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Bioterrorism
Written by:
Diane King, RN, BSN, PHN, CEN
San Jose State University
School of Nursing
NURS 214
Bioterrorism
 The awareness of the use of biological and
chemical weapons have created concern on the
national and intern...
Bioterrorism
What is Bioterrorism?
The intentional release of a
toxin, virus, bacteria or germ
(agent) to cause a serious...
Bioterrorism
 “High-risk targets for acts of terrorism include
military and civilian government facilities,
international...
Bioterrorism Agents
 “Category A diseases as described by the
Center for Disease Control and Prevention
(CDC)are:
 Anthr...
Anthrax
History
 ”A disease caused by a bacterium, Bacillus
anthracis, it has existed for hundreds of years
and still occ...
Anthrax
Epidemiology
 8,000-50,000 spores (aerosol), transmitted
by inhalation, Ingestion, or inoculation
Anthrax
Patient Isolation
 Standard barrier isolation precautions.
Patients do not require isolation rooms.
 Not transmi...
Anthrax
Clinical manifestations
 Fever
 Malaise
 Cough
 Respiratory distress
Anthrax
Treatment
 Ciprofloxin
 Doxycycline
 If vaccine available, 3 doses of anthrax vaccine
 ”The recent reports of ...
Anthrax
Use as a biological weapon
 Spores remain viable in soil for many
years
Anthrax
Documented Outbreaks
“The worst documented outbreak of
inhalation anthrax in humans occurred in
Russia in 1979, wh...
Anthrax
Most people weren't aware of this
weapon until the fall of 2001, when letters
containing anthrax spores sent via t...
Anthrax
Source:http://www.bt.cdc.gov/agent/anthrax/anthrax-images/cutaneous.asp
Anthrax
Source:http://www.bt.cdc.gov/agent/anthrax/anthrax-images/cutaneous.asp
ource:http
Anthrax
Source:http://www.bt.cdc.gov/agent/anthrax/anthrax-images/cutaneous.asp
Tularemia
History
 F. tularensis was discovered in 1911 during an
outburst of rabbit fever, when the disease killed
a lar...
Tularemia
Epidemiology
 10-50 organisms (aerosol)
Tularemia
Patient Isolation
 Standard precautions. Respiratory
isolation is not required.
 Not transmissible person to p...
Tularemia
 Clinical manifestations depend on the route of
entry and the virulence of the agent.
 Typically includes: fev...
Tularemia
Treatment
 Streptomycin
 Gentamycin
 Antibiotic prophylaxis is most effective if
begun within 24 hours
Tularemia
Documented Outbreaks
 “In summer 2000, an outbreak of tularemia
in Martha's Vineyard resulted in one
fatality.
...
Tularemia
Documented Outbreaks
 “In 2004, three researchers at Boston University Medical
Center were accidentally infecte...
Tularemia
Use as a biological weapon
 10-50 organisms (aerosol)
Plague
History
 ”An infectious disease of animals and humans
caused by a bacterium, Yersinia pestis, which is
transmitted...
Plague
Epidemiology
 <100 organisms (aerosol)
Plague
Patient Isolation
 Strict respiratory isolation with droplet
precautions (gown, gloves, and eye
protection) until ...
Plague
 Patient Isolation
 Incubation period 2-3 days
 Duration of illness 1-6 days (usually fatal)
Plague
Clinical manifestations
 High fever
 Chills
 Headache
 Productive cough-watery then bloody
Plague
Treatment
 Streptomycin
 Gentamycin
 Chloramphenicol
 Antibiotic prophylaxis is recommended for
all persons exp...
Plague
Use as a biological weapon
 <100 organisms (aerosol)
Plague
Documented Outbreaks
 “From 165-1950 (Biblical times)
 The Third Pandemic, originated in China
(1855–1950s).” (ht...
Smallpox
Epidemiology
 Highly infectious after aerosolization
 Person-to-person transmission can occur
via droplet nucle...
Smallpox
History
 “An acute contagious disease caused by Variola
virus, a member of the orthopoxvirus family.”
(http://ww...
Smallpox
Patient Isolation
 Strict isolation in negative pressure room
from onset of rash until scabs separate
 Laundry ...
Smallpox
Clinical manifestations
 Non-specific flu-like prodrome (malaise,
fever, headache), 2-3 days later is rash
 The...
Smallpox
Treatment
 Cidofovir
 Vaccine available & most effective if given
within 3 days of exposure
Smallpox
Use as a biological weapon
 Assumed low (10-100 organisms aerosol)
Smallpox
Documented Outbreaks
 “The global eradication of smallpox was
certified in 1979, based on intense
verification a...
