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 Health 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
- 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
- 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 …………………………………………………………………….
- 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
- Frequently Asked Questions
- Technical Information
- CDC’s Roles in the Event of a Radiological Terrorist Event
- Lead Federal Agencies
- CDC’s Roles
- CDC’s Partners
- CDC’s Actions
- Radiation Exposure Registry
- Coping With a Traumatic Event–Information for the Public
- Coping With a Traumatic Event–Information for Health Professionals
- Burns
- Background Information
- Escape Information
- First Aid
- Types of Burns
- Brain Injuries and Mass Trauma Event–Information for the Public
- Brain Injuries and Mass Trauma Events–Information for Clinicians
- Brain Injury Facts
- Signs and Symptoms after an MTBI
- Diagnosis
- Treatment.
- Chemical Agents: Facts About Personal Cleaning and Disposal of Contaminated Clothing
- Introduction
- Section I: General Categorical Recommendations for Any Suspected Bioterrorism Event
- Reporting Requirements and Contact Information
- Potential Agents
- Detection of Outbreaks Caused by Agents of Bioterrorism
- Infection Control Practices for Patient Management
- Post-Exposure Management
- Laboratory Support and Confirmation
- Patient, Visitor, and Public Information
- Section II: Agent- Specific Recommendations
- Anthrax
- Botulism
- Plague
- Smallpox
26. Mass Casualty Disaster Plan Checklist: A Template for Healthcare Facilities
Learning Objectives
After completion of the course you’ll be able to:
Chapter 3: The Prospect of Domestic Bioterrorism
- Discuss the prospect of domestic terrorism and describe the motivational, technical and organizational factors that may help or hamper the perpetrators.
Chapter 5: Epidemiology of Bioterrorism
- Define indication of intentional release of biologic agent.
- Describe the precautions laboratory personnel should take when collecting or handling clinical specimens.
- Discuss the epidemiology of bioterrorism and differentiate between a natural outbreak an intentional attack.
- List 10 clues that together may constitute proof of intentional use of biological agent.
Chapter 7: Anthrax
- Describe the side effects of taking ciprofloxacin and doxycycline.
- Describe recommendations made by the CDC for worker safety under engineering controls, administrative controls, housekeeping controls, and personal protective equipment.
- Implement anthrax worker safety guidelines issued by the CDC.
- Describe the epidemiology of naturally occurring anthrax.
- Discuss the diagnosis of inhalational anthrax.
- Discuss the therapeutic options of anthrax infection.
- Discuss infection control and decontamination protocols for anthrax.
- Describe the procedure for handling suspicious packages or envelopes.
- Provide medication information to patients about ciprofloxacin, doxycycline, penicillin, and amoxicillin.
- Discuss clinical issues in the prophylaxis, diagnosis, and treatment of anthrax.
Chapter 8: Smallpox
- Describe various phases of the smallpox disease, symptoms, and degree of infectiousness.
- Answer questions about the smallpox disease and the vaccine.
- List the categories of people who should not get vaccine.
- List the steps that one should take after vaccination to minimize the risk of spreading vaccinia.
Chapter 9: Botulism
- Describe three main kinds of botulism and their mode of transmission.
- Answer frequently asked questions about botulism.
- List symptoms of botulism.
- Describe infant botulism, its epidemiology, source of C. botulinum, and prevention and control.
- Describe the clinical syndrome of botulism and provide a diagnosis of the disease.
- Put the use of botulinum toxin as a bioweapon in historical perspective.
- Describe the pathogenesis and clinical manifestations of botulism.
- List typical symptoms and signs of foodborne botulism.
- Identify features of an outbreak that would indicate a bioterrorist attack with botulinum toxin.
- Describe the therapy, prophylaxis and decontamination for botulinum toxin.
Chapter 10: Plague
- Answer frequently asked questions about pneumonic and bubonic plague, their signs and symptoms, and treatment.
- Describe the role fleas play in the spread of plague to humans.
- Explain the epidemiology of plague.
- Describe clinical manifestations of bubonic, septicemic, pneumonic, and pharyngeal plague.
- Discuss signs and symptoms and laboratory confirmation that can establish the diagnosis of plague.
- Describe the treatment for plague.
- Outline the strategies for the prevention of plague.
Chapter 11: Tularemia
- Answer frequently asked questions about tularemia.
