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Medical CBRN/WMD Items of Interest / Medical WMD Items of Interest / Medical WMD items of Interest Wk of 25July2010 |
on: Aug 5th, 2010, 3:57pm |
| Started by Roderick_Farrar | Last post by Roderick_Farrar |
To all,
1. More viral "BW" agents: A woman in Florida died of eastern equine encephalitis (EEE). This disease is caused by an alphavirus and is considered a CDC Category B biologic terrorism agent, though she contracted it from a mosquito. EEE is endemic in horses in Florida, though this is the first case in humans. The vector of transmission is the mosquito. Symptoms begin about four to ten days after the mosquito bite(s), and initially consist of headache, high fever, chills, and vomiting. The disease can progress into seizures, disorientation, coma and death. About a third of patients die, and many who survive do have brain damage. There is no specific treatment for EEE. There is a vaccine for horses, but not yet humans. The county in Florida is planning on spraying the area. This particular case is natural in origin, not terrorist related.
A woman in Germany is believed to have died from a hantavirus (Puumala virus) infection. Reservoir is the bank vole. Hantavirus is endemic in the bank vole in Germany, but this year they have had 736 infections in humans in one province, approximately 100 times the usual level. There was a similar outbreak in humans in 2007, with high fever, headaches, generalized myalgia (whole body ache), and stomach aches. The hantaviridae are considered Category C CDC biologic terrorism agents, but these cases, despite the marked increase in incidence, are considered natural in origin.
2. Melioidosis again...: Three weeks ago I mentioned an outbreak in Australia of Burkholderia spp. (glanders, melioidosis) infection, causing skin ulceration and pulmonary infections. These organisms thrive in soil and get their energy from sugar fermentation, but can infect humans in contaminated soil or water. In June several persons involved in a search and rescue operation in Malaysia for a drowned man contracted melioidosis and leptospirosis (leptospirosis, caused by spirochetes, is the most common zoonosis, or disease spread from animals to humans, in the world; it is not considered a BW agent). Six people died (not sure from which, or both, diseases), and dozens of others (83 to 14 have become ill. The area has been closed off to the public now.
3….and also bird flu (H5N1 highly pathogenic avian influenza): Last week Indonesia reported a case of HPAI in a 13-year-old girl, and Egypt in a 20-year-old woman. Both were exposed to sick or dead poultry, and unfortunately both died despite treatment. WHO case/fatality numbers now stand at 502 and 298 respectively.
4. Medical WMD Trivia: Last week we went viral with the trivia questions! The DNA virus that is considered a CDC Category A agent is Variola major (smallpox). Congratulations to Deena Disraelly for getting the answer! Deena and Pat Hebert also got the RNA viruses that are potential BW agents. There are four main families of "BW" RNA viruses: arenaviridae (Lassa fever, Machupo, or Bolivian, hemorrhagic fever, and Junin, or Argentine, hemorrhagic fever--all are Category A); bunyaviridae (Rift valley fever, Crimean-Congo hemorrhagic fever, Nipah virus, and the hantaviruses--all Category C); filoviridae (Ebola and Marburg hemorrhagic fever, Category A); and flaviviridae (yellow fever, which is Category C, and dengue virus). Currently the only recognized antiviral agent is ribavarin, which is often effective against the arenaviridae and bunyaviridae IF administered early. There is promising research going on using small molecules against most of these viral infections. As for vaccines, there are very effective vaccine against smallpox and yellow fever; promising work on filovirus vaccines is going on. A little over a year ago a German researcher sustained a needlestick while working with Ebolavirus and was given an experimental vaccine that had shown effectiveness in primates; so far he is doing well.
This week let's go "nuclear" on medical trivia! In a nuclear detonation there will be hundreds or thousands of people receiving combined blast, thermal and radiation injuries that will require surgical procedures. What would be different about doing, say, an internal fixation of a broken femur or a full thickness skin graft on a burn patient who had received a high but survivable radiation exposure (200-300 rad) vs. doing a similar procedure on a trauma patient who hadn't been irradiated. (Hint: these are examples of extensive but not immediately urgent surgical procedures.)
