Course Outline
1. Bioterrorism as a Public Health Threat
- Why Concern Now?
- Vulnerability to Biological Attack
- Perpetrator Capability
- Intention to Use Biological Weapons
- Nonintentional Pathogen Releases
- Conclusions
- Technical Factors
- Organizational Factors
- The Likeliest Perpetrators
- Conclusions
Bioterrorism: How Prepared Are We?
- Differential Diagnosis
- Epidemiologic Approach
- Recommendations for Preparedness
- Health-Care Providers
- Clinical Case
- Clinical Questions
- Clinical Laboratory Personnel
- Infection-Control Professionals
- State Health Departments
- References
Questions and Answers About Anthrax
- Transmission
- Symptoms
- Testing
- Diagnosis
- Preventive/Vaccine
- Treatment
- Pregnancy
- Risk
- Anthrax and Influenza
- Safety Issues/Mail
- Worker Safety
- Reporting
Anthrax as a Biological Weapon
- Introduction
- History of Current Threat
- Epidemiology
- Microbiology
- Pathogenesis and Clinical Manifestations
- Diagnosis
- Vaccination
- Therapy
- Infection Control
- Decontamination
Update: Investigation of Bioterrorism-Related Anthrax and Interim Guidelines for Exposure Management and Antimicrobial Therapy, October 2001
- Susceptibility Testing of B. anthracis Isolates
- Managing Threats
- Managing Exposures
- Antimicrobial Treatment
Children and Anthrax: A Fact Sheet for Clinicians
- Drug Recommendations For Pediatric Anthrax Cases
Anthrax Technical Information
Fact Sheet: Anthrax Information for Helath Care Providers
Drug Therapy
- Patient Information: Ciprofloxacin 500 MG Oral Tablet
- Patient Information: Doxycycline 100 MG Oral Tablet
- Patient Information: Penicillin VK 500 MG Oral Tablet
- Patient Information: Amoxicillin 250 MG – Oral Capsules Or Amoxicillin 250 MG/5 ML– Oral Suspension
Clinical Issues in the Prophylaxis, Diagnosis, and Treatment of Anthrax
- Prophylaxis (1)
- Clinical Recognition and Diagnosis (2)
- Treatment (3)
Additional Options for Preventive Treatment For Those Exposed to Inhalational Anthrax
- Background
- Options
Smallpox Overview
- The Disease
- Where Smallpox Comes From
- Transmission
Smallpox Disease
- Rash distribution
Smallpox Questions and Answers: The Disease and the Vaccine
- In General
- The Disease
- The Vaccine
- Vaccinia
- After Vaccination: What You Should Know
- Vaccine Safety
Facts About Botulism
Botulism–Technical Information
Frequently Asked Questions
Botulism in the United States
- Introduction
- Foodborne Botulism
- Infant Botulism
- Wound Botulism
- Child or Adult Botulism From Intestinal Colonization
- Clinical Syndrome
- Diagnosis
- Treatment
- Public Health Response
Botulinum Toxin as a Biological Weapon–Medical and Public Health Management
- Introduction
- History of Current Threat
- Microbiology and Virulence Factors
- Pathogenesis and Clinical Manifestations
- Epidemiology
- Diagnosis and Differential Diagnosis
- Table 3. Selected Mimics and Misdiagnoses of Botulism
- Therapy
- Prophylaxis
- Decontamination
- Infection Control
- Research Needs
Facts About Plague
Frequently Asked Questions (FAQ) About Plague
Introduction
History
- The First Pandemic
- The Black Death (The Second Pandemic)
- The Third Pandemic
Plague as a Biological Warfare Agent
Epidemiology
- Exhibit 1: Mammals Known to Harbor Plague in the United States.
