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Bioterrorism Agents: Plague

Bioterrorism Agents: Plague. Lesson 1 Introduction and Overview. Objectives. Identify plague bacterium Epidemiology Natural Occurrence. Bio-Terror Threat. Plague can cause large numbers of cases Could create panic Considered for use since 14 th century. Clinical Syndromes. Bubonic

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Bioterrorism Agents: Plague

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  1. Bioterrorism Agents: Plague Lesson 1 Introduction and Overview

  2. Objectives • Identify plague bacterium • Epidemiology • Natural Occurrence

  3. Bio-Terror Threat • Plague can cause large numbers of cases • Could create panic • Considered for use since 14th century

  4. Clinical Syndromes • Bubonic • Pneumonic • Septicemic • Plague Meningitis • Pharyngeal “Safety Pin” Y. Pestis in blood

  5. Bubonic Plague • Infected flea bite • Exposure through break in skin • No person-to-person • Untreated progresses to pneumonic

  6. Pneumonic Plague • Inhalation of plague bacteria • Disease progression • Respiratory failure • Shock • Rapid death • Person-to-person transmission

  7. Septicemic Plague • Primary Form • Direct inoculation in bloodstream • Secondary Form • Development of untreated pneumonic or bubonic plague

  8. EpidemiologyNatural Reservoirs • Bites of infected flea • Most common – Oropsylla montana • Blood meal from bacteremic animal • Regurgitates into human/ animal host • Common reservoirs • Deer mice • Ground squirrels

  9. EpidemiologyTransmission • Bite of infected flea • Respiratory droplets • Direct contact (6 feet) • Direct skin/mucous membrane less common • BT event – Respiratory droplets or aerosols

  10. Plague IncidenceUnited States,1970-2003 • Endemic to US • Bubonic Most Common • 83% Bubonic • 2% Primary Pneumonic • 15% Septicemic • 5 to 15 cases per year • Greatest Concentrations • Arizona, Colorado, New Mexico, Utah

  11. Plague Case Fatality RatesUnited States, 1970 - 1977 • In US, 14% died • Untreated – 50 to 90% • Treated – 15% • Deaths mostly from delays in diagnosis and treatment

  12. Plague IncidenceWorldwide, 1970 - 1998 • All inhabited continents, but Australia • 1,500 to 3,000 cases annually • Greatest Concentrations • Asia, South America

  13. Plague Bioterrorism Scenario • Most dangerous as aerosol • Outbreak of pneumonic • Possibly pharyngeal or ocular • Report all suspect cases to public health immediately

  14. Review Questions – PlagueLesson 1 Overview

  15. Plague Review QuestionsLesson 1, Question 1 • Santa Fe, New Mexico hospital • Treating suspect plague case • Hearing of more cases in area When do you start to worry about bioterrorism?

  16. Plague Review QuestionsLesson 1, Question 1 When do you start worrying about bioterrorism? • Unrelated clusters • Unusual rise in cases • Both of the above • None of the above

  17. Plague Review QuestionsLesson 1, Question 1 When do you start worrying about bioterrorism? Answer - C. Both of the above • Unrelated clusters • Unusual rise in cases

  18. Plague Review QuestionsLesson 1, Question 2 • Abnormally large, tender lymph node • Right arm • Lab specimen for preliminary testing What organism causes plague?

  19. Plague Review QuestionsLesson 1, Question 2 What organism causes plague? • B. anthracis • C. botulinum • C. burnetii • Y. pestis

  20. Plague Review QuestionsLesson 1, Question 2 What organism causes plague? D. Y. pestis

  21. Plague Review QuestionsLesson 1, Question 3 • New Hampshire hospital • Labs – Unable to rule out plague • Recent US travel Where in the US would you expect the patient to get plague?

  22. Plague Review QuestionsLesson 1, Question 3 Where in the US would you expect the patient to get plague? • Western US, Southwest • Eastern US, Southeast • Northern US, Northeast • Southern US, Southwest

  23. Plague Review QuestionsLesson 1, Question 3 Where in the US would you expect the patient to get plague? A. Western US, Southwest

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