Bioterrorism Awareness: Protection of Human and Animal Health

1. Bioterrorism Awareness:Protection of Human and Animal Health Human Health Professionals

2. Why Are We Here? • September 11, 2001 changed many things • Worst terrorist act in U.S. history • Approximately 3000 dead or missing • Occurred on American soil • Increased sense of vulnerability Center for Food Security and Public Health Iowa State University 2005

3. Biological Attack • Bioterrorism attacks of 2001 • Anthrax in postal system • 22 cases • 5 deaths • U.S. public health realm changed forever Center for Food Security and Public Health Iowa State University 2005

4. Goals of This Presentation • Animals and public health • Bioterrorism • Government agency preparation • Bioterrorism agents and zoonotic potential • Your role and responsibility Center for Food Security and Public Health Iowa State University 2005

5. Animals and Public Health

6. Number of Animals in U.S. Center for Food Security and Public Health Iowa State University 2005

7. Animals and Public Health • Human-animal bond • Sport • Livelihood Center for Food Security and Public Health Iowa State University 2005

8. Animals and Public Health • Zoonotic disease • Direct transmission • Indirect transmission • Foodborne illnesses • Vectors • Fomite Center for Food Security and Public Health Iowa State University 2005

9. Animals and Public Health • Reservoirs, shedders, spreaders of disease • Transmission (spillover) from domestic animals to wildlife • Establishment of enzootic cycle • Recurring human infections • Greater costs to control or eradicate • Spread to neighboring states, countries Center for Food Security and Public Health Iowa State University 2005

10. Animals and Public Health • Sentinels • Emergence of new diseases Center for Food Security and Public Health Iowa State University 2005

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12. Animals and Public Health Center for Food Security and Public Health Iowa State University 2005

13. Risk Factors for Transmission of Zoonoses • Frequent contact with wild or domestic animals • Living on the fringe of wilderness • Keeping exotic animals as pets • Frequenting live animal markets • Working with livestock • Exposure to animal waste • Immunocompromised people Center for Food Security and Public Health Iowa State University 2005

14. Disease Control • Basic hygiene • Wash hands • Child supervision • Disinfect/clean up areas contaminated with animal waste • Livestock, pets, wildlife, rodents Center for Food Security and Public Health Iowa State University 2005

15. Zoonoses Control • Limit exposure to strays and wildlife • Cook food properly • Proper pet selection • Use caution at petting zoos • Guidelines for immunocompromised Center for Food Security and Public Health Iowa State University 2005

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18. Animals and Public Health • Interaction with animals • Positive attributes • Communication between veterinary and human health communities and the public is important Center for Food Security and Public Health Iowa State University 2005

19. Bioterrorism Prevention through Preparedness

20. Preparedness Responsibilities: Human Health Professionals • Anticipate outbreaks locally • Collect, process, and store samples • Know the agents • Typical signs of diseases • Ask questions about exposure to animals • How to report suspected cases • Provide leadership and disseminate information Center for Food Security and Public Health Iowa State University 2005

21. Agroterrorism Bioterrorism Other 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 Center for Food Security and Public Health Iowa State University 2005

22. Many Agents are Zoonotic • Category ABC disease/agent list Center for Food Security and Public Health Iowa State University 2005

23. 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 Center for Food Security and Public Health Iowa State University 2005

24. Exposure Symptoms Seek Care No. Affected Infectious Disease Outbreak Time (Days) Center for Food Security and Public Health Iowa State University 2005

25. Clues to Intentional Zoonotic Agent Release • Clustering of morbidity or mortality • Temporally or geographically • Animals or people • Generally healthy animals or people affected • Unusual symptoms for area • Unusual age distribution • Disease occurring outside typical season Center for Food Security and Public Health Iowa State University 2005

26. U.S. Agencies Dealing with terrorism

27. Public Health Security and Bioterrorism • Preparedness Response Act • 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 Center for Food Security and Public Health Iowa State University 2005

28. 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 Center for Food Security and Public Health Iowa State University 2005

29. 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 Center for Food Security and Public Health Iowa State University 2005

30. Strategic National Stockpile (SNS) • 12-hour Push Package • Complete package of medical materials • Vendor Managed Inventory • Tailored to suspected agents • Technical Advisory Response Unit • Advise on receiving, distribution, etc. of SNS material Center for Food Security and Public Health Iowa State University 2005

