Bioterrorism Awareness: Protection of Human and Animal Health

1. Bioterrorism Awareness:Protection of Human and Animal Health General Public

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

5. 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

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

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

8. Clues Suggesting Biological Agent Release • Clustering of morbidity or mortality • In time and space • Large numbers of animals and/or people • Symptoms that are not typical • 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

9. Many Agents are Zoonotic • Zoonotic means disease can be transmitted from animals to humans • 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

10. 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

11. Routes of Transmission • Direct contact • Gel, liquid, powder • Scratches • Droplet spray onto mucous membranes • Indirect contact: ingestion, injection • Contaminated food, water • Vector • Aerosol 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 Center for Food Security and Public Health Iowa State University 2005

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

14. U.S. Agencies Dealing with terrorism

15. 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

16. 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

17. 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 first agencies to respond to anthrax incidents Center for Food Security and Public Health Iowa State University 2005

18. 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

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

20. 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

21. 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

22. Category ABC Agent Overview

23. 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

24. 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 that disease’s specific presentation. Center for Food Security and Public Health Iowa State University 2005

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

26. Anthrax • Bacteria: Bacillus anthracis • Forms spores • Human disease • Skin • Intestinal • Inhalation • Animal disease • Spreads through the body system; rapid death Center for Food Security and Public Health Iowa State University 2005

27. Botulism • Clostridium botulinum: A bacteria that produces different toxins • Affects the nervous system • Clinical signs • Generalized weakness • Pigs, dogs, and cats fairly resistant Center for Food Security and Public Health Iowa State University 2005

28. Plague • Bacteria: Yersinia pestis • Transmission: Fleabites, aerosol, direct contact • Symptoms: Humans • Enlarged lymph nodes, blood infection, respiratory • Symptoms: Animals • Cat: Similar to human • Dogs, livestock: Somewhat resistant Center for Food Security and Public Health Iowa State University 2005

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

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

31. Tularemia • 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

32. Viral Hemorrhagic Fevers • Early: Fever, fatigue • Severe: Bleed from internal organs, body openings • Progression to shock and 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

33. Brucellosis Glanders 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

34. Brucellosis • Bacteria: Brucella spp. • 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

35. Glanders • Bacteria: Burkholderia mallei • Transmission by ingestion, inhalation or direct contact • Animal-to-human transmission is inefficient • Clinical signs • Humans & horses: Skin and lung lesions, rapidly fatal illness Center for Food Security and Public Health Iowa State University 2005

36. Psittacosis • Bacteria: Chlamydophila psittaci • Occurs worldwide • Reportable in U.S. • Clinical disease • Humans and birds: Ranges from no symptoms to systemic illness with severe pneumonia Center for Food Security and Public Health Iowa State University 2005

37. Q Fever • Coxiella burnetii • Transmission: Inhalation, direct contact, ingestion, ticks • Disease symptoms • Humans: • Acute: Flu-like, pneumonia & liver disease • Chronic: Heart complications, bone inflammation • Animals: Most have no signs • Sheep, cattle and goats: Abortions Center for Food Security and Public Health Iowa State University 2005

38. Typhus Fever • Transmitted in feces of human body louse • Clinical signs: Humans • Fever, headache, red blotches, and a red-dot rash • Not seen in domestic animals • Rickettsia prowazekii • Endemic in Eastern Europe, Middle East, and parts of Africa J. Kalisch Center for Food Security and Public Health Iowa State University 2005

39. Viral Encephalitis • Viruses causing EEE, WEE and VEE • Transmitted via mosquito • Clinical signs • Birds do not become ill but are carriers; act as sentinels • Humans, horses, donkeys, mules: Often no signs or flu-like illness • Brain inflammation in some patients Center for Food Security and Public Health Iowa State University 2005

40. Food Safety Threats • Campylobacter species • Salmonella species • E. coli 0157:H7 • Viruses, parasites, chemicals, toxins • Ingestion of contaminated food • Gastrointestinal upset Center for Food Security and Public Health Iowa State University 2005

41. Food Safety Threats: The Bioweapon • 1984, The Dalles, Oregon • Bagwan Shree Rajneesh cult • Contaminated salad bars • Salmonella typhimurium • Goal: incapacitate voters • 751 people ill Center for Food Security and Public Health Iowa State University 2005

42. Water Safety Threats • 53% of US drinking water is from ground water • Cryptosporidium parvum- protozoa • Vibrio cholerae- bacteria Center for Food Security and Public Health Iowa State University 2005

43. Cryptosporidium • Cryptosporidium parvum- protozoa • Transmission: Inhalation, ingestion • Clinical signs: Humans, calves, others • Acute gastroenteritis • Dogs, cats, horses, pigs: Resistant Center for Food Security and Public Health Iowa State University 2005

44. Vibrio cholerae • Vibrio cholerae- bacteria • Transmission: Fecal-oral, contaminated shellfish • Clinical signs in humans • Acute, mild diarrhea • 5% severe disease • Animals are resistant to disease Center for Food Security and Public Health Iowa State University 2005

45. Water Safety: Public Health Significance • Cryptosporidum parvum • 1993: Municipal water supply contaminated in Milwaukee • 40,000 ill • 1997: Decorative water fountain at the Minnesota Zoo • 369 cases • Mostly young children Center for Food Security and Public Health Iowa State University 2005

46. Category C • Nipah virus • Hantavirus Center for Food Security and Public Health Iowa State University 2005

47. Nipah Virus • Paramyxovirus • Fruit bat reservoir • Clinical signs • Humans: Encephalitis • Pigs: Respiratory, neurological • Dogs and cats: “Distemper” Center for Food Security and Public Health Iowa State University 2005

48. Hantavirus • Asymptomatic reservoir: Rodents • Transmission: Inhalation, ingestion, direct contact • Human clinical signs • Fever, muscle pain, headache • Hantavirus Pulmonary Syndrome • Hemorrhagic Fever with Renal Syndrome • Not seen in domestic animals Center for Food Security and Public Health Iowa State University 2005

49. Other Important Zoonotic Diseases • Transmissible Spongiform Encephalopathies • West Nile Virus • Monkeypox Center for Food Security and Public Health Iowa State University 2005

50. Transmissible Spongiform Encephalopathy • Prions are mutated proteins thought to cause disease • Very long incubation period • Neurological signs in all species • Invariably fatal • No treatment available Center for Food Security and Public Health Iowa State University 2005