bioterrorism

Question 1

BIOCHEMICAL TERRORISM
DEFINITION:

Answer 1

Using bacteria, viruses, toxins, or chemicals as possible biological warfare agents.
Historically Biological weapons have been used at least since 6 BC
Assyrians poisoned enemy wells with rye ergot

Question 2

Bacteria (Anthrax, Q and the plague have bruce and tula)

Answer 2

Anthrax
Brucellosis
Plague
Tularemia
Q-Fever

Question 3

Viruses

(small, hemorrhagic viruses)

Answer 3

Smallpox
Viral Hemorrhagic Fever

Question 4

Toxins

Answer 4

Botulinum

Question 5

Chemical Agents - Nerve:

Answer 5

Nerve:
Sarin Gas

Question 6

Sarin Nerve Gas

Answer 6

Undetectable, colorless, odorless liquid
Symptoms: AMS (altered mental status), fasciculations, seizures, muscle paralysis, apnea

Question 7

ANTHRAX

Answer 7

Known as the wool sorter’s disease in the industrial mills.
Caused by Bacillus Anthracis
Spore forming gram + bacillus
Anthrax spores can survive for yrs
When spores find host they become active and cause disease
In nature human infection is rare and is usually limited to people who work with hoofed animals.

Question 8

Three forms of contracting Anthrax

Answer 8

Cutaneous
1944 – 1994 total 224 cases of cutaneous Anthrax in the U.S. Mostly from working with hoofed animals.
Gastro-intestinal
Extremely rare
Inhalation (most deadly)
1900 – 1970’s 18 cases total (two from lab exposure)
1970’s to 9-11 terrorist attack there were 0 cases.

Question 9

Symptoms of Anthrax

(anthrax is wide now)

Answer 9

Widened Mediastinum, Incubation 7 days
Inhalation Anthrax
Initial symptoms resembles the common cold
Sx’s progress to severe dyspnea and shock

Question 10

Cutaneous Anthrax

Answer 10

Begins as papules followed by blister formation
Vesicles form an ulcer
Ulcer becomes painless and form black eschar that dries and falls off in a couple of weeks.

Question 11

TREATMENT OF ANTHRAX

(anthrax needs to take cipro)

Answer 11

Postexposure prophylaxis for Anthrax
Cipro or doxy po for 60 days
Presumptive (definite) diagnosis of Anthrax
Cipro or Doxycycline intravenously for at least 60 days AND
One or more antimicrobials such as: Rifampin, Vancomycin, or Clindamycin

Question 12

SMALLPOX - test question - when was global erradication?

Answer 12

Caused by the Variola Virus
Most deaths of any infectious disease
Millions of deaths from smallpox
2 million in 1967
HIGHLY CONTAGIOUS
Last Cases
Last US case in 1949
Last International case 1978
Global eradication 1980 (TEST QUESTION)
1971 smallpox vaccines stopped in the US
Vaccine immunity may last 5 -20 years.
80% of adults and 100% of kids are presumed susceptible to the virus now.

Question 13

stages OF SMALLPOX - test question

Answer 13

Incubation Stage:

Prodrome Stage:

Question 14

Eruptive Stage of Smallpox: how long after exposure?

(erupting at 21)

Answer 14

(Total 21+/- days since exposure)
Heralded by mucosal lesions
HIGHLY CONTAGIOUS

Question 15

TREATMENT OF SMALLPOX

Answer 15

Prevention is the best treatment
Pros and Cons of Smallpox Vaccination
Must weigh likelihood of a smallpox attack versus the costs and dangers of receiving the live vaccine.

Question 16

Present Emergent plan if smallpox outbreak

Answer 16

RING’ Vaccination
Vaccinate all those in contact with a person who is contagious with smallpox within 4 days.
And then vaccinate all those in contact with them… thus forming a ‘ring’ of immunization.

Question 17

Smallpox Vaccine

Answer 17

Vaccinia (live virus vaccine)
95% effective in preventing smallpox
High level immunity for 3 – 5 years
Moderate level 5 to 10 years
Vaccination within 3 days of exposure prevents or greatly lessens symptoms.
Vaccination in 4 to 7 days of exposure will offer some protection
Live virus is present at vaccination site until scabs fall off.
Can be transmitted to other parts of the body or to other people.

Question 18

Contraindications to Smallpox Vaccination - what about heart?

Answer 18

Persons with acute or chronic skin conditions (eczema, dermatitis, herpes, acne, psoriasis…)
Immunocompromised (HIV, CA…)
Pregnant, breastfeeding
Present short term illness
Cardiac hx. (CAD, HTN)

Question 19

Normal Systemic Symptoms to the Smallpox Vaccine

Answer 19

30% of recipients will feel too sick to participate in ADL’s.

Question 20

smallpox - how is it spread?

Answer 20

Can be produced in large quantities
Stable for storage and transport
Stable as aerosol
High Mortality (20 to 40% fatal)
Highly infectious
Person-to-person spread
Most of the world has no immunity
No specific treatment
Leaves survivors with disfiguring scars

Question 21

chemical agents = Blood:

(bloody cyanide)

Answer 21

Blood:
Cyanide

Question 22

chemical agents - Pulmonary

(gene in the pulmonary)

Answer 22

Pulmonary:
Phosgene
Chlorine

Question 23

chemical agents - skin

Answer 23

Skin (blister…):
Mustard gas…

Question 24

small pox - Incubation Stage (test question)

(Incubate until 7)

Answer 24

Incubation Stage: (7 to 17 days)
Person feels fine and is not contagious.

Question 25

small pox - Prodrome Stage (test question)
you know this - the same as other virsuses

Answer 25

Prodrome Stage: (2 to 4 days)
Flu like symptoms: Fever, Prostration (weak), Arthralgia, Myalgias, HA, N/V, delirium, oral lesions…

Question 26

small pox - when does a person become contagious? (test question)

Answer 26

At onset of mucosal lesion pt is contagious

Question 27

eruptive stage of smallpox - symptoms

Answer 27

CHARACTERISTIC RASH:
Centrifugal: more concentrated on extremities and face – less on trunk
Macular-papular-pustular-umbilicated- scabs/crusting-falls off.
Contagious until ALL the scabs fall off
Permanent scarring especially on the face