Bioterrorism Awareness: Protection of Human and Animal Health Companion animal veterinarians Why Are We Here? • September 11, 2001 changed many things − Worst terrorist act in U.S. history − More than 3,000 presumed dead − Occurred on American soil − Increased sense of vulnerability Center for Food Security and Public Health Iowa State University 2005 Biological Attack • Bioterrorism attacks of 2001 • Anthrax in postal system • • • 22 cases 5 deaths U.S. public health realm changed forever Center for Food Security and Public Health Iowa State University 2005 Preparedness Responsibilities: Veterinarians Anticipate outbreaks on the local level • Collect and label samples • Know the agents • Know the typical signs of diseases • − Animals and human Know how to report suspected cases • Disseminate knowledge • Center for Food Security and Public Health Iowa State University 2005 Overview • • • • • • Bioterrorism Zoonoses and bioterrorism Disease control and biosecurity U.S. Government agencies involved Bioterrorism agents/diseases Your role and responsibility Center for Food Security and Public Health Iowa State University 2005 Terrorism Agroterrorism Biological, chemical, or radiological agents targeting agriculture or its components •Livestock •Food supply •Crops •Industry •Workers Bioterrorism Biological agents targeting humans, animals, or plants Other Conventional, radiological, nuclear, chemical, cyber •Typically direct human targeting Center for Food Security and Public Health Iowa State University 2005 Characteristics of a Biological Attack • • • • • Difficult to detect release Dissemination may cover large area Possible secondary spread Recognition of agent may be delayed days to weeks Difficulties in catching perpetrator Center for Food Security and Public Health Iowa State University 2005 Infectious Disease Outbreak Exposure Symptoms No. Affected Seek Care Time (Days) Center for Food Security and Public Health Iowa State University 2005 Clues Suggesting Biological Agent Release • Clustering of morbidity or mortality − Temporally or geographically − Large numbers of animals and/or people − Atypical symptoms • • • • Normally healthy people affected Unusual symptoms for area Unusual age distribution Disease occurring outside typical season Center for Food Security and Public Health Iowa State University 2005 Many Agents are Zoonotic Disease may be seen in animals before humans • Animals are sentinels • − Pets, livestock, wildlife Center for Food Security and Public Health Iowa State University 2005 Factors That Promote Transmission of Zoonoses • • • • • • Frequent contact with domestic or wild animals Overlap with wildlife habitat Intensive livestock production Poor animal sanitation Poor personal hygiene Poor animal health Center for Food Security and Public Health Iowa State University 2005 Disease Control: Client Education • Disinfect/clean up areas contaminated with animal waste − Livestock, • pets, wildlife, rodents Basic hygiene − Wash hands − Child supervision Center for Food Security and Public Health Iowa State University 2005 Zoonoses Control: Client Education • • • • • • Proper pet selection Use caution at petting zoos Cook food properly Control strays Communication with physician and veterinarian Follow guidelines for immunocompromised people Center for Food Security and Public Health Iowa State University 2005 Disease Control: Veterinarians • • • • Restrict animal movement, contact in hospital Appropriate disinfection of hands, exam, waiting rooms, surgical suites Regularly disinfect animal holding areas and adequately ventilate Designated isolation area with posted protocols Center for Food Security and Public Health Iowa State University 2005 U.S. Agencies Dealing with terrorism Public Health Security and Bioterrorism Preparedness Response Act of 2002 • • • June 12, 2002 Improve ability of the U.S. to prevent, prepare for, and respond to bioterrorism and other public health emergencies $4.3 billion to various federal, state and local agencies − Upgrade facilities, enhance security, etc Center for Food Security and Public Health Iowa State University 2005 Department of Homeland Security (DHS) • • Established January, 2003 Mission − Prevent, protect, and respond to acts of terrorism on U.S. soil • Established four policy directorates − Responsibilities for coordinating HHS and USDA − Guard borders and airports, coordinate the response for future emergencies, analyze threats and intelligence, protect our critical infrastructure Center for Food Security and Public Health Iowa State University 