Smallpox
Smallpox
Smallpox
Public Health Images Library (PHIL) id# 131. Source: CDC/Barbra Rice
Botulism (food sources)
History
 ”A rare but serious paralytic illness caused by a nerve
toxin that is produced by the ba...
Botulism
Epidemiology
 Botulism neurotoxins (A-F) could be
transmitted by aerosol or contamination of
food and water supp...
Botulism
Patient Isolation
 Non transmissible from person to person
 Incubation is 12-36 hours
 Death in 24-72 hours
 ...
Botulism
Clinical manifestations
 Dry throat
 Blurred vision
 Slurred speech
 Difficulty swallowing
 Progressive desc...
Botulism
Treatment
 Antitoxin (limited supply & only available
from the Division of Communicable
Disease Control, Califor...
Botulism
Use as a biological weapon
 Could be released as an aerosol or used
to contaminate water or food supplies
 “Ira...
Botulism
Documented Outbreaks
 “In April 1991, 91 hospitalized patients in Cairo
were reported to the Egyptian Ministry o...
Prevention
“Local drinking water and waste water
systems could be potential targets for
terrorist or other criminal acts. ...
External Links
 “Raw, unedited footage of terrorism events and
people's reaction to those events can be very
upsetting, e...
References
American Red Cross
http://www.redcross.org/services/disaster/0,1082,0_589_,00.html
Center for Disease Control...
References
 National Institiute of Health
http://www.nih.gov/news/pr/mar2002/niaid-14.htm
http://www.ncbi.nlm.nih.gov/pub...
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Transcript of "Nurs 214.Bioterrorism"

  1. 1. Bioterrorism Written by: Diane King, RN, BSN, PHN, CEN San Jose State University School of Nursing NURS 214
  2. 2. Bioterrorism  The awareness of the use of biological and chemical weapons have created concern on the national and international level.  “Military and civilian medical and public health professionals must become proficient in recognizing that a biological attack has occurred, activating the appropriate agencies and personnel to investigate the event, treating casualties, and preventing spread of disease.”(http://www.usamriid.army.mil/education/index.htm).
  3. 3. Bioterrorism What is Bioterrorism? The intentional release of a toxin, virus, bacteria or germ (agent) to cause a serious illness or death Can be immediate or long term (may take days or weeks to observe symptoms)
  4. 4. Bioterrorism  “High-risk targets for acts of terrorism include military and civilian government facilities, international airports, large cities, and high- profile landmarks.  Terrorists might also target large public gatherings, water and food supplies, utilities, and corporate centers.  Further, terrorists are capable of spreading fear by sending explosives or chemical and biological agents through the mail” (http://www.fema.gov/areyouready/terrorism_general_info.shtm)
  5. 5. Bioterrorism Agents  “Category A diseases as described by the Center for Disease Control and Prevention (CDC)are:  Anthrax  Tularemia  Plague  Smallpox  Botulism  Viral hemorrhagic fever” (http://www.nih.gov/news/pr/mar2002/niaid-14.htm
  6. 6. Anthrax History  ”A disease caused by a bacterium, Bacillus anthracis, it has existed for hundreds of years and still occurs naturally in both animals and humans in many parts of the world, including Asia, southern Europe, sub-Sahelian Africa and parts of Australia.  There are three forms of anthrax in humans: cutaneous, ingestion and inhalational.” (http://www.who.int/csr/delibepidemics/disease/en)
  7. 7. Anthrax Epidemiology  8,000-50,000 spores (aerosol), transmitted by inhalation, Ingestion, or inoculation
  8. 8. Anthrax Patient Isolation  Standard barrier isolation precautions. Patients do not require isolation rooms.  Not transmissible person to person  Incubation 1-6 days  Duration 3-5 days (usually fatal if untreated)
  9. 9. Anthrax Clinical manifestations  Fever  Malaise  Cough  Respiratory distress
  10. 10. Anthrax Treatment  Ciprofloxin  Doxycycline  If vaccine available, 3 doses of anthrax vaccine  ”The recent reports of anthrax exposure have spawned numerous websites and emails selling Ciprofloxacin (Cipro) and other antibiotics for treatment. The Federal Trade Commission (FTC) warns that fraudsters often follow the headlines, tailoring their offers to prey on consumers' fears and vulnerabilities ” (http://www.ftc.gov/bcp/edu/pubs/consumer/alerts/alt104.shtm)
  11. 11. Anthrax Use as a biological weapon  Spores remain viable in soil for many years
  12. 12. Anthrax Documented Outbreaks “The worst documented outbreak of inhalation anthrax in humans occurred in Russia in 1979, when anthrax spores were accidentally released from a military biological weapons facility near the town of Sverdlovsk, killing at least 66 people.
