Bioterrorism Awareness: Protection of Human and Animal Health Food animal producers.

Bioterrorism Awareness:Protection of Human and Animal HealthFood animal producers

Center for Food Security and Public Health Iowa State University 2005

Why Are We Here?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


Biological AttackBiological Attack

• Bioterrorism attacks of 2001• Anthrax in postal system

• 22 cases• 5 deaths

• U.S. public health realm changed forever


OverviewOverview

• Bioterrorism• Zoonoses and bioterrorism• Disease control and biosecurity • U.S. Government agencies involved• Bioterrorism agents/diseases• Your role and responsibility


Biological agents targeting humans, animals, or plants

Biological, chemical or radiological agents targeting agriculture or its components

•Livestock•Food supply•Crops•Industry•Workers

TerrorismTerrorism

BioterrorismAgroterrorism Other

Conventional, radiological, nuclear, chemical,cyber

•Typically direct human targeting


Characteristics of a Biological Attack

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


Time (Days)

No.

Aff

ecte

d

Exposure

Symptoms

Seek Care

Infectious Disease OutbreakInfectious Disease Outbreak


Clues Suggesting Biological Agent Release

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


Many Agents are ZoonoticMany Agents are Zoonotic

• Zoonotic means a disease transmitted from animals to humans

• Disease may be seen in animals before humans

• Animals are sentinels− Pets, livestock, wildlife


Factors That Promote Transmission of Zoonoses

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


Routes of TransmissionRoutes of Transmission

• Direct contact − Gel, liquid, powder− Scratches− Droplet spray onto mucous membranes

• Indirect: Ingestion, injection− Contaminated food, water− Vector

• Aerosol


Disease Control: Client EducationDisease Control: Client Education

• Disinfect/clean up areas contaminated with animal waste−Livestock, pets, wildlife, rodents

• Basic hygiene−Wash hands−Child supervision


Zoonoses ControlZoonoses Control

• Proper pet selection• Use caution at petting zoos• Cook food properly• Control strays• Visit and communicate with physician

and veterinarian • Follow guidelines for

immunocompromised people


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




• 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




• Maintain healthy herd−Vaccinations−Proper hygiene for

animals and handlers• Purchase from

reputable sources• Quarantine newly

purchased animals• Separate sick animals

U.S. Agencies

Dealing with terrorism


Public Health Security and Bioterrorism Preparedness Response Act of 2002

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


Department of Homeland Security (DHS)

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


Centers for Disease Control and Prevention (CDC)

Centers for Disease Control and Prevention (CDC)

• CDC's Mission−Promote health and quality

of life by preventing and controlling disease, injury and disability

• Preparing for bioterrorism since 1998• One of first agencies to respond to anthrax

incidents of 2001


Strategic National StockpileStrategic National Stockpile

• 12-hour Push Package− Complete package of

medical materials

• Vendor Managed Inventory− Tailored to suspected agents


Insert Your State’s Info HereInsert Your State’s Info Here


Preparing IowaPreparing Iowa

• Iowa’s Homeland Security −Administered by

Iowa Emergency Management Division

−Works with public and private partners

www.iowahomelandsecurity.org

http://www.iowahomelandsecurity.org/

http://www.iowahomelandsecurity.org/


Preparing IowaPreparing 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


ClassificationClassification

• Prepared by the CDC’s Bioterrorism Preparedness and Response Office

• Category A: Highest priority• Category B: Second highest priority• Category C: Third highest priority


“Weaponization” of Agents“Weaponization” of Agents

• Alter characteristics of an agent, allowing it to cause a more serious disease−Enhance transmission− Increase virulence−Resistant to antibiotics−Evade vaccine protection −Alter clinical signs

Harder to diagnose


Note to presenterNote 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.


Category A : Agents/DiseasesCategory A : Agents/Diseases

• Anthrax• Botulism• Plague• Smallpox• Tularemia• Viral hemorrhagic fevers


Anthrax: The AgentAnthrax: The Agent

• Bacteria: Bacillus anthracis • Forms spores• Human disease

−Skin− Intestinal− Inhalation

• Animal disease−Spreads through the body−Rapid death


Anthrax: The ResponseAnthrax: The Response

• Vaccine−Humans−Animals

• Antibiotics−Treatment−Prevention

• Hardy in environment −Difficult to disinfect


Botulism: The AgentBotulism: 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


Botulism: The ResponseBotulism: The Response

• Toxoids for high risk people• Antitoxin available

−Case-by-case basis

• Spores destroyed by moist heat


Plague: The AgentPlague: 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


Plague: The ResponsePlague: The Response

• Antibiotics generally effective if given early

• Killed vaccine available • Isolation of sick individuals• Susceptible to a number of common

disinfectants


Smallpox: The AgentSmallpox: The Agent

• Variola virus• Eradicated from the world in 1977• Narrow host range: Humans only• Transmission: Person-to-person,

contaminated items• Clinical signs

−Flu-like, progressive skin eruptions


Smallpox: The ResponseSmallpox: The Response

• No specific treatment• Vaccine has side effects• Vaccination of health care personnel• Isolation of infected individuals• Disinfection of clothing etc. with

steam, fire or bleach


Tularemia: The AgentTularemia: The Agent

• Francisella tularensis• Transmitted by ingestion,

inhalation, vectors, direct contact through skin

• Six clinical forms in humans

UlceroglandularGlandular


Tularemia: The AgentTularemia: 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


