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Dr.T.V.Rao MD BIOTERRORISM HEALTH PREPAREDNESS DR.T.V.RAO MD 1.

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Presentation on theme: "Dr.T.V.Rao MD BIOTERRORISM HEALTH PREPAREDNESS DR.T.V.RAO MD 1."— Presentation transcript:

1 Dr.T.V.Rao MD BIOTERRORISM HEALTH PREPAREDNESS DR.T.V.RAO MD 1

2 2 Definition of Bioterrorism "Bioterrorism” - The unlawful use, or threatened use, of microorganisms or toxins derived from living organisms to produce death or disease in humans, animals, or plants. The act is intended to create fear and intimidate governments or societies in the pursuit of political, religious, or ideological goals. Note: There is no single, universally accepted definition of bioterrorism. DR.T.V.RAO MD

3 HISTORY OF BIOLOGICAL WARFARE 1346Siege of Kaffa; plague 1346Siege of Kaffa; plague 1763French and Indian War; smallpox 1763French and Indian War; smallpox WW IGerman program; anthrax, glanders WW IGerman program; anthrax, glanders 1925Geneva protocol bans biological weapons 1925Geneva protocol bans biological weapons WW IIJapanese program; anthrax, plague, cholera, shigella WW IIJapanese program; anthrax, plague, cholera, shigella DR.T.V.RAO MD 3

4 HISTORY OF BIOLOGICAL WARFARE (CONT.) 1941George W. Merck named U.S. civilian head of Chemical Warfare Service later changed to War ResearcService 1946 U.S. announces its involvement in bioweapons research 1969 Nixon eliminates offensive biological warfare program DR.T.V.RAO MD 4

5 1972Biological Weapons Convention 1979Accidental release of B. anthracis spores at bioweapon research center, Sverdlovsk, U.S.S.R Scientists from the former U.S.S.R. involved in biological weapons research defect to the West History of Biological Warfare (cont.) DR.T.V.RAO MD 5

6 Domestic Biological Terrorism 1984Rajneesh cult members contaminate salad bar with Salmonella typhimurium in Oregon 1984Rajneesh cult members contaminate salad bar with Salmonella typhimurium in Oregon 1992Ricin attack planned by Minnesota militia 1992Ricin attack planned by Minnesota militia 2001 Anthrax releases in FL, DC, NY, NJ 2001 Anthrax releases in FL, DC, NY, NJ DR.T.V.RAO MD 6

7 The use of biological agents to intentionally produce illness or intoxication in a susceptible population BIOLOGICAL TERRORISM DR.T.V.RAO MD 7

8 BIOLOGICAL AGENTS RANKING SYSTEM Public Health impact criteria based on: Morbidity and mortality Delivery potential Public perception (fear, civil disruption) Public health preparedness needs DR.T.V.RAO MD 8

9 CDC SELECT AGENTS* – BACTERIA Bacillus anthracis (spores) Brucella abortus Brucella melitensis Brucella suis Burkholderia mallei (aka Pseudomonas mallei) Burkholderia pseudomallei (aka Pseudomonas pseudomallei) Clostridium (botulinum- producing species) Coxiella burnetii Francisella tularensis Rickettsia prowazekii Rickettsia rickettsii Yersinia pestis n = 12 * Not including agents only on USDA lists. DR.T.V.RAO MD 9

10 CDC Select Agents* – Fungi Coccidioides immitis Coccidioides posadasii n = 2 * Not including agents only on USDA lists. DR.T.V.RAO MD 10

11 CDC Select Agents* – Viruses I Central European Tick-borne encephalitis Cercopithecine herpesvirus 1 Crimean-Congo haemorrhagic fever Eastern Equine encephalitis Ebola Far Eastern Tick-borne encephalitis Flexal South American haemorrhagic fever Guanarito South American haemorrhagic fever Hendra Junin South American haemorrhagic fever Kyasanur Forest disease Lassa fever Marburg * Not including agents only on USDA lists. DR.T.V.RAO MD 11

