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Bioterrorism and veterinary public health

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  • Ocular manifestations associated with hemorrhagic fever viruses range from conjunctival injection to subconjunctival hemorrhage, as seen in this patient. Reprinted with permission from Current Science/Current Medicine A nonpruritic maculopapular rash (resembling the rash of measles) may occur in up to 50% of patients infected with the Ebola or Marburg viruses within the first week of illness. The rash is more common in light-colored skin and desquamates on resolution. Reprinted with permission from Thieme (Martini GA, Knauff HG, Schmidt HA, et al. A hitherto unknown infectious disease contracted from monkeys. Ger Med Mon . 1968;13:457-470).

Transcript

  • 1. BIOTERRORISM AND VETERINARY PUBLIC HEALTH Dr. Shahnawaz ahmad I.V.R.I Div. Of Surgery
  • 2. Definition of Bioterrorism Bioterrorism is the threat of use of biological agents by individuals or groups motivated by political, religious, ecological, social or for other ideological objectives to inculcate fear or cause illness or death in order to achieve their objectives (Carus 1998).
  • 3.
    • According to the United States Centers for Disease Control and Prevention (CDC) a bioterrorism attack is the deliberate release of viruses, bacteria or other germs (agents) or toxins used to cause illness or death in people, animals or plants .
  • 4. BIOLOGIC WARFARE: HISTORY
    • 14 TH century, Caffa: Attacking Tatar force catapulted cadavers of plague victims into city – outbreak of plague led to defeat
    • 18 th century, Fort Pitt, North America: Blankets from smallpox hospital provided to Native Americans – resulted in epidemic of smallpox among tribes in Ohio River valley
    Gen. Jeffrey Amherst, in a letter dated 16 Jully 1763, approved the plan to spread smallpox to Delaware Indians
  • 5.
    • 1932-45, Manchuria: Japanese military physicians infected 10,000 prisoners with biological agents ( B. anthracis, N. meningitidis, Y. pestis, V. cholerae ) – 11 Chinese cities attacked via food/water contamination, spraying via aircraft
    The Japanese army used Chinese prisoners to test bioweapons.
  • 6. Reported cases of bioterrorism World war II – Polish resistance organizations used biological agents against German forces 1952 – Mau Mau, an independence movement in Kenya, used a plant toxin to poison livestock 1966 – Dr. M. Suzuki, a Japanese physician, infected health care providers and patients with S. typhi
  • 7. 1981 – Dark harvest groups got anthrax contaminated soil from Gruinard Island and damped it on Porton Down. 1984 – Rajaneesh in Portland, Oregon (USA) used S. thphimurium to contaminate restaurants salad bars 1995 – AUM Shinrikyo used sarin nerve gas in the Tokyo subway in Japan. 2001 - Anthrax contaminated mails sent to various people in USA
  • 8. Casualties Incident Number of cases Number of deaths Polish resistance Not reported 200 Germans Mau Mau Not reported 33 head of cattle Dark Harvest None None Rajaneesh 751 (45 Hospitalized No deaths AUM Shrinkyo 5500 (641 seen at SJIH on day I & 349 following week 106 hospitalized at SLIH, 12 deaths ( 2 at SLIH) Dr. Suzuki 200 4 deaths Anthrax (USA) 22 4 deaths
  • 9. Motive for Bioterrorism Incident Motive Polish resistance Resistance against foreign occupation Mau Mau Resistance against colonialism Dark Harvest Send a political message Rajneesh Win a local election by incapacitating the non-Rajneeshees voters AUM Shrinkyo Seize control of Japan through mass murder causing fear and apprehension Dr. Suzuki Revenge for unfair treatment he received at the medical training Anthrax (USA) Inculcate fear
  • 10. BIOTERRORISM: WHY NOW?
    • Nuclear arms have great killing capacity but are hard to get.
    • chemical weapons are easy to get but lack such killing capacity
    • Biological agents have both qualities .
  • 11. TRENDS FAVORING BIOLOGICAL WEAPONS
    • Biological weapons have an unmatched destructive potential
    • Technology for dispersing biologic agents is becoming more sophisticated.
    • The lag time between infection and appearance of symptoms generally is longer for biological agents than with chemical exposures.
    • Lethal biological agents can be produced easily and cheaply.
    • Biological agents are easier to produce clandestinely than are either chemical or nuclear weapons.