  13. 13. Anthrax Most people weren't aware of this weapon until the fall of 2001, when letters containing anthrax spores sent via the U.S. Postal Service resulted in 22 cases of anthrax infection. Eleven people were infected with cutaneous anthrax. Eleven others were infected with inhalation anthrax, resulting in five deaths. “ (http://www.ncbi.nlm.nih.gov/pubmed)
  14. 14. Anthrax Source:http://www.bt.cdc.gov/agent/anthrax/anthrax-images/cutaneous.asp
  15. 15. Anthrax Source:http://www.bt.cdc.gov/agent/anthrax/anthrax-images/cutaneous.asp ource:http
  16. 16. Anthrax Source:http://www.bt.cdc.gov/agent/anthrax/anthrax-images/cutaneous.asp
  17. 17. Tularemia History  F. tularensis was discovered in 1911 during an outburst of rabbit fever, when the disease killed a large number of ground squirrels in the area of Tulare Lake in California.  There are two predominant subspecies: F. tularensis tularensis (type A), which is found in North America, is more virulent than F. tularensis palaearctica (type B), which occurs in Asia, Europe, and North America.
  18. 18. Tularemia Epidemiology  10-50 organisms (aerosol)
  19. 19. Tularemia Patient Isolation  Standard precautions. Respiratory isolation is not required.  Not transmissible person to person  Incubation 3-6 days  Duration is 2 weeks
  20. 20. Tularemia  Clinical manifestations depend on the route of entry and the virulence of the agent.  Typically includes: fever, headache, malaise, weight loss, non-productive cough.  There are six forms of tularaemia in humans: ulceroglandular, glandular, oropharyngeal, oculoglandular, respiratory and typhoidal.” (http://www.who.int/csr/delibepidemics/disease/en)
  21. 21. Tularemia Treatment  Streptomycin  Gentamycin  Antibiotic prophylaxis is most effective if begun within 24 hours
  22. 22. Tularemia Documented Outbreaks  “In summer 2000, an outbreak of tularemia in Martha's Vineyard resulted in one fatality.  An outbreak of tularemia occurred in Kosovo in 1999-2000.” (http://www.ncbi.nlm.nih.gov/pubmed)
  23. 23. Tularemia Documented Outbreaks  “In 2004, three researchers at Boston University Medical Center were accidentally infected with F. tularensis, after apparently failing to follow safety procedures  In 2005, small amounts of F. tularensis were detected in the Mall area of Washington, DC the morning after an anti-war demonstration on September 24, 2005  In July 2007, an outbreak was reported in the Spanish autonomous region of Castile and Leonand traced to the plague of voles infesting the region .” (http://www.ncbi.nlm.nih.gov/pubmed)
  24. 24. Tularemia Use as a biological weapon  10-50 organisms (aerosol)
  25. 25. Plague History  ”An infectious disease of animals and humans caused by a bacterium, Yersinia pestis, which is transmitted between rodents by rodent fleas or to people through infected rodent flea bites.  It can also be transmitted to humans through direct contact with infected animal tissue.  There are three main forms of plague in humans: bubonic, septicemic and pneumonic.” (http://www.who.int/csr/delibepidemics/disease/en)
  26. 26. Plague Epidemiology  <100 organisms (aerosol)
  27. 27. Plague Patient Isolation  Strict respiratory isolation with droplet precautions (gown, gloves, and eye protection) until patient has received at least 48 hours of antibiotic therapy and shows clinical improvement.  Highly transmissible person to person
  28. 28. Plague  Patient Isolation  Incubation period 2-3 days  Duration of illness 1-6 days (usually fatal)
  29. 29. Plague Clinical manifestations  High fever  Chills  Headache  Productive cough-watery then bloody
  30. 30. Plague Treatment  Streptomycin  Gentamycin  Chloramphenicol  Antibiotic prophylaxis is recommended for all persons exposed to the aerosol or persons in close physical contact with a confirmed case
  31. 31. Plague Use as a biological weapon  <100 organisms (aerosol)
  32. 32. Plague Documented Outbreaks  “From 165-1950 (Biblical times)  The Third Pandemic, originated in China (1855–1950s).” (http://www.ncbi.nlm.nih.gov/pubmed)
  33. 33. Smallpox Epidemiology  Highly infectious after aerosolization  Person-to-person transmission can occur via droplet nuclei or aerosols expelled from the oropharnx and by direct contact  Contaminated clothing or bed linens can also spread the virus.
