Threats,Impacts & Preparedness Of Bioterrorism

• “...the intentional release of an infectious particle, be it a virus or bacterium, from the confines of a laboratory or medical practice must be formally condemned as an irresponsible threat against the whole human community.” (Lederberg)

Threats (silent threats)

• Threat To Economy• Threat To Wildlife and Biodiversity• Psycho-social Factors During Bioterrorism• Threat To Population Size

Key elements of the threat

• The who (the actor), • The what (the agent),• The where (the target),• How (the mode of attack).

THREAT TO ECONOMY

• The terrorists have an option to use exotic organisms to spread disease in animals and plants.

• Animals Disease• Imagine somebody spread:• Foot and Mouth disease• Rinderpest (infectious,viral)• Glanders (contagious,bacterial)• Swine fever (contagious disease of pigs and wild boar)• Fowl plague• Rabies and so on.

THREAT TO ECONOMY (continued)

• Similarly Plant Diseases• Rice blast (Fungal disease)

• Late blight of potato (A Serious Disease of Potatoes and Tomatoes)

• Black Rust (fungal disease)

• Maize Rust and so on would destroy all the crops and shatter the economy of the country.

• Eg:-Irish Potato Famine• In 1940 due to potato blast half a million people died of starvation and half a

million people migrated. It took one century for the country’s economy to recover.

• Highly pathogenic avian influenza, Hong Kong• The outbreak of highly pathogenic avian influenza (HPAI) type A (H5N1) in live

market chickens in Hong Kong resulted in 6 million deaths and killing of 1.4 million birds.

Threat To Wildlife & Biodiversity• Wildlife populations are more vulnerable to biological

terrorist attacks than are domesticated species.• Access to free-ranging wildlife is unrestricted, chances of

a perpetrator being noticed are very low, and wildlife disease surveillance activities are minimal in most areas.

• Bioterrorist easily spread bioweapons to wild life,due to which extinction of species occurs.

• Due to extinction of species threat to biodiversity also confronted.

• As wild animals and plants are the key elements for food,medicines,industries and other things.Non-availability of these things cause much problems to particular country being attacked.

Is distance between human and urban wildlife necessary?

The close proximity between humans & urban wildlife provides a “bridge” for the delivery of infectious disease that easily could be exploited by bioterroristsbecause of inadequate disease surveillance and monitoring of these wildlife.

Psycho-social Factors during bioterrorism

• Horror• Anger at Terrorist/Government • Panic ( anxiety )• Magical thinking about microbes• Fear of invisible agents and contagion• Social isolation• Loss of faith in social institutions• Attribution of arousal symptoms to infection

MANAGEMENT OF PEOPLE WITH PSYCHOLOGICAL PROBLEMS

• Care of health workers.• Confidence building by the medical workers.• Critical incidence stress management (CISM) for rescue

workers.• Dealing with emotional and psychological problems while

dealing with the dead.• Care of emergency workers, medical and paramedical workers• Critical incidence of stress debriefing(CSID)

Threat To Population Size & Non.Targeting Organisms

• Due to lethal bioweapons,death rate increases and population size of particular area decreases.

• Along with targting,other organism also affected by bioterrorism.

BIOTERRORISM: IMPACT

• Direct infection: Mortality, morbidity(relative incidence of particular disease)

• Indirect infection: Person-to-person transmission,

• Environmental impact: Environmental survival, animal infection.

• Other: Social, political, economic

Preparedness

• Prevention: Regulating environmental and agricultural conditions to

minimize threats. Limiting access to certain biological agents. Improving intelligence to uncover plans for biological or

chemical attacks.• Detection:• Health care provider training and education to improve

diagnosis• Enhanced surveillance & epidemiology to detect outbreaks • improved laboratory capabilities

Preparedness (continued)

• Response: • establishment of response plans,• regular drills or exercises of those plans • regional and interagency coordination and

communication• medical capacity for decontamination, immunization,• and treatment• Most of these capacities has dual use• For natural and bioterroric attacks

PREPARATION FOR BIOTERRORISMATTACK

• Familiarize medical staff with BT agents• Incorporate into Disaster Planning• Decontamination & Infection Control• Communications with key agencies• Laboratory, CDC, Police, FBI, etc.• Contacts to obtain stockpiled supplies: antibiotics, immune sera, vaccines, etc.• Security preparations

Familiarisation

• Nature of Bioterroric Weapons: Biological weapons are

contagious,virulent,robust,difficult to detect drug-resistant, user-controllable.

AwarenessPublic should be warn of invisible enemiesMedical professionalist back to school

DETECTIONIs this the real thing?

Indications of a bioweapon attack

• A rapidly increasing disease incidence (e.g., within hours or days) in a normally healthy population.