  • 12. TRENDS FAVORING BIOLOGICAL WEAPONS
    • Global transportation links facilitate the potential for biological terrorist strikes to inflict mass casualties
    • Urbanization provides terrorists with a wide array of lucrative targets
    • The emergence of global, real-time media coverage increases the likelihood that a major biological incident will induce panic
  • 13.  
  • 14. CENTERS FOR DISEASE CONTROL BIOTERRORIST AGENTS: CATEGORY A
    • Easily disseminated or transmitted
    • person-to-person
    • High mortality, with potential for public
    • health impact
    • Require special action for public health preparedness .
    • Viruses: Variola major (smallpox),
    • Filoviruses (Ebola, Marburg),
    • Arenaviruses (Lassa, Junin)
    • Bacteria : Bacillus anthracis (anthrax), Yersinia pestis (plague), Francisella tularensis (tularemia)
    • Toxins : Clostridium botulinum toxin (botulism)
  • 15. CENTERS FOR DISEASE CONTROL BIOTERRORIST AGENTS: CATEGORY B
    • Moderately easy to disseminate
    • Moderate morbidity and low mortality
    • Require improved diagnostic capacity & enhanced surveillance .
    • Viruses : Alphaviruses (VEE, EEE, WEE)
    • Bacteria : Coxiella burnetii (Q fever), Brucella spp . (brucellosis), Burkholderia mallei (glanders)
    • Toxins: Rinus communis (caster beans) ricin toxin, Clostridium perfringens episolon toxin, Staphylococcus enterotoxin B
    • Food/waterborne pathogens : Salmonella spp ., Vibrio cholerae , Shigella dyseneriae , E. coli O157:H7, Cryptosporidium parvum , etc.
  • 16. CENTERS FOR DISEASE CONTROL BIOTERRORIST AGENTS: CATEGORY C
    • Availability
    • Ease of production and dissemination
    • Potential for high morbidity and mortality and major public health impact
    • Viruses: Nipah, hantaviruses, tick borne hemorrhagic fever viruses, tick borne encephalitis viruses, yellow fever
    • Bacteria : Multi-drug resistant Mycobacterium tuberculosis
  • 17. CHARACTERISTICS* OF PRIORITY AGENTS
    • Infectious via aerosol
    • Organisms fairly stable in aerosol
    • Susceptible civilian populations
    • High morbidity and mortality
    • Person-to-person transmission
    • Difficult to diagnose and/or treat
    • Previous development for BW
    • * * Priority agents may exhibit all or some of the above characteristics
  • 18. SOURCES OF BIOTERRORISM
    • Biological warfare
    • State sponsored terrorism
    • International terrorist groups
    • National cults
    • The deranged “loner”
  • 19. BIOTERRORISM: IMPACT
    • Direct infection: Mortality, morbidity
    • Indirect infection: Person-to-person transmission, fomite transmission
    • Environmental impact: Environmental survival, animal infection
    • Other: Social, political, economic
  • 20. THREAT TO ECONOMY The terrorists have an option to use exotic organisms to spread disease in animals and plants. Imagine somebody spread Foot and Mouth disease, Glanders, VEE, Rinderpest, Brucellosis, Swine fever, Fowl plague, Rabies and so on.
  • 21.
    • Similarly Rice blast, Stem Rust, Late blight of potato, Black Rust and Maize Rust and so on would destroy all the crops and shatter the economy of the country.
    • Eg:- Irish Potato Famine in 1940 due to Potato Blast
    • Half a million people died of starvation and half a million people migrated. It took one century for the country’s economy to recover.
  • 22. BIOLOGICAL WARFARE: IMPACT [ release of 50 kg agent by aircraft along a 2 km line upwind of a population center of 500,000 – Christopher et al., JAMA 278;1997:412
    • Agent Downwind No. dead No.
