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Rational Strategies

Rational Strategies. Interventions of choice Economic, social and other non-medical countermeasures Interventions of last resort Medical countermeasures. Major Components of Detection and Intervention. Monitor, detect and identify agents. Population surveillance (human, animal, plant).

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Rational Strategies

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  1. Rational Strategies • Interventions of choice Economic, social and other non-medical countermeasures • Interventions of last resort Medical countermeasures

  2. Major Components of Detection and Intervention Monitor, detect and identify agents Population surveillance (human, animal, plant) Intervention and stabilization Decontamination, Remediation and Restoration

  3. Detection and Identification Forensics Molecular Microscopic Macroscopic • Sensitive • Specific • Timely

  4. Population Surveillance • Syndromic surveillance • Sentinel diagnosis and/or laboratory tests

  5. Timeline Bacterial and Urgent viral agents Biological toxins Chemical Agents Even more urgent 

  6. Intervention and Stabilization First Responders Medical Countermeasures Meaningful Policies Anticipatory and Reactive Anticipatory and Reactive Reactive

  7. Medical Countermeasures ExtracorporealIntracorporeal Restrict movement Vaccination Quarantine Therapeutic anti- bodies Small molecular weight inhibitors

  8. Meaningful Policy • Timely and flexible • Authentically implementable • Responsive to target population • Sensitive to risk-to-benefit ratio • Designed with adequate capacity • Incorporates data acquisition and means testing

  9. Encompassing Policy • Disciplines and specialties • Cultures and ethnic groups • Regions and nations

  10. Select Agents, Category A • Bacillus anthracis (Anthrax) • Clostridium botulinum neurotoxins (Botulism) • Yersinia pestis (Plague) • Variola major (Smallpox) and related viruses • Francisella tularensis (Tularemia) • Viral hemorrhagic fevers (Lassa Fever, Rift Valley Fever, Dengue, Ebola)

  11. Major Steps in Botulinum Toxin Action Transport Cell Target Cell

  12. Unique Properties of Botulinum Toxin • Most poisonous of all poisons • Not infectious (in traditional sense) • Exists in multiple, serologically distinct types • May not have to be weaponized • Does not produce cell death, but does produce organism death • Potentially long duration of action • Used as therapeutic agent (e.g., drug choice for certain dystonias)

  13. Major Components of Detection and Intervention Monitor, detect and identify agents Population surveillance (human, animal, plant) Intervention and stabilization Decontamination, Remediation and Restoration

  14. Monitor, Detect and Identify • There are seven serotypes of botulinum toxin. • For those serotypes of greatest human concern (A, B and E), there is no cross immunity. • For those serotypes of greatest human concern, there may be numerous subtypes.

  15. Population Surveillance • Syndromic surveillance • Sentinel diagnosis and/or laboratory tests

  16. Identifying Target Populations • Anticipatory population, no current incident • “Walking Well”, periphery of incident • Exposed population, victims of incident

  17. Fundamental Principlesof Intervention Requires minimum need for triage Requires minimum utilization of human resources and facilities Risk-to-benefit ratio should be: a. Acceptable for non-exposed persons b. Desirable for exposed persons

  18. Minimum Need For Triage • For most patients, presentation of signs and symptoms will be first indication of exposure. • When signs and symptoms emerge, patient “rescue” may already be seriously compromised.

  19. MINIMUM UTILIZATION OF RESOURCES • Not practical for seriously ill patients • Must “import” respiratory intensive care personnel and facilities. • Must “export” certain classes of patients.

  20. Risk-to-Benefit Ratio • Data for toxoid and therapeutic antibody. • Risk-to-benefit ratio is not desirable. a. Normal population. b. Dystonia population.

  21. Meaningful Policy • Timely and flexible • Authentically implementable • Responsive to target population • Sensitive to risk-to-benefit ratio • Designed with adequate capacity • Incorporates data acquisition and means testing

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