Clinical Manifestations
Diagnosis
Treatment
Prevention
Summary
- Working Group Recommendation for Treatment of Patients With
- Pneumonic Plague in the Contained and
- Mass Casualty Settings and for Post-exposure Prophylaxis*
Facts About Tularemia
Frequently Asked Questions (FAQ) About Tularemia
Tularemia as a Biological Weapon–Medical and Public Health Management
Introduction
History and Potential Biological Weapon
Epidemiology
- Table 1. Diagnosis of Inhalational Tularemia Following Use of a Biological Weapon
Microbiology and Virulence Factors
Pathogenesis and Clinical Manifestations
Diagnosis
Vaccination
- Treatment
Post-Exposure Antibiotic Recommendations
- Table 2. Working Group Consensus Recommendations for Treatment of Patients With Tularemia in a Contained Casualty Setting*
- Table 3. Working Group Consensus Recommendations for Treatment of Patients With Tularemia in a Mass Casulaty Setting and for Postexposure Prophylaxis*
Infection Control
Environmental Decontamination and Protection
Management of Patients with Suspected Viral Hemorrhagic Fever
- Background
- Recommendations
Hemorrhagic Fever Viruses as Biological Weapons
- Introduction
- Table 1. Hemorrhagic Fever Viruses*
- Consensus Methods
- History and Potential as Biological Weapons
- Epidemiology of Disease Transmission
- Microbiology and Pathogenesis
- Clinical Manifestations
- Table 3. Clinical Characteristics of Hemorrhagic Fever Viruses Noted in Past Case Outbreaks
- Vaccine
- Infection Control
- Box 2. Recommendations for Protective Measures Against Nosocomial Transmission of Hemorrhagic Fever Viruses
Frequently Asked Questions (FAQs) About Ricin
Biotoxin Ricin
ToxFAQs™ for Nerve Agents (GA, GB, GD, VX)
Facts About VX
Technical Information About Nerve Agents
Nerve Agent VX
Blister Agents
- Table 1. Physical Properties of Sulfur Mustards
Health Effects
- Table 2. Clinical Effects and Time of Onset by Severity of Exposure to Sulfur Mustard
Prehospital Management
- Table 3. Triage for Mustard Agent Casualties
Emergency Department Management
General Medical Management
Blister Agents Sulfur Mustard (H, HD, and HT)–Patient Information Sheet
Blister Agent
Health Effects
Prehospital Management
- Table 2. Triage for Nerve Agent Casualties
- Table 3. Recommendations for Nerve Agent Therapy Antidotes1–Prehospital Management
Emergency Department Management
- Table 4. Recommendations for Nerve Agent Therapy–Emergency Department Management Nerve Agents Patient Information Sheet
- Follow-up Instructions
Frequently Asked Consumer Questions About Food Safety and Terrorism
Frequently Asked Questions
Technical Information
Frequently Asked Questions
Technical Information
Frequently Asked Questions
Technical Information
Frequently Asked Questions
Technical Information
Frequently Asked Questions
Technical Information
Learning Objectives
After completion of the course you’ll be able to:
- Discuss the prospect of domestic terrorism and describe the motivational, technical and organizational factors that may help or hamper the perpetrators.
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Define indication of intentional release of biologic agent.
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Describe the precautions laboratory personnel should take when collecting or handling clinical specimens.
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Discuss the epidemiology of bioterrorism and differentiate between a natural outbreak an intentional attack.
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List 10 clues that together may constitute proof of intentional use of biological agent.
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Describe the side effects of taking ciprofloxacin and doxycycline.
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Describe recommendations made by the CDC for worker safety under engineering controls, administrative controls, housekeeping controls, and personal protective equipment.
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Implement anthrax worker safety guidelines issued by the CDC.
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Describe the epidemiology of naturally occurring anthrax.
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Discuss the diagnosis of inhalational anthrax.
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Discuss the therapeutic options of anthrax infection.
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Discuss infection control and decontamination protocols for anthrax.
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Describe the procedure for handling suspicious packages or envelopes.
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Provide medication information to patients about ciprofloxacin, doxycycline, penicillin, and amoxicillin.
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Discuss clinical issues in the prophylaxis, diagnosis, and treatment of anthrax.
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Describe various phases of the smallpox disease, symptoms, and degree of infectiousness.
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Answer questions about the smallpox disease and the vaccine.
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List the categories of people who should not get vaccine.
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List the steps that one should take after vaccination to minimize the risk of spreading vaccinia.
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Describe three main kinds of botulism and their mode of transmission.
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Answer frequently asked questions about botulism.
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List symptoms of botulism.
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Describe infant botulism, its epidemiology, source of C. botulinum, and prevention and control.
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Describe the clinical syndrome of botulism and provide a diagnosis of the disease.
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Put the use of botulinum toxin as a bioweapon in historical perspective.
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Describe the pathogenesis and clinical manifestations of botulism.
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List typical symptoms and signs of foodborne botulism.
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Identify features of an outbreak that would indicate a bioterrorist attack with botulinum toxin.
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Describe the therapy, prophylaxis and decontamination for botulinum toxin.
