Safety: Bioterrorism Response · Best Practices for safe mail handling •Screen all incoming mail •Do not open mail in unauthorized locations •Establish procedures for screening

Safety: Bioterrorism Response

2019 Risk and Safety Conference

Janet Pichette, Chief Epidemiologist

Austin Public Health

https://www.cdc.gov/measles/parent-infographic.html

Agenda

• Public Health Emergencies and Bioterrorism

• Bioterrorism Agents

• Safety Procedures Bioterrorism Threats

• Newly Emerging Infectious Diseases

• Basic Infectious Control Practices in the Workplace

What is a public health emergency?

An event that creates a health risk to the public

•Natural

•Manmade

Natural Disasters•Hurricanes

•Floods

•Tornadoes

•Earthquakes

•Wildfires

•Extreme weather

Manmade

•Chemical

•Biological

•Radiological

•Nuclear

•Explosive

What is bioterrorism?

• Deliberate or threatened use of a bacteria, viruses, and toxins to cause disease, death or fear.

• Directed at livestock, food supply, and environmental resources.

• Spectrum ranges from classic biologic agents to hoaxes.

• Attacks can be covert or announced and can be caused by virtually any pathogenic organism.

Domestic Bioterrorism• 1984, Dalles and Wasco County,

Oregon

• Rajaneeshee cult

• Goal: Tried to incapacitate voters to win a local election and seize control political control of the county.

• Agent: Salmonella Typhimurium

• Vehicle: Local salad bars in the community

• ~750 people ill

Domestic Bioterrorism

• Fall 2001• Target: ABC, CBS,

National Enquirer, Senator Tom Daschle

• Cross-contamination of Hart Senate Building, 23 postal facilities

• Resulted in 5 deaths

Domestic Bioterrorism

• May 2013

• Shannon Guess Richardson

• Actress living in New Boston, TX

• Target: President Obama

• Goal: Tried to frame her estranged husband

• Agent: Ricin/castor beans

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Domestic Bioterrorism

• October 2018• William Clyde Allen III

• Navy Veteran

• Target: • President Trump

• Secretary of Defense James Mattis

• Senator Ted Cruz

• Agent: Ricin/castor beans

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So what is a bioterrorism agent?

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CDC Category A Bioterrorism Agents

• Easily disseminated or transmitted from person to person

• Result in high mortality rates and have the potential for major public health impact

• Potential to cause public panic and social disruption

• Require special action for public health preparedness

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CDC Category A Bioterrorism Agents

• Anthrax (Bacillus anthracis)

• Botulism (Clostridium botulinum toxin)

• Plague (Yersinia pestis)

• Smallpox (variola major)

• Tularemia (Francisella tularensis)

• Viral hemorrhagic fevers

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Category A Agent: Anthrax

• Types of Anthrax: • Cutaneous

• Inhalational

• Gastrointestinal

• Injection

• Infection usually develops 1 -7 days after exposure; can take up to 2 months in inhalational anthrax

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Anthrax: SymptomsCutaneous• Small blisters

• Painless skin sore with black center

• Most often the sore will be on the face, neck, arms, or hands

• Swelling around sore

Inhalational• Fever and chills

• Chest Discomfort

• Shortness of breath

• Confusion or dizziness

• Cough

• Nausea, vomiting, or stomach pains

• Headache

• Sweats (often drenching)

• Extreme tiredness

• Body aches

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CDC Category B Bioterrorism Agents

• Moderately easy to disseminate;

• Result in moderate morbidity rates and low mortality rates; and

• Require specific enhancements of CDC's diagnostic capacity and enhanced disease surveillance.

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CDC Category B Bioterrorism Agents• Brucellosis (Brucella species)

• Epsilon toxin of Clostridium perfringens

• Food safety threats (Salmonella species, Escherichia coliO157:H7, Shigella)

• Glanders (Burkholderia mallei)

• Melioidosis (Burkholderia pseudomallei)

• Psittacosis (Chlamydia psittaci)

• Q fever (Coxiella burnetii)

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• Ricin toxin from Ricinus communis(castor beans)

• Staphylococcal enterotoxin B

• Typhus fever (Rickettsia prowazekii)

• Viral encephalitis

• Water safety threats (Vibrio cholerae, Cryptosporidium parvum)

Category B Agent: Ricin

• Ricin is a poison found naturally in castor beans. If castor beans are chewed and swallowed, the released ricin can cause injury.

