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Bioterrorism

Bioterrorism. Cherie Howk, PhD, FNP-BC Indiana State University. Terrorism VS Bioterrorism. Know the difference Ground zero vs. time delayed illness presentation Differentiated by first responders Emergency medical responders vs healthcare providers. What is Bioterrorism?.

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Bioterrorism

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  1. Bioterrorism Cherie Howk, PhD, FNP-BC Indiana State University

  2. Terrorism VS Bioterrorism • Know the difference • Ground zero vs. time delayed illness presentation • Differentiated by first responders • Emergency medical responders vs healthcare providers

  3. What is Bioterrorism? • Use of disease in a terrorist action to harm or kill an adversary's military forces, population, food, and livestock. This includes any living (or non-living) microorganism or bioactive substance that is produced by a microorganism that can be delivered by military or civilian means.

  4. History of Bioterrorism • 14th Century: Cadavers dropped into wells • 14th Century: Kaffa • 1763: Native Americans given smallpox blankets • Civil War: Animal carcasses

  5. History of Bioterrorism • 1925: Geneva Protocol • WWII: Japanese Unit 731 • 1943 US starts offensive biological program • 1969: Nixon ends BW program • 1972: Biological and Toxin Weapons Convention

  6. History of Bioterrorism • 1978: Ricin assassination in London • 1984: Contamination of salad bars in OR • 1995: Aum Shinrikyo subway attack in Tokyo • 2001: Letters containing anthrax spores

  7. Changing Goals of Terrorism • Traditional terrorists’ goals: High visibility, low casualty • Current goal of many terrorists: Mass casualties - Biological weapons are ideal From small car bombs to...

  8. Why use Biological Weapons? • Large attack area • Detection delayed • Diagnosis delayed • Ease of production

  9. Why use Biological Weapons? • Inexpensive • Knowledge easily accessed • Cold War • Equipment accessible • Safe for perpetrators

  10. Common Characteristics of Likely BT Agents • Liquid or powder • Aerosolized particles (1- 5 microns) • Line source or point source • Weather

  11. Thermal Inversions Normal Conditions:Warm air rises, disperses pollutants, cool air circulates downward Thermal Inversions:Warm air is trapped between cool air layers trapping pollutants at ground level

  12. Delivery of BT Agents • Orally • Food • Water • Aerosol

  13. CDC’s Categories for Bioterrorism Agents • Based on: • Ease of production • Availability • Ease of dissemination (stability) • Lethality • Infectivity • Category A, B, &C

  14. Category A Agents: The Threat • Bacillus anthacis (Anthrax) • Variola major (Smallpox) • Yersinia pestis (Plague) • Botulinum toxin (Botulism) • Francisella tularensis (Tularemia) • Filo and arena viruses (Viral Hemorrhagic Fevers)

  15. Epidemiological Clues • Clues from unlikely source • ER or Family Practice Clinic/Office • Intuition or “hunch” that something is not right • Will require high index of suspicion • Sometimes tips from pharmacist •  mortality,  severe morbidity, or  respiratory illnesses • Large epidemic of acutely ill patients or multiple, simultaneous epidemics

  16. Epidemiological Clues • Unusual or impossible pathogen • Prior or current threat of bioterrorism • Unexplained numbers of dead animals • Will require an astute clinician • Non-specific flu-like illness cluster(s) • High index of suspicion

  17. Recommendations • Maintain an index of suspicion • Protect thyself • Assess the patient • Decontaminate as appropriate • Establish a diagnosis • Render prompt therapy • Practice good infection control • Assist in epidemiologic investigation • Maintain proficiency

  18. Epidemiological Clues Key: Look for change or trend in your population baseline When you hear hoof beats, think of a horse, but don’t rule out a zebra

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