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3 The first well-documented use of smallpox as a biological weapon was by British troops in the French and Indian Wars. In 1763 two blankets and a handkerchief laced with smallpox were given to the Native Americans as gifts killing as many as half of the population of the infected tribes.

Bioterroism4 Bioterroism: violent acts, dangerous to human life that appear to be intended: To intimidate or coerce a civilian population To influence the policy of a government by intimidation or coercion To affect the conduct of a government by assassination or kidnapping

Bioterroism5 Biological weapons are: Living microorganisms such as bacteria, viruses, fungi, that can kill or incapacitate

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7 Classification The Centers for Disease Control and Prevention (CDC) categorize biological agents according to the risk they pose to the public.

Bioterroism8 Category A : Those that pose the highest risk (can be easily disseminated and result in high mortality). Include bacteria and viruses that cause diseases such as: anthrax,anthrax botulism, plague, tularemia, smallpox, and viral hemorrhagic fever (such as hantavirus and ebola).

Bioterroism9 Category B: – pose a moderate risk to the public –can be spread with some ease –can cause a moderate degree of illness –death rates due to these diseases are usually low

Bioterroism10 Other Types of Agents In addition to biological agents, chemical or radioactive agents may also be used as weapons of bioterrorism.

Bioterroism11 Chemical Agents The CDC classifies chemical agents according to their target activity on the skin, in the lungs, in the gastrointestinal tract, and in the nervous system

Bioterroism12 Radioactive agents Colorless, odorless, and invisible to the eye.

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Bioterroism14 Contamination of food, water, or objects may disable or kill humans and animals and be difficult to trace.

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Bioterroism16 Symptoms of Radiation Exposure Symptoms of radiation exposure may include: nausea, vomiting, diarrhea and, depending on the extent of the exposure, bleeding gums, nosebleeds, bruising, and hair loss.

Bioterroism17 The Pain of Exposure Exposure can be through ingestion, inhalation, or contamination of an open wound.

Bioterroism18 Response to bioterroism agents: New Report: North Carolina Earns Grade of 10 out of 10 on Disaster Preparedness

Bioterroism19 Internal reporting requirements (within a facility) Infectious control personnel Epidemiologist (local and state) Administration (health care facility and health department) Office of public affairs in the health facility

Bioterroism20 External contacts (outside of facility) Local health department State health department FBI CDC Local police EMS

Bioterroism21 Examine the containment of bioterroism agents Agents Containment of agents

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Bioterroism24 BACTERIAL ANATHRAXPLAGUE

Bioterroism25 Anthrax Acute infectious disease caused by bacillus anthracis.

Bioterroism26 ANTHRAX Modes of transmission: Inhalation of spores Skin contact Ingestion of contaminated food Incubation period: Pulmonary: 2-60 days Cutaneous: 1-7 days Gastrointestinal: 1-7 days Transmission: Anthrax is not airborne person to person. Direct contact with infectious skin lesions can transmit infection. Prevention: Vaccine available-limited quantities.

Bioterroism27 Infections in humans: Skin contact – cutaneous, ingestion- gastrointestinal, inhalation-pumonary Person-to-person transmission of inhalation disease does not occur. * *direct exposure to vesicle secretions of cutaneous anthrax can result in a secondary infection.

Bioterroism28 Gastrointestinal signs and symptoms: Abdominal pain, nausea, vomiting, fever Bloody diarrhea, hematemesis Positive culture after 2-3 days Prognosis: If progression to toxemia and sepsis, prognosis is poor.

Bioterroism29 Cutaneous signs and symptoms: Local skin involvement with direct contact Commonly seen on head, forearms, or hands Localized itching followed by popular lesion that turns vescular within 2-6 days – develops into depressed black eschar Prognosis: Good if treated with antibiotics.

Bioterroism30 Pulmonary signs and symptoms: S/S –Flu-like symptoms that may briefly improve two to four days after initial symptoms –Abrupt onset of respiratory failure –Hemodynamic collapse –Thoracic edema Widened mediastinum on xray Positive blood culture in 2-3 days of illness Prognosis: Good if treated early. Increased mortality rate if treated after respiratory onset.

