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Cal Poly CHEM 349 - Viral Hemorrhagic Fevers

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Viral HemorrhagicViral HemorrhagicFeversFeversGreg CurtzwilerGreg CurtzwilerCHEM 349 Winter 2008CHEM 349 Winter 2008Cal Poly San Luis ObispoCal Poly San Luis ObispoContentsContentsIntroduction to viralIntroduction to viralhemorrhagic fevershemorrhagic feversA word from the CDCA word from the CDCA word from meA word from meFilovirusesFilovirusesConditionsConditionsTreatmentTreatmentVHFsVHFs as Weapons as WeaponsDetectionDetectionControlling infectionsControlling infectionsVHF IntroductionVHF IntroductionVHFsVHFs belong to 4 RNA virus families belong to 4 RNA virus familiesArenavirusesArenavirusesLassa Fever; Bolivian Hemorrhagic FeverLassa Fever; Bolivian Hemorrhagic FeverBunyavirusesBunyavirusesCrimean-Congo Hemorrhagic Fever; Rift Valley FeverCrimean-Congo Hemorrhagic Fever; Rift Valley FeverFlavivirusesFlavivirusesDengue; Yellow FeverDengue; Yellow FeverFilovirusesFiloviruses::Marburg, EbolaMarburg, EbolaFilovirusesFilovirusesMost likely to be Most likely to be weaponizedweaponizedNatural reservoir is unknownNatural reservoir is unknownFirst observed Ebola in Sudan 1976First observed Ebola in Sudan 1976First observed Marburg in Germany 1967First observed Marburg in Germany 1967First observed in US 1989 from Philippines (monkeys)First observed in US 1989 from Philippines (monkeys)Category A bioterrorism agentCategory A bioterrorism agentHigh mortality/ morbidity rateHigh mortality/ morbidity rateStable in environmentStable in environmentHighly infectious at low concentrations whenHighly infectious at low concentrations whenaerosolizedaerosolizedFeasible for large scale productionFeasible for large scale productionSo WhatSo Whatʼʼs the Deal?s the Deal?Incubation 2-21 daysIncubation 2-21 daysAlmost any tissueAlmost any tissueexcept bone andexcept bone andskeletal muscleskeletal muscleProdromalProdromal (subtle (subtlesymptoms)symptoms)FeverFeverHeadacheHeadacheNauseaNauseaDiarrheaDiarrheaCharacterized byCharacterized byabrupt symptomsabrupt symptomsMajor symptomsMajor symptomsFeverFeverMalaise (Flu like)Malaise (Flu like)Central nervousCentral nervoussystem dysfunctionsystem dysfunctionPetechiaePetechiae (next slide) (next slide)Muscle painMuscle painHemoptysisHemoptysis (two (twoslides)slides)Kidneys and liverKidneys and liverharden from clottingharden from clottingbloodbloodPetechiaePetechiae•Pegtechiae is a result of low platelet count which can be caused by viruses such as Marburg and EbolaHemoptysisHemoptysisTreatmentTreatmentQuarantine known casesQuarantine known cases Supportive care Supportive care –– substantial advanced medical substantial advanced medicalsupportive care is necessarysupportive care is necessaryIntensive care unit facilitiesIntensive care unit facilitiesOxygenOxygenHydration (IV therapy)Hydration (IV therapy)Ventilation support for severe casesVentilation support for severe casesPain managementPain managementAvoiding blood-thinning medications including aspirinAvoiding blood-thinning medications including aspirinVHFsVHFs as Weapons as WeaponsFormer Soviet Union Former Soviet Union weaponizedweaponizedsignificant amounts of quantities ofsignificant amounts of quantities ofMarburg, Ebola, and Lassa.Marburg, Ebola, and Lassa.Japanese cult Japanese cult AumAum ShinrikyoShinrikyo tried to tried toobtain Ebola during an outbreak in 1995obtain Ebola during an outbreak in 1995VHFsVHFs as Weapons as WeaponsAs a biological warfare agent, Ebola posesAs a biological warfare agent, Ebola posesa significant threat to ground troopsa significant threat to ground troopsHighly transmissibleHighly transmissibleInfectiousInfectiousLethalLethalEasily dispersible to ground troops as anEasily dispersible to ground troops as anaerosolaerosolStable in the environmentStable in the environmentWeaponizeWeaponize VHFsVHFsAerosolizationAerosolizationInhalation threatInhalation threatDelivery systems can be simpleDelivery systems can be simpleSpray systemsSpray systemsSub munitionsSub munitionsDetonation containersDetonation containersCrop duster or boatCrop duster or boatBombletsBombletsAircraftAircraftDetectionDetectionPossible methods of detectionPossible methods of detectionDetection of agent in the environmentDetection of agent in the environmentField kits including PCR and Enzyme LinkedField kits including PCR and Enzyme LinkedImmunosorbantImmunosorbant Assay AssayClinical (differential diagnosis)Clinical (differential diagnosis)Medical surveillance (coordination enhancesMedical surveillance (coordination enhancesdetection capability)detection capability)Controlling InfectionsControlling InfectionsCommunicable from person to personCommunicable from person to personSingle room with adjoining anteroom as onlySingle room with adjoining anteroom as onlyentranceentranceHand washing facility with decontamination solution (bleach)Hand washing facility with decontamination solution (bleach)Negative air pressureNegative air pressureStrict barrier precautionsStrict barrier precautionsgloves, gown, mask. Shoe covers, protective gloves, gown, mask. Shoe covers, protective eyeware/faceshieldeyeware/faceshieldconsider HEPA respirator for prominent hemorrhage, vomiting,consider HEPA respirator for prominent hemorrhage, vomiting,diarrhea, coughdiarrhea, coughPatient remains - Quartermaster sectionPatient remains - Quartermaster sectionDecontamination, embalming, transportation in hermeticallyDecontamination, embalming, transportation in hermeticallysealed containerssealed containersAntibody treatment has shown some successAntibody treatment has shown some successSummarySummaryEbola virus is highly infectious Ebola virus is highly infectious filovirusfiloviruswhen aerosolized with a high mortality ratewhen aerosolized with a high mortality rateThe possibility for The possibility for weaponizationweaponization is highly is highlyprobableprobableFormer Soviet Union Former Soviet Union weaponizedweaponized Marburg Marburgand Ebolaand EbolaDetection may not occur until


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