Bioterrorism
Awareness:
Protection of
Human and Animal
Health
Human Health
Professionals
Why Are We Here?
•
September 11, 2001
changed many things
− Worst
terrorist act in
U.S. history
− Approximately 3000 dead
or missing
− 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
system


•
in postal
22 cases
5 deaths
U.S. public health
realm changed
forever
Center for Food Security and Public Health
Iowa State University 2005
Goals of This Presentation
•
•
•
•
•
Animals and public health
Bioterrorism
Government agency preparation
Bioterrorism agents and
zoonotic potential
Your role and responsibility
Center for Food Security and Public Health
Iowa State University 2005
Animals and
Public Health
Number of Animals in U.S.
Dogs
Cats
Horses
Pigs
Cattle
Poultry
Wildlife
> 60 million
> 70 million
5 million
60 million
97 million
440 million
> 1 billion
Center for Food Security and Public Health
Iowa State University 2005
Animals and Public Health
•
•
•
Human-animal bond
Sport
Livelihood
Center for Food Security and Public Health
Iowa State University 2005
Animals and Public Health
•
•
•
Zoonotic disease
Direct transmission
Indirect transmission
− Foodborne
illnesses
− Vectors
− Fomite
Center for Food Security and Public Health
Iowa State University 2005
Animals and Public Health
•
•
Reservoirs, shedders,
spreaders of disease
Transmission (spillover)
from domestic animals to wildlife
− Establishment
of enzootic cycle
− Recurring human infections
− Greater costs to control or eradicate
− Spread to neighboring states, countries
Center for Food Security and Public Health
Iowa State University 2005
Animals and Public Health
•
•
Sentinels
Emergence of
new diseases
Center for Food Security and Public Health
Iowa State University 2005
Center for Food Security and Public Health
Iowa State University 2005
Animals and Public Health
Philos Trans R Soc Lond B Biol Sci. 2001
Jul 29;356(1411):983-9.
Center for Food Security and Public Health
Iowa State University 2005
Risk Factors for
Transmission of Zoonoses
•
Frequent contact with wild or
domestic animals
− Living
on the fringe of wilderness
− Keeping exotic animals as pets
− Frequenting live animal markets
− Working with livestock
•
•
Exposure to animal waste
Immunocompromised people
Center for Food Security and Public Health
Iowa State University 2005
Disease Control
•
Basic hygiene
− Wash
hands
− Child supervision
•
Disinfect/clean up
areas contaminated
with animal waste
− Livestock,
pets,
wildlife, rodents
Center for Food Security and Public Health
Iowa State University 2005
Zoonoses Control
•
•
•
•
•
Limit exposure to strays
and wildlife
Cook food properly
Proper pet selection
Use caution at
petting zoos
Guidelines for
immunocompromised
Center for Food Security and Public Health
Iowa State University 2005
Center for Food Security and Public Health
Iowa State University 2005
Center for Food Security and Public Health
Iowa State University 2005
Animals and Public Health
•
Interaction with animals
− Positive
•
attributes
Communication
between veterinary
and human health
communities and the
public is important
Center for Food Security and Public Health
Iowa State University 2005
Bioterrorism
Prevention through
Preparedness
Preparedness Responsibilities:
Human Health Professionals
•
•
•
Anticipate outbreaks locally
Collect, process, and store samples
Know the agents
− Typical

Ask questions about exposure to animals
− How
•
signs of diseases
to report suspected cases
Provide leadership and disseminate
information
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
Many Agents are Zoonotic
•
Category ABC disease/agent list
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 to Intentional
Zoonotic Agent Release
•
Clustering of morbidity or mortality
− Temporally
or geographically
− Animals or people
•
•
•
•
Generally healthy animals or
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
U.S. Agencies
Dealing with terrorism
Public Health Security and
Bioterrorism
•
Preparedness Response Act
− 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 (SNS)
•
12-hour Push Package
− Complete
package of
medical materials
•
Vendor Managed Inventory
− Tailored
•
to suspected agents
Technical Advisory
Response Unit
− Advise
on receiving,
distribution, etc. of
SNS material
Center for Food Security and Public Health
Iowa State University 2005
Insert Your State’s Info Here
•
The Iowa slides have been included
as an example. Delete them and put
in the information appropriate for
your state.
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
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
Category ABC
Diseases/Agents
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.
•
Disease coverage is brief. If you need more
information on a disease, please refer to the
disease fact sheet or the disease specific
PowerPoint 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
•
Bacillus anthracis
− Spores
•
in soil worldwide
Transmission
Zoonotic Potential
− Direct
contact (wound)
− Inhalation

