1
Q
Common misconceptions and fears about biological incidents
A
- it is very unlikey
- no one would do that
- it would be too hard to do
- i do not want to think about it
2
Q
education is the key
A
- it could really happen
- it has happened before
- i can prepare for this
- i will know what to do
3
Q
baseline
A
- A baseline is the incidence and prevalence of disease that is expected at any given time in a community.
- Changes from the baseline can help health officials recognize outbreaks
- ex. If the baseline for a certain disease is zero cases in a community, one or two cases might be considered an outbreak. If the baseline is 50 cases for a particular disease, 80–100 cases may constitute an outbreak.
4
Q
endemic
A
- Endemic describes a disease or agent that is present in a community at all times but at a relatively low frequency
- you can have it in one place and not expect it in another place
- ex. Bacillus anthracis is endemic in the United States, particularly in the Midwest, West, Texas, and Oklahoma. Livestock or other herbivores are susceptible to infection from consuming contaminated soil or feed.
5
Q
outbreak
A
- a sudden rise in the incidence of a disease, such as when two or more persons who were exposed to a common source are experiencing a similar illness.
- ex. An outbreak may result from an increase in measles in unvaccinated children. An outbreak may involve as few as two cases, such as when an unexpected illness such as plague occurs.
6
Q
epidemic
A
- An epidemic is an outbreak that quickly spreads to many people within a population, resulting in more cases of a disease than would be expected in a community or region during a given time period.
- In epidemics of agents with high mortality, patients either die rapidly or recover, and survivors generally develop some type of immunity.
- ex. SARS is a viral respiratory illness caused by a coronavirus called SARS associated coronavirus (SARS-CoV). SARS was first reported in Asia in February 2003. The epidemic quickly spread to more than two dozen countries in North America, South America, Europe, and Asia before it was contained. This epidemic took the lives of nearly 800 people worldwide. (CDC 2004)
7
Q
pandemic
A
- A pandemic is an epidemic that becomes very widespread and affects an entire region, a continent, or the world.
- The 2009 H1N1 influenza virus is a novel influenza virus that quickly spread from person to person worldwide. The unusual epidemiological patterns, large outbreak out of season, higher severity, and overall lack of immunity led the World Health Organization (WHO) to declare the 2009 H1N1 a pandemic. (CDC 2010)
8
Q
disease scale
A
- pandemic
- epidemic
- outbreak
- endemic
- baseline
9
Q
microorganism vs toxin
A
- microorganism- bacteria or virus
- toxin- is something usually produced by a bacterium or virus
- microorganism or toxin derived from living organisms are biological agents
- fungi
10
Q
biologic incidents
A
- harmful occurrence that involves a biological agent
- can be naturally occurring, accidental (labs), or intentional
- can cause a public health emergency and economic damage
11
Q
types of biological incidents
A
- natural
- accidental
- intentional
12
Q
naturally occurring incidents
A
- occur as result of nature with no human cause or intervention
- typically occur in a predictable season or an expected location
- natural can be dangerous
- bacteria
- viruses
13
Q
accidental incidents
A
- result from human error or technology
- hacking
- lab spills
- unintentional
- potentially occur in an unexpected season or location
- technical crash of transportation
14
Q
intentional incidents
A
- purposefully caused by humans with an intent to do harm
- a crime
- potentially occur in unexpected season or location
- can occur in multiple locations simultaneously
- ex. biocrime, biowardare, bioterrorism, agroterrorism
15
Q
biocrime
A
- an unlawful act in which an individual or group uses biological agents intentionally to cause illness or death in a target for personal reasons (such as revenge or financial gain) and lacks an ideological objective
- ex. In 1996, a hospital laboratory employee contaminated pastries with Shigella dysenteriae and left them in an employee break room. Twelve laboratory workers ate the contaminated pastries and developed acute diarrheal illness. (Dembek et al. 2007)
- usually not trying to impact someone greatly
- may be smaller scale
16
Q
biowarfare
A
-a specialized type of warfare conducted by a government using biological agents against an adversary with the intention of overwhelming a military force
-ex. The deliberate use of biological agents as a biowarfare tool has been attempted numerous times throughout history. The Japanese allegedly developed plague as a biological weapon during World War II. They allowed laboratory-bred fleas to feed on plague-infected rats and then harvested and released them from aircraft over Chinese cities. (Christopher et al.
