This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Preparedness for Emerging Infectious Threats : Avoiding Outbreaks in Europe
MARSEILLE 19-21 march 2012
Laboratory accidents as source of outbreaks : impact on lab worker surveillance.
Dominique VIDAL Biodefense advisor Ministry of Defense
Part 1. Biosafety Principles Principal investigators and laboratory directors are
responsible for biosafety compliance in their institutions to avoid laboratory acquired infections and outbreaks development in the community and in the environment
Pathogenicity of microorganisms Classification of pathogens Group 1 : unlikely to cause human disease/Lactobacillus
acidophilus Group 2 : Can cause HD, Salmonella Group 3 : Can cause severe HD, risk of spreading to the
community, prophylaxis or treatment available/Yersinia pestis
Group 4 : Severe HD, serious hazard, risk of spreading, no prophylaxis nor treatment/Ebola virus
Fire, thermal burns, clothing fire Cold liquid frostbite Electric shock Gaseous leak Chemical spills or dispersion (acid, base burns) Poisoning (ingestion, inhalation) Liquid splashes to the eye Contamination to the body Aerosols, droplets Needlestick, syringe or sharps injury Animal bites Broken device BSlaboratory dysfunction : electric supply or air
treatment failure LabWorker fall down Medical emergency : collapse, heart failure,
Definition : LAI is an infection obtained through laboratory or laboratory-related activities as a result of work with infectious biological agents, which may be either symptomatic or asymptomatic
No systematic collection of data
Difficulty of precise evaluation ESCMID Online Lecture Library
Incidence of tuberculosis among laboratory workers : 3 to 9 times greater than in the general population
High infectivity of M. tuberculosis by aerosol exposure of clinical microbiologists
50 % infective dose : 10 bacilli Use of laminar-flow Biosafety cabinet in BSL3 Annual skin test (Mantoux) If positive test, chest radiography If accidental exposure worker should be tested 3 and 6
Bacterial LAI : Bacillus anthracis After 2001 outbreak of bioterrorism related anthrax
in the US Bacillus anthracis became a major source of concern in laboratories
Increased importance with biodefense emergence programs
In march 2002 a labworker was diagnosed with cutaneous anthrax One day after he had cut himself over the right jaw Handled without gloves vials of B. anthracis from
Biosafety cabinet to freezer Three days later he developed fever, cervical
lymhadenopathy and black eschar on neck Culture were positive with B. anthracis
The tops of the vials were tested positive for B. anthracis
Storage vials were sprayed with 70 % isopropyl unless 10 % bleach
Treated with intravenous doxycycline and ciprofloxacin ESCMID Online Lectu
The Bruce Ivins case and the anthrax attacks in the USA
Bruce Ivins : scientist working on anthrax vaccine, biodefense expert at USAMRIID
September 2001 : intentional release of anthrax in mail
FBI investigate : Ivins participate to the sample expertise 2002, a person of interest : Steven Hatfill march 2008, Steven Hatfill exonerated 5,8 M$ 2006 investigation against Ivins
July 2008 : Ivins kill himself FBI declared he was the sole culprit and he suffered
Fastidious Gram-negative coccobacillus, infrequently encountered in clinical laboratory
Incresed importance with biodefense emergence programs In 2002 12 labworkers were exposed after a suspected case of
pneumonic tularemia in a man who died Clinicians failed to notify the laboratory about the suspicion Culture were initially misidentified as Hemophilus Post-exposure prophylaxis with doxycycline was given : 100 mg
Y. pestis, the agent of plague, a class 3 pathogen A scientist at University of Chicago had been working with a
pigmentation-negative attenuated strain of Y. pestis (KIM D27) This strain is excluded from the National Select Agent Registry
Septicemic plague with KIM D27 strain On September 10 the researcher was evaluated at an outpatient clinic
for fever and cough On September 13 he was admitted to the Chicago hospital because of
worsening breath, fever and cough, and died 12 hours after presentation
On September 18 the clinical laboratory identified Y. pestis in blood cultures
30 co-workers and 64 other close contact were prescribed a 7-days course of doxycycline for prophylaxis
The 60-year old patient had insulin-dependant diabetes and hereditary hemochromatosis
Hemochromatosis is an iron-overload disease and patients are especially susceptible to infection. This disease and iron storage in multiple organs might have enhanced the virulence of the KIM D27 strain of Y. pestis.
