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  • L 11 Epidemics and Emerging Infections 1

    Epidemics and Emerging Infections

    Hospital Preparedness for Emergencies

  • Wars of the Future: Biological Warfare and Chemical

    Weapons

    Teodoro Herbosa MD FPCS Department of Emergency Medicine

    College of Medicine University of the Philippines, Manila

  • L 11 Epidemics and Emerging Infections 3

    Objective

    Identify the fundamentals of a hospital preparedness and response plan for epidemics.

    Upon completion of this unit, you will be able to:

  • L 11 Epidemics and Emerging Infections 4

    Biological Hazards

    Terrorism / Anthrax SARS Avian Flu Dengue MERSCoV Ebola

    Vulnerability emerging to infectious diseases

  • L 11 Epidemics and Emerging Infections 5

    Biological Hazards

    Tartars used plague-infected

    corpses in Kaffa, 1346.

  • L 11 Epidemics and Emerging Infections 6

    Influenza Pandemic

    Nurses work in the Red Cross rooms of Seattle, WA with influenza masks on their faces. December 1918 (Courtesy of the National Archives, 165-WW-269B-10)

  • L 11 Epidemics and Emerging Infections 7

    Basic Dictum

    Safety First!

  • L 11 Epidemics and Emerging Infections 8

    Biological Event

    Bacterial agents Anthrax, Brucellosis, Yersinea pestis

    (Plague) & Cholera , Salmonella Viruses

    Smallpox, Hemorrhagic Fever Virus Biological product

    Botulinum toxin, Endotoxins, Mycotoxin, SEB, ricin,

  • L 11 Epidemics and Emerging Infections 9

    Smallpox Bangladesh, 1976

    A child stricken by smallpox is relatively cured but his health is still threatened by malnutrition and secondary infection. (Courtesy of the National Archives, 76-845)

  • L 11 Epidemics and Emerging Infections 10

    Biological Event

    Infection borne through air, food and water

    Incubation period - delay from time of exposure until clinical symptoms arise

    Extensive exposure may occur before the primary event is appreciated.

  • L 11 Epidemics and Emerging Infections 11

    Rare Diseases can be Overseen

    Rare color photo of Baby with smallpox. National Archive film footage from Vietnam (RG-428-NPC-38594)

  • L 11 Epidemics and Emerging Infections 12

    Biological Event

    Delivered with conventional explosives

    Emergency care, decontamination is necessary (outside the hospital)

    Personnel must be trained in patient decontamination

  • L 11 Epidemics and Emerging Infections 13

    Decontamination Area Storage for decontamination equipment

    and supplies Decontamination area - cooled to reduce

    the heat load on personnel caused by their protective equipment

    The decontamination site has 3 zones: Hot zone incoming casualties Warm zone decontamination area Cold zone triage and transport

  • L 11 Epidemics and Emerging Infections 14

    Contamination reduction (warm) zone

    Support (cold) zone

    Exclusion (hot) zone

    wind

    CORRIDOR

    amp

    Access control points

    Crowd control line

    Decontamination line

    Hot line

  • L 11 Epidemics and Emerging Infections 15

    Decontamination Area

    First responders and medical personnel SHOULD PROTECT THEMSELVES

    Personal Protective Equipment (PPE) Protect eyes, lungs and skin

  • L 11 Epidemics and Emerging Infections 16

    Decontamination Area

    Storage for decontamination equipment and supplies Decontamination area

    cooled to reduce the heat load on personnel caused by their protective equipment

  • L 11 Epidemics and Emerging Infections 17

    Decontamination Area

  • L 11 Epidemics and Emerging Infections 18

    Hot zone

    Support zone

    Decontamination zone

    Patients

    No special protective gear

    hazmat teams with proper protective gear

    gross contaminates removed here

    remove victims contaminated clothing

    wash & final rinse/soap & shampoo

    wash & rinse

    clean stretcher & blankets

  • L 11 Epidemics and Emerging Infections 19

    Decontamination Area

  • L 11 Epidemics and Emerging Infections 20

    Decontamination Area

    First responders (decontamination) protect themselves through PPE.

    Personal Protective Equipment (PPE) respiratory equipment

    Garments and barrier material

  • L 11 Epidemics and Emerging Infections 21

    Decontamination Area

    Maximum protection is achieved through use of positive pressure respirators and total body encapsulation.

