Agent summary statement of Ebola and Bacillus anthracis

Agent summary statement of Ebola and Bacillus anthracis

1. AGENT SUMMARY STATEMENT

2. Huma Qadeer Ruqaiya Shoukat Asmat Jabbar Contributions (Slides Preparation)

3. Huma Qadeer , Ayesha Batool , Hamayat Ullah Ruqaiya Shoukat , Zunaira Mubarik Asmat Jabbar , Namal Javaid Contributions (Presenters )

4. Bacillus anthracis

5. 1 -INTRODUCTION Bacillus anthracis is the etiologic agent of anthrax – a common disease of livestock and occasionally of humans. The bacterium exists in nature in 2 forms : as an active growing cell ( called the vegetative form) or as a dormant spore. Spores can survive for long periods of time ( even decades) in the environment without nutrients or water. DOMAIN : Bacteria FAMILY : Bacillaceae GENUS : Bacillus

6. INFECTIOUS AGENT : NAME : bacillus anthracis SYNONYM : Anthrax, Woolsorters’disease . CHARACTERISTICS : Aerobic ,large Gram positive rods occurring in chains, non – motile, forms resistant spores.

7. CHAINS OF Bacillus anthracis

8. 2 -HEALTH HAZARDS PATHOGENICITY : Cutaneous anthrax : is the result of spores entering the body through small breaks in the skin. This form of disease is characterized by a sore at the point of infection that develops into a painless ulcer covered by a black scab (Eschar). About 95% of human anthrax cases have been reported. Cutaneous anthrax could also occur as a result of an aerosol attack.

9. CUTANEOUS ANTHRAX :

10. INHALATION ANTHRAX : Inhalation Anthrax is the result of breathing B. anthracis spores into the lungs. Initial symptoms are fever, headache, muscle aches . If untreated ,the disease progresses to shortness of breath ,chest discomfort, shock and death.

11. GASTROINTESTINAL ANTHRAX : Occurs as a result of eating the meal of animals, which are infected with B. anthracis . Symptoms include nausea, loss of appetite, and fever. Intestinal tract, mouth or throat (oropharyngeal anthrax) may be infected. The bacteria invades through the bowel wall. Then infection spreads throughout the body,through the blood stream ( septicemia) .

12. EPIDEMIOLOGY Bacillus anthracis found in soil worldwide. Humans may acquire anthrax from contact with infected animals or their products (I. e, hides, wool) In 1979 the accidental release of B. anthracis spores from a military research facility in Russia, resulted in 66 deaths. About 18 cases of inhalation anthrax were reported in the US from 1900 to 2000.

13. HOST RANGE Humans, cattle, sheep, goats, horses, pigs. INFECTIOUS DOSE : 8,000 to 50,000 organisms by inhalation

14. MODE OF TRANSMISSION: Infection of skin: By contact with infected animal tissues and possible by biting flies feeding on such animals or by contaminated wool, hair, hides or products made from them. Inhalation Anthrax :results from inhalation of spores in contaminated soil areas. Intestinal Anthrax :from ingestion of contaminated undercooked meat.

15. INCUBATION PERIOD : ( The period between contact with anthrax and the start of symptoms) It may be relatively short from 1 to 5 days. COMMUNICABILITY : Transmission from person to person is very rare.

16. 3 - DISSEMINATION RESERVIORS : Infected Animals, Soil ZOONOSIS: Yes –disease spreads among grazing animals through contaminated soil and feed. VECTORS : Infection of skin may possibly occur through biting flies which had fed on infected animals.

17. 4 - STABILITY AND VIABILITY DRUG SUSCEPTIBILITY: Susceptible to pencillin , ciprofloxacin, doxycycline., tetracylines , chloramphenicol, erythromycin.

18. SUSCEPTIBILITY TO DISINFECTANTS Spores are resistant to many disinfectants, susceptible to 2% glutaraldehyde Formaldehyde 5% formalin

19. PHYSICAL INACTIVATION : Spores are highly resistant to : drying, heat, and sunlight, adequate sterilization requires direct exposure to 121 degree Celsius for at least 30 min.

20. SURVIVAL OUTSIDE HOST : Spores remain viable in soil, skin and hides of infected animals and contaminated air and wool for decades. Dried on filter paper - 41 years Dried on silk threads - up to 71 years Pond water - 2 years.