- Describe the signs and symptoms of tularemia.
- Identify epidemiological indicators that would suggest a bioterrorism act of inhalational tularemia.
- Describe the pathogenesis and clinical manifestations of F. tularensis.
- Provide a diagnosis of inhalational tularemia following its use as a biological weapon.
- Describe the treatment of tularemia in adults and children.
- Make recommendations for post exposure antibiotic prophylactic treatment in the event of F. tularensis biological attack.
Chapter 12: Viral Hemorrhagic Fevers
- Answer frequently asked questions about the etiology and epidemiology of viral hemorrhagic fevers.
- Describe various ways of preventing and controlling viral hemorrhagic fevers.
- Describe the history and potential of HFVs as biological weapons.
- Describe the clinical manifestations of diseases caused by hemorrhagic fever viruses.
- Provide a diagnosis of viral hemorrhagic fevers and treatment options including drug therapy.
Chapter 13: Ricin
- Answer frequently asked questions about ricin, its signs and symptoms, and its potential for bioterrorism.
Chapter 14: Nerve Agents
- Answer frequently asked questions about nerve agents, GA, GB, GD and VX.
- Describe the signs and symptoms of nerve agents GA, GB, GD and VX, and their effects on health.
- List the things people can do to protect themselves against VX and things they should do if they are exposed to VX.
- Describe the health effects of nerve agents, GA, GB, GD, and VX.
- Describe the prehospital management of victims of nerve agent attack.
Chapter 15: Blister Agents
- Describe the health effects of sulfur mustard on various body systems.
- Describe prehospital management of victims exposed to sulfur mustard.
- List general principles of triage for chemical exposures.
- Describe triage for mustard agent casualties.
Chapter 16: Foodborne Illness
- Describe some of the most common foodborne diseases.
- Identify instances when a doctor should be consulted for a diarrheal illness.
- Describe how outbreaks of foodborne disease are detected and investigated.
- Describe the ways food can become contaminated.
- List foods that are most associated with foodborne illness.
- State five simple precautions one can take to reduce the risk of foodborne diseases.
- Identify persons who are at particularly high risk to contract a foodborne illness.
Chapter 17: Escherichia coli O157:H7
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- List various ways Escherichia coli O157:H7 is spread.
- Describe the illness caused by Escherichia coli O157:H7.
Chapter 18: Salmonellosis
- Answer frequently asked questions about salmonellosis, including how people can catch Salmonella, its health consequences and treatment.
- List eight things one can do to prevent salmonellosis.
Chapter 19: Cholera
- List six things a traveler can do to avoid getting cholera.
Chapter 20: Shigellosis
- 71. Answer frequently asked questions about shigellosis.
- List eight tips for preventing the spread of shigellosis.
Chapter 21: Brucellosis
- Answer frequently asked questions about brucellosis, such as how it is transmitted to humans, ways to prevent infection, and its treatment.
Chapter 22: Typhoid Fever
- Answer frequently asked questions about typhoid fever.
- List steps one can take to avoid typhoid fever.
Chapter 24: Injuries and Mass Trauma Events
- 76. Describe symptoms of posttraumatic stress disorder.
- Identify the kind of injuries that occur in mass trauma events.
- List the things health departments should do to prepare for and subsequent to mass trauma events.
- Identify various steps one should plan to escape from home, workplace or hotel.
- Describe 3 types of burns, their symptoms and early treatment.
- List signs and symptoms after a mild traumatic brain injury (MTBI).
- Describe the procedure for personal cleaning and disposal of contaminated clothing.
- Describe the evacuation procedure in the event of a chemical accident or attack.
- Describe how to prepare to shelter in place in case of a chemical accident or attack.
- Allay general public’s concerns about the safety of drinking water.
- Describe emergency room procedures in chemical hazard emergencies.
Chapter 25: Bioterrorism Readiness Plan: A Template for Healthcare Facilities
- Develop and implement a bioterrorism readiness plan appropriate for a particular healthcare facility.
- Identify 6 features that should alert healthcare providers to the possibility of a bioterrorism-related outbreak.
- Describe clinical features of anthrax infection, infection control practices for patient management, and post-exposure management.
- Describe clinical features of botulism infection, infection control practices for patient management and post-exposure management.
- 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.