1997)
17
Q
bioterrorism
A
- the intentional release of biological agents to cause illness or death when the attacker has political, religious, environmental, or ideological motives; terrorists conduct bioterrorism “with the intent to intimidate or coerce a government or elicit fear in the civilian population to further political or social objectives” (CDC 2007)
- ex. In June 1993, Aum Shinrikyo, a Japanese religious cult, attempted to initiate an outbreak of inhalation anthrax by spraying a liquid form of it from the roof of a building in Tokyo. The attack was unsuccessful for many reasons. The cult used a nonvirulent vaccine strain of the bacteria. This strain does not cause disease in people with normal immune systems. High viscosity caused poor dissemination of the agent.
18
Q
agroterrorism
A
- the intentional use of biological agents against agricultural and food supply industries
- In 1985, Mexican contract workers deliberately spread screwworm (Cochliomyia hominivorax) among livestock in Mexico close to the border with the United States (Carus 2002). In 2011, a man was arrested for threatening to spread foot and mouth disease in the United States and Great Britain if not paid four million US dollars. He was convicted for terrorist activity and money laundering.
19
Q
Spanish influenza pandemic
A
- pandemic
- 20%-40% of worlds population ill
- 50 million deaths worldwide; 675,000 in US
- caused by a mutation of flu virus
- NATURAL incident
20
Q
rajneeshees use salmonella (1984)
A
- cultivated salmonella typhimurium which causes dirrheal illness
- contaminated local salad bards in several restaurants in an attempt to influence local elections
- 751 ill, no deaths
- BIOTERRORISM incident
21
Q
anthrax letters (2001)
A
- letters contaminated with bacillus anthracis spores
- mailed to various media and political personalities
- 22 confirmed or presumptive cases with 5 deaths
- BIOTERRORISM incident
22
Q
SARS (2003)
A
- first reported in Asia in 2003
- spread from asia to norther american, south america, to europe
- 8,098 cases and 774 deaths
- all US cases were travel related
- NATURAL
23
Q
monkeypox outbreak
A
- most of the people infected had contact with infected prairie dogs being kept as pets
- 37 confirmed cases
- 1o probable cases
- no deaths
24
Q
peanut corporation of america: samonella (2009)
A
- 714 infected
- 9 deaths
- one of the largest food recalls in history
- PCA were aware of the contamination
- BIOTERRORISM
25
H1N1 pandemic (2009)
appeared in US in april 2009
- 162,380 cases
- 1154 deaths in 168 countries
- NATURAL
26
MERS (2012)
- first reported in Saudi Arabia in 2012
- spread to 26 countries
- confirmed in camels in egypt, oman, qatar, and saudi arabia
- 2 travel related cases in the US
27
community wide response
- public health
- medical community
- law enforcement
- emergency management
28
be ready act quickly
- recognize warning signs
- protect yourself
- report quickly
29
summary
- scale of biological incidents are classified by size: baseline, endemic, outbreak, epidemic, pandemic
- biological incidents can be natural, accidental, or intentional
- past incidents impacted public response to new or developing biological incidents
30
routes of exposure
- ingestion- salmonella
- injection- bee venom
- absorption-
- inhalation
31
ingestion
-enters when host eats, drinks, or puts contaminated fingers or other objects in mouth
32
injection
- enters host through the skin via
- insect or animal bite
- hypodermic needle
- sharp object
- defects in skin surface
33
absorption
-enters through hosts mucosal surfaces, such as eyes, mouth, nose, or rarely through skin
34
inhalation
enters when host breathes
- optimal particle size ******************* test -> 1-5 microns
- agent establishes itself in lungs
- causes disease or enters bloodstream
35
disease transmission
- contact
- droplet
- airborne
36
infectious vs contagious
- infectious- disease caused by microorganisms
- contagious- infectious disease that can be spread from person to person
- body is affected and is not able to destroy agent -> you are infected but not contagious -> infectious
- contagious is spreading from one person to another
- if you are contagious you are infectious
