Bioterrorism Awareness: Protection of Human and Animal Health

1. Bioterrorism Awareness:Protection of Human and Animal Health Companion animal veterinarians

2. Why Are We Here? • September 11, 2001 changed many things • Worst terrorist act in U.S. history • More than 3,000 presumed dead • Occurred on American soil • Increased sense of vulnerability Center for Food Security and Public Health Iowa State University 2005

3. Biological Attack • Bioterrorism attacks of 2001 • Anthrax in postal system • 22 cases • 5 deaths • U.S. public health realm changed forever Center for Food Security and Public Health Iowa State University 2005

4. Preparedness Responsibilities: Veterinarians • Anticipate outbreaks on the local level • Collect and label samples • Know the agents • Know the typical signs of diseases • Animals and human • Know how to report suspected cases • Disseminate knowledge Center for Food Security and Public Health Iowa State University 2005

5. Overview • Bioterrorism • Zoonoses and bioterrorism • Disease control and biosecurity • U.S. Government agencies involved • Bioterrorism agents/diseases • Your role and responsibility Center for Food Security and Public Health Iowa State University 2005

6. Agroterrorism Bioterrorism Other Terrorism • Biological, chemical, or radiological agents targeting agriculture or its components • Livestock • Food supply • Crops • Industry • Workers • Conventional, radiological, nuclear, chemical,cyber • Typically direct human targeting Biological agents targeting humans, animals, or plants Center for Food Security and Public Health Iowa State University 2005

7. Characteristics of a Biological Attack • Difficult to detect release • Dissemination may cover large area • Possible secondary spread • Recognition of agent may be delayed days to weeks • Difficulties in catching perpetrator Center for Food Security and Public Health Iowa State University 2005

8. Exposure Symptoms Seek Care No. Affected Infectious Disease Outbreak Time (Days) Center for Food Security and Public Health Iowa State University 2005

9. Clues Suggesting Biological Agent Release • Clustering of morbidity or mortality • Temporally or geographically • Large numbers of animals and/or people • Atypical symptoms • Normally healthy people affected • Unusual symptoms for area • Unusual age distribution • Disease occurring outside typical season Center for Food Security and Public Health Iowa State University 2005

10. Many Agents are Zoonotic • Disease may be seen in animals before humans • Animals are sentinels • Pets, livestock, wildlife Center for Food Security and Public Health Iowa State University 2005

11. Factors That Promote Transmission of Zoonoses • Frequent contact with domestic or wild animals • Overlap with wildlife habitat • Intensive livestock production • Poor animal sanitation • Poor personal hygiene • Poor animal health Center for Food Security and Public Health Iowa State University 2005

12. Disinfect/clean up areas contaminated with animal waste Livestock, pets, wildlife, rodents Basic hygiene Wash hands Child supervision Disease Control: Client Education Center for Food Security and Public Health Iowa State University 2005

13. Zoonoses Control:Client Education • Proper pet selection • Use caution at petting zoos • Cook food properly • Control strays • Communication with physician and veterinarian • Follow guidelines for immunocompromised people Center for Food Security and Public Health Iowa State University 2005

14. Disease Control: Veterinarians • Restrict animal movement, contact in hospital • Appropriate disinfection of hands, exam, waiting rooms, surgical suites • Regularly disinfect animal holding areas and adequately ventilate • Designated isolation area with posted protocols Center for Food Security and Public Health Iowa State University 2005

15. U.S. Agencies Dealing with terrorism

16. Public Health Security and Bioterrorism Preparedness Response Act of 2002 • June 12, 2002 • Improve ability of the U.S. to prevent, prepare for, and respond to bioterrorism and other public health emergencies • $4.3 billion to various federal, state and local agencies • Upgrade facilities, enhance security, etc Center for Food Security and Public Health Iowa State University 2005

17. Department of Homeland Security (DHS) • Established January, 2003 • Mission • Prevent, protect, and respond to acts of terrorism on U.S. soil • Established four policy directorates • Responsibilities for coordinating HHS and USDA • Guard borders and airports, coordinate the response for future emergencies, analyze threats and intelligence, protect our critical infrastructure Center for Food Security and Public Health Iowa State University 2005

