bioterrorism dr. e. mcnamara public health lab. hse, dublin. st. james’s hospital
TRANSCRIPT
![Page 1: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/1.jpg)
BIOTERRORISM
Dr. E. McNamaraPublic Health Lab. HSE, Dublin.St. James’s Hospital.
![Page 2: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/2.jpg)
‘9/11 – Changes’
Move to high risk Biological Threat, specialist public
arena Newsworthy Rare/eradicated infections Low clinical experience
![Page 3: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/3.jpg)
‘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
![Page 4: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/4.jpg)
‘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
![Page 5: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/5.jpg)
Benefits Co-operation internationally
WHO CDC EU
National preparedness Plans Multidisciplinary
Government Admininstrative Emergency services Medical Scientific
![Page 6: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/6.jpg)
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
![Page 7: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/7.jpg)
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
![Page 8: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/8.jpg)
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 people40-50 facilities50 agents
![Page 9: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/9.jpg)
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?
![Page 10: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/10.jpg)
Preparing for Biological Attacks Enhance surveillance Resource laboratories Communication systems Bioterrorism education Stockpile vaccines and drugs Molecular surveillance microbial strains Support development diagnostic tests Support research Rx. and vaccines
CDC April 2000
![Page 11: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/11.jpg)
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
![Page 12: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/12.jpg)
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
![Page 13: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/13.jpg)
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%
![Page 14: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/14.jpg)
Anthrax contd.
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
![Page 15: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/15.jpg)
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
![Page 16: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/16.jpg)
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
![Page 17: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/17.jpg)
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%
![Page 18: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/18.jpg)
Anthrax contd.
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
![Page 19: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/19.jpg)
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
![Page 20: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/20.jpg)
Deleted picture
![Page 21: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/21.jpg)
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.
![Page 22: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/22.jpg)
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.
![Page 23: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/23.jpg)
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
![Page 24: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/24.jpg)
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
![Page 25: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/25.jpg)
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
![Page 26: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/26.jpg)
Deleted picture
![Page 27: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/27.jpg)
Deleted picture
![Page 28: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/28.jpg)
Deleted picture
![Page 29: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/29.jpg)
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
![Page 30: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/30.jpg)
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.)
![Page 31: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/31.jpg)
Cl. Botulinum contd.
Differential Dx. Guillain-Barré Myastheria gravis Stoke CNS despressants
![Page 32: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/32.jpg)
Cl. Botulinum contd.
Dx.: Detect botulinum toxin Culture
Rx.: Antitoxin Supportive
Infection Control – standard precautions
![Page 33: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/33.jpg)
Deleted picture
![Page 34: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/34.jpg)
Deleted picture
![Page 35: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/35.jpg)
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
![Page 36: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/36.jpg)
Bubonic Plague
Incubation 1-8 days Fever, rigors, headache Buboes – painful lymph nodes 15% develop pneumonic plague Mortality = 12%
![Page 37: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/37.jpg)
Septicaemic Plague
Primary, or secondary to bubonic Rigors, abdominal pain, V+D Purpura, DIC, necrosis Mortality = 30%
![Page 38: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/38.jpg)
Pneumonic Plague
Highest bioterrorism risk Primary or secondary from
haematogenous Incubation 1-3 days Pneumonic symptoms Respiratory failure and shock Mortality - ↓with rx. = 8%
![Page 39: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/39.jpg)
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.
![Page 40: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/40.jpg)
Deleted picture
![Page 41: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/41.jpg)
Deleted picture
![Page 42: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/42.jpg)
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
![Page 43: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/43.jpg)
Tularaemia
Deleted picture
![Page 44: BIOTERRORISM Dr. E. McNamara Public Health Lab. HSE, Dublin. St. James’s Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062304/56649ec05503460f94bcac0f/html5/thumbnails/44.jpg)
Tularaemia
Deleted picture