- if you are infectious it does not mean you are contagious
37
bacteria
- treated by antibiotics
- complete single celled organism
- can reproduce on their own
- some vaccines are available
- diseases include anthrax and plague
38
viruses
- not alive
- not complete organism
- require host cell to reproduce and survive
- antibiotics are not affective
- some antivirals and vaccines available
- diseases include smallpox and influenza
39
toxins
- comes form living organisms
- not alive
- no replication
- no antibiotics or antivirals
- ex. botulinum toxin and ricin from castor beans ********** test
- offer supportive care
- some antitoxins available
- poison ivy
40
disease process for bacteria and viruses
- encounter -> agent does not enter -> no disease
- encounter -> agent enters body -> immune system wins -> no disease
- encounter -> agent enters body -> immune system overwhelmed -> disease results (probably something novel)
41
natural history of diseses
- natural disease (natural agent)- usually predictable
- intentional disease (processed agent)- not as predicable
- incubation or latency periods
- length of illness
- severity of illness
- recovery time
- appearance and symptoms of host
- viral load
42
advantages and disadvantages for terrorists
-resources are readily available
-easy to produce
-may be used covertly- secretly
-definitive ID may be difficult- confusion
-many casualties possible
-delayed effects- incubation, latency
-some are easy to disseminate- spread
-can tie up community resources
-produce terror
BUT
-dangerous to produce and deploy
-can injure the wrong people
43
agents used intentionally
- are relatively easy to obtain
- can be frown to sufficient numbers
- can typically infect a host with a small amount of product
- usually cause high morbidity and mortality
- provide an added advantage for terrorists if they are contagious
44
biological agent products and production
- liquids
- powders- technically challenging
- similar process to home brewing
- fermenters
- centrifuges
- blenders
- growth media
- biosafety hoods and other PPE items
45
aerosol agents
- easy to disseminate
- highly infectious via inhalation
- high quality powders are difficult to produce
- particle size of 1-5 microns *******
- free flowing
- hydrophobic
46
potential disseminators
- paint sprayer
- trailer sprayer
- backpack sprayer
- rose duster
- two gallon garden sprayer
47
biologic at night vs day
- night-
- day- warms up, brings into atmosphere and spread throughout the area
- particle size
- concentration of agent
- dispersal device
- agent state (liquid or powder)
- environmental conditions such as wind speed and direction, UV light, and temperature inversions
48
point source delivery
- single source dissemination
- depends on wind direction and speed
- mostly used on small , discrete targets
49
line source delivery
- product sprayed perpendicularly to the wind
- target can be many kilometers downwind
- line source delivery can be used on much larger targets
50
food or drink contamination
- possibly the largest potential threat
- simple methods can be used
- potential for large number of victims
- possible targets- buffet style restaurants, salad bars, and produce displays
- what about water?
51
biological attack indicators
- unusual time or year or location for disease
- unusually amount of sick people or death
- unscheduled or unusual dissemination of sprayed materials , such as misquito sprayers or crop dusters
- abandoned spray or dispersion device
52
initial clinical symptoms of incident
- low grade fever
- sore throat
- muscle aches
- headache
- fatigue
- nausea
- nerve agents- effect are immediate
- biologic- can take days
53
2014-2016 ebola outbreak in west africa
- 11,310 deaths
- 8% of doctors in liberia
- 513 healthcare workers
- $2.3 billion allocated by US government
- $2.2 billion lost GNP by liberia, sierra leone, and guinea
Decks in class (18)
# Cards
-
Quiz 146
-
FEMA15
-
Lecture 241
-
Lecture 3: PPE20
-
Quiz 1 Answers6
-
Chemical agents: Epidemiology and clinical characteristics28
-
Chemical Agents and Treatment Protocols37
-
Biologic Incident Awareness53
-
module 431
-
Midterm89
-
nuclear/radiologic agents50
-
bombs25
-
Quiz25
-
NIMS0
-
Scene Size up40
-
Final121
-
ksshntglst12
-
Final Final41
