1. Bioterrorism Awareness: Protection of Human and Animal Health Food animal producers

2. Center for Food Security and Public Health Iowa State University 2005 Why Are We Here? September 11, 2001 changed many things − Worst terrorist act in U.S. history − More than 3,000 presumed dead − Occurred on American soil − Increased sense of vulnerability

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

4. Center for Food Security and Public Health Iowa State University 2005 Overview Bioterrorism Zoonoses and bioterrorism Disease control and biosecurity U.S. Government agencies involved Bioterrorism agents/diseases Your role and responsibility

5. Center for Food Security and Public Health Iowa State University 2005 Biological agents targeting humans, animals, or plants Biological, chemical or radiological agents targeting agriculture or its components Livestock Food supply Crops Industry Workers Terrorism Bioterrorism Agroterrorism Other Conventional, radiological, nuclear, chemical, cyber Typically direct human targeting

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

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

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

9. Center for Food Security and Public Health Iowa State University 2005 Many Agents are Zoonotic Zoonotic means a disease transmitted from animals to humans Disease may be seen in animals before humans Animals are sentinels − Pets, livestock, wildlife

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

11. Center for Food Security and Public Health Iowa State University 2005 Routes of Transmission Direct contact − Gel, liquid, powder − Scratches − Droplet spray onto mucous membranes Indirect: Ingestion, injection − Contaminated food, water − Vector Aerosol

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

13. Center for Food Security and Public Health Iowa State University 2005 Zoonoses Control Proper pet selection Use caution at petting zoos Cook food properly Control strays Visit and communicate with physician and veterinarian Follow guidelines for immunocompromised people

14. Center for Food Security and Public Health Iowa State University 2005 Biosecurity Education for 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. Center for Food Security and Public Health Iowa State University 2005 Biosecurity Education for 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. Center for Food Security and Public Health Iowa State University 2005 Biosecurity Education for the Producer Maintain healthy herd − Vaccinations − Proper hygiene for animals and handlers Purchase from reputable sources Quarantine newly purchased animals Separate sick animals

17. U.S. Agencies Dealing with terrorism

18. Center for Food Security and Public Health Iowa State University 2005 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 to various federal, state and local agencies − Upgrade facilities, enhance security, etc

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

20. Center for Food Security and Public Health Iowa State University 2005 Centers for Disease Control and Prevention (CDC) 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 of 2001

21. Center for Food Security and Public Health Iowa State University 2005 Strategic National Stockpile 12-hour Push Package − Complete package of medical materials Vendor Managed Inventory − Tailored to suspected agents

22. Center for Food Security and Public Health Iowa State University 2005 Insert Your State’s Info Here

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

24. Center for Food Security and Public Health Iowa State University 2005 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 Veterinary Information Network CFSPH training veterinarians to educate others

25. Category ABC Agent Overview

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

27. Center for Food Security and Public Health Iowa State University 2005 “Weaponization” of Agents Alter characteristics of an agent, allowing it to cause a more serious disease − Enhance transmission − Increase virulence − Resistant to antibiotics − Evade vaccine protection − Alter clinical signs  Harder to diagnose

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

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

30. Center for Food Security and Public Health Iowa State University 2005 Anthrax: The Agent Bacteria: Bacillus anthracis Forms spores Human disease − Skin − Intestinal − Inhalation Animal disease − Spreads through the body − Rapid death

31. Center for Food Security and Public Health Iowa State University 2005 Anthrax: The Response Vaccine − Humans − Animals Antibiotics − Treatment − Prevention Hardy in environment − Difficult to disinfect

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

33. Center for Food Security and Public Health Iowa State University 2005 Botulism: The Response Toxoids for high risk people Antitoxin available − Case-by-case basis Spores destroyed by moist heat

34. Center for Food Security and Public Health Iowa State University 2005 Plague: The Agent Yersinia pestis − Gram neg, transmitted by fleabites, aerosol, direct contact Symptoms: Humans − Bubonic, septicemic, pneumonic Symptoms: Animals − Cat: Similar to human − Dogs, livestock: Somewhat resistant

35. Center for Food Security and Public Health Iowa State University 2005 Plague: The Response Antibiotics generally effective if given early Killed vaccine available Isolation of sick individuals Susceptible to a number of common disinfectants

