Bioterrorism

 
Learning Objectives

After completion of the course you’ll be able to:

Chapter 3: The Prospect of Domestic Bioterrorism
  1. Discuss the prospect of domestic terrorism and describe the motivational, technical and organizational factors that may help or hamper the perpetrators.
Chapter 5: Epidemiology of Bioterrorism
  1. Define indication of intentional release of biologic agent.
  2. Describe the precautions laboratory personnel should take when collecting or handling clinical specimens.
  3. Discuss the epidemiology of bioterrorism and differentiate between a natural outbreak an intentional attack.
  4. List 10 clues that together may constitute proof of intentional use of biological agent.
Chapter 7: Anthrax
  1. Describe the side effects of taking ciprofloxacin and doxycycline.
  2. Describe recommendations made by the CDC for worker safety under engineering controls, administrative controls, housekeeping controls, and personal protective equipment.
  3. Implement anthrax worker safety guidelines issued by the CDC.
  4. Describe the epidemiology of naturally occurring anthrax.
  5. Discuss the diagnosis of inhalational anthrax.
  6. Discuss the therapeutic options of anthrax infection.
  7. Discuss infection control and decontamination protocols for anthrax.
  8. Describe the procedure for handling suspicious packages or envelopes.
  9. Provide medication information to patients about ciprofloxacin, doxycycline, penicillin, and amoxicillin.
  10. Discuss clinical issues in the prophylaxis, diagnosis, and treatment of anthrax.
Chapter 8: Smallpox
  1. Describe various phases of the smallpox disease, symptoms, and degree of infectiousness.
  2. Answer questions about the smallpox disease and the vaccine.
  3. List the categories of people who should not get vaccine.
  4. List the steps that one should take after vaccination to minimize the risk of spreading vaccinia.
Chapter 9: Botulism
  1. Describe three main kinds of botulism and their mode of transmission.
  2. Answer frequently asked questions about botulism.
  3. List symptoms of botulism.
  4. Describe infant botulism, its epidemiology, source of C. botulinum, and prevention and control.
  5. Describe the clinical syndrome of botulism and provide a diagnosis of the disease.
  6. Put the use of botulinum toxin as a bioweapon in historical perspective.
  7. Describe the pathogenesis and clinical manifestations of botulism.
  8. List typical symptoms and signs of foodborne botulism.
  9.  Identify features of an outbreak that would indicate a bioterrorist attack with botulinum toxin.
  10. Describe the therapy, prophylaxis and decontamination for botulinum toxin.
Chapter 10: Plague
  1. Answer frequently asked questions about pneumonic and bubonic plague, their signs and symptoms, and treatment.
  2. Describe the role fleas play in the spread of plague to humans.
  3. Explain the epidemiology of plague.
  4. Describe clinical manifestations of bubonic, septicemic, pneumonic, and pharyngeal plague.
  5. Discuss signs and symptoms and laboratory confirmation that can establish the diagnosis of plague.
  6. Describe the treatment for plague.
  7. Outline the strategies for the prevention of plague.
Chapter 11: Tularemia
  1. Answer frequently asked questions about tularemia.
  2. Describe the signs and symptoms of tularemia.
  3. Identify epidemiological indicators that would suggest a bioterrorism act of inhalational tularemia.
  4. Describe the pathogenesis and clinical manifestations of F. tularensis.
  5. Provide a diagnosis of inhalational tularemia following its use as a biological weapon.
  6. Describe the treatment of tularemia in adults and children.
  7. Make recommendations for post exposure antibiotic prophylactic treatment in the event of F. tularensis biological attack.
Chapter 12: Viral Hemorrhagic Fevers
  1. Answer frequently asked questions about the etiology and epidemiology of viral hemorrhagic fevers.
  2. Describe various ways of preventing and controlling viral hemorrhagic fevers.
  3. Describe the history and potential of HFVs as biological weapons.