• It can be in the form of a powder, a mist, or a pellet, or it can be dissolved in water or weak acid.

• Adverse effects of ricin poisoning depend on whether ricin was inhaled, ingested, or injected.

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Ricin: SymptomsInhalation• Symptoms occur as early as 4-8 hours

and as late as 24 hours

• Respiratory distress

• Fever

• Cough

• Nausea and Vomiting

• Tightness in chest

• Heavy sweating

• Pulmonary edema

Ingestion• Initial Symptoms occur in less than 10

hours

• Vomiting

• Diarrhea that can become bloody

• Severe dehydration

• Seizure

• Blood in urine

• Liver, kidney and spleen failure within several days

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Ricin: Symptoms

Skin and Eye Exposure• Absorbed through the skin

• Causes redness and pain in eyes

• Incidental ingestion through hand to mouth contact

Death• Death can occur 36 to 72 hours after exposure

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Do your facilities have procedures for safe mail

handling?

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Risk Assessment of mail handling operations

• Threat

• Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE)

• Vulnerabilities

• Mail room (physical space)

• Mail room operations

• Jobs, tasks, personnel

• Consequences of an incident involving mail room

• Disruption of all services?

• Clients?

• Financial impact

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Best Practices for safe mail handling

• Security/access restriction

• Detailed log of visitors

• Surveillance

• Develop a emergency plan

• Train Workers to recognize and handle suspicious pieces of mail

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Best Practices for safe mail handling

• Screen all incoming mail

• Do not open mail in unauthorized locations

• Establish procedures for screening and isolating suspicious mail, and notifying emergency personnel

• Conduct routine training

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Initial Alert Procedures• Remain calm.

• Alert others in the immediate area that you have identified a suspicious item.

• Do not clean up the powder or attempt to move the suspicious item

• Do not sniff, touch, or taste any contents that may have spilled.

• Do not open the letter or package.

• Do not shake or empty the contents of a suspicious letter or package.

• Do not carry the letter or package or allow others to examine it.

• Notify your building security and supervisor

• Call 911 - Report incident to law enforcement and fire

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Initial Response Procedures

• Leave room and close the door and prevent other from entering

• Shut off any portable fans.

• Obtain a list of everyone in the room and those who handled the letter, and provide to public health and law enforcement

• If possible photograph the suspicious letter

• Emergency responders will help decontaminate those who came in contact with the materials

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Post event

• Conduct a after action review of the event

• Revise plans and procedures accordingly

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Infectious Disease

• Newly Emerging• Zika

• Middle Eastern Respiratory Syndrome (MERS)

• Ebola

• Chikungunya

• Re-emerging disease• Resurgence of endemic disease

(developing countries)

• Microbial resistant strains

• Pandemic influenza

Globalization and infectious disease Factors influence infectious disease:

Technology/economic dependence

• International travel

• Global nature of food handling, processing and sales

Economic competition – reduction of government expenditures (public health programs)

Globalization of disease control -> overpopulation • Overcrowding

• Lack of sanitation

• Stress on the public health care systems

Fidler, D. P. (1996). Globalization, International Law, and Emerging Infectious Diseases. Emerging Infectious Diseases,2(2), 77-84. https://dx.doi.org/10.3201/eid0202.960201.

Conduct a Risk Assessment

• Understand disease transmission• Direct contact

• Airborne

• Vehicle-borne

• Vector-borne

• Assess facility from an exposure standpoint

• Assess sick leave, attendance and alternative work policies

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Recommended Precautions For EmployersPrior to an event:

• Maintain situational awareness about diseases in the community and travel advisories

• Plan for disease outbreak (PPE, telework alternatives, and personnel requirements for essential functions)

• Encourage and support vaccinations

• Educate employees and executives (hand washing, PPE, infectious period)

• Know your organization’s role, if any, in community response plans

During an event:

• Closely monitor health department advisories

• Implement environmental non-pharmaceutical interventions by routinely conducting surface cleaning that helps to eliminate disease spread from frequently touched work surfaces and objects, such as desks, computers, and doors.

• Respond in a timely manner to official advisories regarding business closures

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Disease Prevention Strategies• Get Immunized

• Stay home if you are sick

• Avoid touching your face - your mouth, nose, and eyes

• Wash your hands frequently

• Avoid others who are sick

• Cough or sneeze into your sleeve or into a tissue

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[email protected]

512-972-5486