Contaminated dust
− Ingestion

Contaminated meat
− Person-to-person
transmission rare
Center for Food Security and Public Health
Iowa State University 2005
Anthrax: The Disease
•
Humans
−
Cutaneous


−
Pulmonary

−
Mortality 75-95%
Gastrointestinal

•
95% of natural cases
Mortality 5-20%
Mortality >50% mortality
Animals
−
Ruminants at greatest risk


Sudden death, hemorrhage
No cutaneous lesions
Center for Food Security and Public Health
Iowa State University 2005
Anthrax: Zoonotic Importance
•
Zoonotic potential
Direct contact
− Inhalation
− Ingestion
−
•
High risk groups:
Occupational
Livestock,
slaughterhouse workers
− Tannery or wool
industry workers
− Veterinarians,
lab workers
−
Center for Food Security and Public Health
Iowa State University 2005
Anthrax: The Bioweapon
•
Bioweapon
− History
− Available
− Easy
to produce
− Spores infective and
highly resistant
− Aerosolization
− Low lethal dose
− High mortality
Center for Food Security and Public Health
Iowa State University 2005
Botulism: The Agent
•
Clostridium botulinum
−7
•
different neurotoxins (A-G)
Transmission
− Ingestion
(food-borne)
− Wound infection
− Aerosol
•
Zoonotic potential
− Improperly
fermented fish, undercooked
meat products, honey in infants
Center for Food Security and Public Health
Iowa State University 2005
Botulism: The Disease
•
All species, including humans
− Clinical
signs
Progressive flaccid paralysis
 Difficulty swallowing
 Drooping eyelids
 Paralysis of respiratory muscles

•
Death in 24 hours
− Medical
emergency
Center for Food Security and Public Health
Iowa State University 2005
Botulism: The Bioweapon
•
History
− U.S.
bioweapons program
− Used by Aum Shinrikyo cult in Japan
− Produced by Iraq
•
•
•
•
Aerosolized
Easy to produce and transport
Potent and lethal
Most poisonous substance known
Center for Food Security and Public Health
Iowa State University 2005
Plague: The Agent
•
•
Yersinia pestis
Transmission
− Flea
bite
− Direct contact

Infected animal tissue or fluids
− Aerosol
− Person-to-person
•
Zoonotic potential
− Rodents,
cats
Center for Food Security and Public Health
Iowa State University 2005
Plague: The Disease
•
Humans
− Bubonic
(50-60% fatality)
− Septicemic (~100% fatality)
− Pneumonic (~100% fatality)

•
Primary or secondary
Animals
− Rodents:

reservoir
Ground squirrels, prairie dogs, rats
− Cat:
similar to human forms
Center for Food Security and Public Health
Iowa State University 2005
Plague: Zoonotic Importance
•
•
•
Transfer of infected fleas
Contact with infected rodents
Contact with infected cat
− Sneezing
droplets
− Flea transfer
− Scratch or bite
Center for Food Security and Public Health
Iowa State University 2005
Plague: The Bioweapon
•
•
•
•
History
Available
Pneumonic form highly contagious
WHO estimate
− 50
kg agent: City population 5 million
− 150,000 cases pneumonic plague
− Potential mortality: 100,000
Center for Food Security and Public Health
Iowa State University 2005
Smallpox: The Agent
•
Orthopoxvirus
− Variola
•
virus
Eradicated worldwide in 1977
− Officially
•
declared in 1980
Transmission
− Person-to-person