2005 Centers for Disease Control and Prevention • CDC's Mission − Promote health and quality of life by preventing and controlling disease, injury, and disability • Preparing for bioterrorism since 1998 • One of the first agencies to respond to anthrax incidents of 2001 Center for Food Security and Public Health Iowa State University 2005 Strategic National Stockpile • 12-hour Push Package − • Complete package of medical materials Vendor Managed Inventory − Tailored to suspected agents Center for Food Security and Public Health Iowa State University 2005 Insert Your State’s Info Here Center for Food Security and Public Health Iowa State University 2005 Preparing Iowa • Iowa’s Homeland Security − Administered by Iowa Emergency Management Division − Works with public and private partners www.iowahomeland security.org Center for Food Security and Public Health Iowa State University 2005 Preparing Iowa Iowa Department of Public Health www.idph.state.ia.us/odedp • Iowa Department of Agriculture and Land Stewardship • Highly infectious animal disease program − IRVIN: Iowa Rapid Veterinary Information Network − • CFSPH training veterinarians to educate others Center for Food Security and Public Health Iowa State University 2005 Category ABC Agent Overview Classification • • • • Prepared by the CDC’s Bioterrorism Preparedness and Response Office Category A: Highest priority Category B: Second highest priority Category C: Third highest priority Center for Food Security and Public Health Iowa State University 2005 “Weaponization” of Agents • Alter characteristics of a pathogen to make it a more effective weapon − Enhance transmission − Increase virulence − Resistant to antibiotics − Evade vaccine protection − Alter clinical signs Center for Food Security and Public Health Iowa State University 2005 Note to presenter • • • As time allows select diseases you would like to review. If you have limited time you should focus on the Category A agents. The disease coverage is brief. If you would like more information on a disease, refer to the fact sheet or to the disease specific presentation. Center for Food Security and Public Health Iowa State University 2005 Category A : Agents/Diseases • • • • • • Anthrax Botulism Plague Smallpox Tularemia Viral hemorrhagic fevers Center for Food Security and Public Health Iowa State University 2005 Anthrax: The Agent • • • Bacteria: Bacillus anthracis Forms spores Human disease − Skin − Intestinal − Pulmonary • Animal disease − Septicemia and rapid death Center for Food Security and Public Health Iowa State University 2005 Anthrax: The Bioweapon • • • • • • • History Available & easily produced Spores infective Aerosolization Low lethal dose High mortality Person-to-person transmission rare Center for Food Security and Public Health Iowa State University 2005 Anthrax: The Response • Vaccine − Humans − Animals • Antibiotics − Treatment − Prophylaxis • Disinfection − Sporicidal agents, sterilization Center for Food Security and Public Health Iowa State University 2005 Botulism: The Agent • • Clostridium botulinum – Gram pos, spore-forming bacteria 7 different neurotoxins − Types • A-G Clinical signs − Flaccid paralysis − Pigs, dogs, and cats fairly resistant Center for Food Security and Public Health Iowa State University 2005 Botulism: The Bioweapon • • • • • Used by Aum Shinrikyo cult in Japan Aerosolized Easy to produce and transport Potent and lethal Most poisonous substance known Center for Food Security and Public Health Iowa State University 2005 Botulism: The Response • • Toxoids for high risk people Antitoxin available − Case-by-case • basis Botulinum toxins are easily inactivated with many disinfectants and heat Center for Food Security and Public Health Iowa State University 2005 Plague: The Agent • Yersinia pestis − Gram neg, transmitted by fleabites, aerosol, direct contact • Symptoms: Humans − Bubonic, • septicemic, pneumonic Symptoms: Animals − Cat: Similar to human − Dogs, livestock: Somewhat resistant Center for Food Security and Public Health Iowa State University 2005 Plague: The Bioweapon • WHO estimate − 50kg agent: City population 5 million − 150,000 cases pneumonic plague − Potential mortality: 100,000 • • • Available Person-to-person transmission Pneumonic form ~ 100% fatal if untreated Center for Food Security and Public Health Iowa State University 2005 Plague: The Response • • • • Antibiotics generally effective if given early Killed vaccine available Isolation of sick individuals Susceptible to a number of common disinfectants Center for Food Security and