Bioterroism31 Anthrax

Bioterroism32 What bioterrorism agent was sent through the mail to federal agencies in Washington D.C. in October, 2001? a] Cholera b] Anthrax c] Malaria

Bioterroism33 Plague Plague is an acute bacterial disease caused by yersinia pestis. Signs and Symptoms: Fever Cough Chest pain Hemoptysis Watery sputum Bronchopneumonia on x-ray

Bioterroism34 Plague Bubonic plague : enlarged, tender lymph nodes, fever, chills and prostration Septicemic plague: fever, chills, prostration, abdominal pain, shock and bleeding into skin and other organs Pneumonic plague: fever, chills, cough and difficulty breathing; rapid shock and death if not treated early

Bioterroism35 TRANSMISSION Flea-borne, from infected rodents to humans Direct contact with infected tissues or fluids from handling sick or dead animals Respiratory droplets from cats and humans with pneumonic plague

Bioterroism36 Mode of Transmission: Plague normally transmitted from an infected flea Can be aerosol-probable use in bio terrorism Can be transmitted person to person Incubation period: Flea bite – 2-8 days Aerosol – 1-3 days Prognosis: Good if treated with antibiotics early.

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Bioterroism38 All of the following are ways that the plague can be transmitted except: A) an infected flea B) aerosol C) food and or water

Bioterroism39 The Hot Seat Dr. Thomas Butler Had Very Good Reasons for Carrying Bubonic Plague Aboard Passenger Flights--But That Didn't Stop The U.S. Government From Ruining his Life Plague satisfies all three requirements. A historic terror, the disease decimated one- third of Europe's population in the 14th century. Although initial symptoms of plague are similar to a cold (swollen glands, fever, chills, headache), if the disease progresses, the bacteria can cause internal hemorrhaging and tissue necrosis. The dead tissues eventually become gangrenous, causing the victim to turn black--hence the disease's macabre nickname, "Black Death."

Bioterroism40 Which type of plague is characterized by enlarge, tender lymph nodes A) Pneumonic B) Bubonic C) Septicemic The Wyoming Department of Health is investigating how a Boy Scout who visited northwest Wyoming became infected with bubonic plague.

Bioterroism41 VIRAL SMALLPOX

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Bioterroism43 Smallpox Smallpox is an acute viral illness caused by the variola virus. Mode of transmission: – Airborne: droplets –direct contact with infected bodily fluids or contaminated objects such as bedding or clothing. Signs and symptoms: Flu like symptoms-fever, myalgia Skin lesions appear quickly progressing from macules to papules to vesicles Rash scabs over in 1-2 weeks Rash occurs in all areas at once, not in crops

Bioterroism44 Incubation period: From 7 to17 days, average is 12 days Contagious when the rash is apparent and remains infectious until scabs separate (approx. 3 weeks) Prognosis: Vaccine available and effective post-exposure Passive immunization is also available in the form of vaccina- immune-globulin (VZIG)

Bioterroism45 Smallpox has a high mortality rate. Smallpox (also called variola) is the only disease that has been completely wiped out throughout the world. Smallpox is also potentially one of the most devastating biological weapons ever conceived. The (WHO) officially declared smallpox eradicated in 1980.

Bioterroism46 Current locations of smallpox virus: Only two laboratories in the world are known to house smallpox virus: the (CDC) in Atlanta, Georgia, and the State Research Center of Virology and Biotechnology in Koltsovo, Russia.

Bioterroism47 Why were the British able to infect the American Indians with smallpox

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49 TOXINS BOTULISM RICIN Bioterrorism

Bioterroism50 Botulism Potent neurotoxin caused by an anaerobic bacillus- colstridium botulinum. Transmission: Contaminated food Inhalation

Bioterroism51 Signs and symptoms: Gastrointestinal symptoms Drooping eyelids Weakened jaw clench Difficulty swallowing or speaking Blurred vision Respiratory distress

Bioterroism52 Incubation period: Neurological S/S for food borne botulism – hours after ingestion Neurological S/S for inhalation botulism – hours after exposure Prevention: Vaccine available Botulism cannot be transmitted person to person.