21. 5 -FIRST AID / MEDICAL : SURVEILLANCE: Monitor for suspicious skin lesions and other symptoms,the history ,including the occupation of the person, is important. .Once the anthrax is disseminated, bacteria can be seen in the blood using a microscope. FIRST AID MEASURE: Prompt treatment with high-dose antibiotic.

22. IMMUNIZATION : vaccine available through the centres for disease control and Prevention and is recommended for those workers with frequent exposure to clinical specimens and cultures. PROPHYLAXIS : Antibiotic treatment (oral ciprofloxacin or doxycycline).

23. 6 – LAB HAZARDS : LAB ACQUIRED INFECTIONS : 45 cases with 5 deaths occurring primarily in facilities conducting anthrax research, 25 cases were reported in case of cutaneous anthrax among Armed Forces personnel. SOURCES / SPECIMENS : Blood, skin lesion exudates, and rarely in urine and faeces , hair, wool, and tissues from infected animals. PRIMARY HAZARDS : Direct and indirect contact of skin with cultures and contaminated lab surfaces, exposure to infectious aerosols.

24. SPECIAL HAZARDS: Naturally and experimentally infected animals pose a risk to laboratory personnel. RISK GROUP CLASSIFICATION : It includes risk group 4.

25. 7 -EXPOSURE CONTROL /PERSONAL PROTECTION CONTAINMENT REQUIREMENTS : BSL 3 practices and facilities are recommended for work with anthrax. PROTECTIVE CLOTHING : Use of protective clothing ( gloves, gowns) and facilities for washing and changing clothes should be available after working. OTHER PRECAUTIONS : Care of skin abrasions, and handling of potentially contaminated articles is essential.

26. 8 - HANDLING AND STORAGE : SPILLS : Allow aerosols to settle, wearing a protective clothing, gently cover spill with paper towel and apply suitable disinfectants (glutaraldehyde, formalin) All wastes should be decontaminated before disposal either by steam sterilization or incineration of cultures and media. Animals that have died from Anthrax should be burned or deeply buried. STORAGE: S ealed container should be appropriately labelled and secured in a level 3 facility.

27. COCCIDIOIDES IMMITIS

28. introduction Coccidioides immitis is a pathogenic fungus that resides in the soil in certain parts of the Southwestern United states, northern Mexico, and a few other in the western hemisphere. KINGDOM : Fungi FAMILY: Onygenaceae DIVISION: Ascomycota CLASS: Eurotiomycetes

29. COCCIDIOIDES IMMITIS

30. Infectious agent NAME: coccidioides spp. Synonym : coccidioides immitis , c.posadasii , coccidioidomycosis , valley fever, desert fever Characteristics: these are dimorphic fungi. they exist in a hyphal phase and release infectious anthroconidia VALLEY FEVER Valley fever, also called coccidioidomycosis,is an infection caused by the fungus Coccidioides .

31. Hazard identification Pathogenicity: The majority of individuals infected is asymptomatic or develops a very mild illness, with symptoms including cough, fever, arthralgias , myalgias , and fatigue that can last 2-6 weeks. Symptomatic individuals develop acute pneumonia or valley fever .

32. VALLEY FEVER

33. Clinical features Primary pulmonary disease is often self limiting but some some patient fail to recover and develop chronic pulmonary disease(5 to 10% of cases) Disseminated diseases occurs in an estimated 1% of cases(higher rates of dissemination are observed in certain risk groups), with bones/joints, soft tissues, and meninges most commonly affected. EPIDEMIOLOGY: The major risk factor for infection is environmental exposure to dust and soil . Disseminated infection is more common among black, Asian, or Filipino individuals , pregnant women in the third trimester and immunocompromised individuals.

34. HOST RANGE: Humans, nearly all mammals and some reptiles. INFECTIOUS DOSE: Estimated to be 1-10 anthroconidia . MODE OF TRANSMISSION: Inhalation of anthroconidia INCUBATION PERIOD: 1 to 3 weeks, although some infections are asymptomatic. COMMUNICABILITY: Not contagious but has occasionally been transmitted from person to person via fomites or organ transplants.

