Body Substance Isolation, Biosafety MCI on Biological Concerns Body Substance Isolation • is a practice of isolating all body substances (blood, urine, feces, tears, etc.) • HAZMAT – Hazardous Materials, Toxic Chemicals MASS CASUALTY INCIDENTS OF BIOLOGICAL AGENTS OF CONCERNS LEARNING OBJECTIVES ü Described the CDC and Preventions system for the categorization of biological agents of concern ü Identify Category A-C agents ü Describe available management and tx ü Discuss the potential public health impact. Key notes ü ü ü ü Group of pathogens Causes mortality and morbidity Categories A,B,C Potential use as a WMD – “bioterrorism” Classification of Biological Agents ü ü ü ü Formed in 1999 Divided into three classes Category A,B,C Agents are ranked based on several factors, including public health impact in terms of disease and mortality rates. Category A ü ü ü ü ü ü Most dangerous Most deadly virus known to man Person – person contact Can cause a social disruption Laboratory precautions are in the strictest decorum Even healthcare providers are at risk Category A Agents ü ü ü ü ü ü Anthrax (Bacillus anthracis) Botulinum toxin (Clostridium botulinum) Plague (Yersinia pestis) Smallpox (Variola major) Tularemia (Francisella tularenis) Hemorrhagic fever (HF) viruses including (Arena viruses, Bunyaviruses, Flaviviruses, and Filoviruses) Category B ü ü ü 2nd highest priority Potential moderate morbidity and lower mortality Survival rate is depending on person health history Category B Agents ü ü ü ü ü ü ü ü ü ü ü ü Brucellosis Epsilon toxin of Clostridium perfringens Food safety threats (salmonella shigella, E. coli) Glanders Melioidosis Psittacosis Q fever Ricin toxin (from castor beans) Staphyloccocal enterotoxin B Typhus fever Viral encephalitides Water safety threats (Vibrio Cholerae, Cryptosporidium parvum) Category C ü ü ü Emerging agents MDRTB Corona Viruses (2012) Biosafety Laboratory Classifications v BSL 1- 4 v BSL 3 handles exotic or indigenous agents v BSL 4 – most strict in contagion that handles the most deadly pathogens Biosafety video containment ü https://drive.google.com/file/d/18p5GHMtCSlV4wDqHyPZYJN7Gkqt6pWg/view?usp=sharing ANTHRAX ü ü ü ü ü ü ü ü ü Zoonotic disease Herbivores (sheep, goats, and Cattle.) Ingested spores from contaminated soil Made – up of spore forming bacterium ‘ CA – Bacillus anthracis Human disease comes from contact with infected animals Potential use as a WMD used in Russia in 1979 Researched in Iraq as a WMD by the Biological Weapons Program of their government In 1970, airborne release of 50 kg could cause in a 5m population. 250k individuals could be infected and up to 100k deaths. epidemiology ü ü ü Present worldwide Affects agricultural sectors May occur as GI, inhalational and meningeal forms Inhalational anthrax ü ü ü ü S/sx – Cough, Chest pain, dyspnea Viral URI, sore throat, myalgias, mild fever Lymphadenopathy, widened mediastinum on chest radiograph, pleaural effusions May progress to ARDS, sepsis Meningeal sign ü Hemorrhagic Meningitis Cutaneous Anthrax ü ü ü Raise bump on face, hands, or arms, typically with black ulcerations Black eschar, lymphadenopathy is also present Moderate to severe edema Management ü ü ü ü Vaccination – reserve as a pre – exposure prophylaxis Drug of Choice: Ciprofloxacin, doxycycline, levofloxacin and moxifloxacin Anthrax is resistant to cephalosporins Systemic Tx – raxibacumab and anthrax immune globulin if available botulism ü ü ü ü ü ü Neuroparalytic foodborne illness – 1979 Anerobic bacterium C. botulinum Public health emergency carrying significant widespread of disease and death. Used by Japanese cult Researched by the former Soviet Union and Iraq as a WMD Used in medicine by the term “botox” BOTULISM ü ü ü ü Foodborne botulism accounts for 1000 cases per year Majority are infant (infantile botulism) IV drugs – wound botulism C. Botulinum is commonly found in soil, dust, and food surfaces Signs and symptoms ü ü ü ü Progressive descending, symmetric paralysis or weakness Cranial nerve palsy Affects smooth muscles and have a multiple organ affectations Infants may present a sudden NVD accompanied by decrease in LOC. Management ü ü ü ü Vaccination – under research Supportive symptomatic tx Botulinum antitoxin – provides antibodies to botulinum Antibiotics are not recommended except for wound botulism. Plague History ü ü ü ü ü ü Most feared disease in the history of humankind More than 200M people have died Black death of middle ages 8th – 14th centuries Quarantine – Quaranto CA - Yersinia pestis Plague ü ü ü ü Still present worldwide Plague infected fleas infest rodents as a host Gram negative bacterium Bite of infected flea and droplet and contact with person who have pneumonic plague Bubonic plague ü ü ü ü Present in the middle ages Painful swollen lypmnodes “Bubo” Followed b y generalized bacteremia that leads to organ damage and death Signs and symptoms ü ü ü ü ü High grade fever