Bioterroism53 Ricin

Bioterroism54 Ricin is a potent protein toxin derived from Castor beans. Castor beans are found easily all over the world and the toxin is fairly easily produced. For this reason ricin could be used as a biological weapon with relative ease.

Bioterroism55 Infections in Humans Aerosol Ingestion Signs and Symptoms: hours Weakness Fever Cough Pulmonary edema

Bioterroism hours Severe respiratory distress Death from hypoxemia Incubation period: 8-18 hours Prognosis: Poor-no vaccine available Ricin does not spread easily person to person.

Bioterroism57 All of the following are considered reason for Ricin being so dangerous except A) plant grows everywhere, and is poisonous B) there is no vaccine available, and can be spread by inhalation or ingestion C) It causes paralysis of the muscles causing the person to go into a coma

Bioterrorism 58 Sarin Sarin and other nerve agents may have been used in chemical warfare during the Iran-Iraq War in the 1980s. Sarin was used in two terrorist attacks in Japan in 1994 and 1995.

Bioterroism59 Following release of sarin into the air, people can be exposed through skin contact or eye contact. They can also be exposed by breathing air that contains sarin. Sarin mixes easily with water, so it could be used to poison water. Following release of sarin into water, people can be exposed by touching or drinking water that contains sarin. Following contamination of food with sarin, people can be exposed by eating the contaminated food.

Bioterroism60 How would the bioterrorism agent, Ricin, be classified? a] Fungus b] Virus c] Toxin

Bioterroism61 Containment of bioterroism agents If patients have been exposed and are already ill, the emphasis is not decontamination but rather respiratory isolation of the patient with employment of standard precautions until the agent is known

Bioterroism62 Isolation practices Standard precautions Additional precautions for smallpox and plague

Bioterroism63 How can the general public protect themselves from bioterrorism agents? a] Follow standard precautions b] Avoid travel to Washington D.C. and New York City c] Sterilize household items

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Bioterroism65 ER staff play an important role in:

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Bioterroism67 Patient Placement Routine if small scale Grouping affected patients if large scale

Bioterroism68 How would a health care system manage victims in a large scale bioterrorism attack? a Transport victims to various hospitals to share the responsibility of giving care. b Group affected victims together in the same facility c Open up a special isolation hospital for long term care of victims d Provide routine patient care

Bioterroism69 Patient transport Limited to movement that is essential

Bioterroism70 An American man is in Spain on vacation and is the victim of a bioterrorism attack. How should he be treated? a He should be immediately transported back to the USA for medical care. b He should be transported back to the USA only if he is in critical condition. c He should be treated in Spain until he is noninfectious. d He should be transferred to the closest American military hospital.

Bioterroism71 Cleaning, disinfection and sterilization of equipment and environment- follow standard precautions

Bioterroism72 Discharge management Discharge when noninfectious Home care if large numbers of persons exposed with instruction on barrier precautions, hand washing, waste management, cleaning and disinfection of environment and patient care items.

Bioterroism73 A large scale bioterrorism attack has occurred and the director of the health department has determined that those victims who are least symptomatic can be cared for at home. What will need to be done to prepare for home care? a Instruction on barrier precautions, handwashing, and cleaning b Isolation signs will need to be posted around the outside of the house c No special actions are needed

Bioterroism74 Post - mortem care Notify pathology Provide instructions to funeral director Plague / Smallpox –cremation

Bioterroism75 A patient has died from a bioterrorist attack. Would a funeral director be told the cause of death? a Yes, because special post-mortem precautions must be taken. b No. Disclosure of cause of death would violate HIPPA rules. c] No, because the director might refuse the patient.

Bioterroism76 Hand washing technique

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Bioterroism78 When washing hands, what is the best water temperature to use? a Cold b Cool c Warm d Hot

Bioterroism79 An early example of a biological agent being used to kill, was when the British used blankets infected with what organism to infect American Indians? A) ebola B) anthrax C) Smallpox

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