18. Centers for Disease Control and Prevention • CDC's Mission • Promote health and quality of life by preventing and controlling disease, injury, and disability • Preparing for bioterrorism since 1998 • One of the first agencies to respond to anthrax incidents of 2001 Center for Food Security and Public Health Iowa State University 2005

19. Strategic National Stockpile • 12-hour Push Package • Complete package of medical materials • Vendor Managed Inventory • Tailored to suspected agents Center for Food Security and Public Health Iowa State University 2005

20. Insert Your State’s Info Here Center for Food Security and Public Health Iowa State University 2005

21. Preparing Iowa • Iowa’s Homeland Security • Administered by Iowa Emergency Management Division • Works with public and private partners www.iowahomelandsecurity.org Center for Food Security and Public Health Iowa State University 2005

22. Preparing Iowa • Iowa Department of Public Health www.idph.state.ia.us/odedp • Iowa Department of Agriculture and Land Stewardship • Highly infectious animal disease program • IRVIN: Iowa Rapid Veterinary Information Network • CFSPH training veterinarians to educate others Center for Food Security and Public Health Iowa State University 2005

23. Category ABC Agent Overview

24. Classification • Prepared by the CDC’s Bioterrorism Preparedness and Response Office • Category A: Highest priority • Category B: Second highest priority • Category C: Third highest priority Center for Food Security and Public Health Iowa State University 2005

25. “Weaponization” of Agents • Alter characteristics of a pathogen to make it a more effective weapon • Enhance transmission • Increase virulence • Resistant to antibiotics • Evade vaccine protection • Alter clinical signs Center for Food Security and Public Health Iowa State University 2005

26. Note to presenter • As time allows select diseases you would like to review. • If you have limited time you should focus on the Category A agents. • The disease coverage is brief. If you would like more information on a disease, refer to the fact sheet or to the disease specific presentation. Center for Food Security and Public Health Iowa State University 2005

27. Category A : Agents/Diseases • Anthrax • Botulism • Plague • Smallpox • Tularemia • Viral hemorrhagic fevers Center for Food Security and Public Health Iowa State University 2005

28. Anthrax: The Agent • Bacteria: Bacillus anthracis • Forms spores • Human disease • Skin • Intestinal • Pulmonary • Animal disease • Septicemia and rapid death Center for Food Security and Public Health Iowa State University 2005

29. Anthrax: The Bioweapon • History • Available & easily produced • Spores infective • Aerosolization • Low lethal dose • High mortality • Person-to-person transmission rare Center for Food Security and Public Health Iowa State University 2005

30. Anthrax: The Response • Vaccine • Humans • Animals • Antibiotics • Treatment • Prophylaxis • Disinfection • Sporicidal agents, sterilization Center for Food Security and Public Health Iowa State University 2005

31. Botulism: The Agent • Clostridium botulinum – Gram pos, spore-forming bacteria • 7 different neurotoxins • Types A-G • Clinical signs • Flaccid paralysis • Pigs, dogs, and cats fairly resistant Center for Food Security and Public Health Iowa State University 2005

32. Botulism: The Bioweapon • Used by Aum Shinrikyo cult in Japan • Aerosolized • Easy to produce and transport • Potent and lethal • Most poisonous substance known Center for Food Security and Public Health Iowa State University 2005

33. Botulism: The Response • Toxoids for high risk people • Antitoxin available • Case-by-case basis • Botulinum toxins are easily inactivated with many disinfectants and heat Center for Food Security and Public Health Iowa State University 2005

34. Plague: The Agent • Yersinia pestis • Gram neg, transmitted by fleabites, aerosol, direct contact • Symptoms: Humans • Bubonic, septicemic, pneumonic • Symptoms: Animals • Cat: Similar to human • Dogs, livestock: Somewhat resistant Center for Food Security and Public Health Iowa State University 2005

