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Bioterrorism: The Public Health perspective

Bioterrorism: The Public Health perspective. Paul Le Guerrier, M.D. Outline 1) History 2) Why bother ? 3) Which biological agent ? 4) Who is expected to participate ? 5) What is your role in all this ?. Definitions. Biological warfare: The use of microorganisms or toxins

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Bioterrorism: The Public Health perspective

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  1. Bioterrorism: The Public Health perspective Paul Le Guerrier, M.D.

  2. Outline 1) History 2) Why bother ? 3) Which biological agent ? 4) Who is expected to participate ? 5) What is your role in all this ?

  3. Definitions Biological warfare: The use of microorganisms or toxins derived from living organisms to produce death or disease in humans, animals or plants. Usually reserved for war between nations Bioterrorism: The use of microorganisms or toxins derived from living organisms to produce death or disease and terror or anxiety in humans

  4. History • Early attempts • WW 1 which lead to the 1925 Geneva protocol • Japan and the 731 unit • WW 2 Germany vs The Allies • US program • The Russian program • 1969 Nixon (national security decision 35) BA • 1970 Nixon (national security decision 44) toxins • 1972 Convention on the Prohibition of the • Development,Production and Stockpiling of • Bacteriological and Toxin weapons and their destruction

  5. History • 1978 Markov assasination • The sverdlosvsk anthrax outbreak of 1979 • The Iraqi program • The 1984 salmonella outbreak in The Dalles • Aum Shinrikyo • The US anthrax outbreak • Al Quaeda (ricin in England, January 2003)

  6. History The first successful use of biological weapons in the US was by the Bhagwan Shree Rajneesh cult in 1984. The group contaminated salad bars in 10 restaurants in The Dalles, Ore., with Salmonella Typhimurium, causing 751 people to become ill

  7. History The second successful use of BW in the US

  8. History

  9. History • Biological weapons characterized by: • low visibility, • high potency, • substancial accessibility • relatively easy delivery • There are people out there ready to use them

  10. Why bother ? 1) The threat is low but real

  11. Relation entre la probabilité d’un événement et le nombre de victimes Canulars Probabilité del’événement Actes de bioterrorisme de faible ampleur Actes de bioterrorisme de grande ampleur Nombre de victimes

  12. Why bother ? 1) The threat is low but real 2) Public Health has a legal mandate 3) Cost/benefit studies

  13. Why bother ? 1) The threat is low but real 2) Public Health has a legal mandate 3) Cost/benefit studies 4) If an act of bioterrorism occurs, the response will be difficult 5) There are benefits: May help us respond to new epidemics or out of the ordinary infectious emergencies

  14. Which biological agent ? • 3 ways to identy which biological agent • would be used by a terrorist : • 1) Look at what was developped; • 2) Assess our vulnerability; • 3) Do a risk assessment.

  15. Which biological agent ? • Look at what was developped • 1)World Health organisation report (1970) • 2) NATO report • 3) US program • 4) Russian program • 5) Iraqui program

  16. Which biological agent ? • Assess our vulnerability • CDC + • John Hopkins Center for Civilian biodefense • 4 criteria: • Impact on health/ infectivity • Required competence • Importance of the Public Health response • Public’s reaction/perception • Groupes A, B, C

  17. Which biological agent ?CDC ’s list • Group A agents »Anthrax (Bacillus anthracis) »Botulism (Clostridium botulinum toxin) »Plague (Yersinia pestis) »Smallpox (variola major) »Tularemia(Francisella tularensis) »Viral hemorrhagic fevers (filoviruses [e.g., Ebola, Marburg] and arenaviruses [e.g., Lassa, Machupo])

  18. Which biological agent ?CDC ’s list • Category A Diseases/Agents • The public health system and primary healthcare • providers must be prepared to address these • agents because they: • can be easily disseminated or transmitted from person to person; • result in high mortality rates and have the potential for major public health impact; • might cause public panic and social disruption; and • require special action for public health preparedness.

  19. Which biological agent ?CDC ’s list • Group B agents • »Brucellosis(Brucella species) • » Epsilon toxin of Clostridium perfringens • »Food safety threats • (e.g., Salmonella species, E coli O157:H7, Shigella) • »Glanders (Burkholderia mallei) • » Melioidosis (Burkholderia pseudomallei) • » Psittacosis (Chlamydia psittaci) • »Q fever (Coxiella burnetii)

  20. Which biological agent ?CDC ’s list • Group B agents • »Ricin toxin from Ricinus communis • » Staphylococcal enterotoxin B • » Typhus fever (Rickettsia prowazekii) • » Viral encephalitis • (alphaviruses [e.g., VEE, EEE,WEE]) • » Water safety threats (e.g., Vibrio cholerae, • Cryptosporidium parvum)