35. Stability and viability Drug susceptibility : Susceptible to amphotericin B and the Azole group of antifungal drugs DRUG RESISTANCE: Resistance has been observed against azoles. S USCEPTIBILITY TO DISINFECTANTS: Susceptible to 1:10 dilution of bleach, 8% formaldehyde or 3 % phenolics with a contact time of 20 minutes or more. Reservoir: Soil in southwestern US, parts of Central and South America. ZOONOSIS: None. Although there is zoonotic potential, no reports of transmission between animals and humans have been documented. VECTOR : None

36. S urvival outside host: Coccidioidal anthroconidia are hardy and can survive for long periods of time on inanimate surfaces PHYSICAL INACTIVATION: Fungi in soil can be inactivated by heat at 120C for 30 minutes . First aid /medical measures Surveillance: Diagnosis of coccidioidomycosis can be established using serologic, histopathologic and culture methods FIRST AID TREATMENT: coccidioidomycosis is generally self limiting and will resolve without treatment. Dissemimnated infections , or patients who experience excessive morbidity, should be treated with antifungal medication

37. LABORATORY HAZARDS LABORATORY-ACQUIRED INFECTIONS: 93 cases of laboratory acquired coccidioidomycosis infections and two deaths were reported prior to 1978. A n additional 15 cases were asymptomatic but identified with skin tests.

38. One symptomatic case has been reported from 1979-2004. SOURCES: Lower respiratory tract samples, cerebrospinal fluid, sputum, skin and visceral lesions, and soil samples from infected areas. PRIMARY HAZARD: Inhalation of spores, parenteral inoculation or contact with mucous membranes. SPECIAL HAZARD: None

39. Exposure controls/personal protection Risk group classification: Risk group 3 CONTAINMENT REQUIREMENTS: Containment level 3 facilities, equipment, and operational practices for working involving infectious or potentially infectious materials, animals, or cultures. PROTECTIVE CLOTHING : P rotective clothing may be worn over laboratory clothing when infectious materials are directly handled such as solid front gowns with tight fitted wrists, gloves and respiratory protection. Eye protection must be used where there is a known or potential risk of exposure to splashes.

40. OTHER PRECAUTIONS: Centrifugation of infected materials must be carried out in closed containers placed in sealed safety cups, or in rotors that are loaded or unloaded in a biological safety cabinet. The use of needles, syringes, and other sharp objects should be strictly limited.

41. Handling and storage Spills : Allow aerosols to settle, then, wearing protective clothing, gently cover the spill with absorbent paper towel and apply appropriate disinfectant. DISPOSAL : All wastes should be decontaminated before disposal either by steam sterilization , incineration or chemical disinfection. STORAGE: The infectious agent should be stored in a sealed and identified container.

42. Ebola Virus

43. Name Ebola Virus Agent type Virus Family Filoviridae Genus Ebola Virus Introduction

44. African haemorrhagic fever, Filovirus , Zaire ebolavirus , Sudan ebola virus, Ebola Reston. It was first discovered in 1976 as part of rhadoviridae family which later on given a family ( filoviridae ) based on their genetic structure. Synonym Discovery Introduction

45. 04 Single strand, non-segmented, negative sense RNA 03 Helical nucleocapsid , enveloped having 40-50 nm diameter 02 Pleomorphic viral fragments can take on distinct shapes. 01 Elongated filamentous virus which can vary between 800-1000 nm in length. Properties

46. HAZARD IDENTIFICATION

47. PATHOGENICITY/TOXOCITY Affects host blood coagulate and immune defense system and leads to severe immunosuppression. Early Signs of infection are non-specific and flu-like and may include : fever, asthenia, diarrhea, vomiting, and abdominal pains. Less Common Early Symptoms include conjunctiva injection, sore throat, rashes and bleeding. Later Signs of infection includes Shock, coagulation disorders, and secondary bacterial infection.

48. 01 Occurs mainly in areas surrounding rain forest in equatorial Africa with exception of Reston that originated in Philippines. 02 Largest recorded Ebola outbreak is in March 2014 in Guinea and then identified in surrounding regions : Liberia , Sierra Leone, Nigeria. 03 An Ebola virus outbreak began in the Bikoro region, Equateur Province, in the Democratic Republic of the Congo in May 2018 with confirmed cases reaching 38 by the middle of June 2018. Epidemiology

49. Natural Host Human Various monkey species, chimpanzees, gorillas, baboons, and duikers. Also discovered in two species of rodents and one species of shrew. Other Host Experimental studies of the virus have been done using mouse, pig, guinea pig, and hamster models, suggesting wild-type Ebola virus has limited pathogenicity in these models Host Range

50. Natural Mode of Transmission Person to person Contact with infective animal Exposure to infected body fluids Due to reuse of unsterilized needles, syringes and contaminated medical equipment. Laboratory Mode of Transmission Air borne transmission due to aerosols. Infectious Dose Infectious dose of 1 - 10 organisms by aerosol in non-human primates. The specific infectious dose for Ebola virus is unknown. Transmission And Infectious Dose

