Bioterrorism - Saraniecki

Question 1

What is the definition of bioterrorism?

Answer 1

deliberate release of viruses, bacteria, or other germs, toxins, or agents used to cause illness or death in people, animals, plants
ultimate goal - mass panic

Question 2

How does bioterrorism differ from biowarfare?

Answer 2

when the release is intended as a weapon of war
goal - incapacitate and/or kill the enemy

Question 3

What is our food defense?

Answer 3

resiliency of the food system
reduces the impact of intentional system attacks or catastrophic events

Question 4

How does food safety act as protection against bioterrorism?

Answer 4

our food system reliability
reduces exposure to natural hazards, unintentional errors, and/or failures in the food system

Question 5

What is food security defined as?

Answer 5

food supply sufficiency
access to nutritionally adequate safe food

Question 6

What is the CARVER system from a general standpoint?

Answer 6

originally developed by the US military to identify areas that may be vulnerable to an attacker
in food defense, it is used to identify areas that are most likely to be potential vulnerabilities in the food supply chain

Question 7

What does CARVER + Shock stand for?

Answer 7

Critically - impact on PH&S
Accessibility - ease to access target
Recuperability - recovery from an attack
Vulnerability - can attack be easily accomplished
Effect - direct loss from an attack
Recognizability - ease of identifying target by terrorist
Shock - health, economic, psychological impacts of an attack

Question 8

What are two examples of Agro-terrorism?

Answer 8

1999 - cow carcasses intentionally contaminated with chlordane by environmental extremists in WI sent to rendering plant and converted into animal feed
1997 - restaurant grease contaminated with fungicide by rival company and recycled into poultry feed

Question 9

What are three examples of US Bioterrorism

Answer 9

1763 - smallpox blankets given to Chief Pontiac’s warriors in Pittsburg
1984 - Bagwan Shree Rajneesh followers contaminated salad bar in the Dalles, OR 751 Salmonella cases, no deaths
2001 - Anthrax sent through US mail, 22 cases, 5 deaths

Question 10

What is a Category “A” Definition in bioterrorism?

Answer 10

high priority agents that pose risk to national security
can be easily disseminated or transmitted from person to person
result in high mortality rates and have the potential for major public health impact
might cause public panic and social disruption
require special action for public health preparedness

Question 11

What are the category “A” agents? (7)

Answer 11

Anthrax - Bacillus anthracis
Botulism - Clostridium botulinum toxin
Plague - Yersinia pestis
Smallpox - Variola major
Tularemia - Francisella tularensis
Viral hemorrhagic fevers ie ebola, lassa, machupo, marburg
Water safety threats - vibrio cholerae, cryptosporidium parvo

Question 12

Anthrax
Describe
Transmission? (3)
Treatment?

Answer 12

Spore forming bacterium Bacillus anthracis
cutaneous exposure - blister then black ulcer
ingestion - nausea, bloody diarrhea, fever
inhalation - flu or cold-like symptoms
treatment - early dx and antibiotics, 80% mortality from inhalation or GI
Vaccines available to high risk personnel

Question 13

Smallpox
Still around?
Survivability?
Symptoms?

Answer 13

Eradicated in 1977 globally, 1949 US from vaccines
Repositories - CDC Atlanta and Vector Lab, Siberia
Highly transmissible person to person
Variola major - 30-40% mortality, minor - 1% mortality
very painful disfigurement and rash
Outbreak would cause shutdown of air and train transportation

Question 14

What is the Category “B” Definition in bioterrorism?

Answer 14

second highest priority agents
moderately easy to disseminate
result in moderate morbidity rates and low mortality rates

Question 15

What are some Category “B” Agents?
(11)

Answer 15

Brucellosis (Brucella spp.)
Epsilon toxin of Clostridium perfringens
Salmonella, E. coli O127:H7, Shigella
Glanders - Burkholderia mallei
Meliodosis - Burkholderia pseudomallei
Psittacosis - Chlamydia psittaci
Q fever - Coxiella burnetii
Ricin toxin - Ricinus communis
Staphylococcal enterotoxin B
Typhus fever - Rickettsia prowazekii
Viral encephalitis

Question 16

Why is Salmonella a concern?

Answer 16

for perpetrators, it is easy to make, store, and distribute relatively safely
low security of vulnerable tagets
mimics naturally occurring FBIs
simultaneous multi-outbreaks possible, especially through imported fresh produce

Question 17

What is RICIN and how is it contracted?

Answer 17

extremely toxic plant protein from the seed of the castor bean plant
inhalation exposure thru aerosolized powder
ingestion of contaminated food, water, or agricultural products
cutaneous through abraded skin or wounds
eye exposure through direct contact with aerosols

Question 18

How is RICIN a threat?

Answer 18

Category B bioterrorism agent
Schedule 1 chemical warfare agent
exposure to amounts equal to a few grains of salt can cause death
death caused by inhibition of protein synthesis in body, symptoms between 7 and 24 hours
ricin is several orders of magnitude less toxic than botulism, anthrax, tetanus

Question 19

What should you do in case of a ricin exposure?

Answer 19

remove clothes as fast as possible without touching exterior
do not lift over head, clothes should be removed by someone in PPE cutting off
wash entire body ASAP
contact lenses removed and discarded
all clothes discarded in plastic bag for authorities

Question 20

What is Glanders?
Why are we concerned with it?

Answer 20

caused by Burkholderia mallei
mostly a disease in horses, rare in humans and US
very low inoculant rate with untreated mortality rate 95%
transmission via aerosols to skin abrasions and mucous membranes, also food

Question 21

What is Meliodosis?