12 CDC Select Agents* – Viruses II Machupo South American haemorrhagic fever Monkeypox Nipah Omsk haemorrhagic fever Reconstructed 1918 influenza Rift Valley fever Russian Spring and Summer encephalitis Sabia South American haemorrhagic fever Variola major (smallpox) Variola minor (alastrim) Venezuelan Equine encephalitis n = 24 * Not including agents only on USDA lists. DR.T.V.RAO MD 12

13 CDC Select Agents* – Toxins Abrin Botulinum neurotoxins Clostridium perfingens epsilon toxin Conotoxins Diacetoxyscirpenol Ricin Saxitoxin Shiga-like ribosome-inactivating proteins Shigatoxin Staphylococcal enterotoxins Tetrodotoxin T-2 toxin n = 12 * Not including agents only on USDA lists. DR.T.V.RAO MD 13

14 BIOWEAPON-RELATED DISEASES anthrax botulism brucellosis cholera food poisoning glanders hemorrhagic fever lassa fever melioidosis plague psittacosis Q-fever salmonellosis shigellosis smallpox tularemia typhoid fever typhus viral encephalitis DR.T.V.RAO MD 14

15 ADDITIONAL POTENTIAL BIOTERRORISM AGENTS Chlamydia psittaci Cryptosporidium parvum Escherichia coli O157:H7 hantavirus Salmonella species Shigella species Vibrio cholerae DR.T.V.RAO MD 15

16 16 Potential Bioterrorism Agents Potentially thousands NATO NBC Handbook lists 31 agents CDC created Category A, B, & C lists Based on: –Ease of dissemination –Potential for Public Health Impact –Potential for Public Panic and Social Disruption DR.T.V.RAO MD

17 The Centers for Disease Control (2004) have placed agents in one of three priority categories for initial public health preparedness efforts: A, B, or C. Agents BIOTERRORISM AGENT CLASSIFICATION SYSTEM CDC DR.T.V.RAO MD 17

18 CLASS A Contagious High death rates and high health impact on the public ANTHRAX, BOTULISM, SMALLPOX, TULAREMIA, PLAGUE CLASS B Moderately easy to spread Some illness & death rates TYPHUS, WATER SAFETY THREATS, SALMONELL A CLASS C Easily available Easily produced and spread Have potential for high death & illness rates NIPAH VIRUS CLASSIFYING BIOTERROR AGENTS Hey look, a llama! Never can be too careful… DR.T.V.RAO MD 18

19 CRITICAL BIOLOGICAL AGENTS CATEGORY A Can be easily disseminated or transmitted person-to- person Cause high mortality, with potential for major public health impact Might cause public panic and social disruption Require special action for public health preparedness MMWR 49;RR-4, April 21, 2000 DR.T.V.RAO MD 19

20 variola major (smallpox) Bacillus anthracis (anthrax) Yersinia pestis (plague) Clostridium botulinum toxin (botulism) Francisella tularensis (tularaemia) filoviruses Ebola hemorrhagic fever Marburg hemorrhagic fever arenaviruses Lassa (Lassa fever) Junin (Argentine hemorrhagic fever) and related viruses MMWR 49;RR-4, April 21, 2000 CATEGORY A AGENTS INCLUDE DR.T.V.RAO MD 20

21 CATEGORY B Are moderately easy to disseminate Cause moderate morbidity and low mortality Require specific enhancements of CDC's diagnostic capacity and enhanced disease surveillance MMWR 49;RR-4, April 21, 2000 DR.T.V.RAO MD 21

22 CATEGORY B AGENTS Coxiella burnetti (Q fever); Brucella species (brucellosis) Burkholderia mallei (glanders) alpha viruses Venezuelan encephalomyelitis eastern and western equine encephalomyelitis ricin toxin from Ricinus communis (castor beans) epsilon toxin of Clostridium perfringens Staphylococcus enterotoxin B. MMWR 49;RR-4, April 21, 2000 DR.T.V.RAO MD 22