    • reach, km incapacitated
    • Rift Valley fever 1 400 35,000
    • Tick-borne encephalitis 1 9,500 35,000
    • Typhus 5 19,000 85,000
    • Brucellosis 10 500 125,000
    • Q fever >20 150 125,000
    • Tularemia >20 30,000 125,000
    • Anthrax >20 95,000 125,000
  • 23. Biological Delivery Methods
      • Food / Water
      • Aircraft sprayers
      • Vehicle sprayers
      • Hand sprayers
      • Mail
      • Air handling systems
      • Human Vector
      • Animal Vector
  • 24. CHARACTERISTICS OF BIOWARFARE
    • Potential for massive numbers of casualties
    • Ability to produce lengthy illnesses requiring prolonged and intensive care
    • Ability of certain agents to spread via contagion
    • Paucity of adequate detection systems
    • Presence of an incubation period, enabling victims to disperse widely
    • Ability to produce non-specific symptoms, complicating diagnosis
    • Ability to mimic endemic infectious diseases, further complicating diagnosis
  • 25. FOMITE ACQUISITION
    • Agents acquired from contaminated clothes
    • Variola major (smallpox)
      • Bacillus anthracis (anthrax)
      • Coxiella burnetii (Q fever)
      • Yersinia pestis (plague)
    • Management
      • Remove clothing, have patient shower
      • Place contaminated clothes in impervious bag, wear PPE
      • Decontaminate environmental surfaces with EPA approved
      • germicidal agent or 0.5% bleach (1:10 dilution)
  • 26. Bioterrorism agents: Laboratory risk Agent BSL Laboratory Risk B. anthracis 2 low Y. pestis 2 medium F. tularensis 2/3 high Brucella spp . 2/3 high Botulinum toxin 2 medium Smallpox 4 high Viral Hemorrhagic fever 4 high
  • 27. ANTHRAX IN THE US, 2001
    • Locations: FL, NY, DC, NJ, CT, VA
    • Mechanism: Via the mail (4 letters positive)
    • Infections: 22 cases
      • Cutaneous anthrax: 11 (fatality rate = 0)
      • Inhalation anthrax: 11 (fatality rate = 45%)
    • Prophylaxis
      • Initiated: ~32,000
      • 60 day course recommended: ~5,000
  • 28. UNEXPECTED FEATURES OF ATTACK
    • Targets (news media)
    • Vehicle (US mail)
    • Source of strain (US, probably weaponized)
    • Translocation of spore through envelope
    • Airborne acquisition in mail facilities
    • Wide spread contamination in mail facilities
    • Transmission via mail-to-mail contamination
    • No person or group has claimed responsibility
  • 29. ANTHRAX: EPIDEMIOLOGY
    • Agent: Bacillus anthracis , a Gram-positive,
    • spore forming non-motile bacillus
    • (straightforward lab identification)
    • Reservoir : Herbivores (cattle, goats,
    • sheep),
    • capable of surviving in the environment for
    • prolonged periods
    • Transmission
      • Contact, ingestion, or inhalation of infective spores
      • Sources of infection: Contaminated hides, wool, hair, bone, meat, or other animal products
  • 30. SVERDLOVSK ANTHRAX OUTBREAK
    • Site: Sverdlovsk, USSR
    • Year: 1979
    • Cause: Accidental release from military microbiologic facility – Military report noted: “Filter clogged so I’ve removed it. Replacement necessary”
    • Transmission: Airborne
    • Impact: 68 human deaths, 79 human cases, multiple animal deaths (sheep, cows )
  • 31. ANTHRAX: CLINICAL FEATURES
    • Incubation period: 1-7 days (1-60 days)
    • Clinical syndrome(s): Cutaneous ulcer, respiratory , gastrointestinal, oropharyngeal
    • Inhalation anthrax = main threat
      • Spores may germinate up to 60 days after exposure
      • LD 50 (human): 2,500 to 55,000 spores
      • Bronchopneumonia not a component (hemorrhagic lymphadenitis and mediastinitis)
      • Early diagnosis difficult
  • 32.  
  • 33.  
  • 34.  
  • 35.  
  • 36. Anthrax: Cutaneous Healing after treatment
  • 37. Gastrointestinal Anthrax Hemorrhagic meningitis at autopsy. Photo courtesy of USAMRIID
  • 38. B. ANTHRACIS MENINGITIS Lesion on chin CSF
  • 39. INHALATION ANTHRAX: DIAGNOSIS
    • Epidemiology
      • Sudden appearance of multiple cases of severe flu illness with fulminant course and high mortality
    • Clinical symptoms
      • Non-specific prodrome of flu-like symptoms
      • Possible brief interim improvement
      • Abrupt onset of respiratory failure and hemodynamic collapse 2-4 days after initial symptoms, possibly accompanied by thoracic edema and a widened mediastinum on CxR
  • 40. INHALATION ANTHRAX: DIAGNOSIS
    • Diagnostic studies
      • Chest radiograph with widened mediastinum
      • Peripheral blood smear with gram (+) bacilli on unspun smear
    • Microbiology
      • Blood culture growth of large gram (+) bacilli with preliminary identification of Bacillus spp .