Public Health Iowa State University 2005 Smallpox: The Agent • • • • • Variola virus, Orthopoxvirus Eradicated from the world in 1977 Narrow host range: Humans only Transmission: Person-to-person, fomites, aerosols Clinical signs − Flu-like, progressive skin eruptions Center for Food Security and Public Health Iowa State University 2005 Smallpox: The Bioweapon • • Used historically Disease signals a bioterrorism event − Susceptible • • • population Easy to produce large scale Aerosolization Secondary spread − Person-to-person − Fomites • Mortality approximately 30% Center for Food Security and Public Health Iowa State University 2005 Smallpox: The Response • • • • • • No specific treatment Vaccinia virus vaccination Vaccinia Immune Globulin Isolation of infected individuals Ring vaccination program Disinfection of environment, clothing with various chemicals, boiling or autoclaving Center for Food Security and Public Health Iowa State University 2005 Tularemia: The Agent • • • Francisella tularensis Transmitted by ingestion, inhalation, vectors, direct contact through skin Six clinical forms in humans Glandular Ulceroglandular Center for Food Security and Public Health Iowa State University 2005 Tularemia: The Agent • Sheep, young pigs, horses, dogs, cats • Sudden fever, lethargy, stiffness, prostration, and death • Wildlife • Usually find dead • Rabbits behave strangely • Cattle, older pigs resistant Center for Food Security and Public Health Iowa State University 2005 Tularemia: The Bioweapon • • • • • Stable Aerosolized Low infective dose via inhalation Case fatality: 30-60% (untreated ) WHO estimation: 1970 − 50 kg agent: City population 5 million 250,000 ill 19,000 deaths Center for Food Security and Public Health Iowa State University 2005 Tularemia: The Response • • • Person-to-person transmission not documented Antibiotics effective if early or prophylactic Vaccine − For high risk individuals − Unknown efficacy against inhalational tularemia Center for Food Security and Public Health Iowa State University 2005 Viral Hemorrhagic Fevers: The Agents • • Ebola, Marburg, Lassa, Machupo Human clinical presentation − Early: Fever, fatigue − Severe: Bleed from internal organs, body orifices − Progression to shock & seizures • Vincent Massey Animals: Only non-human primates susceptible Center for Food Security and Public Health Iowa State University 2005 VHF: The Bioweapons • • • • Aerosolized Not readily available, require specialized production Person-to-person and nosocomial transmission occur Untreated fatality rate variable − Humans: 25-90% − Non-human primates: 50-100% Center for Food Security and Public Health Iowa State University 2005 VHF: The Response • • • Intensive supportive care Ribavirin has shown some efficacy Susceptible to bleach solutions, phenolic disinfectants, and UV light Center for Food Security and Public Health Iowa State University 2005 Category B: Agents/Diseases • • • • • Brucellosis Glanders Melioidosis Psittacosis Q Fever • • • • • Typhus fever Viral encephalitis Toxins Food Safety Threats Water Safety Threats Center for Food Security and Public Health Iowa State University 2005 Brucellosis: The Agent • • • Gram-negative bacteria Ingestion, inhalation, or direct contact Clinical signs − Humans: Cyclic fever and flu-like symptoms − Animals: Reproductive signs Center for Food Security and Public Health Iowa State University 2005 Brucellosis: The Agent Species Natural Host Human Pathogen B. abortus Cattle, bison, elk, horses Yes B.melitensis Goats, sheep, cattle Yes B. suis Swine, hares, reindeer, caribou, rodents Yes B. canis Dogs, other canids Yes B. ovis Sheep No Center for Food Security and Public Health Iowa State University 2005 Brucellosis: The Bioweapon • • • • • History Highly infectious Easily aerosolized Stable Prolonged incubation period − May • make diagnosis difficult Person-to-person unlikely Center for Food Security and Public Health Iowa State University 2005 Brucellosis: The Response • • • • • Long term antibiotics generally effective Vaccinate calves, no human vaccine Eliminate reservoir Standard precaution to avoid exposure Thorough disinfection Center for Food Security and Public Health Iowa State University 2005 Glanders: The Agent • • Burkholderia mallei: Gram-negative Transmission by ingestion, inhalation, or direct contact − Animal-to-human transmission is inefficient • Clinical signs − Humans & horses: Cutaneous and pulmonary lesions, rapidly fatal illness Center for Food Security and Public Health Iowa State University 2005 Glanders: The Bioweapon • History − WWI Russian horses − WWII Chinese civilians, horses, POW’s • • • Easy to produce Aerosolized, highly infectious Mortality high in chronic form − 50-70% • Person to person transmission: Rare Center for Food Security and Public Health Iowa State University 2005 Glanders: The Response • • • No vaccine Antibiotic therapy likely effective Destroyed by various chemicals Center for Food Security and Public Health Iowa State University 2005 Melioidosis: The Agent • • • Burkholderia pseudomallei: Gram-negative Transmission: Contact, ingestion, inhalation Clinical signs: Humans, sheep, goats, and pigs − Asymptomatic to pneumonia, lung and wound abscesses Center for Food Security and Public Health Iowa State University 2005 Melioidosis: The Bioweapon • • • • • • Easy to produce Available Aerosolization High mortality: 90% Person-to-person (rare) Animal-to-person (rare) Center for Food Security and Public Health Iowa State University 2005 Melioidosis: The Response • • • Long-term, multiple antibiotics effective Vaccines available: Not in U.S. Easily destroyed by disinfectants Center for Food Security and Public Health Iowa State University 2005 Psittacosis: The Agent • Chlamydophila psittaci − Gram-negative • • • Occurs worldwide Reportable in U.S. Clinical disease in humans and birds − Asymptomatic − Systemic illness with severe pneumonia Center for Food Security and Public Health Iowa State University 2005 Psittacosis: The Bioweapon • • • • • Easily obtained Aerosolized Stable in the environment Person-to-person transmission rare Low mortality Center for Food Security and Public Health Iowa State University 2005 Psittacosis: The Response • • Antibiotics generally effective Decontamination possible with most disinfectants Center for Food Security and Public Health Iowa State University 2005 Q Fever: The Agent • • • Coxiella burnetii Transmission: Inhalation, direct contact, ingestion, ticks Disease symptoms − Humans: Acute: Flu-like + pneumonia & hepatitis Chronic: Endocarditis, osteomyelitis − Animals: Most asymptomatic Sheep, cattle and goats: Abortions Center for Food Security and Public Health Iowa State University 2005 Q Fever: The Bioweapon • • • • • History Easily accessible Environmentally resistant Highly infectious Aerosolization − Travel • ½ mile by wind Low mortality- chronic morbidity Center for Food Security and Public Health Iowa State University 2005 Q Fever: The Response • • • • Often self-limiting disease Antibiotic therapy may limit complications Vaccine developed, not available in U.S. Variable susceptibility to disinfectants Center for Food Security and Public Health Iowa State University 2005 Typhus Fever: The Agent Rickettsia prowazekii: Rickettsial organism • Endemic in Eastern Europe, Middle East, and parts of Africa • Transmitted in feces of human body louse • Clinical signs: Humans • − • Fever, headache, macular eruptions, and petechial rash J. Kalisch Not seen in domestic animals Center for Food Security and Public Health Iowa State University 2005 Typhus Fever: The Bioweapon • WHO estimation: 1970 − 50 kg agent; 5 million people in city − 125,000 ill − 8,000 deaths • • Available Can be aerosolized in lice feces U.S. Typhus Commission Center for Food Security and Public Health Iowa State University 2005 Typhus Fever: The Response • • Antibiotics are generally effective Vaccine, not commercially available Center for Food Security and Public Health Iowa State University 2005 Viral Encephalitis: The Agent • • • The Alphaviruses: EEE, WEE, and VEE Transmitted via mosquito Clinical signs − Humans, horses, donkeys, mules: Often asymptomatic to flu-like − Encephalitis in small proportions • Birds are asymptomatic carriers, act as sentinels Center for Food Security and Public Health Iowa State University 2005 Viral Encephalitis: The Bioweapon • • • • Easy to produce Aerosolization High rate of infection Person-to-person transmission possible Center for Food Security and Public Health Iowa State University 2005 Viral Encephalitis: The Response • • Supportive care Vaccine • Virus unstable in environment − Equine − Human: High risk Center for Food Security and Public Health Iowa State University 2005 Category C • • Nipah virus Hantavirus Center for Food Security and Public Health Iowa State University 2005 Nipah Virus: The Agent • • • Paramyxovirus Fruit bat reservoir Clinical signs − Humans: Encephalitis − Pigs: Respiratory, neurological − Dogs and cats: “Distemper” Center for Food Security and Public Health Iowa State University 2005 Nipah Virus: The Bioweapon • • • • Aerosolization potential Wide