Week 13: Bioterrorism/Adverse Effects of PH Interventions Flashcards
Define bioterrorism.
The use of infective organisms to achieve political, religious or ideological objectives
What are 3 historical examples of bioterrorism?
6th century BC: Assyrians used rye ergot to poison the wells of its enemies
400 BC: Scythian archers dipped arrows in decomposing bodies or manure to
cause wound infections
15th-18th centuries: smallpox-laden clothing and blankets were given to
enemies to induce outbreaks
What are 3 details about modern day bioterrorism?
In the first half of the 20th century, many industrialized nations, including the US, had offensive biological weapons programs
Biological Weapons Convention (1972): treaty developed by the international community preventing the stockpiling of biological agents and research into offensive biological weapons
Despite being signatories of the treaty, several countries, particularly Iraq and the Soviet Union, continued active biological weapons production
What are the 5 reasons why the CDC identified 6 “Category A” biological agents as high priority?
Ease of dissemination or transmissibility from person-to-person
High mortality rates;
Serious public health implications;
Ability to cause social disruption and public panic
Special preparedness requirements
What are the 6 “Category A” biological agents?
Smallpox
Anthrax
Plague
Tularemia
Botulism
Viral hemorrhagic fevers
What are 2 details about anthrax?
Caused by the organism Bacillus anthracis
Transmitted as spores which can survive for long periods in the environment
What is the clinical presentation of anthrax? What 3 infections does it cause?
Clinical presentation: anthrax causes three different types of infection
Cutaneous (skin form): black lesion
Intestinal (abdominal form)
Inhalation (lung form): presents with high fever, chest pain, cough and severe shortness of breath; 89-96% fatal if untreated
What are 2 details about the anthrax treatment? What are 4 public health strategies?
Treatable with antibiotics
Not contagious (no person-to-person spread)
Public health strategies:
Identification of source of release and population exposed
Institution of treatment and prophylactic protocols
Information management
Coordination of the local, state and federal response
What are 2 details about smallpox?
Caused by a virus
Naturally occurring smallpox was
eradicated in 1977 through a vigorous
worldwide vaccination campaign
What is the clinical presentation of smallpox?
Clinical presentation: approximately 12 days after exposure, patient develops flu-like symptoms then the characteristic rash; similar to chickenpox, but all lesions are in the same stage of development and tend to be more prominent on the face and extremities
What are 3 details about smallpox treatment? What are 5 public health strategies?
Highly contagious
No proven treatment, just supportive therapy
Vaccination is available for exposures
Key public health strategies:
Disease surveillance
Rapid laboratory confirmation
Isolation of contagious patients
Contact tracing
Institution of an aggressive vaccination program
What are 2 details about the plague?
Caused by the bacteria Yersinia pestis
Naturally occurring outbreaks still occur worldwide
What are 3 details about the plague’s clinical presentation?
Clinical presentation: plague can take on many forms
Most notorious form is bubonic plague
which is transmitted by fleas and
causes large, painful swollen lymph
nodes (glands) termed “buboes”
An aerosol attack would result in
pneumonic (lung) plague, presenting as
flu-like symptoms with watery then
bloody sputum leading to severe
respiratory distress, shock and death
What are 2 details about plague treatment? What are 4 public health strategies?
Treatable with antibiotics if detected early
Nearly 100% fatality rate when not treated
Public health strategies:
Syndromic surveillance
Identification of the source of the outbreak and exposed population
Contact tracing
Distribution of prophylactic antibiotics
What is 1 detail about botulism?
Caused by botulinum toxin, a nerve toxin produced by the bacteria Clostridium botulinum
What is the clinical presentation of botulism? What are 4 symptoms?
Clinical presentation—following a terrorist attack with aerosolized botulinum toxin, patients will present with paralysis in a descending fashion
Weakness of the eye muscles causes double vision
Weakness of the face and neck muscles causes difficulty speaking and swallowing
Ultimately, weakness of the respiratory muscles leads to respiratory arrest
Mental status is unaffected
What are 5 reasons why bioterrorism poses a challenge to public health?