      • PLET medium
    • Pathology
      • Hemorrhagic mediastinitis, hemorrhagic thoracic lymphadenitis, hemorrhagic meningitis
    INHALATION ANTHRAX: CxR Inhalational anthrax: CT scan
  • 41. INHALATION ANTHRAX, US Prominent superior mediastinum, ?small left pleural effusion B. ANTHRACIS : PERIPHERAL BLOOD SMEAR
  • 42. Cutaneous Anthrax, US 7 mo male infant hospitalized with 2 day history of swelling left arm and weeping lesion at left elbow. Patient had been at his mother’s office at a TV network. Biopsies yielded B. anthracis.
  • 43. Plague
    • Public Health and Clinical
    • Features
  • 44. Introduction
    • Due to infection with the bacterium
    • Yersinia pestis
    • Several forms:
    • – Bubonic
    • – Primary septicemia/
    • secondary
    • pneumonic
    • – Primary pneumonic
    PERIPHERAL BLOOD SMEAR
  • 45.  
  • 46.  
  • 47. Public Health Features
    • Most cases in U.S. occur in southwest
    • Pneumonic plague can be transmitted person to person via respiratory droplets
  • 48. PLAGUE: CLINICAL FEATURES
    • Incubation period: 1-4 days (pneumonia), 1-7 days (bubonic or septicaemic)
    • Clinical syndrome(s)
      • Bubonic, septicemic, pneumonic, cutaneous, meningitis
    • Epidemiology and symptoms
      • Sudden onset fever, shortness of breath, hemoptysis, chest pain
      • Gastrointestinal symptoms common (N, V, diarrhea)
      • Fulminant course and high mortality
  • 49. Inguinal bubo Bubo – ruptured inguinal lymph node
  • 50. Axillary bubo Femoral bubo
  • 51. PLAGUE: CLINICAL MANIFESTATIONS Cervical bubo Ecchymosis, septicemia Gangrene, septicemia
  • 52. PNEUMONIC PLAGUE: CxR
  • 53. PLAGUE: CONTROL
    • Laboratory precautions: BSL 2 (potentially infective clinical material), BSL 3 (activities with high potential for droplet or aerosol production)
    • Prophylaxis:
      • Post-exposure: Doxycycline (alternatives ciprofloxacin or TMP-SMX)
    • CDC isolation guidelines
      • Bubonic: Standard
      • Pneumonic: Droplet (until patient treated for 3 days)
  • 54. SMALLPOX: HISTORY
    • 1754-67: Biological weapon French and Indian wars
    • 1796: Edward Jenner uses vaccinia for immunization
    • 1967: WHO global eradication campaign
    • 1972: US ceases routine vaccination
    • 1977: Last case endemic smallpox (Somalia)
    • 1978: Last laboratory acquired case (England)
    • 1982: Worldwide cessation of vaccination
  • 55. SMALLPOX: VIROLOGY
    • Agent: Variola (family poxviridae)
      • 8 genera in family
    • Human infectious agents
      • Orthopoxviruses: Variola, varicella (chickenpox)
      • Mullucipoxvirus: Mulluscum contagiosum virus
    • Nonhuman orthopoxviruses: Monkeypox, cowpox, canarypox, rabbitpox, etc.
  • 56. VARIOLA (SMALLPOX)
    • Large DNA Virus
    • Dumb bell shaped virus
    • Complex membranes
  • 57.  