Direct contact
Fomites
Aerosol
Center for Food Security and Public Health
Iowa State University 2005
Smallpox: The Disease
•
Human disease
Acute
− Initially flu-like
−


−
Progressive skin eruptions

−
Macules to papules to vesicles
Hemorrhagic and malignant forms possible

•
Fever, malaise
Headache, backache, vomiting
Both have high mortality rate (up to 95%)
Only affects humans
−
Experimentally

Cynomolgus monkeys
Center for Food Security and Public Health
Iowa State University 2005
Smallpox: The Bioweapon
•
•
•
•
•
History
Easy to produce large scale
Aerosolization
Diagnosis signals a bioterrorism event
Secondary spread
Person-to-person
− Fomites
−
Mortality 30% (unvaccinated)
• No effective treatment
•
Center for Food Security and Public Health
Iowa State University 2005
Tularemia: The Agent
•
•
Francisella tularensis
Transmission
Zoonotic Potential
− Vector:
tick, deerfly
− Ingestion

Undercooked meat (rabbit)
− Aerosolization
− Direct

contact
Abraded skin
− Person-to-person
not documented
Center for Food Security and Public Health
Iowa State University 2005
Tularemia: The Disease
•
Humans
− Glandular,
Ulceroglandular,
Oculoglandular, Oropharyngeal
− Severe: Typhoidal, Pneumonic
•
Animals
− Wildlife

Dead or behave strangely
− Other

species
Signs similar to humans, death
Center for Food Security and Public Health
Iowa State University 2005
Tularemia: Bioweapon
•
•
•
•
•
•
History
Stable
Aerosolized
Low infective dose via inhalation
Case-fatality: 30-60% (untreated)
1970 WHO estimation

50 kg agent: city population 5 million
• 250,000 ill
• 19,000 deaths
Center for Food Security and Public Health
Iowa State University 2005
Viral Hemorrhagic Fevers
•
•
•
Ebola and Marburg (Filoviruses)
Machupo and Lassa (Arenaviruses)
Transmission
− Person-to-person
− Direct
contact
− Fomites
− Machupo and Lassa (Zoonotic Potential)

Rodent urine or feces or food and water
contaminated by these materials
Center for Food Security and Public Health
Iowa State University 2005
VHF: The Disease
•
Humans
− Early:
fever, fatigue
− Severe

Hemorrhage of internal organs
and from body orifices
− Shock,
•
seizures
Animals
− Only
non-human primates susceptible
Center for Food Security and Public Health
Iowa State University 2005
VHF: The Bioweapon
− Aerosolized
− Not
readily available
− Requires specialized production
− Person-to-person and nosocomial
transmission occur
− Estimated fatality rate

Variable but can be 50-90% for some
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
•
•
Brucella species
Transmission - Zoonotic
− Direct
contact (breaks in skin)
Vaginal or uterine discharge
 Placenta, blood, urine

− Ingestion

Unpasteurized milk or dairy
− Aerosol
− Self-inoculation
with vaccine
− Person-to-person rare
Center for Food Security and Public Health
Iowa State University 2005
Brucellosis: Zoonotic Potential
Species
B. abortus
Natural Host
Cattle, bison, elk,
horses
B. melitensis Goats, sheep, cattle
Human
pathogen
YES
YES
B. suis
Swine, rodents
YES
B. canis
Dogs
YES
B. ovis
Sheep
NO
Center for Food Security and Public Health
Iowa State University 2005
Brucellosis: The Disease
•
Humans
− Cyclic

fever and flu-like symptoms
Muscle aches, headache, weight loss
− Chronic



•
Osteoarticular (20-60% of cases)
Chronic fatigue, depression
Genitourinary (2-20% of cases)
Animals
− Abortion,
infertility, lameness
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
Glanders: The Agent
•
Burkholderia mallei
− Gram
•
negative bacterium
Transmission
− Ingestion
− Inhalation
− Direct
contact
− Person-to-person rare
− Animal-to-human
•
Zoonotic potential
Center for Food Security and Public Health
Iowa State University 2005
Glanders: The Disease
•
Humans
−
Localized and Chronic