To your health,
Glen
Glen I. Reeves, MD
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Medical CBRN/WMD Items of Interest / Medical WMD Items of Interest / Medical WMD Items of Interest 11 Apr 2010 |
on: Apr 22nd, 2010, 9:48am |
| Started by Roderick_Farrar | Last post by Roderick_Farrar |
[Great info courtesy of Dr Glen Reeves]
1. Radioactive scrap metal (Cobalt-60) in India: The Department of Atomic Energy of India has informed the IAEA that five people have been rendered critically ill by exposure to Cobalt-60 that turned up in scrap metal in and around a street market in Mayapuri, India. Apparently a man bought the material in mid-March and, according to the police, "his hands had turned black, he lost hair and developed patches on his body." Four other members of his shop have also been hospitalized and are reportedly critically ill; I do not have any further medical details. Experts from the Bhabha Atomic Research Centre have isolated eleven chunks of cobalt. Radiation fields from the isolated cobalt sources have been measured from 20 to 1000 R per hour (distances not specified), though some of the sources were partially shielded by other pieces of junk. The original source of the cobalt hasn't been identified, though Co-60 was (and perhaps still is) used in hospitals to treat radiation therapy patients. The IAEA as of this morning hadn't issued a formal report. This is reminiscent of the Cesium-137 accident in 1987 in Goiania, Brazil, where four persons died and 28 others were hospitalized, some requiring amputations. Will keep you posted.
2. Flu news: Avian influenza (H5N1): There have been four cases, three fatal, since 16 Mar. Three of these have been in Egypt, which has had 19 cases this year, seven of whom died. One case in Vietnam has generated concern because several family and neighbors have also been ill; confirmation (or denial) of these cases is pending. The concern is that the disease may have been transmitted from human to human; however, one must rule out whether these persons (if they have HPAI) were all exposed to poultry before assuming this. WHO confirmed case/fatality numbers as of 9 Apr are 493/292.
Swine flu (H1N1): The swine flu outbreak peaked in October 2009 and then began to decline, but was still active as of last month according to the CDC. More than 99% of all characterized viruses weren't the usual seasonal H1N1, H3N2, and B strains. So the WHO and FDA have recommended that next season's vaccine use the A/California/7/2009-like (2009 H1N1) (i.e. last year's swine flu main strain) plus an H3N2 strain similar to last fall's vaccine and a B type like the one used in 2008. Next fall you need to get only the seasonal trivalent vaccine; there won't be a separate swine flu shot.
3. Plague in China: The recent terrible earthquake in China has displaced thousands of people from their homes. Unfortunately the quake was in a county with known foci for naturally occurring plague, and there is concern that the displaced populations will be more likely to come into contact with rodents, including marmots, bearing fleas carrying the plague. (Marmots are also a source of meat.) They are coming out of hibernation around now. The China Ministry of Health isn't expecting a massive outbreak but is concerned that more people than usual might contract this disease and are instituting prevention and control measures.
4. Medical WMD Trivia: Last issue's question was: 1) What is the latency period (time between exposure and onset of symptoms) from anthrax? 2) What are the initial symptoms? 3) After a brief period of remission of symptoms, what then happens clinically? (yes, anthrax is often a biphasic disease) 4) What medications are used in the treatment of anthrax, when should they be started [the answer to such a question is always "as soon as possible"!], and for how long? Answers are: 1-6 days (for inhalational anthrax). Initial symptoms are myalgia (muscle pain), malaise, fatigue, nonproductive cough, and fever. There may be a transient improvement, then recurrence of symptoms of fever, diaphoresis (sweating all over), acute respiratory distress, stridor (difficulty breathing owing to enlarged lymph nodes compressing the trachea), decreased level of consciousness, coma, and often death. Treatment, which should begin immediately after known exposure and certainly after diagnosis, is with ciprofloxacin or doxycycline. If symptomatic, other medications (aminoglycosides, chloramphenicol, rifampin, vancomycin, others) should be used as well. Treatment for exposure should last 60 days, maybe longer. Penicillin can also be used, though some are concerned about genetically engineered penicillin-resistant anthrax strains. I subsequently asked another trivia question: how transmissible is anthrax between humans? One respondent (Lou Mills) quoted an authority that, "It's not very transmissible at all from human to human." I asked where he had obtained the quote, and he said it was from one of my previous newsletters…
Congratulations to Suzanne Burnham, DVM, for giving a complete and thorough answer to the first set of questions! Also to Kate Hooten and Larry Kelly who got the main points, that initially anthrax symptoms can appear very much like flu and that antibiotics have to be administered a long time, not just till symptoms improve.
