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Safety: Bioterrorism Response
2019 Risk and Safety Conference
Janet Pichette, Chief Epidemiologist
Austin Public Health
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https://www.cdc.gov/measles/parent-infographic.html
Agenda
• Public Health Emergencies and Bioterrorism
• Bioterrorism Agents
• Safety Procedures Bioterrorism Threats
• Newly Emerging Infectious Diseases
• Basic Infectious Control Practices in the Workplace
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What is a public health emergency?
An event that creates a health risk to the public
•Natural
•Manmade
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Natural Disasters•Hurricanes
•Floods
•Tornadoes
•Earthquakes
•Wildfires
•Extreme weather
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Manmade
•Chemical
•Biological
•Radiological
•Nuclear
•Explosive
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What is bioterrorism?
• Deliberate or threatened use of a bacteria, viruses, and toxins to cause disease, death or fear.
• Directed at livestock, food supply, and environmental resources.
• Spectrum ranges from classic biologic agents to hoaxes.
• Attacks can be covert or announced and can be caused by virtually any pathogenic organism.
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Domestic Bioterrorism• 1984, Dalles and Wasco County,
Oregon
• Rajaneeshee cult
• Goal: Tried to incapacitate voters to win a local election and seize control political control of the county.
• Agent: Salmonella Typhimurium
• Vehicle: Local salad bars in the community
• ~750 people ill
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Domestic Bioterrorism
• Fall 2001• Target: ABC, CBS,
National Enquirer, Senator Tom Daschle
• Cross-contamination of Hart Senate Building, 23 postal facilities
• Resulted in 5 deaths
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Domestic Bioterrorism
• May 2013
• Shannon Guess Richardson
• Actress living in New Boston, TX
• Target: President Obama
• Goal: Tried to frame her estranged husband
• Agent: Ricin/castor beans
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Domestic Bioterrorism
• October 2018• William Clyde Allen III
• Navy Veteran
• Target: • President Trump
• Secretary of Defense James Mattis
• Senator Ted Cruz
• Agent: Ricin/castor beans
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So what is a bioterrorism agent?
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CDC Category A Bioterrorism Agents
• Easily disseminated or transmitted from person to person
• Result in high mortality rates and have the potential for major public health impact
• Potential to cause public panic and social disruption
• Require special action for public health preparedness
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CDC Category A Bioterrorism Agents
• Anthrax (Bacillus anthracis)
• Botulism (Clostridium botulinum toxin)
• Plague (Yersinia pestis)
• Smallpox (variola major)
• Tularemia (Francisella tularensis)
• Viral hemorrhagic fevers
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Category A Agent: Anthrax
• Types of Anthrax: • Cutaneous
• Inhalational
• Gastrointestinal
• Injection
• Infection usually develops 1 -7 days after exposure; can take up to 2 months in inhalational anthrax
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Anthrax: SymptomsCutaneous• Small blisters
• Painless skin sore with black center
• Most often the sore will be on the face, neck, arms, or hands
• Swelling around sore
Inhalational• Fever and chills
• Chest Discomfort
• Shortness of breath
• Confusion or dizziness
• Cough
• Nausea, vomiting, or stomach pains
• Headache
• Sweats (often drenching)
• Extreme tiredness
• Body aches
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CDC Category B Bioterrorism Agents
• Moderately easy to disseminate;
• Result in moderate morbidity rates and low mortality rates; and
• Require specific enhancements of CDC's diagnostic capacity and enhanced disease surveillance.
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CDC Category B Bioterrorism Agents• Brucellosis (Brucella species)
• Epsilon toxin of Clostridium perfringens
• Food safety threats (Salmonella species, Escherichia coliO157:H7, Shigella)
• Glanders (Burkholderia mallei)
• Melioidosis (Burkholderia pseudomallei)
• Psittacosis (Chlamydia psittaci)
• Q fever (Coxiella burnetii)
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• Ricin toxin from Ricinus communis(castor beans)
• Staphylococcal enterotoxin B
• Typhus fever (Rickettsia prowazekii)
• Viral encephalitis
• Water safety threats (Vibrio cholerae, Cryptosporidium parvum)
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Category B Agent: Ricin
• Ricin is a poison found naturally in castor beans. If castor beans are chewed and swallowed, the released ricin can cause injury.