  4. Describe the clinical manifestations of diseases caused by hemorrhagic fever viruses.
  5. Provide a diagnosis of viral hemorrhagic fevers and treatment options including drug therapy.
Chapter 13: Ricin
  1. Answer frequently asked questions about ricin, its signs and symptoms, and its potential for bioterrorism.
Chapter 14: Nerve Agents
  1. Answer frequently asked questions about nerve agents, GA, GB, GD and VX.
  2. Describe the signs and symptoms of nerve agents GA, GB, GD and VX, and their effects on health.
  3. List the things people can do to protect themselves against VX and things they should do if they are exposed to VX.
  4. Describe the health effects of nerve agents, GA, GB, GD, and VX.
  5. Describe the prehospital management of victims of nerve agent attack.
Chapter 15: Blister Agents
  1. Describe the health effects of sulfur mustard on various body systems.
  2. Describe prehospital management of victims exposed to sulfur mustard.
  3. List general principles of triage for chemical exposures.
  4. Describe triage for mustard agent casualties.
Chapter 16: Foodborne Illness
  1. Describe some of the most common foodborne diseases.
  2. Identify instances when a doctor should be consulted for a diarrheal illness.
  3. Describe how outbreaks of foodborne disease are detected and investigated.
  4. Describe the ways food can become contaminated.
  5. List foods that are most associated with foodborne illness.
  6. State five simple precautions one can take to reduce the risk of foodborne diseases.
  7. Identify persons who are at particularly high risk to contract a foodborne illness.
Chapter 17: Escherichia coli O157:H7
  1. List various ways Escherichia coli O157:H7 is spread.
  2. Describe the illness caused by Escherichia coli O157:H7.
Chapter 18: Salmonellosis
  1. Answer frequently asked questions about salmonellosis, including how people can catch Salmonella, its health consequences and treatment.
  2. List eight things one can do to prevent salmonellosis.
Chapter 19: Cholera
  1. List six things a traveler can do to avoid getting cholera.
Chapter 20: Shigellosis
  1. 71. Answer frequently asked questions about shigellosis.
  2. List eight tips for preventing the spread of shigellosis.
Chapter 21: Brucellosis
  1. Answer frequently asked questions about brucellosis, such as how it is transmitted to humans, ways to prevent infection, and its treatment.
Chapter 22: Typhoid Fever
  1. Answer frequently asked questions about typhoid fever.
  2. List steps one can take to avoid typhoid fever.
Chapter 24: Injuries and Mass Trauma Events
  1. 76. Describe symptoms of posttraumatic stress disorder.
  2. Identify the kind of injuries that occur in mass trauma events.
  3. List the things health departments should do to prepare for and subsequent to mass trauma events.
  4. Identify various steps one should plan to escape from home, workplace or hotel.
  5. Describe 3 types of burns, their symptoms and early treatment.
  6. List signs and symptoms after a mild traumatic brain injury (MTBI).
  7. Describe the procedure for personal cleaning and disposal of contaminated clothing.
  8. Describe the evacuation procedure in the event of a chemical accident or attack.
  9. Describe how to prepare to shelter in place in case of a chemical accident or attack.
  10. Allay general public’s concerns about the safety of drinking water.
  11. Describe emergency room procedures in chemical hazard emergencies.
Chapter 25: Bioterrorism Readiness Plan: A Template for Healthcare Facilities
  1. Develop and implement a bioterrorism readiness plan appropriate for a particular healthcare facility.
  2. Identify 6 features that should alert healthcare providers to the possibility of a bioterrorism-related outbreak.
  3. Describe clinical features of anthrax infection, infection control practices for patient management, and post-exposure management.
  4. Describe clinical features of botulism infection, infection control practices for patient management and post-exposure management.
  5. Describe clinical features of pneumonic plague, infection control practices for patient management, and post-exposure management.