• An unusual increase in the number of people seeking care, especially with fever, respiratory, or gastrointestinal complaints• The rapid outbreak of any disease that is not indigenous to the local area (i.e., vector-borne illness)• Large numbers of casualties concentrated in a certain area or with wind direction.

• Lower attack rates among people who have been indoors, especially in areas with filtered air or closed ventilation systems, compared with people who have been outdoors

• Clusters of patients arriving from a single locale

Even a single case may be a signal• Caused by an uncommon agent• Unusual for region, age group or season• Fulminant(sudden) disease in otherwise healthy patient• Other clues• Similar genetic type of agent from distinct source• Unusual, atypical, genetically engineered, or

antiquated strain• Atypical aerosol, food, or water transmission• Concurrent animal disease

Biosurveillance(Monitoring System

• Biosurveillance is the science of real-time disease outbreak detection”.

• Made its debut in 1999. This collects data from labs,hospitals, and environmental studies in order to detect bioterror attacks as early as possible.

• Detection system• RODS (Real-Time Outbreak Disease

Surveillance).

Detecting the existence of a threat

• Electronic Chips • Tiny electronic chips that would contain living nerve cells to warn of

the presence of bacterial toxins (identification of broad range toxins)

• Fiber-optic • Fiber-optic tubes lined with antibodies coupled to light-emitting

molecules (identification of specific pathogens, such as anthrax, botulinum, ricin)

• Ultraviolet Avalanche Photodiodes(New research )• Ultraviolet avalanche photodiodes offer the high gain, reliability and

robustness needed to detect anthrax and other bioterrorism agents in the air.

• biodetectors molecular identification

WHAT WE NEED TOPREPARE FOR BIOTERRORISM

• More trained epidemiologists to speed detection• Increased laboratory capacity• Health Alert Network• SPECIAL PROBLEMS WITH BIOTERRORISM• Specialized labs needed• for some agents• • Risks to laboratory workers• • Limited resources• • Communication between agencies

WHAT TO DO IF YOU SUSPECT ABIOTERRORIST DISEASE

• IMMEDIATELY NOTIFY:• • Hospital Infection Control• • Isolation: Smallpox,• plague, hemorrhagic• fevers• • Laboratory• • Hospital Administration• • Local Public Health• Department

HOW CAN HOSPITALS PREPARE?

• Familiarize medical staff and lab with bioterrorist threat and agents

• • Incorporate BT planning into disaster planning• • Infection control• • Notification procedures and contact numbers• • Daily surveillance and reporting• • Security preparations• • Media• • Personal Protective Equipment (PPE)

Role of Clinicians & Labs

• Be prepared to diagnose and treat BT diseases• Keep alert to unusual disease patterns• Use reportable disease system to alert • public • Health officials of a potential problem Get involved in disaster planning process• Labs should work on • advanced detection systems to detect early attacks,• identify at-risk areas, and to• give proper Treatment • Forensic teams• work hard to identify biological agents,• their origins and effects

Factors contribute to the emergence and re-emergence

of infectious diseases 1. Unprecedented worldwide population growth draining the natural

resources2. Overcrowding in cities with poor sanitation.3. Rapid and increased international travel.4. Increased international trade in animals and food products.5. Mass distribution of food and unhygienic food preparation practices6. Increased exposure of humans to disease vectors and reservoirs in

nature7. Man-made changes to the environment and climatic changes which

have a direct impact on the population of insect vectors and animal reservoirs.

8. Misuse of antibiotics leading to the evolution of resistant microbes.

What is being done?

• National Pharmaceutical Stockpile Program (NPSP) -- This resource of

medical supplies can be sent anywhere in the country within 12 hours of a

biological attack.

• The Health Alert Network (HAN) – this organizations is developing a national

communication system on the Internet.

• Health department lab preparedness -- The CDC is working with other officials

to ensure that all state health departments are equipped to test suspicious

substances.

• The Association for Professionals in Infection Control and Epidemiology, Inc.

(APIC) has worked with the CDC to develop the Bioterrorism Readiness Plan

Integrated Disease Surveillance Project (IDSP), a decentralized and state-

based surveillance program, was introduced in November 2004 in India.

• It integrates public sector private sector rural and

urban health system

• There is incorporation of International Health Agencies (WHO, CDC, etc.).

• Its major components include

• integration and decentralization of surveillance activities,

• strengthening of public health laboratories

• human resource development

• Use of information technology for collection, collation, compilation,

analysis, and dissemination of data.

CONCLUSION

• The threat of bioterrorism is real. To prepare for it, we must educate our health care team, incorporate bioterrorism preparedness into disaster plans, and support cooperation and communication between the public health department and hospitals

• di1xy2Jy22