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
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Biological Attack• Bioterrorism attacks of 2001
• Anthrax in postal system• 22 cases• 5 deaths
• U.S. public health realm changed forever
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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
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Overview• Bioterrorism• Zoonoses and bioterrorism• Disease control and biosecurity • U.S. Government agencies involved• Bioterrorism agents/diseases• Your role and responsibility
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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
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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
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Time (Days)
No.
Affe
cted
Exposure
Symptoms
Seek Care
Infectious Disease Outbreak
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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
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Many Agents are Zoonotic• Disease may be seen in animals
before humans• Animals are sentinels
− Pets, livestock, wildlife
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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
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Disease Control: Client Education
• Disinfect/clean up areas contaminated with animal waste−Livestock, pets, wildlife, rodents
• Basic hygiene−Wash hands−Child supervision
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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
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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
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Biosecurity Educationfor the Producer
• 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
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Biosecurity Educationfor the Producer
• Maintain healthy herd−Vaccinations−Proper hygiene for
animals and handlers• Purchase from
reputable sources• Quarantine newly
purchased animals• Separate sick animals
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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
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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
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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
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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
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Strategic National Stockpile
• 12-hour Push Package− Complete package of
medical materials
• Vendor Managed Inventory− Tailored to suspected agents
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Insert Your State’s Info Here
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Preparing Iowa• Iowa’s Homeland
Security −Administered by
Iowa Emergency Management Division
−Works with public and private partners
www.iowahomelandsecurity.org
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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
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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
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“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
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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.
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Category A : Agents/Diseases• Anthrax• Botulism• Plague• Smallpox• Tularemia• Viral hemorrhagic fevers
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Anthrax: The Agent• Bacteria: Bacillus anthracis • Forms spores• Human disease
−Skin− Intestinal−Pulmonary
• Animal disease−Septicemia and rapid death
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Anthrax: The Bioweapon• History• Available & easily
produced• Spores infective• Aerosolization• Low lethal dose• High mortality• Person-to-person transmission rare
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Anthrax: The Response• Vaccine
−Humans−Animals
• Antibiotics−Treatment−Prophylaxis
• Disinfection −Sporicidal agents, sterilization
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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
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Botulism: The Bioweapon• Used by Aum Shinrikyo
cult in Japan• Aerosolized• Easy to produce and
transport• Potent and lethal• Most poisonous substance
known
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Botulism: The Response• Toxoids for high risk people• Antitoxin available
−Case-by-case basis• Botulinum toxins are easily
inactivated with many disinfectants and heat
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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
Center for Food Security and Public Health Iowa State University 2005
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
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Plague: The Response• Antibiotics generally effective if given
early• Killed vaccine available • Isolation of sick individuals• Susceptible to a number of common
disinfectants
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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
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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%
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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
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Tularemia: The Agent• Francisella tularensis• Transmitted by ingestion,
inhalation, vectors, direct contact through skin
• Six clinical forms in humans
UlceroglandularGlandular
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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
Center for Food Security and Public Health Iowa State University 2005
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
Center for Food Security and Public Health Iowa State University 2005
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
Center for Food Security and Public Health Iowa State University 2005
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
Center for Food Security and Public Health Iowa State University 2005
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%
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VHF: The Response• Intensive supportive care• Ribavirin has shown some efficacy • Susceptible to bleach solutions,
phenolic disinfectants, and UV light
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Category B: Agents/Diseases• Brucellosis• Glanders• Melioidosis • Psittacosis • Q Fever
• Typhus fever• Viral encephalitis• Toxins• Food Safety Threats • Water Safety Threats
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Brucellosis: The Agent• Gram-negative bacteria• Ingestion, inhalation, or
direct contact• Clinical signs
−Humans: Cyclic fever and flu-like symptoms
−Animals: Reproductive signs
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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
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Brucellosis: The Bioweapon• History• Highly infectious• Easily aerosolized• Stable • Prolonged incubation period
−May make diagnosis difficult• Person-to-person unlikely
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Brucellosis: The Response• Long term antibiotics generally
effective• Vaccinate calves, no human vaccine• Eliminate reservoir• Standard precaution to
avoid exposure• Thorough disinfection
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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
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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
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Glanders: The Response• No vaccine • Antibiotic therapy likely effective• Destroyed by various chemicals
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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
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Melioidosis: The Bioweapon • Easy to produce • Available• Aerosolization• High mortality: 90%• Person-to-person (rare)• Animal-to-person (rare)
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Melioidosis: The Response• Long-term, multiple
antibiotics effective• Vaccines available:
Not in U.S.• Easily destroyed by
disinfectants
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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
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Psittacosis: The Bioweapon• Easily obtained• Aerosolized• Stable in the
environment• Person-to-person
