bioterrorism awareness: protection of human and animal health food animal veterinarians

Bioterrorism Awareness:Protection of Human and Animal HealthFood animal veterinarians

Center for Food Security and Public Health Iowa State University 2005

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

Biological Attack• Bioterrorism attacks of 2001

• Anthrax in postal system• 22 cases• 5 deaths

• U.S. public health realm changed forever

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

Overview• Bioterrorism• Zoonoses and bioterrorism• Disease control and biosecurity • U.S. Government agencies involved• Bioterrorism agents/diseases• Your role and responsibility

Biological agents targeting humans, animals, or plants

Biological, chemical, or radiological agents targeting agriculture or its components

•Livestock•Food supply•Crops•Industry•Workers

TerrorismBioterrorismAgroterrorism Other

Conventional, radiological, nuclear, chemical,cyber

•Typically direct human targeting

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

Time (Days)

Exposure

Symptoms

Seek Care

Infectious Disease Outbreak

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

Many Agents are Zoonotic• Disease may be seen in animals

before humans• Animals are sentinels

− Pets, livestock, wildlife

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

Disease Control: Client Education

• Disinfect/clean up areas contaminated with animal waste−Livestock, pets, wildlife, rodents

• Basic hygiene−Wash hands−Child supervision

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

Biosecurity Educationfor the Producer

• Develop and implement a biosecurity plan

• Train employees to help maintain the plan

• Post signs restricting access to areas of the farm and control traffic flow

• Regulate visitors• Keep visitors sanitary

−Clean clothing, boots−Disposable plastic shoe/boot

covers• Implement insect,

bird, and animal control• Secure water, feed, and nutrient sources

• Maintain healthy herd−Vaccinations−Proper hygiene for

animals and handlers• Purchase from

reputable sources• Quarantine newly

purchased animals• Separate sick animals

Biosecurity: Veterinarians• Disinfect your clothes, boots, equipment

between farms• Avoid vehicle contamination• Follow biosecurity guidelines set forth by

species-specific associations

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

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

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

Strategic National Stockpile

• 12-hour Push Package− Complete package of

medical materials

• Vendor Managed Inventory− Tailored to suspected agents

Insert Your State’s Info Here

Preparing Iowa• Iowa’s Homeland

Security −Administered by

Iowa Emergency Management Division

−Works with public and private partners

www.iowahomelandsecurity.org

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

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

“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

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.

Category A : Agents/Diseases• Anthrax• Botulism• Plague• Smallpox• Tularemia• Viral hemorrhagic fevers

Anthrax: The Agent• Bacteria: Bacillus anthracis • Forms spores• Human disease

−Skin− Intestinal−Pulmonary

• Animal disease−Septicemia and rapid death

Anthrax: The Bioweapon• History• Available & easily

produced• Spores infective• Aerosolization• Low lethal dose• High mortality• Person-to-person transmission rare

Anthrax: The Response• Vaccine

−Humans−Animals

• Antibiotics−Treatment−Prophylaxis

• Disinfection −Sporicidal agents, sterilization

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

Botulism: The Bioweapon• Used by Aum Shinrikyo

cult in Japan• Aerosolized• Easy to produce and

transport• Potent and lethal• Most poisonous substance

Botulism: The Response• Toxoids for high risk people• Antitoxin available

−Case-by-case basis• Botulinum toxins are easily

inactivated with many disinfectants and heat

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

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

Plague: The Response• Antibiotics generally effective if given

early• Killed vaccine available • Isolation of sick individuals• Susceptible to a number of common

disinfectants

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

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%

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

Tularemia: The Agent• Francisella tularensis• Transmitted by ingestion,

inhalation, vectors, direct contact through skin

• Six clinical forms in humans

UlceroglandularGlandular

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

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

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

Viral Hemorrhagic Fevers:The Agents

−Early: Fever, fatigue−Severe: Bleed from internal

organs, body orifices−Progression to shock &

seizures• Animals: Only non-human

primates susceptible

• Ebola, Marburg, Lassa, Machupo • Human clinical presentation

Vincent Massey

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%

VHF: The Response• Intensive supportive care• Ribavirin has shown some efficacy • Susceptible to bleach solutions,

phenolic disinfectants, and UV light

Category B: Agents/Diseases• Brucellosis• Glanders• Melioidosis • Psittacosis • Q Fever