Attack is likely to be covert
Delay in onset of illness (incubation period): makes identification of the
release site and other exposed individuals difficult
Many biological agents cause non-specific, flu-like illnesses initially, which
can delay diagnosis of the disease
Most clinicians are unfamiliar with diseases related to biological terrorism
due to the rarity of naturally occurring cases
Very mobile society: contagious diseases have the potential to spread
rapidly across borders
What are 3 reasons why adverse effects of public health interventions exist?
Many public health interventions may have unintended effects.
PH contrasts markedly with clinical medicine, where there is a substantial
literature on adverse events and patient safety
Limited guidance is available on how to address this question in a structured way
What 3 factors are the most likely to lead to success of public health interventions?
The unique social determinants
The needs and motivations
The implementation context
What are 2 details about the failure of public health interventions?
Historically, PHI have been deemed appropriate for implementation if they abide by ethical principles and are based on a synthesis of effectiveness evidence
A fundamental pitfall of effectiveness evidence is that harm evaluation and
reporting are often absent or incomplete
Define harm.
A deliberately inflicted actual or potential injury, ill effect, adverse event or danger
What are 3 details about the harm principle?
The Harm Principle proposed in 1859 by John Stuart Mill has historically been used to determine when PHI are ethically justifiable
Evidence-based public health (EBPH)
now suggests that decisions regarding the ethical validity of a PHI should be based not only on the Harm Principle, but also on a gold standard of evidence (an up-to-date systematic review of well-executed research) together with preferences of the community
The harm principle holds that the actions of individuals should only be limited to prevent harm to other individuals
What are the 5 different types of harms caused by public health intervention?
Direct harm
Psychological harm
Equity harm
Group & social harm
Opportunity cost harm
What is 1 detail about direct harm? Give 2 examples.
Desired health outcomes may have directly harmful effects, regardless
of the content of the intervention targeting them
Examples:
Sun exposure is associated with a reduced risk of some cancers.
Programs to increase sports participation may increase injury risk
What is 1 detail about psychological harm? Give 3 examples.
Indirect category of harms by having negative psychological impact
Examples:
Some universal psychological interventions, such as ‘debriefing’ after
traumatic events, may have adverse mental health impacts
Dissemination of health messages through educational or media
campaigns may generate damaging feelings of worry or guilt
Moderate consumption of alcohol may facilitate social interactions but interventions aimed at reducing alcohol consumption may reduce social interaction
What are 2 details about equity harm?
Interventions may create harm by worsening health inequalities
Some successful interventions may improve outcomes across the population, but exacerbate existing inequalities by benefiting privileged groups more than disadvantaged groups
What is 1 detail about group and social harm? Give 4 examples.
Group-based interventions may inadvertently create harms by singling out a particular subset of the population
Examples:
Targeting obese population for PH intervention
Alcohol restriction in Aboriginal communities in Australia
Advocacy to promote bicycle helmets may contribute to an exaggerated perception of the injury risks of cycling, and hence lower cycling rates
Social narratives—such as those which determine the boundaries of “appropriate” behavior by pregnant women (eg, around no consumption of alcohol)—may cause stress and guilt
What is 1 detail about opportunity cost harm? Give an example.
Associated with potential benefits which may be forgone as a result of
committing resources to ineffective or to less serious public health problems
Example:
Money spent on certain awareness programs about diseases can be used to treat the actual disease in a population
What are the 4 adaptations to the WHO Think Tank steps?
Describe the components of the intervention to the transdisciplinary team
Identify underlying factors and potential harmful UC and prioritize
Recommend adaptations to the intervention to account for the potential harmful UC
Conceptualize the influence and interaction of underlying harmful UC factors and redesign
Identify examples of potential unintended harms for the question “What are you most worried about?”
Categories:
Cultural
Economic
Environmental
Physical
Political
Psychosocial
Omission
Cultural: empowerment of a group that does not have power may lead to conflicts of power and cultural pushback
Economic: limited resources (poverty) in community may lead to trade-offs
Environmental: possible negative impacts on wildlife AND water availability OR water quality
Physical: possible increased chance of infection from toilets if not kept clean due to an absence of water
Political: mobilizing youth without policy level support may lead to conflict
Psychosocial: knowledge with the inability to overcome resource barriers
may lead to disempowerment/helplessness
Omission: missing important populations: youth not in school