36. Center for Food Security and Public Health Iowa State University 2005 Smallpox: The Agent Variola virus Eradicated from the world in 1977 Narrow host range: Humans only Transmission: Person-to-person, contaminated items Clinical signs − Flu-like, progressive skin eruptions

37. Center for Food Security and Public Health Iowa State University 2005 Smallpox: The Response No specific treatment Vaccine has side effects Vaccination of health care personnel Isolation of infected individuals Disinfection of clothing etc. with steam, fire or bleach

38. Center for Food Security and Public Health Iowa State University 2005 Tularemia: The Agent Francisella tularensis Transmitted by ingestion, inhalation, vectors, direct contact through skin Six clinical forms in humans UlceroglandularGlandular

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

40. Center for Food Security and Public Health Iowa State University 2005 Tularemia: The Response Person-to-person transmission not documented Antibiotics effective if early or preventative Vaccine − For high risk individuals − Unknown effectiveness against inhalation tularemia

41. Center for Food Security and Public Health Iowa State University 2005 Viral Hemorrhagic Fevers: The Agents − Early: Fever, fatigue − Severe: Bleed from internal organs, body orifices − Progression to shock, seizures Animals: Only non-human primates susceptible Ebola, Marburg, Lassa, Machupo Human clinical presentation Vincent Massey

42. Center for Food Security and Public Health Iowa State University 2005 VHF: The Response Intensive supportive care Antiviral medications have shown some efficacy Susceptible to various disinfectants

43. Center for Food Security and Public Health Iowa State University 2005 Category B: Agents/Diseases Brucellosis Glanders Melioidosis Psittacosis Q Fever Typhus fever Viral encephalitis Toxins Food Safety Threats Water Safety Threats

44. Center for Food Security and Public Health Iowa State University 2005 Brucellosis: The Agent Bacteria: Brucella spp. Transmission by − Ingestion − Inhalation − Direct contact Clinical signs − Humans: Cyclic fever and flu-like symptoms − Animals: Reproductive signs

45. Center for Food Security and Public Health Iowa State University 2005 Brucellosis: The Response Long term antibiotics generally effective Vaccinate calves, no human vaccine Eliminate reservoir Standard precaution to avoid exposure Thorough disinfection

46. Center for Food Security and Public Health Iowa State University 2005 Glanders: The Agent Bacteria: Burkholderia mallei Transmission by ingestion, inhalation or direct contact − Animal-to-human transmission is inefficient Clinical signs − Humans & horses: Cutaneous & pulmonary lesions, rapidly fatal illness

47. Center for Food Security and Public Health Iowa State University 2005 Glanders: The Response No vaccine Antibiotic therapy likely effective Destroyed by various chemicals

48. Center for Food Security and Public Health Iowa State University 2005 Melioidosis: The Agent Bacteria: Burkholderia pseudomallei Transmission: Contact, ingestion, inhalation Clinical signs: Humans, sheep, goats and pigs − No symptoms to pneumonia, lung and wound abscesses

49. Center for Food Security and Public Health Iowa State University 2005 Melioidosis: The Response Long-term, multiple antibiotics effective Vaccine not available in U.S. Easily destroyed by disinfectants

50. Center for Food Security and Public Health Iowa State University 2005 Psittacosis: The Agent Bacteria: Chlamydophila psittaci Occurs worldwide Reportable in U.S. Clinical disease − Humans and birds: Ranges from no symptoms to systemic illness with severe pneumonia

51. Center for Food Security and Public Health Iowa State University 2005 Psittacosis: The Response Antibiotics generally effective Decontamination possible with most disinfectants

52. Center for Food Security and Public Health Iowa State University 2005 Q Fever: The Agent Bacteria: Coxiella burnetii Transmission: inhalation, direct contact, ingestion, ticks Disease symptoms − Humans:  Acute: Flu-like, pneumonia, liver disease  Chronic: Heart complications, bone inflammation − Animals: Most have no signs  Sheep, cattle and goats: Abortions

53. Center for Food Security and Public Health Iowa State University 2005 Q Fever: The Response Antibiotic therapy may limit the disease Vaccine developed, not available in U.S. Some disinfectants are effective

