Title: OUTBREAK
1- OUTBREAK!
- RECOGNIZING THE THREAT
- and
- SOUNDING THE ALARM
- Ralph M. Shealy, M.D., FACEP
- Co-Director, Bioterrorism Training Network
- South Carolina AHEC
- Francis Marion University
- Florence, S.C.
- August 12, 2005
2Why should I learn about bioterrorism?
There will never be a terrorist attack here!
3What we should really be concerned about
4What we should really be concerned about is
an OUTBREAK of Infectious Disease!
5Remember the Influenza Pandemic of 1917?
6Remember the Influenza Pandemic of 1917? Twenty
to forty million deaths from respiratory
failure.
7Surely it would be different now!
8Surely it would be different now! Modern
technology.
9Surely it would be different now! Modern
technology. Advances in critical care.
10Surely it would be different now! Modern
technology. Advances in critical care. ICU
beds.
11Surely it would be different now! Modern
technology. Advances in critical care. ICU
beds. Ventilators.
12How many vacant ICU beds do you have in your
hospital?
13In an era of rapid global travel, an infectious
disease outbreak can be a global catastrophe.
14- Do you live and work with people who
15- Visit relatives in Brooklyn?
16- Visit relatives in Brooklyn?
- Change planes at OHare?
17- Visit relatives in Brooklyn?
- Change planes at OHare?
- Deploy to the Middle East?
18Remember the SARS Outbreak of 2003?
19Remember the SARS Outbreak of 2003? Came from
China
20Remember the SARS Outbreak of 2003? Came from
China Shut down Toronto
21SARS first reported in Asia in February 2003.
Over a few months, spread to over two dozen
countries in North America, South America,
Europe, and Asia before it was contained.
Over 8,000 people worldwide became sick.
Almost 800 died.
22Remember who died of SARS?
23Remember who died of SARS? Unprotected
healthcare workers!
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25The earth may be on the brink of a worldwide
epidemic from a bird flu virus that may mutate
to become as deadly and infectious as viruses
that killed millions during three influenza
pandemics of the twentieth century.
26We havent even mentioned bioterrorism yet!
27Chimera The Doomsday Bio-weapon
- Disseminated multiple simultaneous deadly
epidemics - Each could be spread person-to-person
- Each required a different treatment
- Each could only be treated effectively in the
early stages - All look like the flu at first
- Diagnostic features not present until late
28- Since the fall of the Soviet Union, some of its
biological arsenal and the scientists who created
it have not been accounted for.
29Bio-Engineering Nightmare
- Humans have
- Created drug resistant organisms
- Introduced virulence into organisms that are
normally not human pathogens
30Outbreaks Can Be Global
- In an age of rapid global travel, an outbreak
that originates far from home can quickly arrive
in your community.
31We are at risk from a NATURAL or a
MAN-MADEEPIDEMICoriginatingANYWHERE!
32The CONSEQUENCES could be essentially the
same.
33A Disaster
- Threatens public health and safety.
34A Disaster
- Threatens public health and safety.
- May destroy infrastructure.
35A Disaster
- Threatens public health and safety.
- May destroy infrastructure.
- Disrupts essential services.
36A Disaster
- Threatens public health and safety.
- May destroy infrastructure.
- Disrupts essential services.
- Overwhelms routine methods of operation.
37 38- Every DISASTER is LOCAL!
- Its OURS for 72 hours!
39YOU are a FRONT-LINE DEFENDER against threats
to South Carolinas HEALTH and SAFETY!
40We MUST Think OUTSIDE THE BOX!
41We MUST Think OUTSIDE THE BOX!Extraordinary
measures required.
42We MUST Think OUTSIDE THE BOX!Extraordinary
measures required. Scope of practice changes.
43We MUST Think OUTSIDE THE BOX!Extraordinary
measures required. Scope of practice changes.
Standard of care changes.
44Altered Standards of Care in Mass Casualty
Events Office of Public Health Emergency
Preparedness U.S. Department of Health and
Human Services http//www.ahrq.gov/research/altst
and/altstand.pdf
45- Changes in the usual standards of care will be
required to achieve the goal of saving the most
lives in a mass casualty event. RATHER THAN
DOING EVERYTHING POSSIBLE TO SAVE EVERY LIFE, it
will be necessary to allocate scarce resources in
a different manner to SAVE AS MANY LIVES AS
POSSIBLE.
46A communitys success in a disaster will depend
on Effective RELATIONSHIPS
47A communitys success in a disaster will depend
on Effective RELATIONSHIPS across DISCIPLINES
48A communitys success in a disaster will depend
on Effective RELATIONSHIPS across DISCIPLINES
and JURISDICTIONS.
49- Community Health Professionals
- Public Health
- Hospitals
- Emergency Management
- Law Enforcement
- Fire Service
- EMS
- Rescue
- Public Works
- Business and Industry
- Local, State and Federal Government
- Military
50Success will depend on Coordinated PLANNING
51Success will depend on Coordinated PLANNING
Effective PROCEDURES
52Success will depend on Coordinated PLANNING
Effective PROCEDURESPRACTICE to test and refine
plans
53Natural Epidemic or Man-made Epidemic?