transmission rare• Low mortality
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Psittacosis: The Response• Antibiotics
generally effective• Decontamination
possible with most disinfectants
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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
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Q Fever: The Bioweapon• History• Easily accessible• Environmentally
resistant• Highly infectious• Aerosolization
−Travel ½ mile by wind• Low mortality- chronic morbidity
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Q Fever: The Response• Often self-limiting disease• Antibiotic therapy may limit
complications• Vaccine developed, not available in
U.S.• Variable susceptibility to
disinfectants
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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
Center for Food Security and Public Health Iowa State University 2005
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
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Typhus Fever: The Response• Antibiotics are generally effective• Vaccine, not commercially available
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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
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Viral Encephalitis:The Bioweapon
• Easy to produce• Aerosolization• High rate of infection• Person-to-person transmission
possible
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Viral Encephalitis:The Response
• Supportive care• Vaccine
−Equine−Human: High risk
• Virus unstable in environment
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Toxins: The Agents• Staphylococcal
enterotoxin B (SEB)• Ricin toxin from
castor plant • Clostridium
perfringens epsilon toxin
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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
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Ricin: The Agent• Ricin toxin from bean of castor plant • Available worldwide• Clinical signs
−Acute onset of fever,chest tightness, cough,
dyspnea, nausea
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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
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Toxins: The Bioweapon• History• Aerosolized: SEB, ricin • Available worldwide• Easy to produce, stable• Many species affected• No person-to-person transmission
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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
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Food Safety Threats• Campylobacter species• Salmonella species• E. coli 0157:H7 • Viruses, parasites,
chemicals, toxins• Ingestion of
contaminated food• Gastrointestinal upset
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Food Safety Threats: The Bioweapon
• 1984, The Dalles, Oregon−Bagwan Shree Rajneesh cult−Contaminated salad bars
Salmonella typhimurium−Goal: Incapacitate voters−751 people ill
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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
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Water Safety Threats• 53% of US drinking
water is from ground water
• Cryptosporidium parvum- protozoa
• Vibrio cholerae- bacteria
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Cryptosporidium: The Agent• Cryptosporidium parvum- protozoa• Transmission: Inhalation, ingestion• Clinical signs: Humans, calves,
others−Acute gastroenteritis
• Dogs, cats, horses, pigs: Resistant
Center for Food Security and Public Health Iowa State University 2005
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
Center for Food Security and Public Health Iowa State University 2005
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
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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
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Category C• Nipah virus• Hantavirus
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Nipah Virus: The Agent• Paramyxovirus• Fruit bat reservoir• Clinical signs
−Humans: Encephalitis−Pigs: Respiratory, neurological−Dogs and cats: “Distemper”
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Nipah Virus: The Bioweapon• Aerosolization
potential• Wide host range• No person-to-person
transmission expected
• High morbidity and mortality
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Nipah Virus: The Response• Avoid contact with all
infected animals and fluids
• Vaccine being researched• Call authorities
immediately
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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
Center for Food Security and Public Health Iowa State University 2005
Hantavirus: The Bioweapon• Aerosolized• Hospitalization• Unexpected disease
in the U.S.−HFRS limited to
Asia/Europe to date
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Hantavirus: The Response• Supportive care• Limit exposure to
rodent excrement−Wear gloves, face
mask• Virus is
deactivated with bleach
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Other Important Diseases
• Transmissible Spongiform Encephalopathy (TSE)
• Rift Valley Fever• Hendra Virus• West Nile Virus• Foot and Mouth Disease• Monkeypox
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Transmissible Spongiform Encephalopathy: The Agent
• Prions−Proteinaceous infectious particles−Mutated proteins
• Very long incubation period• Neurological signs in all species• No treatment available
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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
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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
Center for Food Security and Public Health Iowa State University 2005
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
Center for Food Security and Public Health Iowa State University 2005
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
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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
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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
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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
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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”
Center for Food Security and Public Health Iowa State University 2005
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
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Spread of WNV in the U.S.: 1999-2002
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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
Center for Food Security and Public Health Iowa State University 2005
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
Center for Food Security and Public Health Iowa State University 2005
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
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FMD: The Response• USDA upgrading safeguarding
measures• Strict biosecurity• Notify authorities immediately• Response and recovery plans
−Quarantine−Depopulation−Disinfection
• Vaccination – complex decision
Center for Food Security and Public Health Iowa State University 2005
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
Center for Food Security and Public Health Iowa State University 2005
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
Center for Food Security and Public Health Iowa State University 2005
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
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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
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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
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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
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Contacts• Phone numbers to know
−State Veterinarian−State Public Health
Veterinarian−APHIS- Area Veterinarian
in Charge−Public Health Officials
Center for Food Security and Public Health Iowa State University 2005
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
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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
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Conclusion
“The best prescription,is knowledge.”
Dr. C. Everett KoopFormer U.S. Surgeon General
Center for Food Security and Public Health Iowa State University 2005
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.
Center for Food Security and Public Health Iowa State University 2005
AcknowledgmentsAuthor:
Reviewers:
Danelle Bickett-Weddle, DVM, MPH
Radford Davis, DVM, MPHGayle Brown, DVM, PhDJean Gladon, BS