Bioterrorism and the GP

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Bioterrorism and the GP

• Rob Jarvis
• Jan 03

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Contents

• Deliberate release
• Role of the GP

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Deliberate release

• Infections

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Deliberate release

• Infections
• Chemicals

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Deliberate release

• Infections
• Chemicals
• Radiological material

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Deliberate release

• Infections
• Chemicals
• Radiological material
• Information

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Outbreaks and incidents

• Incidents of unusual illnesses
• Unknown aetiology
• Not usual to UK
• Not behaving
• Outbreaks
• Number of cases observed greater than expected
• Two cases linked (epidemiology, microbiology)

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Causes of outbreaks and incidents of unusual
illnesses

• Natural
• Accidental
• Deliberate
• Overt
• Covert

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Features suggestive of deliberate release

• A warning
• Deliberate release elsewhere
• Uncommon agent
• Affecting key sector of community
• Simultaneous outbreaks in non-contiguous areas
• Unusual/atypical/antiquated strain

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Deliberate causes - biological

• Anthrax
• Influenza
• Melioidosis
• Plague
• Smallpox
• Botulinum toxin
• Tularaemia
• Viral haemorrhagic fevers

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Viral haemorrhagic fevers

• Ebola
• Marburg
• Congo-Crimean
• Hazard group 4
• Severe human disease, likely to spread through a
  community, usually no effective prophylaxis or
  treatment.

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Deliberate release - chemical

• Mustard
• Chlorine
• Hydrogen cyanide
• Phosgene
• Nerve agents
• Sarin, ricin, tabun, soman, GF, VX.

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Classification of incidents/outbreaks

• Category 1 ACUTE
• Minutes/hours
• Clusters
• Common exposure
• Detected by emergency services or public
• Category 2 DELAYED
• Hours/days/weeks
• ?clusters or common exposure
• Detected by healthcare/ public or routine
  surveillance

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How are GPs involved?

• Exposed and ill
• Exposed but not ill
• Worried well
• Prophylaxis

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What to do if you suspect unusual incident or
outbreak?

• History time, person, place.
• Ensure safety of self and others
• Call for advice
• Public Health consultant on-call
• SCIEH
• CDSC
• Poisons unit Edinburgh or Guys
• CIRS

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Management guided by advice

• Sent home with advice
• Sent home with prophylaxis
• Admitted
• Determine level of risk and decontamination and
  inform ambulance control
• Determine which hospital and call them

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Management (2)

• Do NO invasive investigations
• Determine decontamination, prophylaxis and advice
  for self, staff and contacts
• List all exposed name, identifiers, GP, level
  of exposure
• Keep very accurate records
• Do NOT talk to the press

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And finally..