−
Pulmonary

−
Pneumonia, pulmonary abscesses
Septicemia


•
Nodules, abscesses, ulcers
Fever, chills, death within 7-10 d
Case-fatality 50-95% (untreated)
Horses, mules and donkeys
Acute, Chronic, Latent
− Cutaneous & pulmonary lesions
− Rapidly fatal illness
−
Center for Food Security and Public Health
Iowa State University 2005
Glanders: Zoonotic Importance
•
Animal-to-human transmission
− Possible
but inefficient
− Direct contact with exudates
− Aerosolization of agent
•
High risk groups
− Veterinarians
− Horse
owners, handlers, groomers
− Laboratorians
Center for Food Security and Public Health
Iowa State University 2005
Glanders: The Bioweapon
•
History
World War I: Russian horses
− World War II: Chinese civilians, horses, POW’s
− U.S bioweapon program
−
•
•
•
•
•
Easy to produce
Highly infectious
Stable
Aerosolized
Overall mortality: 40%
−
Septicemia case-fatality: 50-95%
Center for Food Security and Public Health
Iowa State University 2005
Melioidosis: The Agent
•
Burkholderia pseudomallei
− Gram
•
negative
Transmission
− Direct
contact (wounds)
− Ingestion
− Inhalation
− Person-to-person (rare)
− Animal-to-person (rare)
Center for Food Security and Public Health
Iowa State University 2005
Melioidosis: The Disease
•
Human
− Focal
− Pulmonary
− Septicemic
− Chronic/Latent

•
“Vietnamese time bomb”
Animals
− Sheep, goats, and pigs
− Horses, dogs, rodents
− Asymptomatic
− Pneumonia, abscesses
− Lameness
Center for Food Security and Public Health
Iowa State University 2005
Melioidosis: The Bioweapon
•
•
•
•
Minor history
Easy to produce
Available
Aerosolization
− Increased
number of septicemic and
pulmonary forms
•
Mortality rate can be as high as 90%
Center for Food Security and Public Health
Iowa State University 2005
Psittacosis: The Agent
•
Chlamydophila psittaci
Gram negative
− Resistant
−
•
Reportable in U.S.
−
•
50-100 reported
cases per year
Transmission
Zoonotic Potential
Inhalation of contaminated dust from feathers
or bird droppings
− Person-to-person possible
−
Center for Food Security and Public Health
Iowa State University 2005
Psittacosis: The Disease
•
Humans
Asymptomatic
− Flu-like signs
−


−
Severe pneumonia

•
Fever, chills, headache
Nonproductive cough, dyspnea
Especially in adults 30-60 years old
Birds
Depression, nasal discharge, conjunctivitis,
dyspnea
− Yellow-green diarrhea
− Possibly neurologic signs
−
Center for Food Security and Public Health
Iowa State University 2005
Psittacosis: The Bioweapon
•
•
•
Easily obtained
Aerosolized
Stable in the environment
Center for Food Security and Public Health
Iowa State University 2005
Q Fever: The Agent
•
Coxiella burnetii
− Obligate
•
intracellular rickettsia
Transmission
Zoonotic Potential
− Inhalation
− Direct
contact
− Ingestion
− Inoculation (ticks)
− Person-to-person (rare)
Center for Food Security and Public Health
Iowa State University 2005
Q Fever: The Disease
•
Humans
− Acute

Flu-like signs, pneumonia, hepatitis
− Chronic

•
Endocarditis, osteomyelitis
Animals
− Most
asymptomatic
− Abortions, stillbirths
Center for Food Security and Public Health
Iowa State University 2005
Q Fever: Zoonotic Importance
•
•
Parturient material from infected
animals
Urine, feces, milk
− Direct
contact
− Inhalation of droplets
− Inhalation of contaminated dust
Center for Food Security and Public Health
Iowa State University 2005
Q Fever: The Bioweapon
•
•
•
•
History
Easily accessible
Environmentally resistant
Highly infectious
− One
•
organism
Aerosolization
− Travel
•
up to ½ mile by wind
Low mortality but chronic morbidity
Center for Food Security and Public Health
Iowa State University 2005
Typhus Fever: The Agent
•
•
Rickettsia prowazekii
Endemic
− Eastern
Europe, Middle East,
and parts of Africa
•
Transmission
− Human
body louse feces
− Not person-to-person
Center for Food Security and Public Health
Iowa State University 2005
Typhus Fever: The Disease
•
Humans
− Fever,
headache
− Macular eruptions
− Petechial rash
•
Not seen in domestic animals
− Documented