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Answer frequently asked questions about pneumonic and bubonic plague, their signs and symptoms, and treatment.
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Describe the role fleas play in the spread of plague to humans.
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Explain the epidemiology of plague.
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Describe clinical manifestations of bubonic, septicemic, pneumonic, and pharyngeal plague.
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Discuss signs and symptoms and laboratory confirmation that can establish the diagnosis of plague.
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Describe the treatment for plague.
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Outline the strategies for the prevention of plague.
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Answer frequently asked questions about tularemia.
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Describe the signs and symptoms of tularemia.
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Identify epidemiological indicators that would suggest a bioterrorism act of inhalational tularemia.
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Describe the pathogenesis and clinical manifestations of F. tularensis.
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Provide a diagnosis of inhalational tularemia following its use as a biological weapon.
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Describe the treatment of tularemia in adults and children.
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Make recommendations for post exposure antibiotic prophylactic treatment in the event of F. tularensis biological attack.
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Answer frequently asked questions about the etiology and epidemiology of viral hemorrhagic fevers.
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Describe various ways of preventing and controlling viral hemorrhagic fevers.
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Describe the history and potential of HFVs as biological weapons.
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Describe the clinical manifestations of diseases caused by hemorrhagic fever viruses.
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Provide a diagnosis of viral hemorrhagic fevers and treatment options including drug therapy.
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Answer frequently asked questions about ricin, its signs and symptoms, and its potential for bioterrorism.
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Answer frequently asked questions about nerve agents, GA, GB, GD and VX.
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Describe the signs and symptoms of nerve agents GA, GB, GD and VX, and their effects on health.
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List the things people can do to protect themselves against VX and things they should do if they are exposed to VX.
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Describe the health effects of nerve agents, GA, GB, GD, and VX.
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Describe the prehospital management of victims of nerve agent attack.
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Describe the health effects of sulfur mustard on various body systems.
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Describe prehospital management of victims exposed to sulfur mustard.
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List general principles of triage for chemical exposures.
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Describe triage for mustard agent casualties.
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Describe some of the most common foodborne diseases.
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Identify instances when a doctor should be consulted for a diarrheal illness.
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Describe how outbreaks of foodborne disease are detected and investigated.
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Describe the ways food can become contaminated.
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List foods that are most associated with foodborne illness.
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State five simple precautions one can take to reduce the risk of foodborne diseases.
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Identify persons who are at particularly high risk to contract a foodborne illness.
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List various ways Escherichia coli O157:H7 is spread.
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Describe the illness caused by Escherichia coli O157:H7.
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Answer frequently asked questions about salmonellosis, including how people can catch Salmonella, its health consequences and treatment.
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List eight things one can do to prevent salmonellosis.
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List six things a traveler can do to avoid getting cholera.
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Answer frequently asked questions about shigellosis.
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List eight tips for preventing the spread of shigellosis.
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Answer frequently asked questions about brucellosis, such as how it is transmitted to humans, ways to prevent infection, and its treatment.
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Answer frequently asked questions about typhoid fever.
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List steps one can take to avoid typhoid fever.
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Describe symptoms of posttraumatic stress disorder.
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Identify the kind of injuries that occur in mass trauma events.
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List the things health departments should do to prepare for and subsequent to mass trauma events.
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Identify various steps one should plan to escape from home, workplace or hotel.
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Describe 3 types of burns, their symptoms and early treatment.
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List signs and symptoms after a mild traumatic brain injury (MTBI).
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Describe the procedure for personal cleaning and disposal of contaminated clothing.
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Describe the evacuation procedure in the event of a chemical accident or attack.
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Describe how to prepare to shelter in place in case of a chemical accident or attack.
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Allay general public’s concerns about the safety of drinking water.
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Describe emergency room procedures in chemical hazard emergencies.
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Develop and implement a bioterrorism readiness plan appropriate for a particular healthcare facility.
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Identify 6 features that should alert healthcare providers to the possibility of a bioterrorism-related outbreak.
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Describe clinical features of anthrax infection, infection control practices for patient management, and post-exposure management.
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Describe clinical features of botulism infection, infection control practices for patient management and post-exposure management.
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Describe clinical features of pneumonic plague, infection control practices for patient management, and post-exposure management.
To assess the effectiveness of the course material, we ask that you evaluate your achievement of each learning objective on a scale of A to D (A=excellent, B=good, C=fair, D=unsatisfactory). Please indicate your responses next to each learning objective and return it to us with your completed exam.