MAN MADE DISTASTER

Man-made disaster are disasters in which the principal direct causes are identifiable human actions, deliberate or otherwise

(Disaster Nursing and Emergency Preparedness 2nd Ed. Page 4 by Veenema, 2007)

BIOLOGICAL AGENTS

BIOLOGICAL AGENTS
are pathogens used deliberately to infect persons as well as toxins normally derived from plants and animals.
(Disaster Nursing and Emergency Preparedness 2nd Ed. Page 367 by Veenema, 2007)

Category A most deadly microbes known to man .They

are easily disseminated and are the highest priority.

1. Anthrax(Bacillus anthracis) 2. Botulinum toxin(Clostridium botulinum) 3. Plague (Yersinia pestis) 4. Tularemia (Variola major) 5. Tularemia(Francisella tularensis) 6. Hemorrhagic fever viruses including Ebola, Marburg, Lassa etc.

Category B they share common characteristics

such as potential for moderate morbidity and lower mortality. They are the second-highest priority

1. 2. 3. 4. 5. 6. 7. 8.

Brucellosis Epsilon toxin or Clostridium perfringes Salmonella, Shigella, E.coli etc. Melioidosis and Psittacosis Q fever and Typhoid fever Ricin toxin(from castor beans) Staphylococcal enterotoxin B Viral encephalitis (from alphaviruses like VEE,EEE,WEE) 9. Vibrio cholera and Cryptosporidium parvum

Category C emerging agents that

is potential future infective threats such as Nipah fever and Hantavirus

(Disaster Nursing and Emergency Preparedness 2nd Ed. Page 404 by Veenema, 2007)

BIOTERRORIS M

Unlawful release of biologic agent or toxins with the intent to intimidate or coerce a government or civilian population
(Disaster Nursing and Emergency Preparedness 2nd Ed. Page 607 by Veenema, 2007)

ANTHRAX
zoonotic diseases generally found in herbivores such as sheep, goat and cattle that ingest spores from contaminated soil. Causative agent is a spore forming bacterium Bacillus anthracis.

-it can be spread through inhalation, direct contact in the skin and ingestion of the agent.

 -biosafety level 2 are recommended for laboratory personnel who may come in contact with anthrax specimen like laminar flow hood with protective eyewear, gloves, and avoiding activities that may produce aerosol or droplet dispersal.

-biosafety level 3 are recommended for personnel who work extensively with anthrax specimens including producing quantities for research purposes. It is the same as biosafety level 2 in addition of respiratory protective equipment as needed, negative air pressure in laboratory and decontamination of all waste

-health care workers who come in contact with anthrax patients should use universal precautions at all times including use of rubber gloves, disposal of sharps, and frequent handwashing.

(Disaster Nursing and Emergency Preparedness 2nd Ed. Page 404-407 by Veenema, 2007)

Bioterrorism in History

The 2001 U.S. Anthrax Letter Attacks In this incident, letters containing spores of the causative agent of anthrax, Bacillus anthracis, were sent to several U.S. media outlets (print and TV) and to two U.S. senators. A total of 5 letters were sent, infecting 22 people, 11 with the pulmonary form of the disease, and 11 with the cutaneous form. Five of the victims with pulmonary anthrax died.

 neuroparalytic, primarily foodborne illness. Caused by anerobic bacteria Clostridium botulinum. -most common form is food borne botulism which is through ingestion of infected honey and home processed foods. Wound botulism involving intravenous drug users who inject drugs intravenously or subcutaneously -Coats, gloves, face shields and protective cabinets are recommended for handling botulism specimens. Laboratory personnel should be vaccinated with C.botulinum anti-toxin. Universal precautions should be used in caring for patients suspected with botulism. Isolation is not necessary but droplet precautions are instituted.

PLAGUE

-Plague is possibly the most feared infectious disease in the history of human kind. More than 200 million people have died from plague. -It is caused by Yersinia pestis, a non motile gram-negative bacterium. Transmission to humans is typically through the bite of an infected flea, although droplet spread from patients with pneumonic plague is another route of infection. -Biosafety level II precautions should be used for specimens from patients suspected of Y.pestis infection. -Biosafety Level III precautions are needed only if extensive work with infected specimens is expected. -Gowns, gloves, masks, and eye protection should be worn for atleast the first 48 hours of treatment.