35. Plague: The Bioweapon • WHO estimate • 50kg agent: City population 5 million • 150,000 cases pneumonic plague • Potential mortality: 100,000 • Available • Person-to-person transmission • Pneumonic form ~ 100% fatal if untreated Center for Food Security and Public Health Iowa State University 2005

36. Plague: The Response • Antibiotics generally effective if given early • Killed vaccine available • Isolation of sick individuals • Susceptible to a number of common disinfectants Center for Food Security and Public Health Iowa State University 2005

37. Smallpox: The Agent • Variola virus, Orthopoxvirus • Eradicated from the world in 1977 • Narrow host range: Humans only • Transmission: Person-to-person, fomites, aerosols • Clinical signs • Flu-like, progressive skin eruptions Center for Food Security and Public Health Iowa State University 2005

38. Smallpox: The Bioweapon • Used historically • Disease signals a bioterrorism event • Susceptible population • Easy to produce large scale • Aerosolization • Secondary spread • Person-to-person • Fomites • Mortality approximately 30% Center for Food Security and Public Health Iowa State University 2005

39. Smallpox: The Response • No specific treatment • Vaccinia virus vaccination • Vaccinia Immune Globulin • Isolation of infected individuals • Ring vaccination program • Disinfection of environment, clothing with various chemicals, boiling or autoclaving Center for Food Security and Public Health Iowa State University 2005

40. Tularemia: The Agent • Francisella tularensis • Transmitted by ingestion, inhalation, vectors, direct contact through skin • Six clinical forms in humans Glandular Ulceroglandular Center for Food Security and Public Health Iowa State University 2005

41. Tularemia: The Agent • Sheep, young pigs, horses, dogs, cats • Sudden fever, lethargy, stiffness, prostration, and death • Wildlife • Usually find dead • Rabbits behave strangely • Cattle, older pigs resistant Center for Food Security and Public Health Iowa State University 2005

42. Tularemia: The Bioweapon • Stable • Aerosolized • Low infective dose via inhalation • Case fatality: 30-60% (untreated ) • WHO estimation: 1970 • 50 kg agent: City population 5 million • 250,000 ill • 19,000 deaths Center for Food Security and Public Health Iowa State University 2005

43. Tularemia: The Response • Person-to-person transmission not documented • Antibiotics effective if early or prophylactic • Vaccine • For high risk individuals • Unknown efficacy against inhalational tularemia Center for Food Security and Public Health Iowa State University 2005

44. Viral Hemorrhagic Fevers:The Agents • Early: Fever, fatigue • Severe: Bleed from internal organs, body orifices • Progression to shock & seizures • Animals: Only non-human primates susceptible • Ebola, Marburg, Lassa, Machupo • Human clinical presentation Vincent Massey Center for Food Security and Public Health Iowa State University 2005

45. VHF: The Bioweapons • Aerosolized • Not readily available, require specialized production • Person-to-person and nosocomial transmission occur • Untreated fatality rate variable • Humans: 25-90% • Non-human primates: 50-100% Center for Food Security and Public Health Iowa State University 2005

46. VHF: The Response • Intensive supportive care • Ribavirin has shown some efficacy • Susceptible to bleach solutions, phenolic disinfectants, and UV light Center for Food Security and Public Health Iowa State University 2005

47. Brucellosis Glanders Melioidosis Psittacosis Q Fever Typhus fever Viral encephalitis Toxins Food Safety Threats Water Safety Threats Category B: Agents/Diseases Center for Food Security and Public Health Iowa State University 2005

48. Brucellosis: The Agent • Gram-negative bacteria • Ingestion, inhalation, or direct contact • Clinical signs • Humans: Cyclic fever and flu-like symptoms • Animals: Reproductive signs Center for Food Security and Public Health Iowa State University 2005

49. Brucellosis: The Agent Center for Food Security and Public Health Iowa State University 2005

50. Brucellosis: The Bioweapon • History • Highly infectious • Easily aerosolized • Stable • Prolonged incubation period • May make diagnosis difficult • Person-to-person unlikely Center for Food Security and Public Health Iowa State University 2005