  • 58. SMALLPOX: EPIDEMIOLOGY
    • Agent: Variola virus
    • Reservoir: Humans
    • Transmission
      • Contact, droplet, and airborne
      • Transmission does not occur until the onset rash
      • Maximum infectiousness, days 7-10 of rash
      • Increased infectiousness if patient coughing or has a hemorrhagic form of smallpox
  • 59. SMALLPOX: CLINICAL FEATURES
    • Incubation period: 12 days (7-17 days)
    • Clinical features
      • Non-specific prodrome (2-4 days) of fever, mylagias
      • Rash most prominent on face and extremities (including palms and soles) in contrast to truncal distribution of varicella
      • Rash scabs over in 1-2 weeks
      • Variola rash has a synchronous onset (in contrast to the rash of varicella which arises in crops)
  • 60. SMALLPOX IN A CHILD
  • 61. Classic Centrifugal Rash of Smallpox Involving Face and Extremities. Photo courtesy of National Archives
  • 62. Smallpox in an adult Nigeria, 1970 27 yo female Lesions have a peripheral distribution, Facial edema, and Uniform in terms of Stage of development
  • 63. SMALLPOX: DIAGNOSIS
    • Appearance of rash
      • Hemorrhagic smallpox may be mistaken for meningococcemia or severe acute leukemia
    • Culture of lesions
      • Should be obtained by immunized person; place specimen in vacutainer tube, tape juncture of stopper and tube, place in second durable, watertight container
      • Alert lab
  • 64. SMALLPOX: CONTROL
    • Laboratory precautions: BSL 4
    • Clothing/fomites: Decontaminate
    • Prophylaxis
      • Pre-exposure: Vaccine
      • Post-exposure: Vaccine (within 4 days) or vaccine plus VIG (>4 days); potential role for cidofovir
    • Isolation: Contact plus airborne
  • 65. Vaccination With the Bifurcated Needle
  • 66. EVOLVING PRIMARY VACCINATION
  • 67.  
  • 68. Photo courtesy of CDC Fatal case of Vaccinia necrosum at inoculation site Accidental auto-inoculation of the eye with Vaccinia virus
  • 69. VACCINIA VACCINE: PRECAUTONS AND CONTRAINDICATIONS
    • Severe allergic reaction to prior dose of vaccine
    • History or presence of eczema, other skin conditions
    • Pregnancy (children in the household is not a contraindication)
    • Altered immocompetence
      • HIV, Leukemia, lymphoma, generalized malignancy
      • Solid organ transplant, BMT
      • Corticosteroids, alkylating agents, antimetabolites, radiation
      • Cardiac disease
    • Allergies
      • Neomycin, polymyxin b, tetracyclines, streptomycin
  • 70. VACCINIA VACCINE: PREVENTION OF CONTACT TRANSMISSION
    • Vaccinia virus can be cultured from primary vaccination site beginning at the time of development papule (2-5d after vaccination)
    • Transmission via direct skin contact may occur
    • Vaccination site should be covered with a porous bandage until scab has separated and underlying skin has healed (do not use an occlusive dressing)
      • Use impermeable bandage when bathing
    • Vaccinated HCWs may continue to work (vaccination site covered with sterile gauze and semipermeable dressing, and practice of good handwashing)
  • 71.  
  • 72. Botulism Toxin
      • A major bioweapons threat because of its extreme potency and lethality
        • The single most poisonous substance known.
          • Easy to produce, transport and misuse
          • The average incubation period is 12-72 hours after ingestion.
    • Neurotoxin produced by Clostridium botulinum
      • Most lethal substance known
  • 73. Modes of transmission
    • No person-to-person transmission
    • Exposure types
      • Foodborne - Ingestion of toxin
      • Infant – Ingestion of C. botulinum
      • Wound – Infection with C. botulinum
      • Inhalation of aerosolized toxin
    • As BT agent may be aerosolized or added to food or water
  • 74.
    • Patients with botulism typically present with difficulty speaking, seeing and/or swallowing.
    • Prominent neurologic findings include ptsosis, diplopia, blurred vision, dysarthria and dysphagia.
    • Patients typically are afebrile and do not have an altered level of consciousness.
    • Patients may initially present with gastrointestinal distress, nausea, and vomiting preceding neurological symptoms.
    Six-week old infant with botulism.