Tularemia: The ResponseTularemia: The Response

• Person-to-person transmission not documented

• Antibiotics effective if early or preventative

• Vaccine−For high risk individuals−Unknown effectiveness against inhalation tularemia


Viral Hemorrhagic Fevers:The Agents

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


VHF: The ResponseVHF: The Response

• Intensive supportive care• Antiviral medications have shown

some efficacy • Susceptible to various disinfectants


Category B: Agents/DiseasesCategory B: Agents/Diseases

• Brucellosis• Glanders• Melioidosis • Psittacosis • Q Fever

• Typhus fever• Viral encephalitis• Toxins• Food Safety Threats • Water Safety Threats


Brucellosis: The AgentBrucellosis: The Agent

• Bacteria: Brucella spp.• Transmission by

− Ingestion− Inhalation−Direct contact

• Clinical signs−Humans: Cyclic fever

and flu-like symptoms−Animals: Reproductive signs


Brucellosis: The ResponseBrucellosis: The Response

• Long term antibiotics generally effective

• Vaccinate calves, no human vaccine• Eliminate reservoir• Standard precaution to

avoid exposure• Thorough disinfection


Glanders: The AgentGlanders: The Agent• Bacteria: Burkholderia mallei • Transmission by ingestion,

inhalation or direct contact−Animal-to-human transmission

is inefficient

• Clinical signs−Humans & horses: Cutaneous &

pulmonary lesions, rapidly fatal illness


Glanders: The ResponseGlanders: The Response

• No vaccine • Antibiotic therapy likely effective• Destroyed by various chemicals


Melioidosis: The AgentMelioidosis: The Agent

• Bacteria: Burkholderia pseudomallei

• Transmission: Contact, ingestion, inhalation

• Clinical signs: Humans, sheep, goats and pigs−No symptoms to pneumonia,

lung and wound abscesses


Melioidosis: The ResponseMelioidosis: The Response

• Long-term, multiple antibiotics effective

• Vaccine not available in U.S.

• Easily destroyed by disinfectants


Psittacosis: The AgentPsittacosis: The Agent

• Bacteria: Chlamydophila psittaci • Occurs worldwide• Reportable in U.S.• Clinical disease

−Humans and birds: Ranges from no symptoms to systemic illness with severe pneumonia


Psittacosis: The ResponsePsittacosis: The Response

• Antibiotics generally effective

• Decontamination possible with most disinfectants


Q Fever: The AgentQ Fever: The Agent

• Bacteria: Coxiella burnetii • Transmission: inhalation, direct

contact, ingestion, ticks• Disease symptoms

− Humans: Acute: Flu-like, pneumonia, liver disease Chronic: Heart complications, bone inflammation

− Animals: Most have no signs Sheep, cattle and goats: Abortions


Q Fever: The ResponseQ Fever: The Response

• Antibiotic therapy may limit the disease

• Vaccine developed, not available in U.S.

• Some disinfectants are effective


Typhus Fever: The AgentTyphus Fever: The Agent

• Bacteria: Rickettsia prowazekii• Endemic in Eastern Europe, Middle

East, and parts of Africa• Transmitted in feces of

human body louse • Clinical signs: Humans

−Fever, headache, red blotches, and a red-dot rash

• Not seen in domestic animals

J. Kalisch


Typhus Fever: The ResponseTyphus Fever: The Response

• Antibiotics are generally effective• Vaccine, not commercially available


Viral Encephalitis: The AgentViral Encephalitis: The Agent• Viruses causing EEE, WEE, and VEE• Transmitted via mosquito• Clinical signs

• Birds do not become ill but are carriers; act as sentinels

−Humans, horses, donkeys, mules: Often no signs to flu-like illness

−Brain inflammation in some patients


Viral Encephalitis:The Response

Viral Encephalitis:The Response

• Supportive care• Vaccine

−Equine−Human: high risk

• Virus cannot live in environment


Toxins: The AgentsToxins: The Agents

• Staphylococcal enterotoxin B (SEB)

• Ricin toxin from castor plant

• Clostridium perfringens epsilon toxin


SEB: The AgentSEB: The Agent

• Staphylococcal enterotoxin B (SEB)• A common cause of food poisoning • Clinical signs: Humans

−Fever, chills, headache, aches−Non-productive cough if inhaled−GI signs if ingested

• Animals: Likely similar to human


Ricin: The AgentRicin: The Agent

• Ricin toxin from bean of castor plant • Available worldwide• Clinical signs

−Acute onset of fever,chest tightness, cough,

dyspnea, nausea


Epsilon Toxin: The AgentEpsilon 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


