oberle - Bioterrorism Disasters Pan Flu Bioterrorism...

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Unformatted text preview: Bioterrorism, Disasters, Pan Flu: Bioterrorism, Infectious Disease Issues Infectious Mark Oberle, MD, MPH [email protected] Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine 1 Bioterrorism & Disasters: Bioterrorism Infectious Disease Issues Infectious Develop an awareness of: The potential agents that might be used in a The bioterrorism event Infectious diseases in famine / starvation “Natural” disasters 2 UW Northwest Center for Public Health Practice Diseases of Bioterrorist Potential: Diseases Overview Overview CDC, AFIP 3 UW Northwest Center for Public Health Practice Terrorism The unlawful use (or threat) of force or violence against persons or property to intimidate or coerce a government, intimidate coerce the civilian population, or any segment thereof , in furtherance of political or political social objectives. social 28 CFR Section 0.85 4 UW Northwest Center for Public Health Practice FBI Classification of Terrorism Domestic terrorist threats Right-wing (e.g., Aryan Nation) Left-wing (e.g., Revolutionary Communist Party) Special interest (e.g., anti-abortion groups) International terrorist threats State sponsors (e.g., Iran, Iraq, Libya and e.g., Sudan) Sudan) Formal terrorist organizations (e.g., IRA, e.g., HAMAS) HAMAS) Loosely-affiliated extremists (e.g., Osama bin e.g., Laden) 5 Laden) UW Northwest Center for Public Health Practice Biological Agents of Highest Concern Biological Category A Agents Category Smallpox (Variola major) Smallpox (Variola Anthrax (Bacillus anthracis) Plague (Yersinia pestis) Tularemia (Francisella tularensis) Botulism (Botulinum toxin) Botulism (Botulinum Viral hemorrhagic fevers (Filoviruses & Arenaviruses) Arenaviruses) 5 Anthrax: Cutaneous Left, Forearm lesion on day 7 - vesiculation and ulceration of initial macular or papular anthrax skin lesion. Right, Eschar of the neck on day 15 of illness, typical of the last stage of the lesion. From Binford CH, Connor DH, eds. Pathology of Tropical and Extraordinary Diseases. Vol 1. Washington, DC: AFIP; 1976:119. AFIP negative 71-1290-2. 7 UW Northwest Center for Public Health Practice 8 UW Northwest Center for Public Health Practice Biological Agents of 2nd Highest Concern Biological Category B Agents Q-fever (Coxiella burnetti) Brucellosis (Brucella species) Glanders (Burkholderia mallei) Venezuelan, Western and Eastern Venezuelan, encephalomyelitis (Alphaviruses) (Alphaviruses) Ricin toxin from Ricinus communis (castor Ricinus bean) bean) Epsilon toxin from Clostridium perfringens Epsilon Clostridium Staphlococcus enterotoxin B 6 Biological Agents of 2nd Highest Concern Biological Food- or Waterborne Category B Agents Salmonella species Salmonella species Shigella dysenteriae Escherichia coli 0157:H7 Escherichia 0157:H7 Vibrio cholera Cryptosporidium parvum 7 Types of Illnesses Types These Agents Can Cause “Flu-like” illness (fever, sweats, nausea) Flu-like” Cough and/or pneumonia Skin ulcers (anthrax, tularemia, plague) (anthrax, Skin Rashes (smallpox, Ebola) Rashes (smallpox, Paralysis (botulism) Paralysis (botulism) Diarrhea & vomiting (food- and water-borne agents) Headache, confusion 11 UW Northwest Center for Public Health Practice Contagious Agents (Person-to-Person Transmission) Smallpox Smallpox Plague pneumonia Some viral hemorrhagic fevers (e.g., Ebola) Food- and water-borne agents (e.g., Salmonella Food& Shigella) Shigella 12 UW Northwest Center for Public Health Practice Agents That May Require Agents Antibiotics or Immunization to Prevent Disease to Antibiotics Immunization Anthrax Plague Tularemia Q Fever Fever Brucellosis Smallpox Anthrax 13 UW Northwest Center for Public Health Practice Infection Control Most of the biological agents of concern Most produce an initial non-specific or “flu-like” illness. illness. Standard precautions should be used with all Standard patients following a bioterrorism incident. patients 14 UW Northwest Center for Public Health Practice Suspicious Packages Notify building security and local law Notify enforcement if a suspicious package or substance is received. If exposed to a suspicious substance, remove If contaminated clothing, and wash with soap and water. water. 15 UW Northwest Center for Public Health Practice Documented BT Attacks in USA Anthrax (FL, DC, NJ, NY) Salmonella (OR) Smallpox (GA, OH….historical accounts) 16 UW Northwest Center for Public Health Practice Responding to a BT event Suspicion Recognition Identification Mobilization Response Control Recovery Public Health System Many Societal Systems 17 UW Northwest Center for Public Health Practice Epidemics and Prevention “Natural” Outbreak Primary Prevention Secondary Prevention Tertiary Prevention Clean water; Immunization Routine surveillance; Contact tracing Rehabilitation 18 UW Northwest Center for Public Health Practice Source: RT Ravenholt, 19 1961 UW Northwest Center for Public Health Practice NATURAL VS INTENTIONAL OUTBREAKS “Natural” Outbreak Primary Prevention Secondary Prevention Tertiary Prevention Clean water; Immunization Intentional Outbreak Global intelligence Addressing 1o Causes? (e.g., international aid) Syndromic Routine surveillance; surveillance Outbreak Outbreak investigation investigation Rehabilitation Rehabilitation services 20 UW Northwest Center for Public Health Practice 21 UW Northwest Center for Public Health Practice MMWR: November 02, 2001 / 50(43);941-8 22 UW Northwest Center for Public Health Practice DEATHS BY CAUSE, USA OCTOBER 2001 Anthrax: Tobacco 4 related deaths: 34,000 23 UW Northwest Center for Public Health Practice Famines and Infectious Disease Lessons from China, India and Peru 24 UW Northwest Center for Public Health Practice Deaths by Type of Disaster 1947-1980 Hurricanes/typhoons Earthquakes Floods Storms/tornadoes Tsunamis 499,000 450,000 194,000 29,000 5,000 Reference: Shah, BV. 1983. Disasters 7:202-209. 