1. Unit F: Infectious Diseases
Bioterrorism
Agents and Containment
BT 06.05

2. 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

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

4. 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.

5. 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

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

7. 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.

8. 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

9. 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

10. 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

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

12. 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 from an infected flea (that has bitten an infected rat!)
Can be aerosol-probably use in bioterrorism
Can be transmitted person to person

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

14. 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.

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

16. 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

17. 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

18. 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.

19. 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.

20. 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

21. 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)

22. 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.

23. 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

24. 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.

25. 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

26. 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

27. 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)

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