host range No person-to-person transmission expected High morbidity and mortality Center for Food Security and Public Health Iowa State University 2005 Nipah Virus: The Response • • • Avoid contact with all infected animals and fluids Vaccine being researched Call authorities immediately Center for Food Security and Public Health Iowa State University 2005 Hantavirus: The Agent • • • • Bunyaviridae family Asymptomatic reservoir: Rodents Transmission: Inhalation, ingestion, direct contact Human clinical signs − Fever, myalgia, headache − Hantavirus Pulmonary Syndrome − Hemorrhagic Fever with Renal Syndrome • Not seen in domestic animals Center for Food Security and Public Health Iowa State University 2005 Hantavirus: The Bioweapon • • • Aerosolized Hospitalization Unexpected disease in the U.S. − HFRS limited to Asia/Europe to date Center for Food Security and Public Health Iowa State University 2005 Hantavirus: The Response • • Supportive care Limit exposure to rodent excrement − Wear mask • gloves, face Virus is deactivated with bleach Center for Food Security and Public Health Iowa State University 2005 Other Important Diseases • • • • • • Transmissible Spongiform Encephalopathy (TSE) Rift Valley Fever Hendra Virus West Nile Virus Foot and Mouth Disease Monkeypox Center for Food Security and Public Health Iowa State University 2005 Transmissible Spongiform Encephalopathy: The Agent • Prions − Proteinaceous infectious particles − Mutated proteins • • • Very long incubation period Neurological signs in all species No treatment available Center for Food Security and Public Health Iowa State University 2005 Bovine Spongiform Encephalopathy • • • Mad cow disease Incubation: 2 to 8 years 1995, United Kingdom − vCJD − People • exposed to BSE Before bovine offal ban in 1989 Active U.S. surveillance since 1990 Center for Food Security and Public Health Iowa State University 2005 TSE: The Response • Very resistant − Heat, • sterilization and disinfectants Early identification not possible − Lack of host immune response − Long incubation period • • • No effective treatment or vaccine Surveillance program Import restrictions Center for Food Security and Public Health Iowa State University 2005 Rift Valley Fever: The Agent • • • Phlebovirus in family Bunyaviridae Transmission: Mosquito, inhalation, contact with infected body fluids Clinical signs − Humans: headache Flu-like, fever, Severe disease: Retinitis, hemorrhagic fever − Animals: Abortions, death in neonates Center for Food Security and Public Health Iowa State University 2005 Rift Valley Fever: The Bioweapon • WHO estimate: 1970 − 50 kg of virus aerosolized − 35,000 incapacitated − 400 deaths (1% mortality) • • Stable at most temperatures Inactivated by various chemicals Center for Food Security and Public Health Iowa State University 2005 Rift Valley Fever: The Response • • • Vaccinate ruminants in endemic areas Control mosquitoes Avoid contact with infected tissues & blood − Wear • protective clothing No person-to-person transmission Center for Food Security and Public Health Iowa State University 2005 Hendra Virus: The Agent • Newly discovered − Australia Fruit bats • Transmission: Urine, body fluids • Incubation: 6-18 days • Humans • − • Flu-like illness, respiratory failure Horses, cats − Acute respiratory signs, nasal discharge, fever, encephalitis, sudden death Center for Food Security and Public Health Iowa State University 2005 Hendra Virus: The Response • • • Little is known about disease Highest level of security to work with the agent Potentially serious consequences − High mortality rate − Lack of treatment Center for Food Security and Public Health Iowa State University 2005 West Nile Virus: The Agent Flavivirus • Transmission • Mosquitoes: Culex species − Blood transfusion, organ donation, breast feeding − Animals: Horses, birds, mammals, and reptiles • Humans • Duration: 3-6 days − 80% have no signs − 20% develop “West Nile Fever” − Center for Food Security and Public Health Iowa State University 2005 West Nile Virus: Public Health Significance • Human illness in U.S. in 2003 − 9,100 • cases, 222 deaths Horses illness in U.S. in 2003 − 4,554 cases − 40% of ill result in death • Method of introduction to U.S. unknown *data current as of 1/30/04 Center for Food Security and Public Health Iowa State University 2005 Spread of WNV in the U.S.: 1999-2002 Center for Food Security and Public Health Iowa State University 2005 West Nile Virus: The Response Treatment: Supportive care • Vaccine available for horses, not humans • Source elimination • − • Mosquito larval habitats Personal protection Reduce time outdoors − Wear long pants and sleeves − Use mosquito repellent − Center for Food Security and Public Health Iowa State University 2005 Foot and Mouth Disease: FMD • • • • • Picornavirus Transmission: Direct contact, aerosol, fomites Species: Cloven-hooved animals (not horses) Signs: Fever, vesicles, salivation, lameness Extremely rare, mild symptoms in people Center for Food Security and Public Health Iowa State University 2005 FMD: Agroterrorism Threat • • Most important livestock disease in the world U.S. agriculture as a target − One sixth of the U.S. domestic product is tied to agriculture − Immunologically naive population • Vulnerabilities − Increased travel, poor biosecurity Center for Food Security and Public Health Iowa State University 2005 FMD: The Response • • • • USDA upgrading safeguarding measures Strict biosecurity Notify authorities immediately Response and recovery plans − Quarantine − Depopulation − Disinfection • Vaccination – complex decision Center for Food Security and Public Health Iowa State University 2005 Monkeypox: The Agent Orthopoxvirus, related to smallpox • Transmission • Reservoir may be African squirrel − Bites, aerosol, direct contact − Zoonotic, animal-to-animal, person-to-person − Animals: Fever, rash, pustules conjunctivitis • Humans: Flu-like, rash, pustules, lymphadenopathy • Center for Food Security and Public Health Iowa State University 2005 Monkeypox: Public Health Significance • 2003 U.S. Outbreak Zoonotic disease − 6 Midwestern states − • Animal illness Suspect cases: 93 − Confirmed cases: 10 − • Human illness Suspect cases: 72 − Confirmed cases: 37 − • All had contact with infected prairie dogs Potential bioweapon Center for Food Security and Public Health Iowa State University 2005 Monkeypox: The Response Treatment: supportive care • Smallpox vaccination • Moderately protective (85% of cases) − 30 individuals in 2003, no adverse events − • Infection Control EPA registered detergent disinfectant − 0.5% sodium hypochlorite (bleach) − Embargo • Euthanasia of animals • Quarantine for 6 weeks • Center for Food Security and Public Health Iowa State University 2005 The Veterinarian’s Responsibility Opportunities for the Veterinary Profession • Integrate into the public health system − Be aware, contribute, assist in development of surveillance programs − Report trends in disease and clinical signs − Be involved with emergency response plans at all levels Center for Food Security and Public Health Iowa State University 2005 The Veterinarian’s Responsibility • • • • Guardian of animal and public health Sharpen awareness of potential bioterrorism Alert officials early You are the expert − Provide leadership and input to clients and community Center for Food Security and Public Health Iowa State University 2005 What to do if bioterrorism is suspected • • • • • • Stay informed and remain calm Response is event specific Response is everyone's responsibility Follow the advice of public health officials Follow federal and state guidelines Movement restrictions may be necessary Center for Food Security and Public Health Iowa State University 2005 Contacts • Phone numbers to know − State Veterinarian − State Public Health Veterinarian − APHIS- Area Veterinarian in Charge − Public Health Officials Center for Food Security and Public Health Iowa State University 2005 Summary • • • • Bioterrorism is a real threat Public health infrastructure is being strengthened Many bioterrorism agents are zoonotic Awareness education is an important component of preparedness and protection Center for Food Security and Public Health Iowa State University 2005 Summary • • • Prevention, recognition, and response involves everyone Report any suspicious activity, unexplained behavior or death loss in your clients’ herd or flock You play a critical role Center for Food Security and Public Health Iowa State University 2005 Conclusion “The best prescription, is knowledge.” Dr. C. Everett Koop Former U.S. Surgeon General Center for Food Security and Public Health Iowa State University 2005 Acknowledgments Development of this presentation was funded by a grant from the Centers for Disease Control and Prevention to the Center for Food Security and Public Health at Iowa State University. Center for Food Security and Public Health Iowa State University 2005 Acknowledgments Author: Glenda Dvorak, DVM, MS, MPH Reviewers: Radford Davis, DVM, MPH Gayle Brown, DVM, PhD Jean Gladon, BS Center for Food Security and Public Health Iowa State University 2005