in flying squirrels
Asymptomatic
Few human cases associated
Center for Food Security and Public Health
Iowa State University 2005
Typhus Fever: The Bioweapon
•
•
•
Available
Can be aerosolized in lice feces
WHO estimation: 1970
− 50
kg agent
− 5 million people in city
− 125,000 ill

8,000 deaths
Center for Food Security and Public Health
Iowa State University 2005
Viral Encephalitis: The Agents
•
Arboviruses
− Alphaviruses


•
Bird  Mosquito
Horses and humans dead end hosts
Transmission
− Mosquitoes
− Person-to-person
possible
Center for Food Security and Public Health
Iowa State University 2005
Viral Encephalitis: The Disease
•
Humans
−
Asymptomatic to flu-like illness

−
Neurological

•
Disorientation, stupor, coma, seizures, paralysis
Horses
−
•
Fever, myalgia, headache,  nausea and vomiting
Signs similar to humans
Birds
Asymptomatic carriers
− Neurological or death
− Can act as sentinels
−
Center for Food Security and Public Health
Iowa State University 2005
Viral Encephalitis: The Bioweapon
•
•
•
•
History
Easy to produce
Aerosolization
High rate of infection
− With
long term disability possible
Center for Food Security and Public Health
Iowa State University 2005
Toxins: The Agents
•
Staphylococcal
enterotoxin B (SEB)
•
Ricin toxin from
castor plant
•
Clostridium
perfringens epsilon
toxin
Center for Food Security and Public Health
Iowa State University 2005
Staphyloccal Enterotoxin B
(SEB): The Agent
Staphylococcus aureus
• Transmission: Ingestion and inhalation
• Humans
•
Fever, chills, headache, myalgia
− Inhalation  non-productive cough
− Ingestion  nausea, vomiting, diarrhea
−

•
Typically self limiting in 8-24 hours
Animals
Limited information available
− Signs likely to be similar to human
−
Center for Food Security and Public Health
Iowa State University 2005
Ricin: The Agent
Toxin from bean
of castor plant
(Ricinus communis)
• Transmission
•
−
Ingestion


−
Inhalation

−
•
Severe gastrointestinal signs
Hemorrhagic enteritis
Respiratory signs with death
as rapidly as 36-72 hours
Injection
Horses most susceptible animal species
Center for Food Security and Public Health
Iowa State University 2005
Epsilon Toxin: The Agent
•
Clostridium perfringens type B and D
− Increases
intestinal and vascular
permeability and liver damage
•
Clinical signs
− Calves

Diarrhea, abdominal pain, listlessness,
neurologic
− Sheep,

goats
Watery to bloody diarrhea, neurologic
− Humans

Little information
Center for Food Security and Public Health
Iowa State University 2005
Toxins: The Bioweapon
•
•
•
•
•
•
History
Aerosolized: SEB, Ricin
Available worldwide
Easy to produce, stable
Many species affected
No person-to-person transmission
Center for Food Security and Public Health
Iowa State University 2005
Food Safety Threats
•
•
•
•
Campylobacter species
Salmonella species
E. coli 0157:H7
Others:
− 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
to incapacitate voters
− 751 people ill
Center for Food Security and Public Health
Iowa State University 2005
Water Safety Threats
•
•
53% of U.S. drinking
water is from
ground water
Cryptosporidium
parvum
− Protozoan
•
Vibrio cholerae
− Bacteria
Center for Food Security and Public Health
Iowa State University 2005
Cryptosporidium: The Agent
•
Cryptosporidium parvum
− Protozoa
•
Transmission
− Inhalation,
•
ingestion
Clinical signs
− Humans,