  21. Which biological agent ? • Category B Diseases/Agents • Second highest priority agents include those that: • are moderately easy to disseminate; • result in moderate morbidity rates and low mortality rates; and • require specific enhancements of national diagnostic capacity and enhanced disease surveillance

  22. Which biological agent ?CDC ’s list Group C agents Emerging pathogens

  23. Which biological agent ? Do a risk assessment 1) Souches d’ensemensement 2) Culture microbienne +++ 3) Purification 4) Lyophilisation (séchage à froid) 5) Élimination de la charge statique 6) Pulvérisation 7) Stabilisation 8) Stockage 9) Mécanisme de dispersion

  24. Which biological agent ? • Le charbon: • Difficulté d’obtenir des souches pathogènes • Spores sont très stables et résistantes • Le bacille de la peste: • Très difficile d’obtenir des • souches pathogènes • Difficile de produire une arme efficace, • la bactérie résiste mal aux UV et à la chaleur

  25. Which biological agent ? • Le bacille de la tularémie: • Difficulté d’obtenir des souches pathogéniques • Résiste au froid et non à la chaleur • Les toxines botuliniques: • Très difficile d’obtenir des souches qui soient • hautement productrices de toxines • Stable • Pas considérées comme une arme de • destruction massive

  26. Which biological agent ? • Les FHV: • Difficulté d’obtenir des souches • virales et de les manipuler • relativement instable • Le virus de la variole: • Très difficile d’obtenir des souches • Difficile de produire une arme efficace • Le virus est très stable dans l’environnement

  27. Which biological agent ? • Routes of exposure • By inhalation • By ingestion • By cutaneaous exposition • By using a vector • By the subcutaneous route

  28. Which biological agent ? The targets Difficulté +++ de produire de grands aérosols • Par conséquent, les terroristes viseraient des • petites cibles • Établissements • Stades • Réseau de transport - gares, aéroports • (métro de Montréal cible de choix !) • Lieux de rassemblement extérieurs

  29. Which biological agent ? • The likliest perpetrators (J Stern, EID vol.5, no4 1999) • Religious and extreme right-wing groups • Groups seeking revenge who view secular rulers • and the law they uphold as illegitimate • They are unconstrained by fear of goverment or • public backlash, since their actions are carried • out to please God or themselves.

  30. Les deux scénarios 1) Les actes annoncés Law enforcement leads 2) Les actes non annoncés Public Health leads

  31. Who is expected to participate ? 4 levels : Local Provincial National International

  32. Who is expected to participate ? The local level

  33. Rôle de la santé publique(Maladies infectieuses) Notre expertise: 1. Évaluation du risque lié au mode de transmission des agents biologiques (enquête épidémiologique). 2. Prise en charge des personnes exposées (pas les blessés).

  34. Rôle de la santé publique(Maladies infectieuses) • Informe les intervenants, les décideurs et le public sur les mesures à prendre pour se protéger. • Évalue la pertinence d’un suivi • clinique et épidémiologique.

  35. Événement à Saint-Léonard • Appel au 911 • Enquête policière • Conférence téléphonique CAAM

  36. Événement à Saint-Léonard

  37. Événement à Saint-Léonard • Prises en charge des lieux SPVM • Évacuation • Délimitation des zones • Les personnes exposées ont du • se laver les mains

  38. Événement à Saint-Léonard

  39. Événement à Saint-Léonard • Armorcé une enquête : • auprès des personnes exposées • auprès des lieux • ( bâtiment, ventilation chauffage, • machineries, etc) • Identifié les personnes : • exposées; • potentiellement exposées; • non exposées.

  40. Événement à Saint-Léonard • Offert une protection post-exposition • aux personnes exposées. • Noté le noms des • personnes potentiellement exposées. • Renseigné et répondu aux questions.

  41. Événement à Saint-Léonard

  42. Événement à Saint-Léonard • Prélèvement d’un échantillon par • un policier de l’équipe technique • (avec l’aide de l’unité d’intervention • des produits chimiques • Décontamination partielle des lieux

  43. Événementà Saint-Léonard

  44. Événementà Saint-Léonard • Fermeture des lieux • (Assurer par les policiers) • Réouverture des lieux lorsque les • analyses se sont révélées négatives • (Aviser les responsables des compagnies, aviser les personnes exposées de cesser leur médication)

  45. Who is expected to participate ? The provincial level Régie régionale

  46. Who is expected to participate ? The federal level

  47. Office of Emergency preparedness, planning and training • Office of public health security • Office of laboratory security • Office of emergency services • Office of the Executive Director

  48. What is your role ? Law enf. P.H. Medical Deterence of bioterrorism X Surveillance of unusual outbreaks X Law enforcement response X Public Health response X Medical response X Research and development X X X

  49. What is your role ? • Get to know these possible BWA • How to recognize them • How to treat them • Be suspicious • Call Public Health • Could be part of mobilized teams

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