Bioterrorism Agents: PlagueBioterrorism Agents: Plague

Lesson 1Lesson 1

Introduction and OverviewIntroduction and Overview

ObjectivesObjectives

• Identify plague bacteriumIdentify plague bacterium

• EpidemiologyEpidemiology

• Natural OccurrenceNatural Occurrence

Bio-Terror ThreatBio-Terror Threat

• Plague can cause large numbers of Plague can cause large numbers of casescases

• Could create panicCould create panic

• Considered for use since 14Considered for use since 14thth century century

Clinical SyndromesClinical Syndromes

• BubonicBubonic

• PneumonicPneumonic

• SepticemicSepticemic

• Plague MeningitisPlague Meningitis

• PharyngealPharyngeal

““Safety Pin” Y. Pestis in bloodSafety Pin” Y. Pestis in blood

Bubonic PlagueBubonic Plague

• Infected flea biteInfected flea bite

• Exposure through Exposure through break in skinbreak in skin

• No person-to-personNo person-to-person

• Untreated progresses Untreated progresses to pneumonicto pneumonic

Pneumonic PlaguePneumonic Plague

• Inhalation of plague Inhalation of plague bacteriabacteria

• Disease progressionDisease progression– Respiratory failureRespiratory failure– ShockShock– Rapid deathRapid death

• Person-to-person Person-to-person transmissiontransmission

Septicemic PlagueSepticemic Plague

• Primary FormPrimary Form– Direct inoculation in bloodstreamDirect inoculation in bloodstream

• Secondary FormSecondary Form– Development of untreated pneumonic or Development of untreated pneumonic or

bubonic plaguebubonic plague

EpidemiologyEpidemiologyNatural ReservoirsNatural Reservoirs

• Bites of infected fleaBites of infected flea

• Most common – Oropsylla montanaMost common – Oropsylla montana

• Blood meal from bacteremic animalBlood meal from bacteremic animal

• Regurgitates into human/ animal hostRegurgitates into human/ animal host

• Common reservoirsCommon reservoirs– Deer miceDeer mice– Ground squirrelsGround squirrels

EpidemiologyEpidemiologyTransmissionTransmission

• Bite of infected fleaBite of infected flea• Respiratory dropletsRespiratory droplets• Direct contact (6 Direct contact (6

feet)feet)• Direct skin/mucous Direct skin/mucous

membrane less membrane less commoncommon

• BT event – BT event – Respiratory droplets Respiratory droplets or aerosolsor aerosols

Plague IncidencePlague IncidenceUnited States,1970-2003United States,1970-2003

• Endemic to USEndemic to US• Bubonic Most CommonBubonic Most Common

– 83% Bubonic83% Bubonic– 2% Primary Pneumonic2% Primary Pneumonic– 15% Septicemic15% Septicemic

• 5 to 15 cases per year5 to 15 cases per year• Greatest ConcentrationsGreatest Concentrations

– Arizona, Colorado, New Arizona, Colorado, New Mexico, UtahMexico, Utah

Plague Case Fatality RatesPlague Case Fatality RatesUnited States, 1970 - 1977United States, 1970 - 1977

• In US, 14% diedIn US, 14% died

• Untreated – 50 to Untreated – 50 to 90%90%

• Treated – 15%Treated – 15%

• Deaths mostly from Deaths mostly from delays in diagnosis delays in diagnosis and treatmentand treatment

Plague IncidencePlague IncidenceWorldwide, 1970 - 1998Worldwide, 1970 - 1998

• All inhabited continents, but AustraliaAll inhabited continents, but Australia

• 1,500 to 3,000 cases annually1,500 to 3,000 cases annually

• Greatest ConcentrationsGreatest Concentrations– Asia, South AmericaAsia, South America

Plague Bioterrorism ScenarioPlague Bioterrorism Scenario

• Most dangerous as Most dangerous as aerosolaerosol

• Outbreak of Outbreak of pneumonicpneumonic

• Possibly pharyngeal Possibly pharyngeal or ocularor ocular

• Report all suspect Report all suspect cases to public cases to public health immediatelyhealth immediately

Review Questions – PlagueReview Questions – PlagueLesson 1Lesson 1

OverviewOverview

Plague Review QuestionsPlague Review QuestionsLesson 1, Question 1Lesson 1, Question 1

• Santa Fe, New Mexico hospitalSanta Fe, New Mexico hospital

• Treating suspect plague caseTreating suspect plague case

• Hearing of more cases in areaHearing of more cases in area

When do you start to worry about When do you start to worry about bioterrorism?bioterrorism?

When do you start worrying about When do you start worrying about bioterrorism?bioterrorism?

A.A. Unrelated clustersUnrelated clusters

B.B. Unusual rise in casesUnusual rise in cases

C.C. Both of the aboveBoth of the above

D.D. None of the aboveNone of the above

Plague Review QuestionsPlague Review QuestionsLesson 1, Question 1Lesson 1, Question 1

When do you start worrying about When do you start worrying about bioterrorism?bioterrorism?

Answer - C. Both of the aboveAnswer - C. Both of the above

• Unrelated clustersUnrelated clusters

• Unusual rise in casesUnusual rise in cases

Plague Review QuestionsPlague Review QuestionsLesson 1, Question 1Lesson 1, Question 1

• Abnormally large, tender lymph nodeAbnormally large, tender lymph node

• Right armRight arm

• Lab specimen for preliminary testingLab specimen for preliminary testing

What organism causes plague?What organism causes plague?

Plague Review QuestionsPlague Review QuestionsLesson 1, Question 2Lesson 1, Question 2

What organism causes plague?What organism causes plague?

• B. anthracisB. anthracis

• C. botulinumC. botulinum

• C. burnetiiC. burnetii

• Y. pestisY. pestis

Plague Review QuestionsPlague Review QuestionsLesson 1, Question 2Lesson 1, Question 2

What organism causes plague?What organism causes plague?

D. D. Y. pestisY. pestis

Plague Review QuestionsPlague Review QuestionsLesson 1, Question 2Lesson 1, Question 2

• New Hampshire hospitalNew Hampshire hospital

• Labs – Unable to rule out plagueLabs – Unable to rule out plague

• Recent US travelRecent US travel

Where in the US would you expect the Where in the US would you expect the patient to get plague?patient to get plague?

Plague Review QuestionsPlague Review QuestionsLesson 1, Question 3Lesson 1, Question 3

Where in the US would you expect the Where in the US would you expect the patient to get plague?patient to get plague?

A.A. Western US, SouthwestWestern US, Southwest

B.B. Eastern US, SoutheastEastern US, Southeast

C.C. Northern US, NortheastNorthern US, Northeast

D.D. Southern US, SouthwestSouthern US, Southwest

Plague Review QuestionsPlague Review QuestionsLesson 1, Question 3Lesson 1, Question 3

Plague Review QuestionsPlague Review QuestionsLesson 1, Question 3Lesson 1, Question 3

Where in the US would you expect the Where in the US would you expect the patient to get plague?patient to get plague?

A. Western US, SouthwestA. Western US, Southwest