. Case definitions under public
  health surveillance.

http//www.doh.wa.gov
http//www.apic.org/bioterror
199746(RR-10)1-55
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Quick References for Health Care Providers

• Johns Hopkins Center for Civilian Biodefense
• Saint Louis Center for the Study of Bioterrorism
  and Emerging Infections
• Santa Clara County Health Department
• Washington State Department of Health

http//www.hopkins-biodefense.org
http//bioterrorism.slu.edu
http//www.sccphd.org/diseasecontrol/bioterrorism.
asp
http//www.doh.wa.gov/BioTerr/BioTerLHO.htmBackgr
ound