54Natural Epidemic or Man-made Epidemic? INITIAL
course of action is the SAME!
55We must RECOGNIZE IT
56We must RECOGNIZE IT REPORT IT
57We must RECOGNIZE IT REPORT IT and RESPOND
EFFECTIVELY
58Recognize an Outbreak
- Case or a cluster of cases
- that are
- DIFFERENT
- FROM THE NORM
59Disease Outbreak
- Incidence of a symptom complex at a rate
EXCEEDING NORMAL BASELINE - For a disease that is not supposed to occur (such
as smallpox), a single case constitutes an
outbreak.
60Red Flags
- Whenever an experienced clinician thinks,
- Hmmmm.Something ODD about this!
61Clues to an Outbreak
- Symptoms
- Appear in an AGE GROUP that is not typical
62Clues to an Outbreak
- Symptoms
- Appear in an AGE GROUP that is
- not typical
- Fall outside of their USUAL SEASON
63Clues to an Outbreak
- Symptoms
- Appear in an AGE GROUP that is not typical
- Fall outside of their USUAL
- SEASON
- MORE SEVERE than expected
64Clues to an Outbreak
- Symptoms
- Appear in an AGE GROUP that is
- not typical
- Fall outside of their USUAL
- SEASON
- MORE SEVERE than expected
- FAIL TO RESPOND to the usual treatment
65Clues to an Outbreak
- A cluster of patients with
- SYMPTOMS DEVELOPING IN UNISON, as though they
were all exposed at the same time. -
66Clues to an Outbreak
- A cluster of patients with
- SYMPTOMS DEVELOPING IN UNISON, as though they
were all exposed at the same time. - EXPOSURE TO THE SAME enclosed space, the same
ventilation system, the same food or water source.
67 68- Same SYMPTOMS.
- Same TIME.
69- Same SYMPTOMS.
- Same TIME.
- Same PLACE.
70- Same SYMPTOMS.
- Same TIME.
- Same PLACE.
- Could this be an OUTBREAK?!
71Biological Agents of Highest ConcernCategory A
Agents
- Easily disseminated, infectious via aerosol
- Susceptible civilian populations
- Cause high morbidity and mortality
- Person-to-person transmission
- Unfamiliar to providers difficult to
diagnose/treat - Cause panic and social disruption
- Previous development for biologic weapons
72Biological Agents of Terror
- Bacteria
- Viruses
- Biological Toxins
73Bacteria
74Viruses
- Smallpox
- Viral Hemorrhagic Fevers
75Biological Toxins
76- Success in an outbreak does not depend on
memorizing technical aspects of microbiology and
pharmacology. -
77- Success in an outbreak does not depend on
memorizing technical aspects of microbiology and
pharmacology. - Technical data and scientific understanding
CHANGE. -
78- Success in an outbreak does not depend on
memorizing technical aspects of microbiology and
pharmacology. - Technical data and scientific understanding
CHANGE. - The MOST RECENT INFORMATION will quickly become
available when you need it. -
79The Ultimate Resource!www.bt.cdc.gov
80Most forms of terrorism are obvious.
81COVERT Bioterrorism is NOT OBVIOUS.
82Overt Biological Attack
83Overt Biological Attack
- Attack announced
- Credit claimed
84Overt Biological Attack
- Attack announced
- Credit claimed
- Motive explained
85Overt Biological Attack
- Attack announced
- Credit claimed
- Motive explained
- Agent identified
86Overt Biological Attack
- Attack announced
- Credit claimed
- Motive explained
- Agent identified
- Lights and Sirens response
87Overt Biological Attack
- Attack announced
- Credit claimed
- Motive explained
- Agent identified
- Lights and Sirens response
- ANTHRAX LETTERS an example
88Covert Bioterrorism
- Clandestine sneak attack.
-
89Covert Bioterrorism
- Clandestine sneak attack.
- Agent widely disseminated
-
90Covert Bioterrorism
- Clandestine sneak attack.
- Agent widely disseminated
- Causes high morbidity and mortality
-
91Covert Bioterrorism
- Clandestine sneak attack.
- Agent widely disseminated
- Causes high morbidity and mortality
- Preferably transmitted person- to-person
92Covert Bioterrorism
- Organisms unfamiliar to healthcare providers
93Covert Bioterrorism
- Organisms unfamiliar to healthcare providers
- Initial symptoms non-specific
94Covert Bioterrorism
- Organisms unfamiliar to healthcare providers
- Initial symptoms non-specific
- Best treated in early stages, when difficult or
impossible to diagnose
95Covert Bioterrorism
- Organisms unfamiliar to healthcare providers
- Initial symptoms non-specific
- Best treated in early stages, when difficult or
impossible to diagnose - Hard to treat when characteristic signs are
apparent
96Covert Bioterrorism
- Community providers are front line of defense!!