23 Salmonella species Shigella dysenteriae Escherichia coli O157:H7 Vibrio cholerae Cryptosporidium parvum SUBSET OF LIST B AGENTS INCLUDES PATHOGENS THAT ARE FOOD- OR WATERBORNE - THESE PATHOGENS INCLUDE DR.T.V.RAO MD 23

24 CATEGORY C INCLUDES EMERGING PATHOGENS THAT COULD BE ENGINEERED FOR MASS DISSEMINATION IN THE FUTURE Nipah virus Hantaviruses Fick-borne hemorrhagic fever viruses Tick-borne encephalitis viruses Yellow fever Multidrug-resistant tuberculosis DR.T.V.RAO MD 24

25 25 Biological Delivery Methods Food / Water Aircraft sprayers Vehicle sprayers Hand sprayers Mail Air handling systems Human Vector Animal Vector DR.T.V.RAO MD

26 Occurrence of vector-borne disease where there is no vector Cluster of sick or dead animals Atypical seasonality Geographic Pattern of Illness More respiratory presentation of disease KEY INDICATORS OF A BIOLOGICAL TERROR EVENT DR.T.V.RAO MD 26

27 The Ideal Bioterror Weapon Would Be 1.contagious 2.virulent 3.robust 4.difficult to detect 5.drug-resistant 6.user-controllable No natural agent meets all of these criteria. Thus, sooner or later, terrorists may decide to devise novel weapons using the techniques of synthetic biology to enhance or replace the characteristics of pre-existing organisms or toxins. Countermeasures must be pursued vigorously – in advance. DR.T.V.RAO MD 27

28 PREPARATION FOR BT ATTACK Familiarize medical staff with BT agents Incorporate into Disaster Planning Decontamination & Infection Control Communications with key agencies Laboratory, Respective health authorities of the Nation. Contacts to obtain stockpiled supplies: antibiotics, immune sera, vaccines, etc. Security preparations DR.T.V.RAO MD 28

29 IMMEDIATELY NOTIFY: Hospital Infection Control Isolation: Smallpox, plague, hemorrhagic fevers Laboratory Hospital Administration Local Public Health Department WHAT TO DO IF YOU SUSPECT A BIOTERRORIST DISEASE DR.T.V.RAO MD 29

30 WHAT DOES PUBLIC HEALTH DO IN A BIOTERRORIST EVENT? Assess health impacts in the community Environmental health assesses water safety and sanitation Public health nurses coordinate with Shelter Operations Acute communicable disease tracks infectious diseases Injury program tracks injuries and fatalities Health Officer coordinates information for the public and health care providers Public Health Laboratories identify agents (either in-house or through referral to State governments or health authorities ) DR.T.V.RAO MD 30

31 Identifying a covert attack Social disruption Prophylaxis for large populations Decontamination Secondary transmission SPECIAL PROBLEMS WITH BT DR.T.V.RAO MD 31

32 Forensic teams work hard to identify biological agents, their origins and effects TECHNOLOGY AT WORK DR.T.V.RAO MD 32

33 Labs are working on advanced detection systems to detect early attacks, identify at-risk areas, and to give proper treatment TECHNOLOGY AT WORK DR.T.V.RAO MD 33

34 Bio surveillance: Real- Time-Outbreak Disease Surveillance system made its debut in This collects data from labs, hospitals, and environmental studies in order to detect bioterror attacks as early as possible. TECHNOLOGY AT WORK DR.T.V.RAO MD 34

35 Wyatt-Lorenz was founded as a spin-off of Wyatt Technology Corporation ("WTC") with a unique mission: To provide immediate bioterrorism bioagent warning systems for the protection of people and property from biological and chemical threats. These Bioterrorism threats are often directed toward elements of the private sector long ignored by the Department of Defense and Department of Homeland Securitybioterrorism bioagent warning systems BIOTERRORISM BIOAGENT WARNING SYSTEMS DR.T.V.RAO MD 35

36 Specialized labs needed for some agents Risks to laboratory workers Limited resources Communication between agencies SPECIAL PROBLEMS WITH BIOTERRORISM DR.T.V.RAO MD 36