  34. 34. Smallpox History  “An acute contagious disease caused by Variola virus, a member of the orthopoxvirus family.” (http://www.who.int/csr/delibepidemics/disease/en
  35. 35. Smallpox Patient Isolation  Strict isolation in negative pressure room from onset of rash until scabs separate  Laundry and waste should be autoclaved before being laundered or incinerated  Incubation 12-14 days  Duration is 4 weeks
  36. 36. Smallpox Clinical manifestations  Non-specific flu-like prodrome (malaise, fever, headache), 2-3 days later is rash  Then synchronously evolving maculopapular rash progressing to vesicles then pustules  Lesions more predominant on the face and extremities than on the trunk
  37. 37. Smallpox Treatment  Cidofovir  Vaccine available & most effective if given within 3 days of exposure
  38. 38. Smallpox Use as a biological weapon  Assumed low (10-100 organisms aerosol)
  39. 39. Smallpox Documented Outbreaks  “The global eradication of smallpox was certified in 1979, based on intense verification activities in countries.” (http://www.who.int/csr/delibepidemics/disease/en
  40. 40. Smallpox
  41. 41. Smallpox
  42. 42. Smallpox Public Health Images Library (PHIL) id# 131. Source: CDC/Barbra Rice
  43. 43. Botulism (food sources) History  ”A rare but serious paralytic illness caused by a nerve toxin that is produced by the bacterium Clostridium botulinum. Botulism toxin can be inhaled or ingested via contaminated food or water. There are five clinical categories:  foodborne botulism  wound botulism  infant botulism  adult infectious botulism  inadvertent, following botulinum toxin injection.” (http://www.who.int/csr/delibepidemics/disease/en)
  44. 44. Botulism Epidemiology  Botulism neurotoxins (A-F) could be transmitted by aerosol or contamination of food and water supplies
  45. 45. Botulism Patient Isolation  Non transmissible from person to person  Incubation is 12-36 hours  Death in 24-72 hours  Lasts months if not lethal
  46. 46. Botulism Clinical manifestations  Dry throat  Blurred vision  Slurred speech  Difficulty swallowing  Progressive descending symmetrical paralysis
  47. 47. Botulism Treatment  Antitoxin (limited supply & only available from the Division of Communicable Disease Control, California Department of Health Services)  Supportive care
  48. 48. Botulism Use as a biological weapon  Could be released as an aerosol or used to contaminate water or food supplies  “Iraq deployed 12,000 liters of botulinum toxin in over 100 munitions during the Gulf War in 1991” (Recognizing Bioterrorism Agents, 2000. Santa Clara County Health Department Zebra Information Binder)
  49. 49. Botulism Documented Outbreaks  “In April 1991, 91 hospitalized patients in Cairo were reported to the Egyptian Ministry of Health with botulism intoxication.  Cases of botulism in the northern province of Iran were studied in March and April 1997.  In the late 1996, an outbreak of botulism affected eight young people in Italy.” (http://www.ncbi.nlm.nih.gov/pubmed)
  50. 50. Prevention “Local drinking water and waste water systems could be potential targets for terrorist or other criminal acts. “ (http://cfpub.epa.gov/safewater/watersecurity/publicInvolve.cfm)
  51. 51. External Links  “Raw, unedited footage of terrorism events and people's reaction to those events can be very upsetting, especially to children.  We do not recommend that children watch television news reports about such events, especially if the news reports show images over and over again about the same incident.  Young children do not realize that it is repeated video footage, and think the event is happening again and again.” (http://www.redcross.org/services/disaster/0,1082,0_589_,00.html)
  52. 52. References American Red Cross http://www.redcross.org/services/disaster/0,1082,0_589_,00.html Center for Disease Control http://www.bt.cdc.gov/agent/anthrax/anthrax-images/cutaneous.asp http://www.bt.cdc.gov/agent/smallpox/smallpox-images/smallpox3.htm Source:CDC/Cheryl Tyron. Public Health Images Library (PHIL) ID # 3. http://www.bt.cdc.gov/agent/smallpox/smallpox-images/smallpox3.htm Source: CDC/James Hicks. Public Health Images Library (PHIL) id# 284. http://www.bt.cdc.gov/agent/smallpox/smallpox-images/smallpox3.htm Source: CDC/Barbra Rice. Public Health Images Library (PHIL) id# 131. http://phil.cdc.gov/Phil/details.asp •Environmental Protection Agency http://cfpub.epa.gov/safewater/watersecurity/publicInvolve.cfm •Federal Trade Commission http://www.ftc.gov/bcp/edu/pubs/consumer/alerts/alt104.shtm
  53. 53. References  National Institiute of Health http://www.nih.gov/news/pr/mar2002/niaid-14.htm http://www.ncbi.nlm.nih.gov/pubmed  Santa Clara County Health Department: Bioterrorism information for clinicians zebra packet. November 4, 2000.  U.S. Army and Medical Research Institute of Infectious Disease http://www.usamriid.army.mil/education/index.htm  World Health Organization http://www.who.int/csr/delibepidemics/disease
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