Unit F: Infectious Diseases Bioterrorism Agents and Containment BT 06.05

Bioterrorism Terrorism is defined as violent acts or acts dangerous to human life that appear to be intended to: Intimidate or coerce a civilian population Influence the policy of a govt Affect the conduct of a govt

Bioterrorist Agents Bacterial – like Anthrax and Plague Viral – like smallpox Toxins – like Botulism and Ricin

ANTHRAX Acute infectious disease caused by bacillus anthracis Infection in humans: Skin contact – cutaneous, ingestion-gastrointestinal, inhalation-pulmonary Person-to-person transmission of inhalation disease does not occur.

Pulmonary Anthrax S/S Flu-like symptoms that may briefly improve 2-4 days after initial symptoms Abrupt onset of respiratory failure Hemodynamic collapse Thoracic edema Widened mediastinum on xray Positive blood culture in 2-3 days of illness Incubation Period: 2-60 days

Pulmonary Anthrax cont: Prognosis is good only if treated early. Increased mortality rate if treated after respiratory onset.

Cutaneous Anthrax S/S Local skin involvement with direct contact Commonly seen on head, forearms, or hands Localized itching followed by papular lesion that turns vesicular within 2-6 days – develops into depressed black eschar. Incubation period: 1-7 days Prognosis good if treated with antibiotics.

Gastrointestinal Anthrax S/S: Abdominal pain, nausea, vomiting, & fever Bloody diarrhea, hematemesis Positive culture after 2-3 days Incubation period: 1-7 days Prognosis: If progression to toxemia and sepsis, prognosis is poor

Anthrax overview Modes of Transmission Incubation Periods: Inhalation of spores Skin contact Ingestion of contaminated food Incubation Periods: Pulmonary: 2-60 days Cutaneous: 1-7 days Gastrointestinal: 1-7 days Transmission: Anthrax IS NOT airborne person to person. Direct contact with infectious skin lesions CAN transmit infections. Prevention: Vaccine available – quantities limited

BOTULISM Potent neurotoxin caused by an anaerobic bacillus-clostridium botulinum Transmission Contaminated food inhalation S/S GI symptoms Drooping eyelids Weakened jaw clench Difficulty swallowing or speaking Blurred vision Respiratory distress

Botulism Cont: Incubation period: Prevention: Neurological S/S for food borne botulism – 12-36 hours after ingestion Neurological S/S for inhalation botulism – 24-72 hours after exposure Prevention: Vaccine is available Botulism CANNOT be transmitted from person to person

PLAGUE Plague is an acute bacterial disease caused by yersinia pestis. S/S Fever - Chest pains - Hemoptysis - Watery sputum Cough - Bronchopneumonia on xray Mode of Transmission: Plague normally transmitted form an infected flea (that has bitten an infected rat!) Can be aerosol-probably use in bioterrorism Can be transmitted person to person

Plague Cont: Incubation period: Prognosis: Flea bite – 2-8 days Aerosol – 1-3 days Prognosis: Good if treated with antibiotics early.

RICIN Ricin is a potent protein toxin derived from Castor beans. The toxin is fairly easily produced. Can be used as a biological weapon with relative ease.

Ricin Cont: Infections in Humans: Incubation period: S/S: Aerosol Ingestion Incubation period: 8-18 hours S/S: Within 18-24 hours: Weakness Fever Cough Pulmonary edema

Ricin Cont: S/S continued: Prognosis: Within 36-72 hours: Severe respiratory distress Death from hypoxemia Prognosis: Poor – No vaccine available You’re GOING TO DIE! Ricin DOES NOT spread easily from person to person

SMALLPOX Smallpox is an acute viral illness caused by the variola virus. Mode of transmission: Airborne :droplets (sneeze, cough, drip, or exhale) S/S: Flu like symptoms – fever, myalgia Skin lesions quickly progressing from macules to papules to vesicles Rash scabs over in 1-2 weeks Rash occurs in all areas at once, not in crops

Smallpox Cont. Incubation Period: Prognosis: From 7-17 days, average is 12 days Contagious when the rash is apparent and remains infectious until scabs separate (appx 3 weeks) Prognosis: Vaccine available and effective post-exposure Passive immunization is also available in the form of a vaccina immune globulin (Vig) antibody transfer Smallpox has a high mortality rate.

CONTAINMENT OF BIOTERRORISM AGENTS 1. Isolation Precautions All pts in healthcare facilities, including symptomatic pts with suspected or confirmed bioterrorism-related illnesses, should be managed utilizing STANDARD PRECAUTIONS Standard precautions include things like: Handwashing - after touching blood, body flds, etc Wearing gloves – clean gloves, exchange b/w tasks and procedures. Remove gloves and wash hands B4 leaving a pt care area.

Standard Precautions Cont. Gowns Worn to protect skin and prevent soiling of clothes Soiled gowns are promptly removed and hands are washed when finished Masks/ Eye protection or Face Shields Worn to protect mucus membranes Prevent splashes of blood, body fluids

Containment of bioterrorism agents 2. Patient placement Normal infection control practices should be followed if numbers allow. With large numbers, group affected patients together into designated ward or floor (possibly even a separate building) Consult with engineering staff (airflow and ventilation, plumbing and waste disposal, and capacity)

Containment of bioterrorism agents 3. Patient Transport Most bioterroristic agents cannot be transmitted from patient to patient. Transport and movement of pts should be limited to movement that is essential to provide pt care. This SHOULD reduce the opportunities for transmission of microorganisms within healthcare facilities.

Containment of bioterrorism agents 4 Containment of bioterrorism agents 4. Cleaning, disinfection, and sterilization of equipment & environment Standard precautions should be followed. All facilities have in place procedures. Cleaning agents should be available for spills and disinfecting equipment. Contaminated equipment – wear gloves Sterilize all instruments

Containment of bioterrorism agents 5. Discharge management Pts will not be discharged until they are deemed non-infectious Home care instructions should include barrier precautions, handwashing, waste mgmt, and cleaning and disinfection.

Containment of bioterrorism agents 6. Post-mortem care Pathology depts and labs should be informed! All autopsies should be performed carefully using PPE and standard precautions. Instruct funeral directors of diagnosis

Containment of bioterrorism agents 7. Handwashing Push sleeves and watch 4-5 inches up on arms Stand back from sink and adjust water temperature until warm Wet wrists and hands without splashing and with fingertips pointed downward Apply soap using friction Later well, keeping hands lower than elbows Rush hands together in circular motion, being sure to wash between fingers and two inches above wrists Clean under nails by rubbing against palms Wash for at least 15 seconds or longer if contaminated Rinse wrists and hands with running water Dry hands thoroughly with paper towel and discard towel into trashcan Turn faucets off with a new paper towel and discard into trash can

Response to bioterrorism agents Internal reporting requirements (within a facility) Infection control personnel Epidemiologist (local and state) Administration (health care facility) Office of public affairs (media coverage)

Response to bioterrorism agents External contacts (outside of facility) Local health department State health department FBI CDC Local police EMS