    Surgical mask and a pair of latex gloves provide minimum protection

  • L 11 Epidemics and Emerging Infections 22

    Decontamination Area

  • L 11 Epidemics and Emerging Infections 23

    Personal Protective Equipment

    Red Cross workers of Boston, MA removing bundles of masks for American Soldiers from a table where other women are busily engaged in making them. March 1919. (Courtesy of the National Archives, 165-WW-269B-37)

  • L 11 Epidemics and Emerging Infections 24

    Medical Response

    Pandemic large number of

    casualties with similar symptoms

    dissemination device receipt of a warning hospital may receive

    untreated casualties directly from the site

    Emergency Hospital at Brookline, MA to care for influenza cases.

    October 1918

  • L 11 Epidemics and Emerging Infections 25

    Medical Response

    First responders and medical personnel SHOULD PROTECT THEMSELVES

    September 11

  • L 11 Epidemics and Emerging Infections 26

    Medical Response

    Why is the level of Epidemic preparedness so critical?

    Because the consequences of not being prepared are so catastrophic

    Smallpox Vaccine

  • L 11 Epidemics and Emerging Infections 27

    Category A The public health systems and primary health-care providers must be prepared to address varied biological agents, including pathogens that are rarely seen. High-priority agents include organisms that pose a risk to national security because they

    can be easily disseminated or transmitted person-to-person;

    cause high mortality, with potential for major public health impact;

    might cause public panic and social disruption; and

    require special action for public health preparedness.

  • L 11 Epidemics and Emerging Infections 28

    Category A Agents Include:

    Variola major (Smallpox): Bacillus anthracis (Anthrax); Yersinia pestis (Plague); Clostridium botulinium toxin

    (Botulism); Francisella tullarensis

    (Tularemia);

  • L 11 Epidemics and Emerging Infections 29

    Category A Agents Include:

    Filoviruses - Ebola Hemorrhagic Fever; - Marburg Hemorrhagic Fever; and

    Arenaviruses - Lassa (Lassa Fever)

    - Junin (Argentine Hemorrhagic Fever) related viruses.

  • L 11 Epidemics and Emerging Infections 30

    Category B

    Second-highest priority agents: moderately easy to disseminate cause moderate morbidity and low

    mortality require specific enhancements of CDCs

    diagnostic capacity and enhanced disease surveillance

  • L 11 Epidemics and Emerging Infections 31

    Category B agents include: Coxiella burnetti (Q fever) Brucella species (Brucellosis) Burkholderia mallei (Glanders) Alphaviruses

    Venezuelan encephalomyelitis Eastern and Western equine

    encephalomyelitis Rich toxin from Ricinus communis (castor beans) Epsilon toxin of Clostridium perfringens Staphylococcus enterotoxin B

  • L 11 Epidemics and Emerging Infections 32

    Category BA subset of List B agents include pathogens that are food or waterborne. These pathogens include, but are not limited to:

    Salmonella species Shigella dysenteriae Escherichia coli O157:H7 Vibrio cholerae Cryptosporidium parvum

  • L 11 Epidemics and Emerging Infections 33

    Category C

    Third-highest priority agents include emerging pathogens that could be engineered for mass dissemination in the future because of:

    availability ease of production and dissemination potential for high morbidity and mortality

    due to major health impacts

  • L 11 Epidemics and Emerging Infections 34

    Category C agents include:

    Nipah virus Hantaviruses Tickbone hemorrhagic fever viruses Tickbone encephalitis viruses Yellow fever Multi-drug resistant tuberculosis

  • L 11 Epidemics and Emerging Infections 35

    Category C

    Preparedness for List C agents requires ongoing research to improve disease detection, diagnosis, treatment and prevention. Linking bio-terrorism preparedness efforts with ongoing disease surveillance and outbreak response activities as defined in CDCs emerging infectious disease strategy is imperative.

  • L 11 Epidemics and Emerging Infections 36

    Cholera epidemic, Europe 1830 - 1847 intensive infectious disease diplomacy multilateral cooperation; First International Sanitary Conference, Paris 1851

    1948 WHO Constitution 1951 WHO adopted International Sanitary

    Regulations International Health Regulations, 1969

    History of the IHR

  • L 11 Epidemics and Emerging Infections 37

    IHR (1969) to monitor and control six serious infectious diseases: Cholera, Plague, Yellow fever, Smallpox, Relapsing fever and Typhus

    IHR (1969) - Cholera, Plague and Yellow fever remain of concern WHO must be informed

    History of the IHR

  • L 11 Epidemics and Emerging Infections 38