31. Insert Your State’s Info Here • The Iowa slides have been included as an example. Delete them and put in the information appropriate for your state. Center for Food Security and Public Health Iowa State University 2005

32. Preparing Iowa • Iowa’s Homeland Security • Administered by Iowa Emergency Management Division • Works with public and private partners www.iowahomelandsecurity.org Center for Food Security and Public Health Iowa State University 2005

33. 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 Center for Food Security and Public Health Iowa State University 2005

34. Category ABC Agent Overview

35. Classification • Prepared by the CDC’s Bioterrorism Preparedness and Response Office • Category A: Highest priority • Category B: Second highest priority • Category C: Third highest priority Center for Food Security and Public Health Iowa State University 2005

36. “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 Center for Food Security and Public Health Iowa State University 2005

37. Category ABCDiseases/Agents

38. 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. • Disease coverage is brief. If you need more information on a disease, please refer to the disease fact sheet or the disease specific PowerPoint presentation. Center for Food Security and Public Health Iowa State University 2005

39. Category A : Agents/Diseases • Anthrax • Botulism • Plague • Smallpox • Tularemia • Viral hemorrhagic fevers Center for Food Security and Public Health Iowa State University 2005

40. Anthrax: The Agent • Bacillus anthracis • Spores in soil worldwide • Transmission Zoonotic Potential • Direct contact (wound) • Inhalation • Contaminated dust • Ingestion • Contaminated meat • Person-to-person transmission rare Center for Food Security and Public Health Iowa State University 2005

41. Anthrax: The Disease • Humans • Cutaneous • 95% of natural cases • Mortality 5-20% • Pulmonary • Mortality 75-95% • Gastrointestinal • Mortality >50% mortality • Animals • Ruminants at greatest risk • Sudden death, hemorrhage • No cutaneous lesions Center for Food Security and Public Health Iowa State University 2005

42. Anthrax: Zoonotic Importance • Zoonotic potential • Direct contact • Inhalation • Ingestion • High risk groups: Occupational • Livestock, slaughterhouse workers • Tannery or wool industry workers • Veterinarians, lab workers Center for Food Security and Public Health Iowa State University 2005

43. Anthrax: The Bioweapon • Bioweapon • History • Available • Easy to produce • Spores infective and highly resistant • Aerosolization • Low lethal dose • High mortality Center for Food Security and Public Health Iowa State University 2005

44. Botulism: The Agent • Clostridium botulinum • 7 different neurotoxins (A-G) • Transmission • Ingestion (food-borne) • Wound infection • Aerosol • Zoonotic potential • Improperly fermented fish, undercooked meat products, honey in infants Center for Food Security and Public Health Iowa State University 2005

45. Botulism: The Disease • All species, including humans • Clinical signs • Progressive flaccid paralysis • Difficulty swallowing • Drooping eyelids • Paralysis of respiratory muscles • Death in 24 hours • Medical emergency Center for Food Security and Public Health Iowa State University 2005

46. Botulism: The Bioweapon • History • U.S. bioweapons program • Used by Aum Shinrikyo cult in Japan • Produced by Iraq • Aerosolized • Easy to produce and transport • Potent and lethal • Most poisonous substance known Center for Food Security and Public Health Iowa State University 2005

47. Plague: The Agent • Yersinia pestis • Transmission • Flea bite • Direct contact • Infected animal tissue or fluids • Aerosol • Person-to-person • Zoonotic potential • Rodents, cats Center for Food Security and Public Health Iowa State University 2005

48. Plague: The Disease • Humans • Bubonic (50-60% fatality) • Septicemic (~100% fatality) • Pneumonic (~100% fatality) • Primary or secondary • Animals • Rodents: reservoir • Ground squirrels, prairie dogs, rats • Cat: similar to human forms Center for Food Security and Public Health Iowa State University 2005

49. Plague: Zoonotic Importance • Transfer of infected fleas • Contact with infected rodents • Contact with infected cat • Sneezing droplets • Flea transfer • Scratch or bite Center for Food Security and Public Health Iowa State University 2005

50. Plague: The Bioweapon • History • Available • Pneumonic form highly contagious • WHO estimate • 50 kg agent: City population 5 million • 150,000 cases pneumonic plague • Potential mortality: 100,000 Center for Food Security and Public Health Iowa State University 2005