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Unformatted text preview: Bioterrorism Written by: Diane King, RN, BSN, PHN, CEN San Jose State University School of Nursing NURS 214 Bioterrorism The awareness of the use of biological and chemical weapons have created concern on the national and international level. "Military and civilian medical and public health professionals must become proficient in recognizing that a biological attack has occurred, activating the appropriate agencies and personnel to investigate the event, treating casualties, and preventing spread of disease."(
What is Bioterrorism? The intentional release of a toxin, virus, bacteria or germ (agent) to cause a serious illness or death Can be immediate or long term (may take days or weeks to observe symptoms) Bioterrorism "High-risk targets for acts of terrorism include military and civilian government facilities, international airports, large cities, and highprofile landmarks. Terrorists might also target large public gatherings, water and food supplies, utilities, and corporate centers. Further, terrorists are capable of spreading fear by sending explosives or chemical and biological agents through the mail"
(http://www.fema.gov/areyouready/terrorism_general_info.shtm) Bioterrorism Agents "Category A diseases as described by the Center for Disease Control and Prevention (CDC)are: Anthrax Tularemia Plague Smallpox Botulism Viral hemorrhagic fever" (http://www.nih.gov/news/pr/mar2002/niaid-14.htm Anthrax
History "A disease caused by a bacterium, Bacillus anthracis, it has existed for hundreds of years and still occurs naturally in both animals and humans in many parts of the world, including Asia, southern Europe, sub-Sahelian Africa and parts of Australia. There are three forms of anthrax in humans: cutaneous, ingestion and inhalational." (http://www.who.int/csr/delibepidemics/disease/en) Anthrax
Epidemiology 8,000-50,000 spores (aerosol), transmitted by inhalation. Ingestion, or inoculation Anthrax
Patient Isolation Standard barrier isolation precautions. Patients do not require isolation rooms. Not transmissible person to person Incubation 1-6 days Duration 3-5 days (usually fatal if untreated) Anthrax
Clinical manifestations Fever Malaise Cough Respiratory distress Anthrax
Treatment Ciprofloxin Doxycycline If vaccine available, 3 doses of anthrax vaccine "The recent reports of anthrax exposure have spawned numerous websites and emails selling Ciprofloxacin (Cipro) and other antibiotics for treatment. The Federal Trade Commission (FTC) warns that fraudsters often follow the headlines, tailoring their offers to prey on consumers' fears and vulnerabilities " (
Use as a biological weapon Spores remain viable in soil for many years Anthrax
Documented Outbreaks "The worst documented outbreak of inhalation anthrax in humans occurred in Russia in 1979, when anthrax spores were accidentally released from a military biological weapons facility near the town of Sverdlovsk, killing at least 66 people. Anthrax
Most people weren't aware of this weapon until the fall of 2001, when letters containing anthrax spores sent via the U.S. Postal Service resulted in 22 cases of anthrax infection. Eleven people were infected with cutaneous anthrax. Eleven others were infected with inhalation anthrax, resulting in five deaths. "
(http://www.ncbi.nlm.nih.gov/pubmed) Anthrax Source:http://www.bt.cdc.gov/agent/anthrax/anthrax-images/cutaneous.asp Anthrax
ource:http Source:http://www.bt.cdc.gov/agent/anthrax/anthrax-images/cutaneous.asp Anthrax Source:http://www.bt.cdc.gov/agent/anthrax/anthrax-images/cutaneous.asp Tularemia
History F. tularensis was discovered in 1911 during an outburst of rabbit fever, when the disease killed a large number of ground squirrels in the area of Tulare Lake in California. There are two predominant subspecies: F. tularensis tularensis (type A), which is found in North America, is more virulent than F. tularensis palaearctica (type B), which occurs in Asia, Europe, and North America. Tularemia
Epidemiology 10-50 organisms (aerosol) Tularemia
Patient Isolation Standard precautions. Respiratory isolation is not required. Not transmissible person to person Incubation 3-6 days Duration is 2 weeks Tularemia Clinical manifestations depend on the route of entry and the virulence of the agent. Typically includes: fever, headache, malaise, weight loss, non-productive cough. There are six forms of tularaemia in humans: ulceroglandular, glandular, oropharyngeal, oculoglandular, respiratory and typhoidal."
Treatment Streptomycin Gentamycin Antibiotic prophylaxis is most effective if begun within 24 hours Tularemia
Documented Outbreaks "In summer 2000, an outbreak of tularemia in Martha's Vineyard resulted in one fatality. An outbreak of tularemia occurred in Kosovo in 1999-2000."
Documented Outbreaks "In 2004, three researchers at Boston University Medical Center were accidentally infected with F. tularensis, after apparently failing to follow safety procedures In 2005, small amounts of F. tularensis were detected in the Mall area of Washington, DC the morning after an anti-war demonstration on September 24, 2005 In July 2007, an outbreak was reported in the Spanish autonomous region of Castile and Leonand traced to the plague of voles infesting the region ."
Use as a biological weapon 10-50 organisms (aerosol) Plague
History "An infectious disease of animals and humans caused by a bacterium, Yersinia pestis, which is transmitted between rodents by rodent fleas or to people through infected rodent flea bites. It can also be transmitted to humans through direct contact with infected animal tissue. There are three main forms of plague in humans: bubonic, septicemic and pneumonic."
