Bioterrorism/Poxviruses Flashcards
What are possible indications of a biological attack?
Noticing an unusual clinical case:
- not usual disease in this area
- more virulent
- in a different patient population
Unusual epidemiology:
- season
- mode of spread
- number and clustering of cases
Who might be the most important front-line defender of a biological attack?
An ED physician b/c early diagnosis and treatment are critical.
What findings were missing in the October 2001 that indicated a biological attack?
Anthrax CXR normally shows characteristic widening of the mediastinum. This was missing from 4 of 11 cases.
Definition of Bio-warfare
The offensive use of biological agents by nations to harm the military of the enemy
Definition of Bioterrorism
The intentional release or use of viruses, bacteria, fungi or other products for the purpose of harming or killing humans, animals, plants, and to influence the conduct of government or to intimidate or coerce the civilian population
Definition of Bio-crimes
The use of biological agents or their products to attack or assassinate individuals (ie Ricin with Bulgarian dissident George Markov on Waterloo Bridge)
Where does ricin come from?
It is the residue that remains after caster beans are boiled down into caster oil.
What defense exists before an attack?
- Intelligence (NSA, CIA)
- Contingency planning
- Develop detection, drugs, vaccines to suspected agents
What defenses for after an attack?
- Prevent additional attacks
- Detect and identify the microbial threat
- Coordinate public health to respond to the disease
- Develop vaccines and drugs to prevent or treat
- Scale up!
- Deliver to at-risk people (Stockpile drugs and vaccines for later threats)
Does your response differ between an intentional release or an emerging infectious disease?
No, you respond the same way in either case.
What is an organism that looks like anthrax, behaves like anthrax, but is not anthrax?
Bacillus cerus G9241
- somehow acquired the gene for a very similar toxin to anthrax pXO1 plasmid
- did NOT have a pXO2 plasmid which carries the genes for the synthesis of the D-glutamic acid capsule of anthrax… however, it still made a capsule.
Types of biothreat agents
Toxins and Microorganisms
Category A agents
Anthrax, Botulinum, Small pox, Tularemia
- easily transmissible
- high mortality and public health impact
- panic and social disruption
- require special action for preparedness
Category B agents
Q-Fever, B. mallei, Ricin, Mycotoxins, Cholera
- moderately easy to disseminate
- moderate morbidity rates and low mortality
- require enhanced diagnostic capacity
- could be genetically enhanced for use as a weapon
What is the purpose of putting cultures of anthrax and B. mallei in sugar cubes?
Infect shipments of horses, mules, cattle, sheep and reindeer
How much anthrax is required to kill 3 million people?
100 kg
How do you decontaminate a 520 acre island (contaminated with anthrax)?
280 tons of formaldehyde diluted in 2000 tons of seawater
What happened in Sverdlovsk?
Accidental release of a live vaccine strain of anthrax. It does not have the plasmid that encodes the enzymes to make a capsule
Ecthyma gangrenosum
Cutaneous anthrax - pathognomonic of pseudomonas aeruginosa sepsis
Can someone be infected with smallpox, transmit it, and be asymptomatic?
Yes, for 3-4 days they will be infectious but asymptomatic
Smallpox kills ___% of people it infects
30%
When was the last known fatal case of smallpox?
UK in 1978
What makes smallpox transmission spread so wide?
A sneeze releases thousands of virus enriched particles that can travel far. The people are often asymptomatic as well because there is a long incubation period.
Orthopox viruses are large ___ viruses that replicate in the ___ of infected cells
DNA viruses that replicate in the cytoplasm