PLAGUE IN HISTORY
A secret branch of the Japanese army was reported to have developed and dropped Y.pestis infected fleas and grain over populated areas of China on several occasions during World War II. The grain was used to attract the rats causing outbreaks of plague.

Tulermia
-Tulermia,is a higly infectious zoonotic disease caused by the bacterium, Franscisella tularenis. - It is typically found in animals such as rabbits and rodents, and can be transmitted to humans in several ways. Contact with infected animal carcasses; ingestion of contaminated meat, soil, or water; inhalation of the bacterium especially in laboratory workers; Inoculation of the bacterium via cuts or abrasions; as well as the bite of infected arthropods such as ticks are among the ways tulermia can be contracted. -Tulermia is extremely infectious in aerosol form. Laboratory personnel have inhalational tularemia simply byu examining an open culture palte. -Biosafety Level II precautions should be used for initial evaluation then specimens should be forwarded to a BLS-3 laboratory for further testing -Universal precautions are recommended for patients suspected of tularemia infection.
(Tener,et.al, Disaster Nuring and Emmergency Preparedness for Chemical, Biological, and raidiological Terrorism and other hazards, 2007,page412-413,2nd edition)

-Small pox, a DNA virus, is a member of the genus othopovirus, like monkeypox, vaccinia, or cow pox. -It contains a large complex viral genome and is the only orthopox virus to be readily transmitted from person to person. -The main portal of entry is the respiratory tract. Skin, conjunctival, and transplacental infection are less common. -Laboratory diagnosis of small pox is essential and specimens should be obtained by people vaccinated against small pox. -Because of its high infectivity, pathogenicity and ease of person-to-person transmission, Biosafety level IV (BSL-4) containment procedures, protective equipment and facilities are necessary for evaluation of potential small pox samples. These procedures include specially designed laboratory spaced secured with air locks and decontamination rooms.

Small pox

-Personnel working in these spaces must wear a one piece positive pressure suit equipped with HEPA-filterred life-support system. -Multiple redundant back-up systems and other safety guards are also in place with BSL-4 to prevent release of these extremely dangerous microbes. (Department of health Human Service 1999) -All patients in whom small pox is suspected should be placed in strict respiratory isolation in negative pressure rooms. -Contacts of patients should be vaccinated and placed under surveillance. Isolated in-home or non-hospital facilities are preferable, due to high risk of transmission of smallpox via aerosol within hospital environments

Viral Hemorrhagic Fevers

-Viral hemorrhagic fevers (VHF) are group of febrile illness caused by RNA viruses from several viral families. They include the filoviruses (Ebola and Marburg), the arena viruses (Lassa and New World arenaviruses), and tha flaviviruses (Yellow fever among others).

-Aerosol transmission of certain VHF viruses has been theorized and has been seen in animal experiments. -BSL-4 precautions are necessary when handling specimens from patients suspected of VHF infection. Every effort should be made to ensure that specimens from these patients are secured and properly sealed for transportation of laboratories with the capability for VHF diagnosis.

-In their analysis of VHF as a biological weapon, the working group for Civilian Biodefense makes specific management recommendations for patients suspected of having VHF infection, including
Strict hand washing Double gloving Impermeable gowns N-95 masks or powered air-purifying respirators and negative pressure isolation rooms Leg and shoe coverings Face shields and googles Restricted access to patients room Environmental disinfection -All medical personnel which have had close contact with patients suspected of VHF infection before the safeguards were instituted should be placed under medical surveillance.

(Tener,et.al, Disaster Nuring and Emmergency Preparedness for Chemical, Biological, and raidiological Terrorism and other hazards, 2007,page415-418,2nd edition)

SMALL POX

HISTORICAL USES OF BIOLOGICAL AGENTS

SALMONELLA

1763: First use in warfare: British commander Geoffrey Amherst spread smallpox to Indians by giving them infected blankets

The 1984 Rajneeshee bioterror attack was the food poisioning of 751 individuals in The Dallas, Oregon, United States, through the deliberate contamination of salad bars at ten local restaurants with salmonella.