calves, others
Acute gastroenteritis
− Dogs,
cats, horses, pigs: Resistant
− Zoonotic Potential
Center for Food Security and Public Health
Iowa State University 2005
Vibrio cholerae: The Agent
•
Vibrio cholerae
−
•
Gram negative bacteria
Transmission
Fecal-oral
− Contaminated shellfish
−
•
Humans
Acute, mild diarrhea
− 5% severe disease
−
•
Animals
−
Resistant to disease
Center for Food Security and Public Health
Iowa State University 2005
Water Safety:
Public Health Significance
•
1993
− Municipal

water supply contaminated
Milwaukee, WI
− Cryptosporidum
− 40,000
•
parvum
ill
1997
− Decorative

water fountain
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: The Agent
•
•
•
Paramyxovirus; Henipavirus
Reservoir: Fruit bats
Transmission
− Aerosol,
direct contact with
infective tissues
− Not person-to-person
•
•
Zoonotic Potential
2004 break: Bangladesh
− 26
human deaths
Center for Food Security and Public Health
Iowa State University 2005
Nipah Virus: The Disease
•
Humans
−
Encephalitis

−
•
Fever, headache, dizziness, disorientation
Respiratory distress possible
Swine
Asymptomatic
− Severe respiratory disease
−

−
•
Dyspnea, open mouth breathing, barking cough
Neurological signs possible
Dogs and cats
−
Neurological and respiratory
Center for Food Security and Public Health
Iowa State University 2005
Nipah Virus: The Bioweapon
•
•
•
•
•
Emerging pathogen
Aerosolization potential
Wide host range
High morbidity and
mortality
Biolevel 4
Center for Food Security and Public Health
Iowa State University 2005
Hantavirus: The Agent
•
Bunyaviridae
− Sin
•
Reservoir: Rodents


•
Nombre
Deer mouse in U.S.
Not house mouse
Transmission
− Infective



rodent feces, urine or saliva
Inhalation
Direct contact
Ingestion
Center for Food Security and Public Health
Iowa State University 2005
Hantavirus: The Disease
•
Humans
− Fever,
myalgia, headache
− Rapid progression to severe respiratory
disease


Hantavirus Pulmonary Syndrome
Hemorrhagic Fever with Renal Syndrome
− Death
•
can occur in 48 hours
Not seen in domestic animals
Center for Food Security and Public Health
Iowa State University 2005
Hantavirus: The Bioweapon
•
•
Aerosolized
Rapid disease
− Requires
•
•
hospitalization
Mortality 40%
Hemorrhagic Fever with
Renal Syndrome
− Clinical
form not
typically seen in U.S.
Center for Food Security and Public Health
Iowa State University 2005
Other Important Diseases
•
•
•
•
•
•
Transmissible Spongiform
Encephalopathy
Rift Valley Fever
Hendra Virus
West Nile Virus
Monkeypox
Foot and Mouth Disease
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
First case December 2003
− Now have enhanced surveillance
−
Center for Food Security and Public Health
Iowa State University 2005
Rift Valley Fever: The Agent
•
Family Bunyaviridae
− Phlebovirus
•
Transmission
− Mosquitoes
− Inhalation
− Contact
with infected body fluids
− Not person-to-person
•
Zoonotic Potential
Center for Food Security and Public Health
Iowa State University 2005
Rift Valley Fever: The Disease
•
Humans
− Asymptomatic
flu-like signs

Fever, headache
− Severe

•
or self-limiting
disease
Retinitis, hemorrhagic fever
Animals
− Abortions,
neonatal death
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
Hendra Virus: The Agent
•
Newly discovered
−
Paramyxovirus