• Typhus fever• Viral encephalitis• Toxins• Food Safety Threats • Water Safety Threats

Brucellosis: The Agent• Gram-negative bacteria• Ingestion, inhalation, or

direct contact• Clinical signs

−Humans: Cyclic fever and flu-like symptoms

−Animals: Reproductive signs

Brucellosis: The AgentSpecies Natural Host Human

PathogenB. 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 YesB. ovis Sheep No

Brucellosis: The Bioweapon• History• Highly infectious• Easily aerosolized• Stable • Prolonged incubation period

−May make diagnosis difficult• Person-to-person unlikely

Brucellosis: The Response• Long term antibiotics generally

effective• Vaccinate calves, no human vaccine• Eliminate reservoir• Standard precaution to

avoid exposure• Thorough disinfection

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 & pulmonary lesions, rapidly fatal illness

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

Glanders: The Response• No vaccine • Antibiotic therapy likely effective• Destroyed by various chemicals

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

Melioidosis: The Bioweapon • Easy to produce • Available• Aerosolization• High mortality: 90%• Person-to-person (rare)• Animal-to-person (rare)

Melioidosis: The Response• Long-term, multiple

antibiotics effective• Vaccines available:

Not in U.S.• Easily destroyed by

disinfectants

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

Psittacosis: The Bioweapon• Easily obtained• Aerosolized• Stable in the

environment• Person-to-person

transmission rare• Low mortality

Psittacosis: The Response• Antibiotics

generally effective• Decontamination

possible with most disinfectants

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

Q Fever: The Bioweapon• History• Easily accessible• Environmentally

resistant• Highly infectious• Aerosolization

−Travel ½ mile by wind• Low mortality- chronic morbidity

Q Fever: The Response• Often self-limiting disease• Antibiotic therapy may limit

complications• Vaccine developed, not available in

U.S.• Variable susceptibility to

disinfectants

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, maculareruptions, and petechial rash

• Not seen in domestic animals

J. Kalisch

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

Typhus Fever: The Response• Antibiotics are generally effective• Vaccine, not commercially available

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

Viral Encephalitis:The Bioweapon

• Easy to produce• Aerosolization• High rate of infection• Person-to-person transmission

possible

Viral Encephalitis:The Response

• Supportive care• Vaccine

−Equine−Human: High risk

• Virus unstable in environment

Toxins: The Agents• Staphylococcal

enterotoxin B (SEB)• Ricin toxin from

castor plant • Clostridium

perfringens epsilon toxin

SEB: The Agent• Staphylococcal enterotoxin B (SEB)• A common cause of food poisoning • Clinical signs: Humans

−Fever, chills, headache, myalgia−Non-productive cough if inhaled−GI signs if swallowed

• Animals: Likely similar to human

Ricin: The Agent• Ricin toxin from bean of castor plant • Available worldwide• Clinical signs

−Acute onset of fever,chest tightness, cough,

dyspnea, nausea

Epsilon Toxin: The Agent• Clostridium perfringens type B and D• Increases intestinal and vascular

permeability, liver and neurological damage

• Clinical signs−Calves: Diarrhea, abdominal pain,

listlessness, neurologic−Sheep, goats: Watery to bloody

diarrhea, neurologic−Humans: Little information

Toxins: The Bioweapon• History• Aerosolized: SEB, ricin • Available worldwide• Easy to produce, stable• Many species affected• No person-to-person transmission