54. Center for Food Security and Public Health Iowa State University 2005 Typhus Fever: The Agent Bacteria: Rickettsia prowazekii Endemic in Eastern Europe, Middle East, and parts of Africa Transmitted in feces of human body louse Clinical signs: Humans − Fever, headache, red blotches, and a red-dot rash Not seen in domestic animals J. Kalisch

55. Center for Food Security and Public Health Iowa State University 2005 Typhus Fever: The Response Antibiotics are generally effective Vaccine, not commercially available

56. Center for Food Security and Public Health Iowa State University 2005 Viral Encephalitis: The Agent Viruses causing EEE, WEE, and VEE Transmitted via mosquito Clinical signs Birds do not become ill but are carriers; act as sentinels − Humans, horses, donkeys, mules: Often no signs to flu-like illness − Brain inflammation in some patients

57. Center for Food Security and Public Health Iowa State University 2005 Viral Encephalitis: The Response Supportive care Vaccine − Equine − Human: high risk Virus cannot live in environment

58. Center for Food Security and Public Health Iowa State University 2005 Toxins: The Agents Staphylococcal enterotoxin B (SEB) Ricin toxin from castor plant Clostridium perfringens epsilon toxin

59. Center for Food Security and Public Health Iowa State University 2005 SEB: The Agent Staphylococcal enterotoxin B (SEB) A common cause of food poisoning Clinical signs: Humans − Fever, chills, headache, aches − Non-productive cough if inhaled − GI signs if ingested Animals: Likely similar to human

60. Center for Food Security and Public Health Iowa State University 2005 Ricin: The Agent Ricin toxin from bean of castor plant Available worldwide Clinical signs − Acute onset of fever, chest tightness, cough, dyspnea, nausea

61. Center for Food Security and Public Health Iowa State University 2005 Epsilon Toxin: The Agent Clostridium perfringens type B and D Increases intestinal and vascular permeability, liver and neurological damage Clinical signs − Calves: Diarrhea, abdominal pain, listlessness, neurologic − Sheep, goats: Watery to bloody diarrhea, neurologic − Humans: Little information

62. Center for Food Security and Public Health Iowa State University 2005 Toxins: The Response Supportive care No vaccines currently available for SEB or ricin Vaccines for animals for clostridial disease Toxins are inactivated with common disinfectants

63. Center for Food Security and Public Health Iowa State University 2005 Food Safety Threats Campylobacter species Salmonella species E. coli 0157:H7 Viruses, parasites, chemicals, toxins Ingestion of contaminated food Gastrointestinal upset

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

65. Center for Food Security and Public Health Iowa State University 2005 Water Safety Threats 53% of US drinking water is from ground water Cryptosporidium parvum- protozoa Vibrio cholerae- bacteria

66. Center for Food Security and Public Health Iowa State University 2005 Cryptosporidium: The Agent Cryptosporidium parvum- protozoa Transmission: Inhalation, ingestion Clinical signs: Humans, calves, others − Acute gastroenteritis Dogs, cats, horses, pigs: Resistant

67. Center for Food Security and Public Health Iowa State University 2005 Vibrio cholerae: The Agent Vibrio cholerae- bacteria Transmission: fecal-oral, contaminated shellfish Clinical signs: humans − Acute, mild diarrhea − 5% severe disease Animals are resistant to disease

68. Center for Food Security and Public Health Iowa State University 2005 Water Safety: Public Health Significance Cryptosporidum parvum − 1993: Municipal water supply contaminated in Milwaukee − 40,000 ill − 1997: Decorative water fountain at the Minnesota Zoo − 369 cases − Mostly young children

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

70. Center for Food Security and Public Health Iowa State University 2005 Category C Nipah virus Hantavirus

71. Center for Food Security and Public Health Iowa State University 2005 Nipah Virus: The Agent Fruit bats Clinical signs − Humans: Brain inflammation − Pigs: Respiratory; neurological − Dogs and cats: “Distemper”

72. Center for Food Security and Public Health Iowa State University 2005 Nipah Virus: The Response Avoid contact with all infected animals and fluids Vaccine being researched Call authorities immediately

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

74. Center for Food Security and Public Health Iowa State University 2005 Hantavirus: The Response Supportive care Limit exposure to rodent excrement Virus is deactivated with bleach