37 PREPARATION FOR BIOTERRORISM ATTACK Familiarize medical staff with BT agents Incorporate into Disaster Planning Decontamination & Infection Control Communications with key agencies Laboratory, CDC, Police, FBI, etc. Contacts to obtain stockpiled supplies: antibiotics, immune sera, vaccines, etc. Security preparations DR.T.V.RAO MD 37

38 CLASSIFICATION OF BIOTERRORISM LABORATORIES Level-A Labs - Assess Risks for Aerosols and Use Biosafety Cabinet A - Adequate safety to rule-out and forward organisms Level B Lab Work at BSL-3 with BT agents B - Safety and proficiency adequate to confirm & characterize susceptibility Level C Lab BSL-3 C - Safety and proficiency sufficient to probe, type, perform toxigenicity testing Safety & proficiency to probe for universe of bio- and chemical agents in non-clinical specimen D - High level characterization (seek evidence of molecular chimeras) and secure banking of isolates Level D Lab BSL-4 DR.T.V.RAO MD 38

39 IMMEDIATELY NOTIFY: Hospital Infection Control Isolation: Smallpox, plague, hemorrhagic fevers Laboratory Hospital Administration Local Public Health Department WHAT TO DO IF YOU SUSPECT A BIOTERRORIST DISEASE DR.T.V.RAO MD 39

40 Health Officer coordinates information for the public and medical providers Community Health and PHN’s provide education, information to the public and to community providers Treatment and prophylaxis Quarantine PUBLIC HEALTH’S ROLE IN BIOTERRORISM EVENT DR.T.V.RAO MD 40

41 PROJECT BIOSHIELD " We refuse to remain idle when modern technology might be turned against us. We will rally the great promise of American science and innovation to confront the greatest danger of our timeFormer President George W. Bush, at the signing of the Project Bio shield Act of 2004 Authorized spending of $5.6 billion over a span of 10 years in order to pay for vaccines and medical facilities in case of national biological emergency Gave the National Institute of Health grants to pursue medical research & technology Emergency Use Authorization – EUA – gave access to best medical responses in case of an emergency as declared by the Secretary of Human Healthy & Services OR Secretary of Homeland Security DR.T.V.RAO MD 41

42 Coordinating with the Public Health System COORDINATING WITH SYSTEM IS PRIORITY DR.T.V.RAO MD 42

43 More trained epidemiologists to speed detection Increased laboratory capacity Health Alert Network Medical professionals “back to school” National Pharmaceutical Stockpile WHAT WE NEED TO PREPARE FOR BIOTERRORISM DR.T.V.RAO MD 43

44 HOW CAN HOSPITALS PREPARE? Familiarize medical staff and lab with bioterrorist threat agents Incorporate BT planning into disaster planning Infection control Notification procedures and contact numbers Daily surveillance and reporting Security preparations Media Personal Protective Equipment (PPE) DR.T.V.RAO MD 44

45 Outbreak of rare disease Seasonal disease at wrong time Unusual age distribution Unusual clinical symptoms Unusual epidemiologic features Outbreak in region normally not seen IS IT A TRUE TERRORISM ? DR.T.V.RAO MD 45

46 STEPS IN PREPARING PUBLIC HEALTH AGENCIES FOR BIOLOGICAL ATTACKS Enhance epidemiologic capacity to detect and respond to biological attacks. Supply diagnostic reagents to state and local public health agencies. Establish communication programs to ensure delivery of accurate information. Enhance bioterrorism-related education and training for health-care professionals. MMWR 49;RR-4, April 21, 2000 DR.T.V.RAO MD 46

47 Preparation for a biological mass disaster requires coordination of diverse groups of medical and non-medical personnel Preparation can not occur without support and participation by all levels of government Preparation must be a sustained and evolutionary process BIOTERRORISM AND THE PUBLIC HEALTH SECTOR DR.T.V.RAO MD 47

48 Created by Dr.T.V.Rao MD for ‘e” Learning Resources for Medical and Public Personal on Bioterrorism DR.T.V.RAO MD 48


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