Toxins: The Response• Supportive care• No vaccines currently available for

SEB or ricin• Vaccines for animals for clostridial

disease• Toxins are inactivated with common

disinfectants

Food Safety Threats• Campylobacter species• Salmonella species• E. coli 0157:H7 • Viruses, parasites,

chemicals, toxins• Ingestion of

contaminated food• Gastrointestinal upset

Food Safety Threats: The Bioweapon

• 1984, The Dalles, Oregon−Bagwan Shree Rajneesh cult−Contaminated salad bars

Salmonella typhimurium−Goal: Incapacitate voters−751 people ill

Food Safety Threats: The Response

• Constant vigilance to improve food safety

• Food irradiation at processing plants• Wash hands and utensils frequently• Proper cooking temperature and

storage

Water Safety Threats• 53% of US drinking

water is from ground water

• Cryptosporidium parvum- protozoa

• Vibrio cholerae- bacteria

Cryptosporidium: The Agent• Cryptosporidium parvum- protozoa• Transmission: Inhalation, ingestion• Clinical signs: Humans, calves,

others−Acute gastroenteritis

• Dogs, cats, horses, pigs: Resistant

Vibrio cholerae: The Agent• Vibrio cholerae- Gram-

negative bacteria• Transmission: Fecal-oral,

contaminated shellfish• Clinical signs, humans

−Acute, mild diarrhea−5% severe disease

• Animals are resistant to disease

Water Safety: Public Health Significance

• 1993: Municipal water supply contaminated in Milwaukee−Cryptosporidum parvum −40,000 ill

• 1997: Decorative water fountain at the Minnesota Zoo−C. parvum −369 cases −Mostly young children

Water Safety Threats: The Response

• Government has laws to protect our water supply

• Treatment facilities are equipped and will likely inactivate most organisms

−Chlorination, filtration, ozone• Dilution factor

Category C• Nipah virus• Hantavirus

Nipah Virus: The Agent• Paramyxovirus• Fruit bat reservoir• Clinical signs

−Humans: Encephalitis−Pigs: Respiratory, neurological−Dogs and cats: “Distemper”

Nipah Virus: The Bioweapon• Aerosolization

potential• Wide host range• No person-to-person

transmission expected

• High morbidity and mortality

Nipah Virus: The Response• Avoid contact with all

infected animals and fluids

• Vaccine being researched• Call authorities

immediately

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

Hantavirus: The Bioweapon• Aerosolized• Hospitalization• Unexpected disease

in the U.S.−HFRS limited to

Asia/Europe to date

Hantavirus: The Response• Supportive care• Limit exposure to

rodent excrement−Wear gloves, face

mask• Virus is

deactivated with bleach

Other Important Diseases

• Transmissible Spongiform Encephalopathy (TSE)

• Rift Valley Fever• Hendra Virus• West Nile Virus• Foot and Mouth Disease• Monkeypox

Transmissible Spongiform Encephalopathy: The Agent

• Prions−Proteinaceous infectious particles−Mutated proteins

• Very long incubation period• Neurological signs in all species• No treatment available

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

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

Rift Valley Fever: The Agent• Phlebovirus in family Bunyaviridae• Transmission: Mosquito, inhalation,

contact with infected body fluids• Clinical signs

−Humans: Flu-like, fever, headache Severe disease: Retinitis, hemorrhagic

fever−Animals: Abortions, death in neonates

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

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

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

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

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”

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

Spread of WNV in the U.S.: 1999-2002

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

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

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

FMD: The Response• USDA upgrading safeguarding

measures• Strict biosecurity• Notify authorities immediately• Response and recovery plans

−Quarantine−Depopulation−Disinfection

• Vaccination – complex decision

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

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

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

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

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

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

Contacts• Phone numbers to know

−State Veterinarian−State Public Health

Veterinarian−APHIS- Area Veterinarian

in Charge−Public Health Officials

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

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

Conclusion

“The best prescription,is knowledge.”

Dr. C. Everett KoopFormer U.S. Surgeon General

AcknowledgmentsDevelopment 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.

AcknowledgmentsAuthor:

Reviewers:

Danelle Bickett-Weddle, DVM, MPH

Radford Davis, DVM, MPHGayle Brown, DVM, PhDJean Gladon, BS

bioterrorism awareness: protection of human and animal health food animal veterinarians

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