Epidemiology <100 organisms (aerosol) Plague
Patient Isolation Strict respiratory isolation with droplet precautions (gown, gloves, and eye protection) until patient has received at least 48 hours of antibiotic therapy and shows clinical improvement. Highly transmissible person to person Plague Patient Isolation Incubation period 2-3 days Duration of illness 1-6 days (usually fatal) Plague
Clinical manifestations High fever Chills Headache Productive cough-watery then bloody Plague
Treatment Streptomycin Gentamycin Chloramphenicol Antibiotic prophylaxis is recommended for all persons exposed to the aerosol or persons in close physical contact with a confirmed case Plague
Use as a biological weapon <100 organisms (aerosol) Plague
Documented Outbreaks "From 165-1950 (Biblical times) The Third Pandemic, originated in China (18551950s)." (http://www.ncbi.nlm.nih.gov/pubmed) Smallpox
Epidemiology Highly infectious after aerosolization Person-to-person transmission can occur via droplet nuclei or aerosols expelled from the oropharnx and by direct contact Contaminated clothing or bed linens can also spread the virus. Smallpox
History "An acute contagious disease caused by Variola virus, a member of the orthopoxvirus family."
Patient Isolation Strict isolation in negative pressure room from onset of rash until scabs separate Laundry and waste should be autoclaved before being laundered or incinerated Incubation 12-14 days Duration is 4 weeks Smallpox
Clinical manifestations Non-specific flu-like prodrome (malaise, fever, headache), 2-3 days later is rash Then synchronously evolving maculopapular rash progressing to vesicles then pustules Lesions more predominant on the face and extremities tan on the trunk Smallpox
Treatment Cidofovir Vaccine available & most effective if given within 3 days of exposure Smallpox
Use as a biological weapon Assumed low (10-100 organisms aerosol) Smallpox
Documented Outbreaks "The global eradication of smallpox was certified in 1979, based on intense verification activities in countries."
(http://www.who.int/csr/delibepidemics/disease/en Smallpox Smallpox Smallpox Public Health Images Library (PHIL) id# 131. Source: CDC/Barbra Rice Botulism (food sources)
History "A rare but serious paralytic illness caused by a nerve toxin that is produced by the bacterium Clostridium botulinum. Botulism toxin can be inhaled or ingested via contaminated food or water. There are five clinical categories: foodborne botulism wound botulism infant botulism adult infectious botulism inadvertent, following botulinum toxin injection."
Epidemiology Botulism neurotoxins (A-F) could be transmitted by aerosol or contamination of food and water supplies Botulism
Patient Isolation Non transmissible from person to person Incubation is 12-36 hours Death in 24-72 hours Lasts months if not lethal Botulism
Clinical manifestations Dry throat Blurred vision Slurred speech Difficulty swallowing Progressive descending symmetrical paralysis Botulism
Treatment Antitoxin (limited supply & only available from the Division of Communicable Disease Control, California Department of Health Services) Supportive care Botulism
Use as a biological weapon Could be released as an aerosol or used to contaminate water or food supplies "Iraq deployed 12,000 liters of botulinum toxin in over 100 munitions during the Gulf War in 1991" (Recognizing Bioterrorism Agents, 2000. Santa Clara County Health Department Zebra Information Binder) Botulism
Documented Outbreaks "In April 1991, 91 hospitalized patients in Cairo were reported to the Egyptian Ministry of Health with botulism intoxication. Cases of botulism in the northern province of Iran were studied in March and April 1997. In the late 1996, an outbreak of botulism affected eight young people in Italy." (http://www.ncbi.nlm.nih.gov/pubmed) Prevention
"Local drinking water and waste water systems could be potential targets for terrorist or other criminal acts. "
(http://cfpub.epa.gov/safewater/watersecurity/publicInvolve.cfm) External Links "Raw, unedited footage of terrorism events and people's reaction to those events can be very upsetting, especially to children. We do not recommend that children watch television news reports about such events, especially if the news reports show images over and over again about the same incident. Young children do not realize that it is repeated video footage, and think the event is happening again and again."
American Center Red Cross http://www.redcross.org/services/disaster/0,1082,0_589_,00.html for Disease Control http://www.bt.cdc.gov/agent/anthrax/anthrax-images/cutaneous.asp http://www.bt.cdc.gov/agent/smallpox/smallpox-images/smallpox3.htm Source:CDC/Cheryl Tyron. Public Health Images Library (PHIL) ID # 3. Tyron http://www.bt.cdc.gov/agent/smallpox/smallpox-images/smallpox3.htm Source: CDC/James Hicks. Public Health Images Library (PHIL) id# 284. Hicks http://www.bt.cdc.gov/agent/smallpox/smallpox-images/smallpox3.htm Source: CDC/Barbra Rice. Public Health Images Library (PHIL) id# 131. Rice http://phil.cdc.gov/Phil/details.asp Environmental Protection Agency
http://cfpub.epa.gov/safewater/watersecurity/publicInvolve.cfm Federal Trade Commission
http://www.ftc.gov/bcp/edu/pubs/consumer/alerts/alt104.shtm Federal Emergency Management Agency
http://www.fema.gov/areyouready/terrorism_general_info.shtm References National Institiute of Health http://www.nih.gov/news/pr/mar2002/niaid-14.htm http://www.ncbi.nlm.nih.gov/pubmed Santa Clara County Health Department: Bioterrorism information for clinicians zebra packet. November 4, 2000. U.S. Army and Medical Research Institute Infectious Disease of World http://www.usamriid.army.mil/education/index.htm http://www.who.int/csr/delibepidemics/disease Health Organization ...
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