Bioterrorism
Awareness:
Protection of
Human and Animal
Health
General Public
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
Overview
•
•
•
•
•
•
Bioterrorism
Zoonoses and bioterrorism
Disease control
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 a large
area
Possible secondary spread
Recognition of agent may be delayed
days to weeks
Difficulties in catching perpetrators
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
− In
time and space
− Large numbers of animals and/or people
− Symptoms that are not typical
•
•
•
•
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
•
•
•
Zoonotic means disease can be
transmitted from animals to humans
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
Routes of Transmission
•
Direct contact
Gel, liquid, powder
− Scratches
− Droplet spray onto mucous membranes
−
•
Indirect contact: ingestion, injection
Contaminated food, water
− Vector
−
•
Aerosol
Center for Food Security and Public Health
Iowa State University 2005
Disease Control
•
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
•
•
•
•
•
•
Proper pet selection
Use caution at petting zoos
Cook food properly
Control strays
Visit and communicate with physician
and veterinarian
Follow guidelines for
immunocompromised people
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 first agencies to respond to anthrax
incidents
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
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 that disease’s 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
•
•
•
Bacteria: Bacillus anthracis
Forms spores
Human disease
− Skin
− Intestinal
− Inhalation
•
Animal disease
− Spreads
through the body
system; rapid death
Center for Food Security and Public Health
Iowa State University 2005
Botulism
Clostridium botulinum: A
bacteria that produces different
toxins
• Affects the nervous
system
• Clinical signs
•
− Generalized weakness
− Pigs, dogs, and cats
fairly resistant
Center for Food Security and Public Health
Iowa State University 2005
Plague
•
•
•
Bacteria: Yersinia pestis
Transmission: Fleabites,
aerosol, direct contact
Symptoms: Humans
− Enlarged
lymph nodes, blood
infection, respiratory
•
Symptoms: Animals
− Cat:
Similar to human
− Dogs, livestock:
Somewhat resistant
Center for Food Security and Public Health
Iowa State University 2005
Smallpox
•
•
•
•
•
Variola virus
Eradicated from the world in 1977
Narrow host range: Humans only
Transmission: Person-to-person,
contaminated items
Clinical signs
− Flu-like,
progressive skin
eruptions
Center for Food Security and Public Health
Iowa State University 2005
Tularemia
•
•
•
Bacteria: Francisella tularensis
Transmitted by ingestion,
inhalation, tick bites, direct
contact through skin
Six clinical forms in humans
Ulceroglandular
Glandular
Center for Food Security and Public Health
Iowa State University 2005
Tularemia
•
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
Viral Hemorrhagic Fevers
•
•
Ebola, Marburg, Lassa, Machupo
Human clinical presentation
− Early:
Fever, fatigue
− Severe: Bleed from internal
organs, body openings
− Progression to shock and
seizures
•
Vincent Massey
Animals: Only non-human
primates susceptible
Center for Food Security and Public Health
Iowa State University 2005
Category B: Agents/Diseases
•
•
•
•
Brucellosis
Glanders
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
•
•
•
Bacteria: Brucella spp.
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
Glanders
•
•
Bacteria: Burkholderia mallei
Transmission by
ingestion, inhalation or
direct contact
− Animal-to-human
transmission is inefficient
•
Clinical signs
− Humans
& horses: Skin and lung
lesions, rapidly fatal illness
Center for Food Security and Public Health
Iowa State University 2005
Psittacosis
•
•
•
•
Bacteria: Chlamydophila psittaci
Occurs worldwide
Reportable in U.S.