  • 75. Botulism
  • 76. Botulism
    • Symptoms:
      • Acute, afebrile, symmetric, decending paralysis of facial musculature, multiple cranial nerve palsies
        • Onset and severity dependent on amount of toxin absorbed
        • Incubation variable 2 hrs to 8 days after ingestion
      • Neurologic symptoms:
        • Ptosis, diplopia, blurred vision, loss of head control
        • Deep tendon reflexes diminish
        • Death results from airway obstruction;
          • Respiratory and diaphragmatic muscle paralysis
    • Diagnosis:
      • Index of suspicion for botulism; clusters of cases
    • Treatment:
      • Supportive care and administration of passive equine antitoxin
  • 77. Botulinum Toxin as a Bioweapon
    • Aum Shinrikyo 1990, 1993, 1995: attempted aerosol dispersion in Japan
    • Japan WW II (Unit 731): fed cultures to prisoners in China
    • US bioweapons program
    • Soviet Union program: gene splicing
    • Iraq 19,000 liters weaponized
    • ? Iran, North Korea, Syria
  • 78. Viral Hemorrhagic Fevers
    • Arena Viruses
    • Lassa fever
    • Argentine hemorrhagic fever
    • Bolivian hemorrhagic fever
    • Flaviviridae
    • Yellow fever
    • Dengue
    • Bunyaviridae
    • Crimean-Congo fever
    • Filoviruses
    • Marburg Ebola hemorrhagic fevers
  • 79. Ebola and Marburg – Etiologic agents
    • Flioviridae family viruses
    • Among the most virulent viruses (25-90% case fatality depending on strain)
    • Zoonotic
    • Humans are incidental hosts Marburg
    Ebola
  • 80.  
  • 81. Clinical features - VHF
    • Severe multisystem syndrome
    • Overall vascular system damage
    • Body’s ability to regulate itself is impaired
    • Often accompanied by hemorrhagic (in itself not usually life threatening)
  • 82. Ebola & Marburg Viruses - clinical course
    • Sudden onset of flu-like illness
    • May progress to nausea, vomiting, diarrhea, abdominal pain, photophobia, maculopapular rash, DIC, internal and external hemorrhage, multiorgan failure with jaundice and renal insufficiency
  • 83. Atlanta, Georgia: Electron Micrograph: Ebola virus causing African Hemorrhagic Fever. (Courtesy of the National Archives, 82-424)
  • 84. Marburg & Ebola – Occurrence
    • Naturally occurring sporadic outbreaks in Africa
    • Cases have occurred in West as a result of exposure to animal reservoirs
    • BT potential
      • Russian biowarfare program
      • Iraq is believe to have tried
  • 85. Ebola and Marburg - transmission
    • Direct contact with infected tissue and body fluids or contaminated objects
    • Probably aerosol inhalation
  • 86. Borio, et al JAMA consensus statement 2002 Maculopapular Rash in Marburg Disease Ocular Manifestations in Bolivian Hemorrhagic Fever
  • 87. Psychological and Social Factors during bioterrorism
    • Horror
    • Anger
    • Panic
    • Magical thinking about microbes
    • Fear of invisible agents Fear of contagion
    • Anger at Terrorist/Government
    • Scapegoat
    • Paranoia
    • Social isolation
    • 10. Demoralization
    • 11. Loss of faith in social institutions
    • 12. Attribution of arousal symptoms to infection
  • 88. MANAGEMENT OF PEOPLE WITH PSYCHOLOGICAL PROBLEMS
    • care of health workers
    • Critical incidence stress management (CISM) for rescue workers
    • Prevention of public fleeing
    • Confidence building by the medical workers
    • Dealing with emotional and psychological problems while dealing with the dead.
    • Care of emergency workers, medical and paramedical workers
    • Critical incidence of stress debriefing(CSID)
  • 89. 8.Prevention of group panic 9. Avoidance of emotion based responses (Knee jerk quarantine) 10. Effective risk communication 11. Control of symptoms secondary to hyper arousal 12. Reassurance 13. Management of anger fear (Diazepam and other anxiolytic drugs) 14. Provision of respite as required 15. Social support of the community
  • 90. Role of Clinicians
    • Be prepared to diagnose and treat BT diseases
    • Keep alert to unusual disease patterns
    • Use reportable disease system to alert public health officials of a potential problem
    • Get involved in disaster planning process
  • 91. Clusters of patients with the same disease or syndrome
    • Especially when:
    • there is more cases than would be expected
    • cases are geographically or temporally clustered
    • the illness is unexplained
    • there are multiple atypical presentations of the disease
    • the mortality or morbidity is higher than expected
  • 92. Even a single case may be a signal
    • Caused by an uncommon agent
    • Unusual for region, age group or season
    • Fulminant disease in otherwise healthy patient
    • Atypical presentation
  • 93. Other clues
    • Similar genetic type of agent from distinct sources
    • Unusual, atypical, genetically engineered, or antiquated strain
    • Atypical aerosol, food, or water transmission
    • Concurrent animal disease
  • 94. DETECTION OF OUTBREAKS
    • Recognition
      • Syndrome criteria
      • Epidemiological features
    • Communication
    • Medical
      • Triage, psychological aspects, lab support, public information
      • Patient isolation (Follow CDC guidelines), decontamination
      • Post-exposure prophylaxis, treatment of infected persons
  • 95. DETECTION OF OUTBREAKS
    • Epidemiologic features
      • A rapidly increasing disease incidence
      • An unusual increase in the number of people seeking care, esp. with
      • fever, respiratory, or gastrointestinal symptoms
      • An endemic disease rapidly emerging at an uncharacteristic time or in
      • an usual pattern
      • Lower attack rate among persons who had been indoors
      • Clusters of patients arriving from a single local
      • Large numbers of rapidly fatal cases
      • Any patient presenting with a disease that is relatively uncommon and
      • has bioterrorism potential
  • 96. DETECTION AND IDENTIFICATION OF BIOWEAPON AGENT
    • The conventional microbiological methods viz., culture, immunodetection, serology, molecular identification take long time (hours to days)
    • Several biodetectors (bioluminometer) based on the principles of bioluminescence and biofluorescence are being developed _ Fire fly luciferage gene .