 

Learning Objectives

To assess the effectiveness of the course material, we ask that you evaluate your achievement of each learning objective on a scale of A to D (A=excellent, B=good, C=fair, D=unsatisfactory). Please indicate your responses next to each learning objective and return it to us with your completed exam.
Contents Outline

1. Bioterrorism as a Public Health Threat

2. The Threat of Biological Attack:

Why Concern Now?

Vulnerability to Biological Attack

Perpetrator Capability

Intention to Use Biological Weapons

Nonintentional Pathogen Releases

Conclusions

3. The Prospect of Domestic Bioterrorism Motivational Factors

Technical Factors

Organizational Factors

The Likeliest Perpetrators

Conclusions

4. Biologic Terrorism–Responding to the Threat

v Bioterrorism: How Prepared Are We?

5. Epidemiology of Bioterrorism

Differential Diagnosis

Epidemiologic Approach

Recommendations for Preparedness

6. Medical Aspects of  Biological Terrorism

Health-Care Providers

Clinical Case

Clinical Questions

Clinical Laboratory Personnel

Infection-Control Professionals

State Health Departments

References

7. Anthrax

v Questions and Answers About Anthrax

Transmission

Symptoms

Testing

Diagnosis

Preventive/Vaccine

Treatment

Pregnancy

Risk

Anthrax and Influenza

Safety Issues/Mail

Worker Safety

Reporting

v Anthrax as a Biological Weapon

Introduction

History of Current Threat

Epidemiology

Microbiology

Pathogenesis and Clinical Manifestations

Diagnosis

Vaccination

Therapy

Infection Control

Decontamination

v Update: Investigation of Bioterrorism-Related Anthrax and Interim Guidelines for Exposure Management and Antimicrobial Therapy, October 2001

Susceptibility Testing of B. anthracis Isolates

Managing Threats

Managing Exposures

Antimicrobial Treatment

v Children and Anthrax: A Fact Sheet for Clinicians

Drug Recommendations For Pediatric Anthrax Cases

v Anthrax Technical Information

v Fact Sheet: Anthrax Information for Helath Care Providers

v Drug Therapy

Patient Information: Ciprofloxacin 500 MG Oral Tablet

Patient Information: Doxycycline 100 MG Oral Tablet

Patient Information: Penicillin VK 500 MG Oral Tablet

Patient Information: Amoxicillin 250 MG – Oral Capsules Or Amoxicillin 250 MG/5 ML– Oral Suspension

v Clinical Issues in the Prophylaxis, Diagnosis, and Treatment of Anthrax

Prophylaxis (1)

Clinical Recognition and Diagnosis (2)

Treatment (3)

v Additional Options for Preventive Treatment For Those Exposed to Inhalational Anthrax

Background

Options

8. Smallpox

v Smallpox Overview

The Disease

Where Smallpox Comes From

Transmission

v Smallpox Disease

Rash distribution

v Smallpox Questions and Answers: The Disease and the Vaccine

In General

The Disease

The Vaccine

Vaccinia

After Vaccination: What You Should Know

Vaccine Safety

9. Botulism

v Facts About Botulism

v Botulism–Technical Information

v Frequently Asked Questions

v Botulism in the United States

Introduction

Foodborne Botulism

Infant Botulism

Wound Botulism

Child or Adult Botulism From Intestinal Colonization

Clinical Syndrome

 Diagnosis

Treatment

Public Health Response

v Botulinum Toxin as a Biological Weapon–Medical and Public Health Management

Introduction

History of Current Threat

Microbiology and Virulence Factors

Pathogenesis and Clinical Manifestations

Epidemiology

Diagnosis and Differential Diagnosis

Table 3. Selected Mimics and Misdiagnoses of Botulism

Therapy

Prophylaxis

Decontamination

Infection Control

Research Needs

10. Plague

v Facts  About  Plague

v Frequently Asked Questions (FAQ) About Plague

v Introduction 

v History

The First Pandemic

 The Black Death (The Second Pandemic)

The Third Pandemic

v Plague as a Biological Warfare Agent

v Epidemiology

Exhibit 1: Mammals Known to Harbor Plague in the United States.

v Clinical Manifestations

v Diagnosis

v Treatment

v Prevention

v Summary

Working Group Recommendation for Treatment of Patients With

Pneumonic Plague in the Contained and

Mass Casualty Settings and for Post-exposure Prophylaxis*

11. Tularemia

v Facts about Tularemia

v Frequently Asked Questions (FAQ) About Tularemia

v Tularemia as a Biological Weapon–Medical and Public Health Management

v Introduction

v History and Potential Biological Weapon

v Epidemiology  

Table 1. Diagnosis of Inhalational Tularemia Following Use of a Biological Weapon

v Microbiology and Virulence Factors

v Pathogenesis and Clinical Manifestations

v Diagnosis

v Vaccination

Treatment

v Post-Exposure Antibiotic Recommendations

Table 2. Working Group Consensus Recommendations for Treatment of Patients With Tularemia in a Contained Casualty Setting*

