bioterrorism
Download
Skip this Video
Download Presentation
BIOTERRORISM

Loading in 2 Seconds...

play fullscreen
1 / 30

BIOTERRORISM - PowerPoint PPT Presentation


  • 105 Views
  • Uploaded on

BIOTERRORISM. Dr. E. McNamara Public Health Lab., SWAHB, St. James’s Hospital. ‘9/11 – Changes’. Move to high risk Biological Threat, specialist public arena Newsworthy Rare/eradicated infections Low clinical experience. ‘Autumn 2001 – USA’. 5 letters, finely milled anthrax spores

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'BIOTERRORISM' - torn


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
bioterrorism

BIOTERRORISM

Dr. E. McNamara

Public Health Lab., SWAHB,

St. James’s Hospital

9 11 changes
‘9/11 – Changes’
  • Move to high risk
  • Biological Threat, specialist public arena
  • Newsworthy
  • Rare/eradicated infections
  • Low clinical experience
autumn 2001 usa
‘Autumn 2001 – USA’
  • 5 letters, finely milled anthrax spores
  • 11 pulmonary anthrax (5 died)
  • 7 cutaneous anthrax
  • All sent from Trenton, New Jersey, 1 person
  • American origin, B. anthracis
  • Criminal Act : Terrorist
lessons learned
‘Lessons Learned’
  • No one prepared
  • Easy to produce contagious material
  • Easy to spread, (except aerosolization)
  • Small numbers affected, major concern
  • Copy cat phenomenon – ‘Hoaxes’
  • Lab. techniques for diagnosis
  • Major disruption
  • Use of prophylactic antibiotics
benefits
Benefits
  • Co-operation internationally
    • WHO
    • CDC
    • EU
  • National preparedness Plans
  • Multidisciplinary
    • Government
    • Admininstrative
    • Emergency services
    • Medical
    • Scientific
history biological warfare
History – Biological Warfare
  • Water wells contaminated with corpses
  • Siege Caffa, Crimea 1346, used plague corpses
  • British, gave Smallpox contaminated blankets as presents to Native Americans
modern history biological warfare
Modern History – Biological Warfare
  • Germany WWI
    • sold anthrax infected horses
  • WWI-II
    • Many countries started biological programme
  • WWII – Not Used
    • UK 5 million anthrax ‘cattle-cakes’
    • USA Botulinum
    • Canada Plague
    • Germany Salmonella
    • Japan POW/Chinese trials
post wwii
Post WWII
  • USA
    • 3400 people 1969, BTWC
    • Allegation
      • Korean War
      • Cuba
    • Misinformation, FBI to Soviets
  • Soviets
    • 1920 – 1969, BTWC signed
    • 1975 Enlarged, Biopreparat

60,000 people

40-50 facilities

50 agents

post wwii contd
Post WWII contd.
  • 1979 Sverdlovks, Anthrax, 69 died
  • 1980 – 1990 Defections
  • 1990 Yelsin – cessation?
  • Iraq 1974?, S. Africa 1980-1993
  • 10 – 12 trying to acquire, evidence?
preparing for biological attacks
Preparing for Biological Attacks
  • Enhance surveillance
  • Resource laboratories
  • Communication systems
  • Bioterrorism education
  • Stockpile vaccines and drugs
  • Molecular surveillance microbial strains
  • Support development diagnostic test
  • Support research Rx. and vaccines