Toxins: The ResponseToxins: The Response

• Supportive care• No vaccines currently available for

SEB or ricin• Vaccines for animals for clostridial

disease• Toxins are inactivated with common

disinfectants


Food Safety ThreatsFood Safety Threats• Campylobacter species• Salmonella species• E. coli 0157:H7 • Viruses, parasites,

chemicals, toxins• Ingestion of

contaminated food• Gastrointestinal upset


Food Safety Threats: The Response

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


Water Safety ThreatsWater Safety Threats

• 53% of US drinking water is from ground water

• Cryptosporidium parvum- protozoa

• Vibrio cholerae- bacteria


Cryptosporidium: The AgentCryptosporidium: The Agent

• Cryptosporidium parvum- protozoa• Transmission: Inhalation, ingestion• Clinical signs: Humans, calves,

others−Acute gastroenteritis

• Dogs, cats, horses, pigs: Resistant


Vibrio cholerae: The AgentVibrio cholerae: The Agent

• Vibrio cholerae- bacteria• Transmission: fecal-oral,

contaminated shellfish• Clinical signs: humans

−Acute, mild diarrhea−5% severe disease

• Animals are resistant to disease


Water Safety: Public Health Significance

Water Safety: Public Health Significance

• Cryptosporidum parvum −1993: Municipal water supply

contaminated in Milwaukee−40,000 ill−1997: Decorative water fountain at the

Minnesota Zoo−369 cases −Mostly young children


Water Safety Threats: The Response

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


Category CCategory C

• Nipah virus• Hantavirus


Nipah Virus: The AgentNipah Virus: The Agent

• Fruit bats• Clinical signs

−Humans: Brain inflammation−Pigs: Respiratory; neurological−Dogs and cats: “Distemper”


Nipah Virus: The ResponseNipah Virus: The Response

• Avoid contact with all infected animals and fluids

• Vaccine being researched• Call authorities

immediately


Hantavirus: The AgentHantavirus: 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


Hantavirus: The ResponseHantavirus: The Response

• Supportive care• Limit exposure to

rodent excrement• Virus is

deactivated with bleach


Other Important Diseases

Other Important Diseases

• Transmissible Spongiform Encephalopathy (TSE)

• Rift Valley Fever• Hendra Virus• West Nile Virus• Foot and Mouth Disease• Monkeypox


Transmissible Spongiform Encephalopathy: The AgentTransmissible Spongiform

Encephalopathy: The Agent• Prions

−Proteinaceous infectious particles−Mutated proteins

• Very long incubation period• Neurological signs in all species• No treatment available


Bovine Spongiform Encephalopathy

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


TSE: The ResponseTSE: 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


Rift Valley Fever: The AgentRift Valley Fever: The Agent

• Virus• Transmission: mosquito, inhalation,

contact with infected body fluids• Clinical signs

−Humans: Flu-like, fever, headache Severe disease: Vision complications,

bleeding with fever−Animals: Abortions, death in newborns


Rift Valley Fever: The Response

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


Hendra Virus: The AgentHendra 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


Hendra Virus: The ResponseHendra Virus: The Response

• Little is known about disease• Potentially serious consequences

−High death rate−Lack of treatment


West Nile Virus: The AgentWest 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”


West Nile Virus: Public Health Significance

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


Spread of WNV in the U.S.: 1999-2002

Spread of WNV in the U.S.: 1999-2002


West Nile Virus: The Response

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


Foot and Mouth Disease: FMDFoot 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


FMD: Agroterrorism ThreatFMD: 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


FMD: The ResponseFMD: The Response• USDA upgrading safeguarding

measures• Strict biosecurity• Notify authorities immediately• Response and

recovery plans−Quarantine−Depopulation−Disinfection

• Vaccination – complex decision


Monkeypox: The AgentMonkeypox: 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,

red eyes• Humans: Flu-like, rash,

pustules, swollen lymph nodes


Monkeypox: Public Health Significance

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


Monkeypox: The ResponseMonkeypox: 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

Conclusion


What to do if bioterrorism is suspected

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


ContactsContacts

• Phone numbers to know−Local veterinarian−Local physician−Public health officials


SummarySummary

• 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


SummarySummary

• Prevention, recognition and response involves everyone

• Report any suspicious activity, unexplained behavior or death loss in your herd or flock

• You play a critical role


ConclusionConclusion

“The best prescription,is knowledge.”

Dr. C. Everett KoopFormer U.S. Surgeon General


AcknowledgmentsAcknowledgments

Development 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.


AcknowledgmentsAcknowledgments

Authors:

Reviewers:

Danelle Bickett-Weddle, DVMJamie Snow, DVM

Radford G. Davis, DVM, MPHGayle B. Brown, DVM, PhDJean Gladon, BS

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Bioterrorism Awareness: Protection of Human and Animal Health Food animal producers.

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