−
Henipahvirus
1994: Australia
Fruit bats
• Transmission
•
Close contact with urine, body fluids
− Ingestion
− Not person-to-person
−
•
Zoonotic potential
Center for Food Security and Public Health
Iowa State University 2005
Hendra Virus: The Disease
•
Humans
− Flu-like
illness
− Rapid progression to
respiratory failure or encephalitis
•
Horses, cats
− Acute
respiratory signs
− Nasal discharge, fever
− Encephalitis
− Sudden death
Center for Food Security and Public Health
Iowa State University 2005
West Nile Virus: The Agent
•
•
•
Flavivirus
Reservoir: Birds (Corvids)
Humans and horses
− Dead
•
end hosts
Transmission
− Mosquitoes

Culex species
− Person-to-person

Blood transfusion, organ donation,
breast feeding
Center for Food Security and Public Health
Iowa State University 2005
West Nile Virus: The Disease
•
Humans
− ~80%
Asymptomatic
− ~20% “West Nile Fever”
Fever, headache, myalgia, prolonged fatigue
 1:150 cases severe

•
•
“West Nile Encephalitis”
• Case-fatality 3-15%
• Highest in elderly
Animals
− Horses,
birds, mammals, and reptiles
Center for Food Security and Public Health
Iowa State University 2005
West Nile Virus:
Public Health Significance
•
2003
− Human

9,862 cases - 264 deaths
− Equine


•
illness in U.S.
4,554 cases
40% of ill result in death
− Other

illness in U.S.
mammals
dogs, squirrels, cats
Method of introduction to
U.S. unknown
Center for Food Security and Public Health
Iowa State University 2005
Map courtesy of CDC
Center for Food Security and Public Health
Iowa State University 2005
Foot and Mouth Disease: FMD
•
•
•
Picornavirus
Highly contagious
Minimal risk to humans
− Extremely
rare
− Mild symptoms in people
•
Transmission
− Direct
contact
− Aerosol
− Fomites
Center for Food Security and Public Health
Iowa State University 2005
FMD: The Disease
•
Species
− Cloven-hoofed

Cattle, sheep, goats, swine
− Not
•
animals
horses
Signs
− Fever
− Vesicles


Mouth, lips,
tongue,
and hoof lesions
Hypersalivation, anorexia, and lameness
Center for Food Security and Public Health
Iowa State University 2005
FMD: Agroterrorism Threat
•
Most important livestock disease
in the world
− Economically
•
devastating
U.S. agriculture as a target
− One
sixth of the U.S. domestic
product is tied to agriculture
− Immunologically naive population
•
Vulnerabilities
Center for Food Security and Public Health
Iowa State University 2005
Monkeypox: The Agent
•
Orthopoxvirus
− Related
•
to smallpox
Transmission
− Bites
− Aerosol
− Direct
contact
− Fomites
− Person-to-person
•
Zoonotic potential
Center for Food Security and Public Health
Iowa State University 2005
Monkeypox: The Disease
•
Humans
− Flu-like
signs
− Rash, vesicles, pustules
− Lymphadenopathy
•
Animals-Rodents
− Fever
− Cutaneous
rash and vesicles
− Conjunctivitis
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
Responsibility
Integrated Public Health System
•
•
•
•
Communication
Be aware, contribute,
assist in development
of disease surveillance
programs
Report zoonoses
Be involved with emergency
response plans at all levels
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
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
− Public

Health Officials
Local and State
− Local
Veterinarian
− State Public Health
Veterinarian or
State Veterinarian
Center for Food Security and Public Health
Iowa State University 2005
Summary
•
•
•
•
•
Bioterrorism is a real threat
Many bioterrorism agents are zoonotic
Animals may be the first to show signs
Ask questions about animals exposure
and clinical signs
Public health infrastructure is
being strengthened
Center for Food Security and Public Health
Iowa State University 2005
Summary
Awareness education is important
component of preparedness
and protection
• Prevention, recognition, and response
involves everyone
• You play a critical role
•
Center for Food Security and Public Health
Iowa State University 2005
Readings
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
Co-authors:
Gayle Brown, DVM, PhD
Radford Davis, DVM, MPH
Reviewer:
Danelle Bickett-Weddle, DVM, MPH
Center for Food Security and Public Health
Iowa State University 2005