CDC April 2000

biological agents
Biological Agents
  • Category A
    • Easily dessiminated
    • High mortality
    • Public panic
    • Require special preparedness
  • Category B
    • Moderately easy to dessiminate
    • Low mortality
    • Need enhanced Dx./surveillance
  • Category C
    • Emerging pathogens
anthrax b anthracis
Anthrax, B. anthracis
  • Zoonotic, spore forming rod
  • Soil reservoir, years
  • Affects large domestic and wild herbivoires
  • Worldwide
  • Humans
    • Contact with infected animals/products
    • Skin – cutaneous
    • GIT/resp. – inhalation
  • 2000 cases, cutaneous / year
  • 5 cases USA, 1 case UK
  • No cases Ireland for 25 years
anthrax contd
Anthrax contd.
  • Bioterrorist threat – inhalation spores
  • No person – person spread ! (cutaneous?)
  • Cutaneous
    • Skin inoculation
    • Painless swelling
    • Papular – vescle – ulcer
    • Black eschar
    • Toxaemia
    • Mortality with Rx., < 1%.
  • GIT
    • Ingest contaminated meat
    • Pain, diarrhoea, haematemesis, septicaemia
    • Mortality > 50%
anthrax contd1
Anthraxcontd.
  • Dx. (Confirm reference laboratory)
    • Hazard Group 3 – CL3
    • Non motile, GPB, Aerobic
    • Central / Terminal spores
    • Non–haemolytic
    • Sensitivity tests
  • Rx. – Penicillin / Ciprofloxacin
  • Post exposure prophylaxis = Ciprofloxacin
  • Infection Contol – standard precautions
inhalation anthrax
Inhalation Anthrax
  • Bioterrorist agent
  • Mortality 90%
  • Incubation 1 – 60 days
  • Initial Phase (hrs – days)
    • Non-specific symptoms
    • Non-specific clincial signs + Dx. test
    • Recover / Progress to fulminant
  • Fulminant Phase
    • Septicaemia / Toxaemia
    • Dyspnoea with CXR mediastenal widening
    • 50% haemorrhagic menigitis and death
    • Mortality increased with short incubation
small pox
Small Pox
  • Human, DNA variola virus
  • 2 Forms
    • Variola major, mortality 30% (3% vaccinated)
    • Variola minor, mortality 1%
    • Airborne spread, contact
    • Secondary attack rate 50% (unvaccinated)
    • Last death – 1978 UK.
    • WHO 1980, eradicated.
small pox contd
Small Pox contd.
  • Incubation 12-14 days, rash further 2-4 days
  • Fever, headache, myalgia, abdominal pain and vomiting
  • Delirium 15%
  • Rash, centrifugal, face and extremities
  • Copious virus on mucosal lesions
  • Secondary bacterial pneumonia (mortality > 50%)
  • Haemorrhagic Small Pox (95% mortality)
  • Differental = Chicken Pox.
small pox contd1
Small Pox contd.
  • Dx.
    • Hazard Group 4
    • EM (Herpes : Pox) - CL3
    • PCR (differentites Pox viruses) – CL4
    • Culture – CL4
  • Public Health Emergency – International
  • Case: Standard, contact and airborne precautions
    • Isolate: negative pressure, HEPA extract
    • PPE. Decontamination protocol
    • Immune HCW (vaccinated)
    • Rx. = supportive
  • Contact/Exposed
    • Quarantine for 18 days - monitor temperature
  • Infectious form onset of fever
small pox vaccine
Small Pox Vaccine
  • Face – face contacts
  • HCW (core, prepardness)
  • Designated emergency personnel
  • Vaccine
    • Live vaccinia virus (not variola)
    • Vaccine site, infectious until scab heals
    • Newer vaccine development
      • S/E
      • Efficancy
small pox vaccine contd
Small Pox Vaccine contd.
  • CI – atopic dermatitis, pregnant, immunocompromised
  • S/E
    • Fever headache, rigors, vastles
    • Generalised vaccinia (GV)
    • Eczema vaccinatum (EV)
    • Progressive vaccinia (PV)
    • Post vaccinial CNS (PVE)
  • Incident 1968
    • Life threatening = 52 / million
    • Deaths = 1.5 / million
cl botulinum
Cl. Botulinum
  • Botulinum neurotoxin – most potent
  • Contaminated food, canned products
  • Wound botulism, contaminated soil, IVDA
  • Bioterrorism agent
    • Aerosolisation – inhalation
    • Contaminate food – ingestion
    • Large numbers with acute flaccid paralysis
cl botulinum contd
Cl. Botulinum contd.
  • Incubation
    • 2hrs – 8 days, Foodborne
    • 1hr – 5 days, Aerosol
  • Foodborne
    • V+D, diplopia, dysarthria, weakness
    • Ptosis, facial palsy, ↓gag Hypotonic
  • Inhalation
    • Dysplagia, nystagmins, ↓speech, ↓gait
  • Terminal
    • Progressive muscular paralysis
    • Mortality 5% (with Rx.)
cl botulinum contd1
Cl. Botulinum contd.
  • Differential Dx.
    • Guillain-Barré
    • Myastheria gravis
    • Stoke
    • CNS despressants
cl botulinum contd2
Cl. Botulinum contd.
  • Dx.:
    • Detect botulinum toxin
    • Culture
  • Rx.:
    • Antitoxin
    • Supportive
  • Infection Control – standard precautions
plague
Plague
  • Yersinia pestis – HG3
    • GNCB, 02
  • Aerosol, flea vector, person-person
  • 3 Forms
    • Bubonic – 90%
    • Septicaemic – 10%
    • Pneumonic – 1%
  • Bioterrorist agent
    • Aerosol – pneumonic
    • Fleas – bubonic, septicaemic
bubonic plague
Bubonic Plague
  • Incubation 1-8 days
  • Fever, rigors, headache
  • Buboes – painful lymph nodes
  • 15% develop pneumonic plague
  • Mortality = 12%
septicaemic plague
Septicaemic Plague
  • Primary, or secondary to bubonic
  • Rigors, abdominal pain, V+D
  • Purpura, DIC, necrosis
  • Mortality = 30%
pneumonic plague
Pneumonic Plague
  • Highest bioterrorism risk
  • Primary or secondary from haematogenous
  • Incubation 1-3 days
  • Pneumonic symptoms
  • Respiratory failure and shock
  • Mortality - ↓with rx. = 8%
plague1
Plague
  • Dx.:
    • Culture
  • Rx.:
    • Gentamicin, Streptomycin IV
    • Ciprofloxacin, Doxycycline P.O.
  • Infection Control:
    • Standard and droplet, single room, surgical mask
  • Contacts:
    • Prophylaxis – Ciprofloxacin – 72 hrs.
tularaemia
Tularaemia
  • F. tularensis
    • Non-motile, aerobic, GNCB, zoonosis, rabbits, deerfly
    • HG3
    • Worldwide
    • Low inoculum – 10 CFU
  • Ulceroglandular
  • Typhoidal
    • Mortality 35-60% (untreated)
    • Inhalation
  • Infection Control – standard (no person-person)
  • Rx. Gentamicin/Streptomycin – 10 days
  • Contacts : prophylaxis
ad