Viral HemorrhagicViral HemorrhagicFeversFeversGreg CurtzwilerGreg CurtzwilerCHEM 349 Winter 2008CHEM 349 Winter 2008Cal Poly San Luis ObispoCal Poly San Luis ObispoContentsContentsIntroduction to viralIntroduction to viralhemorrhagic fevershemorrhagic feversA word from the CDCA word from the CDCA word from meA word from meFilovirusesFilovirusesConditionsConditionsTreatmentTreatmentVHFsVHFs as Weapons as WeaponsDetectionDetectionControlling infectionsControlling infectionsVHF IntroductionVHF IntroductionVHFsVHFs belong to 4 RNA virus families belong to 4 RNA virus familiesArenavirusesArenavirusesLassa Fever; Bolivian Hemorrhagic FeverLassa Fever; Bolivian Hemorrhagic FeverBunyavirusesBunyavirusesCrimean-Congo Hemorrhagic Fever; Rift Valley FeverCrimean-Congo Hemorrhagic Fever; Rift Valley FeverFlavivirusesFlavivirusesDengue; Yellow FeverDengue; Yellow FeverFilovirusesFiloviruses::Marburg, EbolaMarburg, EbolaFilovirusesFilovirusesMost likely to be Most likely to be weaponizedweaponizedNatural reservoir is unknownNatural reservoir is unknownFirst observed Ebola in Sudan 1976First observed Ebola in Sudan 1976First observed Marburg in Germany 1967First observed Marburg in Germany 1967First observed in US 1989 from Philippines (monkeys)First observed in US 1989 from Philippines (monkeys)Category A bioterrorism agentCategory A bioterrorism agentHigh mortality/ morbidity rateHigh mortality/ morbidity rateStable in environmentStable in environmentHighly infectious at low concentrations whenHighly infectious at low concentrations whenaerosolizedaerosolizedFeasible for large scale productionFeasible for large scale productionSo WhatSo Whatʼʼs the Deal?s the Deal?Incubation 2-21 daysIncubation 2-21 daysAlmost any tissueAlmost any tissueexcept bone andexcept bone andskeletal muscleskeletal muscleProdromalProdromal (subtle (subtlesymptoms)symptoms)FeverFeverHeadacheHeadacheNauseaNauseaDiarrheaDiarrheaCharacterized byCharacterized byabrupt symptomsabrupt symptomsMajor symptomsMajor symptomsFeverFeverMalaise (Flu like)Malaise (Flu like)Central nervousCentral nervoussystem dysfunctionsystem dysfunctionPetechiaePetechiae (next slide) (next slide)Muscle painMuscle painHemoptysisHemoptysis (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 EbolaHemoptysisHemoptysisTreatmentTreatmentQuarantine known casesQuarantine known cases Supportive care Supportive care –– substantial advanced medical substantial advanced medicalsupportive care is necessarysupportive care is necessaryIntensive care unit facilitiesIntensive care unit facilitiesOxygenOxygenHydration (IV therapy)Hydration (IV therapy)Ventilation support for severe casesVentilation support for severe casesPain managementPain managementAvoiding blood-thinning medications including aspirinAvoiding blood-thinning medications including aspirinVHFsVHFs as Weapons as WeaponsFormer 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 WeaponsAs a biological warfare agent, Ebola posesAs a biological warfare agent, Ebola posesa significant threat to ground troopsa significant threat to ground troopsHighly transmissibleHighly transmissibleInfectiousInfectiousLethalLethalEasily dispersible to ground troops as anEasily dispersible to ground troops as anaerosolaerosolStable in the environmentStable in the environmentWeaponizeWeaponize VHFsVHFsAerosolizationAerosolizationInhalation threatInhalation threatDelivery systems can be simpleDelivery systems can be simpleSpray systemsSpray systemsSub munitionsSub munitionsDetonation containersDetonation containersCrop duster or boatCrop duster or boatBombletsBombletsAircraftAircraftDetectionDetectionPossible methods of detectionPossible methods of detectionDetection of agent in the environmentDetection of agent in the environmentField kits including PCR and Enzyme LinkedField kits including PCR and Enzyme LinkedImmunosorbantImmunosorbant Assay AssayClinical (differential diagnosis)Clinical (differential diagnosis)Medical surveillance (coordination enhancesMedical surveillance (coordination enhancesdetection capability)detection capability)Controlling InfectionsControlling InfectionsCommunicable from person to personCommunicable from person to personSingle room with adjoining anteroom as onlySingle room with adjoining anteroom as onlyentranceentranceHand washing facility with decontamination solution (bleach)Hand washing facility with decontamination solution (bleach)Negative air pressureNegative air pressureStrict barrier precautionsStrict barrier precautionsgloves, gown, mask. Shoe covers, protective gloves, gown, mask. Shoe covers, protective eyeware/faceshieldeyeware/faceshieldconsider HEPA respirator for prominent hemorrhage, vomiting,consider HEPA respirator for prominent hemorrhage, vomiting,diarrhea, coughdiarrhea, coughPatient remains - Quartermaster sectionPatient remains - Quartermaster sectionDecontamination, embalming, transportation in hermeticallyDecontamination, embalming, transportation in hermeticallysealed containerssealed containersAntibody treatment has shown some successAntibody treatment has shown some successSummarySummaryEbola virus is highly infectious Ebola virus is highly infectious filovirusfiloviruswhen aerosolized with a high mortality ratewhen aerosolized with a high mortality rateThe possibility for The possibility for weaponizationweaponization is highly is highlyprobableprobableFormer Soviet Union Former Soviet Union weaponizedweaponized Marburg Marburgand Ebolaand EbolaDetection may not occur until
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