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Minnesota veterans homes board

MINNESOTA DEPARTMENT OF VETERANS AFFAIRS
MN Veterans Homes
POLICY: Bioterrorism Preparedness & Responses
OBJECTIVE
The Minnesota Veterans Homes will be prepared to identify and respond expediently to a threat or event related to biological
and chemical terrorism agents in our facilities and communities.
POLICY
A procedure will be established at each MVH, as part of the Emergency Preparedness and Infection Control Plans, to identify,
report, protect and care for residents and staff in the event of a bioterrorism threat or event.
DEFINITIONS
Terrorism:
The unlawful threat of or use of force or violence against persons or property to intimidate or coerce a
government or civilian population in the furtherance of political or social objectives.
Bioterrorism: Refers to the threat of terrorists using biological or chemical agents against civilian and/or government
populations.
Bioterrorism Agents: Refers to a broad range of potential agents, including bacteria, viruses, toxins (of microbial, plant, or
animal origin) and gases capable of producing disabling or lethal diseases. Routes of exposure include respiratory, oral
consumption (food and water), and percutaneous (skin).
PROCEDURE

I. Detection and Surveillance – Bioterrorism may occur as a covert event (in which persons are unknowingly exposed and
unusual disease symptoms occur) or an announced threat of exposure. Personnel should be vigilant for the following
occurrences:
A. Covert Exposure Features – contact MDH to report suspicion of an event – see appendix A
Bioterrorism Preparedness & Response Page 1 1. A rapid increase in disease incidence (within hours or days).
2. An epidemic curve that rises and falls during a short time period.
3. An unusual increase in the number of people with fever, respiratory or gastrointestinal complaints not consistent with
seasonal disease history and predictability.
4. An endemic disease rapidly emerging at an uncharacteristic time or in an unusual pattern.
5. Large numbers of rapid fatalities.
6. Any person presenting with a disease that is uncommon and has bioterrorism potential.
B. Announced Threats – Contact local emergency authorities. See appendix A
II. Communication and Reporting – In the event of a suspected or threatened bioterrorism event each facility will activate
their Emergency Action Plan, which should contain phone numbers for notification of the following :
A. Internal Contacts
1. Administrator or designee and Public Affairs officer, if available.
2. Infection Control Practitioner
3. Medical Director
4. The MVH Central Office
B. External Contacts
1. Designated Local Emergency Authorities (see appendix A)
a. ensure contact is made with MDH and/or EMS
III. Identification of Bioterrorism Agent – Rapid response to a bioterrorism event requires prompt identification because of
the rapid progression to illness and potential for dissemination. Response will be based on recognition of high-risk syndromes.
See Attachment B-E for syndrome descriptions of what are considered to be the most frequently identified bioterrorism
agents.
IV. Infection Control Practices
A. Standard Precautions – All residents should be managed with Standard Precautions. For certain diseases or syndromes
additional precautions may be needed to reduce the likelihood for transmission. See Attachment B-E.
B. Hand Hygiene – follow the Agency Hand Hygiene policy.
C. Personal Protective Equipment (PPE) will be used according to Infection Control policies.
D. Victim Placement
1. In consultation with the medical director and local emergency authorities, determine if the exposed Victim (resident or staff
member) should remain in the facility or be transferred to an available community resource. Patient Victim transport
requirements for specific potential agents are listed in Attachment B-E.
2. Routine victim placement and infection control practices should be followed if the exposed person(s) remain at the facility.
3. If the number of exposed persons is too large to allow routine triage and isolation strategies, plans for cohorting should be
implemented. The cohort site should have controlled entry and patterns of airflow and ventilation should be considered when
choosing the site.
E. Cleaning, Disinfecting, Sterilization of Equipment and Environment – Infection Control
Standards will be applied for the management of resident care equipment and environmental control.
F. Clinical Specimens – Handling, packaging and transport of clinical specimens must be coordinated with the Minnesota
Department of Health.
V. Resident, Visitor and Public Information – Fact sheets from the Minnesota Department of Health may be distributed.
VI. Bioterrorism Readiness Plan – For more specific information regarding each bioterrorism agent and required special
precautions, refer to the attached plan developed by the Centers for Disease Control and Prevention (CDC) and the Association
for Professionals in Infection Control and Epidemiology (APIC).
REFERENCES
Bioterrorism Readiness Plan, a Template for Healthcare Facilities, a publication by CDC and APIC, MVH Emergency Action
Plans.
MN Chapter 4605
Recognition of Illness Associated with the International release of Biologic Agents; MMWR 10/19/01
APIC Bioterrorism Planning Template; 08/08/04;
MDH Consumer Fact Sheets on Bioterrorism Agents: http://www.health.state.mn.us/bioterrorism/index.html

DISTRIBUTION
Facility Emergency Action Plans, all Infection Control Manuals, Administrators, Medical Directors, Central Office.
Regulations: MN Chapter 4605
Signed: _______/s/_ _______________________ ATTACHMENT A:
AGENCY OPERATING POLICY: INFECTION CONTROL PROGRAMS Reporting Agents of Bioterrorism How To Report Agents of Bioterrorism • Call MDH at 612-676-5414 or 877-676-5414 immediately to report agents of Bioterrorism. Agents of Bioterrorism may be reported immediately by phone 24 hours a day, seven days a week. General Questions: If you have questions or comments about this page, contactor call 612-676-5414 (TTY: 612-676-5653) for the MDH Per MDH Website 042406: Diseases to Report Immediately by Telephone:
Reportable Infectious Diseases (Per MDH Website 042406)
Certain infectious diseases with particularly critical public health significance are reportable immediately by phone to the Minnesota Department of Health. For diseases that require immediate reporting call the Infectious Disease Epidemiology, Prevention and Control Divison 24 hours a day, 7 days a week at: 651-201-5414 or 1-877-676-5414. Additional information including: specifically what must be reported for each disease, criteria for reporting, clinical specimen submission guidelines, and any supplemental reporting that may be requested are available by clicking on the name of the disease. For diseases that require immediate reporting call the Infectious Disease Epidemiology, Prevention and Control Divison at: 651-201-5414 or 1-877-676-5414. • A member of the Minnesota Department of Health, Infectious Disease Epidemiology, Prevention and Control staff is available for disease consultation and reporting 24 Diseases to Report Within One Working Day:
Reportable Infectious Diseases