75. Center for Food Security and Public Health Iowa State University 2005 Other Important Diseases Transmissible Spongiform Encephalopathy (TSE) Rift Valley Fever Hendra Virus West Nile Virus Foot and Mouth Disease Monkeypox

76. Center for Food Security and Public Health Iowa State University 2005 Transmissible Spongiform Encephalopathy: The Agent Prions − Proteinaceous infectious particles − Mutated proteins Very long incubation period Neurological signs in all species No treatment available

77. Center for Food Security and Public Health Iowa State University 2005 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 since 1990

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

79. Center for Food Security and Public Health Iowa State University 2005 Rift Valley Fever: The Agent Virus Transmission: mosquito, inhalation, contact with infected body fluids Clinical signs − Humans: Flu-like, fever, headache  Severe disease: Vision complications, bleeding with fever − Animals: Abortions, death in newborns

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

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

82. Center for Food Security and Public Health Iowa State University 2005 Hendra Virus: The Response Little is known about disease Potentially serious consequences − High death rate − Lack of treatment

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

84. Center for Food Security and Public Health Iowa State University 2005 West Nile Virus: Public Health Significance Human illness in U.S. in 2003 − 9,100 cases, 222 deaths Horses illness in U.S. in 2003 − 4,554 cases − 40% of ill result in death Method of introduction to U.S. unknown *data current as of 1/30/04

85. Center for Food Security and Public Health Iowa State University 2005 Spread of WNV in the U.S.: 1999-2002

86. Center for Food Security and Public Health Iowa State University 2005 West Nile Virus: The Response Treatment: Supportive care Vaccine available for horses, not humans Source elimination − Mosquito larval habitats Personal protection − Reduce time outdoors − Wear long pants and sleeves − Use mosquito repellent

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

88. Center for Food Security and Public Health Iowa State University 2005 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 − Increased travel, poor biosecurity

89. Center for Food Security and Public Health Iowa State University 2005 FMD: The Response USDA upgrading safeguarding measures Strict biosecurity Notify authorities immediately Response and recovery plans − Quarantine − Depopulation − Disinfection Vaccination – complex decision

90. Center for Food Security and Public Health Iowa State University 2005 Monkeypox: The Agent Orthopoxvirus, related to smallpox Transmission − Reservoir may be African squirrel − Bites, aerosol, direct contact − Zoonotic, animal-to-animal, person-to-person Animals: Fever, rash, pustules, red eyes Humans: Flu-like, rash, pustules, swollen lymph nodes

91. Center for Food Security and Public Health Iowa State University 2005 Monkeypox: Public Health Significance 2003 U.S. Outbreak − Zoonotic disease − 6 Midwestern states Animal illness − Suspect cases: 93 − Confirmed cases: 10 Human illness − Suspect cases: 72 − Confirmed cases: 37  All had contact with infected prairie dogs Potential bioweapon

92. Center for Food Security and Public Health Iowa State University 2005 Monkeypox: The Response Treatment: Supportive care Smallpox vaccination − Moderately protective (85% of cases) − 30 individuals in 2003, no adverse events Infection Control − EPA registered detergent disinfectant − 0.5% sodium hypochlorite (bleach) Embargo Euthanasia of animals Quarantine for 6 weeks

93. Conclusion

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

95. Center for Food Security and Public Health Iowa State University 2005 Contacts Phone numbers to know − Local veterinarian − Local physician − Public health officials

96. Center for Food Security and Public Health Iowa State University 2005 Summary Bioterrorism is a real threat Public health infrastructure is being strengthened Many bioterrorism agents are zoonotic Awareness education is an important component of preparedness and protection

97. Center for Food Security and Public Health Iowa State University 2005 Summary Prevention, recognition and response involves everyone Report any suspicious activity, unexplained behavior or death loss in your herd or flock You play a critical role

98. Center for Food Security and Public Health Iowa State University 2005 Conclusion “The best prescription, is knowledge.” Dr. C. Everett Koop Former U.S. Surgeon General

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

100. Center for Food Security and Public Health Iowa State University 2005 Acknowledgments Authors: Reviewers: Danelle Bickett-Weddle, DVM Jamie Snow, DVM Radford G. Davis, DVM, MPH Gayle B. Brown, DVM, PhD Jean Gladon, BS