    • There are various types of biosensors such as immunosensors, nucleic acid sensors, tissue based sensors and laser sensors
  • 97. EMERGING INFECTIONS AND BIOTERRORISM
    • New diseases have also appeared within the developed nations including United States. Some of these include:
    • Lyme disease
    • Legionnaires’ disease
    • New variant of Creutzfeldt -Jakob disease
    • West-Nile virus disease
    • Hantavirus pulmonary syndrome (HPS)
    • Multi-drug resistant TB,
    • Antibiotic resistant staphylococcal, enterococcal and pneumococcal infections
    • Diarrhoeal diseases caused by the parasite Cryptosporidium parvum and then certain strains of Escherichia coli bacteria.
  • 98. Factors contribute to the emergence and re-emergence of infectious diseases 1. Unprecedented worldwide population growth draining the natu ral resources 2. Overcrowding in cities with poor sanitation 3. Rapid and increased international travel 4. Increased international trade in animals and food products 5. Mass distribution of food and unhygienic food preparation practices 6. Increased exposure of humans to disease vectors and reservoirs in nature 7. Man-made changes to the environment and climatic changes which have a direct impact on the population of insect vectors and animal reservoirs. 7. Misuse of antibiotics leading to the evolution of resistant microbes.
  • 99. Impact of biological agents on national economies
    • Highly pathogenic avian influenza, Hong Kong
    • The outbreak of highly pathogenic avian influenza (HPAI) type A (H5N1) in live market chickens in Hong Kong resulted in 6 million deaths and killing of 1.4 million birds.
  • 100. Nipah virus, Malaysia
    • Nipah virus, a previously un known virus was identified in 1998, primarily in pigs and in humans in Malaysia.
    • The virus caused over 250 human cases resulting in 100 deaths. Approximately 1 million pigs were killed. Other countries in the region banned he importation of pork products.
    • Malaysia authorities blamed the disease on a deliberate attack by rival Asian countries trying to slowdown Malaysia’s recovery from the Asian Economic Crisis of the 1997.
  • 101. Foot and Mouth disease, Taiwan
    • The 1997 Foot and mouth disease outbreak in Taiwan had a devasting effect on export oriented pork industry.
    • The virus is believed to have been brought into Taiwan through smuggled animals, meat products or illegal immigrants from mainland China.
    • The epizootic resulted in the depopulation of 3.8 million pigs.
    • At one point the outbreak it was blamed as deliberate introduction of FMD into Taiwan by mainland China. The economic impact on Taiwan has been estimated in the billions of dollars.
  • 102.  
  • 103. Conclusions
    • Less developed nations can produce biological weapons that are as lethal as nuclear weapons include: Iran, Iraq, Israel, North Korea, China, Libya, Syria and Taiwan.
    • Recent terrorist activities in India underscores it’s vulnerability to bioterrorism and the need for a comprehensive plan to defend against an attack.
    • Currently, it does not have the infrastructure to quickly detect and identify many pests and pathogens nor is the country able to respond to even small-scale attack.
  • 104. कुनै बेला TERRORISM TODAY
  • 105. THANKS