Table 3. Working Group Consensus Recommendations for Treatment of Patients With Tularemia in a  Mass Casulaty Setting and for Postexposure Prophylaxis*

v Infection Control

v Environmental Decontamination and Protection

12. Viral Hemorrhagic Fevers

v Management of Patients with Suspected Viral Hemorrhagic Fever 

Background

Recommendations

v Hemorrhagic Fever Viruses as Biological Weapons

Introduction

Table 1. Hemorrhagic Fever Viruses*

Consensus Methods

History and Potential as Biological Weapons

Epidemiology of Disease Transmission

Microbiology and Pathogenesis

Clinical Manifestations         

Table 3.  Clinical Characteristics of Hemorrhagic Fever Viruses Noted in Past Case  Outbreaks 

Vaccine

Infection Control

Box 2. Recommendations for Protective Measures Against Nosocomial Transmission of Hemorrhagic Fever Viruses

13. Ricin

v Frequently Asked Questions (FAQs) About Ricin

v Biotoxin Ricin

14. Nerve Agents

v ToxFAQs™ for  Nerve Agents (GA, GB, GD, VX)

v Facts About VX

v Technical Information About Nerve Agents

v Nerve Agent VX

v Health Effects

v Prehospital Management

Table 2. Triage for Nerve Agent Casualties

Table 3. Recommendations for Nerve Agent Therapy Antidotes1–Prehospital Management

v Emergency Department Management

Table 4. Recommendations for Nerve Agent Therapy–Emergency Department Management Nerve Agents Patient Information Sheet

Follow-up Instructions

15. Blister Agents

v Blister Agents

Table 1. Physical Properties of Sulfur Mustards

v Health Effects

Table 2. Clinical Effects and Time of Onset by Severity of  Exposure to Sulfur Mustard

v Prehospital Management

Table 3. Triage for Mustard Agent Casualties

v Emergency Department Management

v General Medical Management

v Blister Agents Sulfur Mustard (H, HD, and HT)–Patient Information Sheet

v Blister Agent ...............................................................................

 16. Foodborne Illness

v Frequently Asked Consumer Questions About Food Safety and Terrorism

 17. Escherichia coli O157:H7

v Frequently Asked Questions

v Technical Information  

18. Salmonellosis

v Frequently Asked Questions

v Technical Information

19. Cholera

v Frequently Asked Questions

v Technical Information

20. Shigellosis

v Frequently Asked Questions

v Technical Information

21. Brucellosis

v Frequently Asked Questions

v Technical Information

22. Typhoid Fever

v Frequently Asked Questions

v Technical Information

23. Radiological Emergencies

v CDC’s Roles in the Event of a Radiological Terrorist Event

Lead Federal Agencies

CDC’s Roles

CDC’s Partners

CDC’s Actions

Radiation Exposure Registry

24. Injuries and Mass Trauma Events

v Coping With a Traumatic Event–Information for the Public  

v Coping With a Traumatic Event–Information for Health Professionals

v Burns

Background Information

Escape Information  

First Aid

Types of Burns

v Brain Injuries and Mass Trauma Event–Information for the Public

v Brain Injuries and Mass Trauma Events–Information for Clinicians

Brain Injury Facts 

Signs and Symptoms after an MTBI

Diagnosis

Treatment 

v Chemical Agents: Facts About Personal Cleaning and Disposal of Contaminated Clothing

25. Bioterrorism Readiness Plan: A Template for Healthcare Facilities

v Introduction

v Section I: General  Categorical Recommendations for Any Suspected Bioterrorism Event

  1. Reporting Requirements and Contact Information

  2. Potential Agents

  3. Detection of Outbreaks Caused by Agents of Bioterrorism

  4. Infection Control Practices for Patient Management

  5. Post-Exposure Management

  6. Laboratory Support and Confirmation

  7. Patient, Visitor, and Public Information

v Section II: Agent- Specific Recommendations

A.  Anthrax

B.  Botulism

C.  Plague

D. Smallpox

26. Mass Casualty Disaster Plan Checklist:  A Template for Healthcare Facilities