• It can be in the form of a powder, a mist, or a pellet, or it can be dissolved in water or weak acid.
• Adverse effects of ricin poisoning depend on whether ricin was inhaled, ingested, or injected.
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Ricin: SymptomsInhalation• Symptoms occur as early as 4-8 hours
and as late as 24 hours
• Respiratory distress
• Fever
• Cough
• Nausea and Vomiting
• Tightness in chest
• Heavy sweating
• Pulmonary edema
Ingestion• Initial Symptoms occur in less than 10
hours
• Vomiting
• Diarrhea that can become bloody
• Severe dehydration
• Seizure
• Blood in urine
• Liver, kidney and spleen failure within several days
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Ricin: Symptoms
Skin and Eye Exposure• Absorbed through the skin
• Causes redness and pain in eyes
• Incidental ingestion through hand to mouth contact
Death• Death can occur 36 to 72 hours after exposure
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Do your facilities have procedures for safe mail
handling?
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Risk Assessment of mail handling operations
• Threat
• Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE)
• Vulnerabilities
• Mail room (physical space)
• Mail room operations
• Jobs, tasks, personnel
• Consequences of an incident involving mail room
• Disruption of all services?
• Clients?
• Financial impact
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Best Practices for safe mail handling
• Security/access restriction
• Detailed log of visitors
• Surveillance
• Develop a emergency plan
• Train Workers to recognize and handle suspicious pieces of mail
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Best Practices for safe mail handling
• Screen all incoming mail
• Do not open mail in unauthorized locations
• Establish procedures for screening and isolating suspicious mail, and notifying emergency personnel
• Conduct routine training
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Initial Alert Procedures• Remain calm.
• Alert others in the immediate area that you have identified a suspicious item.
• Do not clean up the powder or attempt to move the suspicious item
• Do not sniff, touch, or taste any contents that may have spilled.
• Do not open the letter or package.
• Do not shake or empty the contents of a suspicious letter or package.
• Do not carry the letter or package or allow others to examine it.
• Notify your building security and supervisor
• Call 911 - Report incident to law enforcement and fire
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Initial Response Procedures
• Leave room and close the door and prevent other from entering
• Shut off any portable fans.
• Obtain a list of everyone in the room and those who handled the letter, and provide to public health and law enforcement
• If possible photograph the suspicious letter
• Emergency responders will help decontaminate those who came in contact with the materials
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Post event
• Conduct a after action review of the event
• Revise plans and procedures accordingly
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Infectious Disease
• Newly Emerging• Zika
• Middle Eastern Respiratory Syndrome (MERS)
• Ebola
• Chikungunya
• Re-emerging disease• Resurgence of endemic disease
(developing countries)
• Microbial resistant strains
• Pandemic influenza
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Globalization and infectious disease Factors influence infectious disease:
Technology/economic dependence
• International travel
• Global nature of food handling, processing and sales
Economic competition – reduction of government expenditures (public health programs)
Globalization of disease control -> overpopulation • Overcrowding
• Lack of sanitation
• Stress on the public health care systems
Fidler, D. P. (1996). Globalization, International Law, and Emerging Infectious Diseases. Emerging Infectious Diseases,2(2), 77-84. https://dx.doi.org/10.3201/eid0202.960201.
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Conduct a Risk Assessment
• Understand disease transmission• Direct contact
• Airborne
• Vehicle-borne
• Vector-borne
• Assess facility from an exposure standpoint
• Assess sick leave, attendance and alternative work policies
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Recommended Precautions For EmployersPrior to an event:
• Maintain situational awareness about diseases in the community and travel advisories
• Plan for disease outbreak (PPE, telework alternatives, and personnel requirements for essential functions)
• Encourage and support vaccinations
• Educate employees and executives (hand washing, PPE, infectious period)
• Know your organization’s role, if any, in community response plans
During an event:
• Closely monitor health department advisories
• Implement environmental non-pharmaceutical interventions by routinely conducting surface cleaning that helps to eliminate disease spread from frequently touched work surfaces and objects, such as desks, computers, and doors.
• Respond in a timely manner to official advisories regarding business closures
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Disease Prevention Strategies• Get Immunized
• Stay home if you are sick
• Avoid touching your face - your mouth, nose, and eyes
• Wash your hands frequently
• Avoid others who are sick
• Cough or sneeze into your sleeve or into a tissue
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