and chills Myalgia Swollen painful lympnodes n/v Cough with bloody sputum management • Vaccine – under research • Antibiotic prophylaxis • DOC: streptomycin, doxycycline, ciprofloxacin, moxifloxacin and chloramphenicol. Smallpox SMALLPOX • Viral disease present for centuries • But used as a WMD during French – Indian wars 1754 • Eradicated thru vaccination • Last occurred in Somalia 1977 Mode of transmission • Person – person contact • Droplet spread Signs and sx • Backache, fatigue malaise • Fever subsides when the rash appears • Macular – vesicular rash deeply imbedded in the dermis management • Supportive symptomatic • Vaccination • Cidofovir • brincidofivir Ebola (Viral Hemorrhagic Fever) • • • • Group of febrile illness caused by RNA viruses Ebola virus (species Zaire ebolavirus) Sudan virus (species Sudan ebolavirus) Ebola virus was first discovered in 1976 near the Ebola River in what is now the Democratic Republic of Congo. Since then, the virus has been infecting people from time to time, leading to outbreaks in several African countries. Scientists do not know where Ebola virus comes from. Transmission • Scientists think people are initially infected with Ebola virus through contact with an infected animal, such as a fruit bat or nonhuman primate. This is called a spillover event. After that, the virus spreads from person to person, potentially affecting a large number of people. transmission • Blood or body fluids (urine, saliva, sweat, feces, vomit, breast milk, amniotic fluid, and semen) of a person who is sick with or has died from Ebola virus disease (EVD). • Objects (such as clothes, bedding, needles, and medical equipment) contaminated with body fluids from a person who is sick with or has died from EVD. • Infected fruit bats or nonhuman primates (such as apes and monkeys). • Semen from a man who recovered from EVD (through oral, vaginal, or anal sex). The virus can remain in certain body fluids (including semen) of a patient who has recovered from EVD, even if they no longer have symptoms of severe illness. There is no evidence that Ebola can be spread through sex or other contact with vaginal fluids from a woman who has had Ebola. Signs and sx • Symptoms may appear anywhere from 2 to 21 days after contact with the virus, with an average of 8 to 10 days. The course of the illness typically progresses from “dry” symptoms initially (such as fever, aches and pains, and fatigue), and then progresses to “wet” symptoms (such as diarrhea and vomiting) as the person becomes sicker. • Primary signs and symptoms of Ebola often include some or several of the following: • Fever • Aches and pains, such as severe headache and muscle and joint pain • Weakness and fatigue • Sore throat • Loss of appetite • Gastrointestinal symptoms including abdominal pain, diarrhea, and vomiting • Unexplained hemorrhaging, bleeding or bruising • Other symptoms may include red eyes, skin rash, and hiccups (late-stage). management • The U.S. Food and Drug Administration (FDA) approved the Ebola vaccine rVSV-ZEBOV (called Ervebo®) on December 19, 2019. This is the first FDA-approved vaccine for Ebola. Treatment There are currently two treatments* approved by the U.S. Food and Drug Administration (FDA) to treat EVD caused by the Ebola virus, species Zaire ebolavirus, in adults and children. The first drug approved in October 2020, Inmazeb™external icon, is a combination of three monoclonal antibodies. The second drug, Ebanga™external icon, is a single monoclonal antibody and was approved in December 2020. Monoclonal antibodies (often abbreviated as mAbs) are proteins produced in a lab or other manufacturing facility that act like natural antibodies to stop a germ such as a virus from replicating after it has infected a person. These particular mAbs bind to a portion of the Ebola virus’s surface called the glycoprotein, which prevents the virus from entering a person’s cells. . Both of these treatments, along with two others, were evaluated in a randomized controlled trial during the 2018-2020 Ebola outbreak in the Democratic Republic of the Congo. Overall survival was much higher for patients receiving either of the two treatments that are now approved by the FDA. Neither Inmazeb™ nor Ebanga™ have been evaluated for efficacy against species other than Zaire ebolavirus. Supportive Care Whether or not other treatments are available, basic interventions can significantly improve chances of survival when provided early. These are referred to as supportive care, and include: Providing fluids and electrolytes (body salts) orally or through infusion into the vein (intravenously). Using medication to support blood pressure, reduce vomiting and diarrhea, and to manage fever and pain. Treating other infections, if they occur REFERENCES DISASTER NURSING AND EMERGENCY PREPAREDNESS – TENER GOODWIN VEENEMA NDRMMC IMPACT RESPONSE GUIDELINES https://www.youtube.com/watch?v=8qz0PpzFGJc Thank you!