Severe acute respiratory syndrome SARS is respiratory disease that infected over 8 000 people in 37 countries
from late 2003 through 2004, with high mortality rate of 9 to 14 %. Started in November 2002 in South of China (Guangdong). Highly contagious patients infected customers at Metropole Hotel in Hong
Kong in February 2003 and spead in their countries In March WHO trigger a “Global Alert”. On 21 of march 2003 the coronavirus responsible of SRAS was identified by
4 months after the end of SARS epidemic, a graduate student in Singapore working on a non-attenuated strain of West Nile virus, was evaluated for flu-like symptoms
The patient denied exposure to SARS and had no travel history
5 days later due to persistent fever and because Singapore remained in SARS alert, a PCR test was done and revealed to be positive
Epidemiologic investigation revealed that the laboratory worked on SARS and that a culture of West Nile virus was contaminated with the same strain of SARS coronavirus ESCMID Online Lectu
LAI Vaccinia virus infection in Virginia Vaccinia virus (VACV) is the live viral component of smallpox vaccine Severe complications can occur in person with underlying risk factors
On July 5, 2008 a 20-year man working in a laboratory went to a local urgent care clinic reporting swelling of cervical lymph nodes and pain and inflammation of his right earlobe
On July 7 : he return to emergency department with increasing eye pain ; he was treated with intravenous vancomycin/ceftriaxone
Investigation revealed that he worked on mice infected with VACV On July 10 he was administered 800 mg acyclovir then was improving and full
French Legislation : décret 2008-244 Code du travail, protection des travailleurs article R 4425 : formation et information
risques biologiques pour la santé procédures à suivre en cas d’accident gestes de secours déclaration
article R 4426-9 : surveillance médicale renforcée liste des travailleurs exposés à des agents biologiques des groupes 3 et 4 conservation au moins 10 ans du dossier médical individuel après la fin de
l’exposition (Burkholderia : 40 ans) article R 4624-19
dossier médical spécial information conservation de l’information
European Community Directive : 2000/54/CE/18 September 2000
Protection of workers from risks related to exposure to biological agents at work Article 9 Information and training of workers Article 10 Worker information in particular cases Article 11 List of exposed workers Article 14 Health surveillance
2000/54/CE/18 September 2000 Protection of workers from risks related to
exposure to biological agents at work Hygiene and individual protection
Workers do not eat or drink in working areas Workers are provided appropriate protective clothing and equipment Workers are provided appropriate washing and toilet facilities, including eye
washes and skin antiseptics Article 9 Information and training workers Article 10 Worker information in particular cases
Procedure in case of serious accident or incident Workers shall immediately report any accident or incident involving the
handling of biological agent to the person responsible for safety and health at work
Employers shall inform the workers of any accident or incident with biological agent
Article 11 List of exposed workers Workers exposed to class 3 or 4 biological agents List kept at least 10 years, up to 40 years
2000/54/CE/18 September 2000 Protection of workers from risks related to
exposure to biological agents at work
Article 14 Health surveillance
Done prior to exposure, and at regular interval there after When necessary effective vaccine When a worker is suffering from occupational infection, all co-workers shall
be offered medical surveillance if similarly exposed Medical reports kept for at least 10 years Information and advice must be given to workers regarding health
List of biological agents handled In the medical file of the worker Blood sample : renal, hepatic, inflammatory and hematologic functions Pulmonary radiography
Medical surveillance of lab-workers after an incident or accident
Technical incident : material failure, centrifuge, broken tube, air ventilation system failure… Medical examination Biological or medical surveillance Post exposure prophylaxis or treatment ? Declaration Investigation occupational physician
Accident : needlestick injury, spills or splash of biologic fluids, animal bite Immediate decontamination/disinfection, antiseptics, undressing, shower Medical examination , medical support, by referent infectious disease specialist Biological or medical surveillance Post exposure prophylaxis or treatment ? Declaration Investigation
Security surveillance of BSL3-BSL4 lab-workers : to be considered
New approaches Always working in pairs (two-person rule) Video-monitoring in BSL3 and BSL4 laboratories Inspections and controls :
strain collection stock and movements Compliance inspections
Security investigation and risk assessment (SRA) For biodefense laboratories working with Biological Select Agents & Toxins
(BSAT) and MOT (micro-organisms & toxins) Defense secret habilitation or Security clearance
at employment at 5-years frequency
Reliability of workers Personal Reliability Program : in discussion Judiciary history Psychiatric disorders, mentally impaired Personal conflicts (woks colleagues, institution, wife/husband) Behaviorial surveillance Credit difficulties Drug use
Biosafety committees Project evaluation (new virus construct, synthetic biology…) Dual-use publications (unexpected or controversial results)
A technician suffering obesity willing enter space suite A labworker suffering claustrophobia A technician suffering deep depression who attempted to kill herself with
toxic substances Laboratory Liquid splashes to the eye of a technician, the filtered liquid
supposed to be sterile was not and contained Burkholderia pseudomallei A scientist who inadvertently inoculated him with vaccinia virus A scientist who dissimulated that he injected him with live spore
suspension when handling mouse and treated himself with antibiotics A electric fire in autoclave with thick smoke and the BSL3 lab to evacuate
Thank you for attention ! ESCMID Online Lecture Library