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

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

2. Define indication of intentional release of biologic agent.

3. Describe the precautions laboratory personnel should take when collecting or handling clinical specimens.

4. Discuss the epidemiology of bioterrorism and differentiate between a natural outbreak an intentional attack.

5. List 10 clues that together may constitute proof of intentional use of biological agent.

Chapter 7: Anthrax

6. Describe the side effects of taking ciprofloxacin and doxycycline.

7. Describe recommendations made by the CDC for worker safety under engineering controls, administrative controls, housekeeping controls, and personal protective equipment.

8. Implement anthrax worker safety guidelines issued by the CDC.

9. Describe the epidemiology of naturally occurring anthrax.

10. Discuss the diagnosis of inhalational anthrax.

11. Discuss the therapeutic options of anthrax infection.

12. Discuss infection control and decontamination protocols for anthrax.

13. Describe the procedure for handling suspicious packages or envelopes.

14. Provide medication information to patients about ciprofloxacin, doxycycline, penicillin, and amoxicillin.

15. Discuss clinical issues in the prophylaxis, diagnosis, and treatment of anthrax.

Chapter 8: Smallpox

16. Describe various phases of the smallpox disease, symptoms, and degree of infectiousness.

17. Answer questions about the smallpox disease and the vaccine.

18. List the categories of people who should not get vaccine.

19. List the steps that one should take after vaccination to minimize the risk of spreading vaccinia.

Chapter 9: Botulism

20. Describe three main kinds of botulism and their mode of transmission.

21. Answer frequently asked questions about botulism.

22. List symptoms of botulism.

23. Describe infant botulism, its epidemiology, source of C. botulinum, and prevention and control.

24. Describe the clinical syndrome of botulism and provide a diagnosis of the disease.

25. Put the use of botulinum toxin as a bioweapon in historical perspective.

26. Describe the pathogenesis and clinical manifestations of botulism.

27. List typical symptoms and signs of foodborne botulism.

28.  Identify features of an outbreak that would indicate a bioterrorist attack with botulinum toxin.

29. Describe the therapy, prophylaxis and decontamination for botulinum toxin.

Chapter 10: Plague

30. Answer frequently asked questions about pneumonic and bubonic plague, their signs and symptoms, and treatment.

31. Describe the role fleas play in the spread of plague to humans.

32. Explain the epidemiology of plague.

33. Describe clinical manifestations of bubonic, septicemic, pneumonic, and pharyngeal plague.

34. Discuss signs and symptoms and laboratory confirmation that can establish the diagnosis of plague.

35. Describe the treatment for plague.

36. Outline the strategies for the prevention of plague.

Chapter 11: Tularemia

37. Answer frequently asked questions about tularemia.

38. Describe the signs and symptoms of tularemia.

39. Identify epidemiological indicators that would suggest a bioterrorism act of inhalational tularemia.

40. Describe the pathogenesis and clinical manifestations of F. tularensis.

41. Provide a diagnosis of inhalational tularemia following its use as a biological weapon.

42. Describe the treatment of tularemia in adults and children.

43. Make recommendations for post exposure antibiotic prophylactic treatment in the event of F. tularensis biological attack.

Chapter 12: Viral Hemorrhagic Fevers

44. Answer frequently asked questions about the etiology and epidemiology of viral hemorrhagic fevers.

45. Describe various ways of preventing and controlling viral hemorrhagic fevers.

46. Describe the history and potential of HFVs as biological weapons.

47. Describe the clinical manifestations of diseases caused by hemorrhagic fever viruses.

48. Provide a diagnosis of viral hemorrhagic fevers and treatment options including drug therapy.

Chapter 13: Ricin

49. Answer frequently asked questions about ricin, its signs and symptoms, and its potential for bioterrorism.

Chapter 14: Nerve Agents

50. Answer frequently asked questions about nerve agents, GA, GB, GD and VX.

51. Describe the signs and symptoms of nerve agents GA, GB, GD and VX, and their effects on health.

52. List the things people can do to protect themselves against VX and things they should do if they are exposed to VX.

53. Describe the health effects of nerve agents, GA, GB, GD, and VX.

54. Describe the prehospital management of victims of nerve agent attack.

Chapter 15: Blister Agents

55. Describe the health effects of sulfur mustard on various body systems.

56. Describe prehospital management of victims exposed to sulfur mustard.

57. List general principles of triage for chemical exposures.

58. Describe triage for mustard agent casualties.

Chapter 16: Foodborne Illness

59. Describe some of the most common foodborne diseases.

60. Identify instances when a doctor should be consulted for a diarrheal illness.

61. Describe how outbreaks of foodborne disease are detected and investigated.

62. Describe the ways food can become contaminated.

63. List foods that are most associated with foodborne illness.

64. State five simple precautions one can take to reduce the risk of foodborne diseases.

65. Identify persons who are at particularly high risk to contract a foodborne illness.

Chapter 17: Escherichia coli O157:H7

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.

Comments:

"I like how easily the course was to get online. Reading the book was really easy. Everything was spelled out in words that werer understandable and to the point. Thank you!" - T. L. M., RN, NV