25 UW Northwest Center for Public Health Practice http://pubs.usgs.gov/circ/c1187/ 26 UW Northwest Center for Public Health Practice USGS Shake Map 27 UW Northwest Center for Public Health Practice Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine 28 First wave recedes from entrance 29 UW Northwest Center for Public Health Practice Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine 30 Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine 31 Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine 32 Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine 33 Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine 34 Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine 35 PUBLIC HEALTH CONCERNS Trauma care system Food, water, shelter Food, Person to person transmission, e.g., measles measles Vector borne disease: malaria, dengue (?) (?) Mortuary services Mortuary Rehabilitation medicine Rehabilitation Mental health services Mental 36 UW Northwest Center for Public Health Practice Source: MMWR January 28, 2005 / 54(03):61-64. Source: January 37 UW Northwest Center for Public Health Practice Deaths by Type of Disaster 1947-1980 Hurricanes/typhoons Earthquakes Floods Storms/tornadoes Tsunamis 499,000 450,000 194,000 29,000 5,000 Reference: Shah, BV. 1983. Disasters 7:202-209. 38 UW Northwest Center for Public Health Practice http://www.metrokc.gov/health/prevcont/docs/panflu- 39 UW Northwest Center for Public Health Practice 40 UW Northwest Center for Public Health Practice PUBLIC HEALTH CONCERNS Trauma care system Food, water, shelter Food, Person to person transmission, e.g., measles measles Vector borne disease: malaria, dengue (?) (?) Mortuary services Mortuary Rehabilitation medicine Rehabilitation Mental health services Mental 41 UW Northwest Center for Public Health Practice Resources Resources Centers for Disease Control & Prevention Centers Bioterrorism Web page: http://www.bt.cdc.gov/ Bioterrorism CDC Office of Health and Safety Information System CDC (personal protective equipment) (personal http://www.cdc.gov/od/ohs/ USAMRIID -- includes link to on-line version of USAMRIID Medical Management of Biological Casualties Handbook Medical http://www.usamriid.army.mil/ Johns Hopkins Center for Civilian Biodefense Johns Studies Studies http://www.hopkins-biodefense.org 42 UW Northwest Center for Public Health Practice Resources Resources Office of the Surgeon General: Medical Office Nuclear, Biological and Chemical Information Nuclear, http://www.nbc-med.org St. Louis University Center for the Study of St. Bioterrorism and Emerging Infections http://bioterrorism.slu.edu Public Health - Seattle & King County http://www.metrokc.gov/health 43 UW Northwest Center for Public Health Practice Resources Resources Washington State Department of Health Washington http://www.doh.wa.gov Communicable Disease Epidemiology (206) 361-2914 OR (206) OR (877) 539-4344 (24 hour emergency) http://faculty.washington.edu/moberle/Tsunami/ http://www.apic.org/bioterror http://www.sphereproject.org/ http:// http://www.bt.cdc.gov/disasters/tsunamis/ http:// 44 UW Northwest Center for Public Health Practice Acknowledgements Acknowledgements This presentation, and the accompanying instructor’s manual, were prepared by Jennifer Brennan Braden, MD, MPH, at the Northwest Center for Public Health Practice in Seattle, WA, for the purpose of educating public health employees in the general aspects of bioterrorism preparedness and response. Instructors are encouraged to freely use all or portions of the material for its intended purpose. The following people and organizations provided information and/or support in the development of this curriculum. A complete list of resources can be found in the accompanying instructor’s guide. Patrick O’Carroll, MD, MPH Project Coordinator Centers for Disease Control and Prevention Judith Yarrow Design and Editing Health Policy and Analysis; University of WA Washington State Department of Health Jeff Duchin, MD Jane Koehler, DVM, MPH Communicable Disease Control, Epidemiology and Immunization Section Public Health - Seattle and King County Ed Walker, MD; University of WA Department of Psychiatry 45 UW Northwest Center for Public Health Practice Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine 46 Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine 47 ...
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This note was uploaded on 04/05/2010 for the course UCONJ 445 taught by Professor Beaton during the Winter '10 term at University of Washington.

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