51. Range of 2-21 days, but normally 4-10 days. Communicability Communicable as long as blood, body fluids or organs contain the virus. It has been isolated from semen 61 to 82 days after the onset of illness, and transmission through semen has occurred 7 weeks after clinical recovery. Incubation Period

52. Natural reservoir of Ebola is unknown, but specific species of bat are considered a possible natural reservoir based on the presence of serum antibodies and viral RNA Zoonosis Unknown Vector Unknown Reservoir Dissemination

53. STABILITY AND VIABILTY Drug Susceptibility Unknown Drug Resistance There are no known antiviral treatments available for human infections.

54. It is susceptible to 3% acetic acid, 1% glutaraldehyde , alcohol-based products, calcium hypochlorite (bleach powder), and dilutions of 5.25% household bleach (i.e., 0.525% to 0.0525% sodium hypochlorite for ≥ 10 min). Moderately thermolabile and inactivated by heating for 30 minutes to 60 minutes at 60°C, boiling for 5 minutes, or gamma irradiation combined with 1% glutaraldehyde . moderately sensitive to UVC radiation. Survive for weeks in blood and survive on contaminated surfaces, low temperatures (4°C). When dried in tissue culture media onto glass and stored at 4 °C, Zaire Ebola virus survived for over 50 days. Resrsusceptibilty to Disinfectants Physical Inactivation Survival Stability And Viability

55. Prophylaxis Unknown Immunization Unknown First Aid/ Treatment No effective antiviral treatment is supportive and directed at maintaining organ function and electrolyte balance and competing hemorrhage and shock. Surveillance RT-PCR to detect viral RNA, ELISA based techniques immunoelectron microscopy immunofluorescence to detect antiviral antibodies . First Aid/ Medical Measures

56. LABORATORY HAZARDS

57. Special Hazards Work with, or exposure to, infected non-human primates, rodents or their carcasses represents a risk of human infection Primary Hazards Accidental parenteral inoculation, respiratory exposure to infectious aerosols /droplets and direct contact with skin or mucous membranes. Sources & Specimens Blood, vomit, serum, urine, respiratory and throat secretions, semen, and organs or their homogenates from human or animal hosts. LAI Three reported near-fatal case Two following a minute finger prick and one during performing an autopsy on a chimpanzee. Laboratory Acquired Infections (LAI)

58. Risk Group Classification: Risk Group 4 Containment Requirement Biosafety Cabinet 4, BSC 4 facilities equipment and operational facilities. Protective Clothing Personnel entering the lab should remove street clothing, including undergarments & jewelry. Change into dedicated laboratory clothing and shoes, or don full coverage protective clothing (Positive pressurized HEPA-filtered air supplied protective suit) . Additional protection may be worn over laboratory clothing when infectious materials are directly handled, such as solid-front gowns with tight fitting wrists, two pairs of gloves, and an approved particulate respirator. Eye protection should be used where there is a known or potential risk of exposure to splashes (e.g., goggles, face shields ). Exposure Controls/ Personal Protection

59. Other Precautions Centrifugation of infected materials must be carried out in closed containers placed in sealed safety cups, or in rotors that are unloaded in a biological safety cabinet. The integrity of positive pressure suits must be routinely checked for leaks. The use of needles, syringes, and other sharp objects to be strictly limited. Open wounds, cuts, scratches, and grazes to be covered with waterproof dressings. Minimize activities that may generate aerosols (e.g., mixing samples, by pipetting, centrifugation). Additional precautions to be considered with work involving animal activities. Exposure Controls/ Personal Protection

60. Allow aerosols to settle for minimum 30 minutes. Wearing protective clothing. Gently cover the spill with absorbent paper towel. Apply suitable disinfectant (1% sodium hypochlorite). Starting at the perimeter and working towards the centre . Allow sufficient contact time (10 minutes) before clean-up. All materials that have come in contact with the infectious agent should be completely decontaminated before they are removed from the containment zone. This is done by decontamination methods such as chemical disinfectants, autoclaving, irradiation, incineration, an effluent treatment system, or gaseous decontamination . In sealed leak proof containers. Appropriately labeled Biohazard symbol, agent name, supervisor name and contact number, agent hazard. Locked in a containment level 4 facility. SPILLS DISPOSAL S TORAGE Handling and Storage