Bioterrorismo: gli agenti Prof. Pasquale Urbano 7 aprile 2011

Categoria A: Massima priorità Facili a disseminare e a propagarsi Molto letali Capaci di sconvolgere la società Richiedono una preparazione specifica per essere fronteggiati The CDC classifies bioterrorist agents into 3 categories: A, B and C based on the combined factors of availability of the agent, potential for morbidity and mortality, and ease of dissemination. Category A agents are believed to have the greatest potential for use as a biological weapon. Category A agents meet the following criteria: Easily disseminated or transmitted: refers to agents that can either be aerosolized or spread through secondary contact. High mortality: results in casualties well above what would occur from endemic levels of the disease with the likelihood of creating an outbreak. Social disruption: would result from the public’s reaction to news of a bioterrorist attack and the possible lack of adequate resources by local response teams. Special Preparation: by the health care community is required to prepare for a bioterrorist attack of this level because category A agent response may require stockpiling of antibiotics, isolation rooms, extensive tracking and monitoring systems. Although virtually any micro-organism has the potential to be used as a biological weapon, most would be difficult to weaponize and disseminate effectively. Article References: Lillibridge SR, Bell AJ, Roman RS. Centers for Disease Control and Prevention bioterrorism preparedness and response. Am J Infect Control 1999;27:463-4. Centers for Disease Control and Prevention, MMWR 2000;49(RR-4) or http://www.bt.cdc.gov/

Agenti di Categoria A Carbonchio Botulismo Peste Vaiolo Tularemia Febbri emorragiche virali

Agenti di Categoria B Abbastanza facili da disseminare Provocano morbosità moderata e bassa letalità Richiedono misure specifiche per migliorare le possibilità diagnostiche e il sistema di sorveglianza e controllo

Agenti di Categoria B Coxiella burneti (Febbre Q) Brucella species (brucellosi)   Burkholderia mallei (morva)  e B. pseudomallei [melioidosi] Enterotossina B stafilococcica Ricino tossina da Ricinus communis Tossina epsilon di Clostridium perfringens Melioidosis is a bioterrorism category B disease, and _B. pseudomallei_ is a soil/water organism found primarily in Southeast Asia and northern Australia. Severe pneumonia with sepsis syndrome is the most common cause of death with this infection and usually occurs in the compromised host, particularly the diabetic. No information is given regarding co-morbidities that may have existed in the boy.

Agenti di Categoria C Facilmente disponibili Facili a produrre e a disseminare Potenziali cause di alte morbosità e mortalità, con forte impatto sui sistemi sanitari

Agenti di Categoria C Nipah virus Hantavirus [v. nota – Germania] Virus da zecca delle febbri emorragiche o delle encefaliti Virus della Febbre gialla M.tbc multi-resistente [E. Tortoli] Date: Fri, 26 Feb 2010 15:18:55 -0500 (EST) From: ProMED-mail <promed@promed.isid.harvard.edu> Subject: PRO/AH/EDR> Hantavirus update 2010 - Europe: Germany (BW)   HANTAVIRUS UPDATE 2010 - EUROPE: GERMANY (BADEN-WUERTTEMBERG) ************************************************************ A ProMED-mail post <http://www.promedmail.org> ProMED-mail is a program of the International Society for Infectious Diseases <http://www.isid.org> Date: Wed 24 Feb 2010 Source: RP Online (RPO), Deutscher Depeschendienst (DDP) report [in German, machine trans., edited] <http://www.rp-online.de/panorama/deutschland/Hantaviren-Epidemie-in-Baden-Wuerttemberg_aid_824308.html> A dangerous hantavirus is spreading in Baden-Wurttemberg. Since the beginning of the year [2010], 85 cases have been reported in the administrative district of Stuttgart, the regional council announced on Wednesday [24 Feb 2010]. The number is unusually high for the season and exceeded the previous record year of 2007 with 41 cases in the same period, it said. This leaves an expectation of high infection levels in the coming months. The [number of] cases have been piling up since December [2009]. According to [health] information, hantavirus disease [in this part of Europe] manifests itself usually in the form of a common cold with sudden onset and high fever. In addition, [infected individuals] have head and body aches and abdominal pain. The illness lasts about 3 weeks and more than half of those affected are hospitalized. Some patients develop kidney failure. A vaccine does not exist. Hantaviruses are [maintained in] wild rodents that spread the virus primarily through faeces and urine. Humans usually become infected by inhaling dust [with excreta having the] pathogen. [The red-backed vole, _Myodes] glareolus_, whose principal food is beechnuts, is the main reservoir. Regions with a high prevalence are Swabian Alb and Schoenbuch, which are the most affected. The current incidence is probably due to a particularly high population of red-backed voles. - -- communicated by: HealthMap Alerts via ProMED-mail <promed@promedmail.org> [The virus involved in these cases is most likely Puumala hantavirus. A detailed account of the 2007 Puumala virus outbreak in Germany can be found in ProMED-mail archive no. 20070506.1463. Images of the bank vole reservoir of Puumala virus in Germany (_Myodes glareolus_), can be accessed at <http://commons.wikimedia.org/wiki/Category:Myodes_glareolus>. A map of Germany showing the location of Baden-Wurttemberg state can be accessed at <http://www.lib.utexas.edu/maps/europe/germany.jpg>. A HealthMap/ProMED-mail interactive map of Germany can be accessed at <http://healthmap.org/r/018s>. - Mod.TY] [see also: 2007 - --- Puumala virus infections - Germany 20070506.1463 Category C agents are third highest priority agents that include emerging pathogens that could be engineered for mass dissemination in the future because of Availability; Ease of production and dissemination; and Potential for high morbidity and mortality and major health impact. It is important to remember that just because these biological agents have been identified by the CDC as the priority agents, whether A, B, or C, a terrorist using a biological agent is not bound to use one of these. Physicians and all primary health care providers need to be alert to all unusual syndromes. For more information on these agents, visit: www.bt.cdc.gov

Panoramica sugli Agenti: Manifestazioni cliniche e trattamento This first discussion will focus on Category A agents. In order to better understand and identify the biological agents, it may be easier to understand the diseases by the syndromes they produce.

Carbonchio da inalazione Peste polmonare Tularemia polmonare/tifoide Sindromi Polmonari Carbonchio da inalazione Peste polmonare Tularemia polmonare/tifoide Category A agents that produce pneumonic syndromes are: Inhalational anthrax Pneumonic plague Pneumonic/typhoidal tularemia Melioidosis is a bioterrorism category B disease, and _B. pseudomallei_ is a soil/water organism found primarily in Southeast Asia and northern Australia. Severe pneumonia with sepsis syndrome is the most common cause of death with this infection and usually occurs in the compromised host, particularly the diabetic. No information is given regarding co-morbidities that may have existed in the boy.

Botulismo Avvelenamento da ricinotossina Sindromi tossiche Botulismo Avvelenamento da ricinotossina Continua

Sindromi eruttive e febbrili Vaiolo Febbri emorragiche virali Collegamenti: consensus Linee guida