Answer 21

aka Whitmore’s disease
caused by Burkholderia pseudomallai
clinically and pathologically similar to Glanders
transmission via contaminated water and soil
mortality rate 40%

Question 22

What is the definition for Category “C” bioterrorism?

Answer 22

third highest priority
includes emerging pathogens that could be engineered for mass dissemination due to availability, ease of production and dissemination, and potential for high morbidity/mortality rates

Question 23

What are some examples of Category “C” agents? (3)

Answer 23

Emerging infectious disease
Nipah virus found in Australian Bats
Hantavirus
Multi-drug resistant Tuberculosis

Question 24

What is SARIN?

Answer 24

human made chemical warfare nerve agent
highly toxic, 1-10 ml skin exposure = death
clear, colorless, tasteless, odorless liquid
easily evaporates making is an immediate but short-lived threat
can be mixed with water and used to contaminate crops (vapor will not)
vapor is heavier than air

Question 25

What are exposure risks to SARIN?

Answer 25

primary exposure risk is skin and eye
secondary is inhalation
mixes easily with water to form poison
vapor exposed clothing is hazardous for over 30 mins, should be removed asap

Question 26

When has SARIN been seen used?

Answer 26

March 1995
Fatalist cult members of Aum Shinrikyo in Japan released this gas in Tokyo subway
5000 injured, only 12 deaths

Question 27

What is the DHS BioWatch program?

Answer 27

early warning network of AIR sensors to detect biological and chemical aerosol attacks
currently monitoring 31+ cities and portable units
goal is to monitor 90% population’s air in 50 jurisdictions and 160 high risk facilities
current detection lapse is 6 hrs, goal is 4

Question 28

What is the CDC BioSense 2.0 Program?

Answer 28

cloud based electronic data aggregator of emergency dept visits and hospitalizations based on sx and ICD 10 codes, lab response network of 150+ labs, pharmacy rx and OTC meds, health depts
allows enhanced surveillance during emergencies and mass gatherings such as inaugurations, super bowl

Question 29

What does syndrome surveillance mean?

Answer 29

BEFORE diagnosis in ER

Question 30

What does Biosafety Level 1 entail?

Answer 30

minimal potential hazard to lab personnel
PPE: lab goats, gloves
Equipment: open bend, open sink, hand sink
General lab practices
Agents: non-pathogenic E. coli

Question 31

What does Biosafety Level 2 entail?

Answer 31

moderate potential hazards to personnel and the environment
requires specific training in handling infectious agents
requires class 2 safety cabinets and autoclave
PPE: lab coat, gloves, face splash protection, no respiratory PPE
sharps precautions

Question 32

What agents are found in BSL 2? (12)

Answer 32

C. difficile
HAV
HBV
HIV
Influenza A
Lyme disease
Dengue fever
Salmonella
Mumps
Measles
Shigella
Yersinia pestis

Question 33

What does Biosafety Level 3 entail?

Answer 33

indigenous or exotic agents with potential for aerosol transmission, disease may have serious or lethal consequence through inhalation
decontamination of all wastes and lab clothing
baseline serum testing of lab workers
controlled lab access
PPE: coats, gloves, face guard, respiratory protection
exhaused negative air flow
self-closing double door

Question 34

What are some BSL 3 agents? (9)

Answer 34

Leishmania ssp
Mycobacterius tuberculosis
Bacillus anthracis
WNV
EEE
Salmonella typhii
Coxiella burneti
Rickettsia rickettsii
yellow fever

Question 35

What does Biosafety Level 4 entail?

Answer 35

dangerous/exotic agents which pose high risk of life-threatening disease, aerosol-transmitted lab infections, or related agents with unknown risk of transmission
same as BSL3 but clothing change before entering, shower on exit, full body air supply positive pressure personnel moon suite
separate building or isolated zone, dedicated supply, exhaust, and decon systems

Question 36

What are some BSL 4 agents? (5)

Answer 36

Marburg virus
Ebola virus
Lassa fever
Crimean-Congo fever
Smallpox

Question 37

What did the 2002 Bioterrorism Act require of facilities in refards to FDA?

Answer 37

food facilities are required to register with FDA
FDA must be given advance notice on shipments of imported foods
all domestic and foreign facilities that manufacture, process, pack, or hold food for human or animal consumption is US must register with FDA and renew registration every 2 years

Question 38

What are some exempt facilities from the 2002 Bioterrorism Act?

Answer 38

a foreign facility whose manufacturing/processing occurs outside US
farms
retail food establishments
non-profit charitable food establishments
fishing vessels
USDA inspected plants (meat, poultry,egg)
facilities that process food contact substances

Question 39

What does the 2002 Bioterrorism Act require of community drinking water systems?

Answer 39

Systems serving more than 3300 persons must:
conduct vulnerability assessment
certify and submit a copy of the vulnerability assessment to the EPA administrator
prepare emergency response plan based on results of vulnerability assessment
certify to EPA within 6 months that emergency response has been completed

Question 40

What are the three FDA recall classifications?

Answer 40

Class I- potential for serious injury or death
Class II- possibility of serious adverse events with irreversible consequences
Class III- not likely to cause adverse health consequences, but still a chance

Question 41

What are the three USDA recall classifications?

Answer 41

Class 1 - food will cause health problems or death
Class 2 - remote probability of health adversities
Class 3 - food will not cause adverse health effects