- EARLY RECOGNITION AND APPROPRIATE RESPONSE will
avert great loss of life.
97Syndromic Surveillance
- Watches for SYMPTOM COMPLEX.
98Syndromic Surveillance
- Watches for SYMPTOM COMPLEX.
- Detects an unusually HIGH INCIDENCE of similar
symptoms present in the community at the same
time.
99Syndromic Surveillance
- Watches for SYMPTOM COMPLEX.
- Detects an unusually HIGH INCIDENCE of similar
symptoms present in the community at the same
time. - Unexplained VARIANCES FROM THE BASELINES can be
recognized
100Syndromic Surveillance
- Requires seasonal BASELINE RATES of index
symptoms
101Syndromic Surveillance
- Requires seasonal BASELINE RATES of index
symptoms - In order to be successful, reportable conditions
must be REPORTED IN A TIMELY FASHION to public
health authorities.
102During an Unrecognized Outbreak
- Disease is transmitted person to person.
-
-
103During an Unrecognized Outbreak
- Disease is transmitted person to person.
- Health providers and laboratory workers put at
risk -
104During an Unrecognized Outbreak
- Disease is transmitted person to person.
- Health providers and laboratory workers put at
risk - Disease progresses in the infected
-
105Natural vs. Intentional Epidemic
106Natural vs. Intentional Epidemic
- Many features in common.
- You dont need to
- DIAGNOSE TERRORISM.
-
-
-
-
107Natural vs. Intentional Epidemic
- Many features in common.
- You dont need to
- DIAGNOSE TERRORISM.
- You dont need to
- IDENTIFY A CAUSITIVE ORGANISM.
-
-
-
108Natural vs. Intentional Epidemic
- Many features in common.
- You dont need to
- DIAGNOSE TERRORISM.
- You dont need to
- IDENTIFY A CAUSITIVE ORGANISM.
- CRITICAL TO
- RECOGNIZE AND REPORT
- an OUTBREAK!
109-
- Even when we suspect something,
- we are often
- RELUCTANT to REPORT
- for fear of
- BEING WRONG
- and
- LOOKING FOOLISH.
-
110In the case of an outbreak, it is better to
REPORT SUSPICIONS and be wrong than to delay
reporting until youre sure!
111- Recognize and report POSSIBLE threats
- Public authorities will sort it out
112- A DHEC Epidemiology Team is on call around the
clock to investigate potential threats to public
health. - SC DHEC 24/7 Disease Reporting
- 888-847-0902
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114If precautions are observed, health
professionals can work safely in an environment
containing biological agents of terror.
115PERSONAL PROTECTIVEEQUIPMENT
- PROTECT
- Eyes
- Mucous membranes
- Respiratory tract
- Skin defects
116PERSONAL PROTECTIVEEQUIPMENT
- WEAR
- Protective Eyewear
- N 95 mask
- Gloves
- Gown or scrubs
117PERSONAL PROTECTIVEEQUIPMENT
- In other words
- HEPA filtered air
- through fit tested mask
- with splash protection.
118SPACE SUITSare for CHEMICALS,for
CONTAINMENT,andfor the Movies!
119DECONTAMINATION OF EXPOSED PERSONS
- Showering thoroughly with SOAP AND WATER is
adequate. - Use of bleach not necessary.
120DECONTAMINATION Environment and Equipment
- Five percent
- sodium hypochlorite solution
- for thirty minutes.
121SUMMARY
122An OUTBREAK of infectious disease ORIGINATING
ANYWHERE on the globe can become a PUBLIC
HEALTH CRISIS in YOUR home town.
123Whether the outbreak is of NATURAL ORIGIN or is
the result of DELIBERATE human action, the
CONSEQUENCES can be essentially THE SAME.
124- The SUCCESS of a community
- in a DISASTER depends upon
- strong RELATIONSHIPS
- between DISCIPLINES
- and across JURISDICTIONS.
125 Collaborative PLANNING, effective PROCESSES,
and repeated PRACTICE are keys to success.
126PRIMARY HEALTH PROVIDERS are well positioned to
DETECT an OUTBREAK of infectious disease. YOU
are our FIRST LINE OF DEFENSE.
127Report ANY SUSPICION of an infectious disease
OUTBREAK to public health authorities. THEY
will investigate. FEAR of making an unfounded
report can COST LIVES.
128FAITHFUL use of ROUTINE PRECAUTIONS offers
ADEQUATE PROTECTION against biological agents of
terror.
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130SC AHEC Terrorism 101
- The Bacteria
- The Viruses
- The Toxins
- Radiation
- Explosions/Blasts
- Chemical Agents
- Sounding the Alarm
- The Forensic Proces
- Psychosocial Issues
- Interdisciplinary Planning
- Pharmacological Issues
- Personal Protective Equipment
- Decontamination
- Agricultural Bioterrorism
131QUESTIONS?