Clinical disease
− Humans
and birds: Ranges from no
symptoms to systemic illness with
severe pneumonia
Center for Food Security and Public Health
Iowa State University 2005
Q Fever
•
•
•
Coxiella burnetii
Transmission: Inhalation,
direct contact, ingestion, ticks
Disease symptoms
− Humans:


Acute: Flu-like, pneumonia & liver disease
Chronic: Heart complications, bone
inflammation
− Animals:

Most have no signs
Sheep, cattle and goats: Abortions
Center for Food Security and Public Health
Iowa State University 2005
Typhus Fever
Rickettsia prowazekii
• Endemic in Eastern Europe, Middle East,
and parts of Africa
• Transmitted in feces of
human body louse
• Clinical signs: Humans
•
J. Kalisch
−
•
Fever, headache, red blotches,
and a red-dot rash
Not seen in domestic animals
Center for Food Security and Public Health
Iowa State University 2005
Viral Encephalitis
•
•
•
Viruses causing EEE, WEE and VEE
Transmitted via mosquito
Clinical signs
− Humans,
horses, donkeys,
mules: Often no signs or
flu-like illness
− Brain inflammation in
some patients
•
Birds do not become ill but are
carriers; act as sentinels
Center for Food Security and Public Health
Iowa State University 2005
Food Safety Threats
•
•
•
•
•
•
Campylobacter species
Salmonella species
E. coli 0157:H7
Viruses, parasites,
chemicals, toxins
Ingestion of
contaminated food
Gastrointestinal upset
Center for Food Security and Public Health
Iowa State University 2005
Food Safety Threats:
The Bioweapon
•
1984, The Dalles, Oregon
− Bagwan
Shree Rajneesh cult
− Contaminated salad bars
 Salmonella typhimurium
− Goal: incapacitate voters
− 751 people ill
Center for Food Security and Public Health
Iowa State University 2005
Water Safety Threats
•
•
•
53% of US drinking
water is from ground
water
Cryptosporidium
parvum- protozoa
Vibrio choleraebacteria
Center for Food Security and Public Health
Iowa State University 2005
Cryptosporidium
•
•
•
Cryptosporidium parvum- protozoa
Transmission: Inhalation, ingestion
Clinical signs: Humans, calves,
others
− Acute
•
gastroenteritis
Dogs, cats, horses, pigs: Resistant
Center for Food Security and Public Health
Iowa State University 2005
Vibrio cholerae
•
•
•
Vibrio cholerae- bacteria
Transmission: Fecal-oral,
contaminated shellfish
Clinical signs in humans
− Acute,
mild diarrhea
− 5% severe disease
•
Animals are resistant to
disease
Center for Food Security and Public Health
Iowa State University 2005
Water Safety:
Public Health Significance
•
Cryptosporidum parvum
− 1993:
Municipal water supply
contaminated in Milwaukee
− 40,000 ill
− 1997: Decorative water fountain at the
Minnesota Zoo
− 369 cases
− Mostly young children
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
•
•
•
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
Hantavirus
•
•
•
Asymptomatic reservoir: Rodents
Transmission: Inhalation,
ingestion, direct contact
Human clinical signs
− Fever,
muscle pain,
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
Other Important
Zoonotic Diseases
•
•
•
Transmissible Spongiform
Encephalopathies
West Nile Virus
Monkeypox
Center for Food Security and Public Health
Iowa State University 2005
Transmissible Spongiform
Encephalopathy
•
•
•
•
•
Prions are mutated proteins thought
to cause disease
Very long incubation period
Neurological signs in all species
Invariably fatal
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 1999
Center for Food Security and Public Health
Iowa State University 2005
West Nile Virus
•
Transmission
Mosquitoes
− 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.
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
•
−
•
Eliminate 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
Monkeypox
Virus related to smallpox
• Transmission
•
Reservoir may be African squirrel
− Bites, aerosol, direct contact
− Zoonotic, animal-to-animal,
person-to-person
−
Animals: Fever, rash, pustules,
red eyes
• Humans: Flu-like, rash,
pustules, swollen lymph nodes
•
Center for Food Security and Public Health
Iowa State University 2005
Conclusion
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
− Local
veterinarian
− Local physician
− 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
your animals
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:
Ann Peters, DVM, MPH
Jamie Snow, DVM, MPH
Reviewer:
Radford Davis, DVM, MPH
Gayle Brown, DVM, PhD
Center for Food Security and Public Health
Iowa State University 2005