Additional information including: specifically what must be reported for each disease, criteria for reporting, clinical specimen submission guidelines, and any supplemental reporting that may be requested are available by clicking on the name of the disease. Summary of Potential Agents of Bioterrorism Incubation Period
Clinical Syndrome
Transmission Mode
Precautions
Non-specific viral syndrome followed in 2-5 days by severe respiratory Cutaneous, Inhalation, distress, mediastinitis, shock and death. Acute onset of fever, cough with bloody sputum, may develop Droplet and cutaneous. Standard Precautions. pneumonia, respiratory distress, malaise, myalgia Possible skin lesions. Spread person-to- Acute febrile illness, often pneumonia, may develop respiratory Non-specific, fever, cough, pleuritic chest pain. Irregular fever, headache, fatigue, weakness, osteoarticular involvement, anorexia, possible development of skin lesions. Acute fever followed in 2-3 days by macules progressing to pustules, most on extremities and face, rash over face and extremities, Private Room. Transfer to facility with negative air pressure room as soon as possible. Limit transport of patient within facility. Blurred vision, diploplia, dry mouth, ptosis, symmetrical, descending, flaccid paralysis. (drooping eyelids, weakened jaw clench, difficulty swallowing or speaking), respiratory dysfunction, gastrointestinal Fever, headache, nonproductive cough, dyspnea. Gastrointestinal symptoms and hemorrhage, weakness, fever, cough, Appendix C: BW Agent Characteristics
Transmit
Infective Dose
Incubation
Duration of Illness
Lethality (approx.
Persistence of Organism
Vaccine Efficacy
Man to Man
(Aerosol)
case fatality rates)
(aerosol exposure)
Inhalation
Brucellosis
Glanders
Pneumonic
Tularemia
94% protection against 3,500 LD50 in guinea pigs Smallpox
Venezuelan
Encephalitis
Viral

Hemorrhagic
Botulism
Enterotoxin B
Mycotoxins
Appendix D: BW Agents - Vaccine, Therapeutics, and Prophylaxis Bioport vaccine (licensed) Ciprofloxacin 400 mg IV q 8-12 h Ciprofloxacin 500 mg PO bid Potential alternates for Rx: gentamicin, x 4 wk If unvaccinated, begin erythromycin, and chloramphenicol Doxycycline 200 mg IV, then 100 mg Doxycycline 100 mg PO bid x Wyeth-Ayerst Vaccine 2 Oral rehydration therapy during Vaccine not recommended for routine protection doses 0.5 mL IM or SC @ period of high fluid loss in endemic areas (50% efficacy, short term) Quinolones for tetra/doxy resistant strains Tetracycline 500 mg PO q 6 h x 5-7 Tetracycline start 8-12 d Currently testing vaccine to determine the Doxycycline 100 mg PO q 12 h x 5-7 Doxycycline start 8-12 d No large therapeutic human trials have been conducted owing to the rarity of natural y Greer inactivated vaccine Streptomycin 30 mg/kg/d IM in 2 Doxycycline 100 mg PO bid x Plague vaccine not protective against aerosol 7 d or duration of exposure chal enge in animal studies longer available: 1.0 mL 10 d (or gentamicin) Doxy 200 mg IV then 100 mg IV bid Doxycycline 100 mg PO bid x Alternate Rx: trimethoprim-sulfamethoxazole Gentamicin 3-5 mg/kg/d IV x 10-14 Tetracycline 500 mg PO QID Doxycycline and rifampin x 3 Trimethoprim-sulfamethoxazole may be substituted for rifampin; however, relapse may encephalitides attenuated vaccine (IND): anticonvulsants prn Only effective against subtypes 1A, 1B, and 1C C-84 vaccine used for non-responders to TC-83 EEE and WEE inactivated vaccines are poorly Aggressive supportive care and management of Wyeth calf lymph vaccinia No current Rx other than supportive; Vaccinia immune globulin 0.6 Pre and post exposure vaccination recommended DOD pentavalent toxoid DOD heptavalent equine despeciated Skin test for hypersensitivity before equine for serotypes A - E (IND): antitoxin for serotypes A-G (IND): 1 0.5 ml deep SC @ 0, 2 & vial (10 mL) IV Appendix E: Specimens for Laboratory Diagnosis
Face or Nasal
Blood Culture
Acute &
Convalescent
Brucellosis
Bone marrow and spinal fluid cultures; tissues, exudates Bubo aspirate, CSF, sputum, lesion scraping, LN aspirate Tularemia
Hemorrhagic
Fever
VEE

Clostridial
Toxins
SEB Toxin

Ricin Toxin
2Fluorescent antibody test on infected lymph node smears. Gram stain has little value. 3Virus isolation from blood or throat swabs in appropriate containment. 4C. burnetii can persist for days in blood and resists desiccation. EDTA anticoagulated blood preferred. Culturing should not be done except in BL3 containment.

Source: http://intranet.mdva.state.mn.us/PoliciesandProcedures/MVH/Bioterrorism%20Preparedness%20&%20Response.pdf

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