As for this week's trivia question: I attended a very fascinating program Monday on "Chemical Terrorism for the Clinician: Detection, Diagnosis, and Treatment." The nerve agent section was fascinating. Organophosphate nerve agents work by binding acetylcholinesterase so it can't break down the acetylcholine transmitters, thus resulting in overstimulation and eventual fatigue of the stimulated nerve or muscle cell. However, botulinum toxin works by preventing release of acetylcholine, resulting in a flaccid paralysis rather than overstimulation of the distal nerve or muscle. And there's one other neurotoxin that at low doses works by stimulating select acetylcholine receptors but at high doses results in their blockade. It's not ordinarily considered a CW agent (though the CDC considers it a possible one), but was used to poison 92 persons in Michigan earlier this decade. It has also caused significant toxicity in those who handle the plant that is its source. What is it?
Glen I. Reeves, MD |
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Employment Opportunities / Help Wanted / CBRN Training Specialist $57K at Ft Wood |
on: Apr 22nd, 2010, 9:46am |
| Started by Roderick_Farrar | Last post by Roderick_Farrar |
I thought some 74D/74Z who are leaving the military soom might be interested in teaching and sharing all their expertise.
Training Specialist: The responsibility for developing and/or reviewing a variety of Chemical, Biological, Radiological and Nuclear (CBRN) emergency response and CBRN defense training products. Design and develop training products relevant to the CBRN School in support of the National Guard Bureau Civil Support Teams and Active Guard and Reserve Components CBRN missions. Review instructional material and related training aids and devices used in conducting the training for CBRN defense courses.
Announcement closes April 28, 2010.
SWKA10191399
Good luck,
Scott Farrar
84th Chemical Battalion
USAJOBS Announcement # is: |
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CBRNE Officer/NCO Corner / General Forum / UV Lasers for decon-article |
on: Apr 22nd, 2010, 9:19am |
| Started by Roderick_Farrar | Last post by Roderick_Farrar |
open source article with photos from: http://www.physorg.com/news191078533.html
INL laser research could help U.S. respond to terror attack [April 21st, 2010]
According to chemists at Idaho National Laboratory, lasers might be able to help the nation respond in the case of a possible chemical or radiological attack. Lasers, the INL scientists say, could play a big cleanup role. Lasers could help scrub chemical- or radiation-contaminated buildings clean, returning life to normal as safely and smoothly as possible.
Fixing the damage would require decontaminating any buildings, roads and other infrastructure that soaked up radioactive atoms (known as radionuclides). Doing this quickly and effectively would be vital, minimizing disruptions to people’s lives and the American economy.
In theory, chemists already know how to clean up radiological contaminants. They can "chelate" affected areas, for instance, using grabby, reactive chemicals to wrench radionuclides off surfaces. But in the real world, that’s easier said than done. Many building materials — like cement and brick — are extremely porous.
"Getting contaminants off surfaces is difficult," says INL chemist Gary Groenewold. "They start inhabiting cracks and pores."
Water inhabits those cracks and pores, too, and that’s where lasers come in. Fox, Groenewold and their colleagues have shown that laser pulses can flash that water into steam, carrying the contaminants back to the surface for removal by chelation or other means.
"It’s a kind of laser steam-cleaning," Fox says.
Cleaning up chemical agents: In the last few years, the INL team has extended its work to chemical-weapon decontamination, another high national-defense priority. Nerve agents like sarin, VX and sulfur mustard are extremely dangerous, and cleaning them up can be difficult, costly and time-consuming. Most preferred methods employ other chemicals — bleach solutions, for example — which must themselves be dealt with.
"Using bleach creates a lot of secondary waste, which you have to collect and dispose of," Groenewold says. "And bleach is quite chemically aggressive, meaning it may well damage the structures you’re trying to decontaminate."
Again, lasers show promise as a possible remediation upgrade. In a series of tests still under way at the U.S. Army’s Aberdeen Proving Ground, the INL team has been using ultraviolet-wavelength lasers to scrub surfaces of sulfur mustard and VX. The tests have been successful so far, even on complex, porous surfaces like concrete.
The power of light! Lasers can degrade weapons like VX in two ways: photochemically or photothermally. In photochemical decomposition, high-energy laser photons blast apart chemical bonds, slicing the agent into pieces. In photothermal decomposition, photons heat up the target surface enough to speed along natural degradation reactions. In some cases, the intense heat by itself can cause contaminant molecules to fall apart.
Some chemical agents are susceptible photochemically, others photothermally. Knowing how chemical contaminants fall apart is key, because some of their degradation products can themselves be hazardous. But according to Fox, the tests look good in this regard, too.
"The lasers are showing neutralization of agent without generation of dangerous byproducts," he says.
Even if they’re not used to degrade VX or other agents, lasers could still be helpful in cleanup scenarios. Laser light could blast nasty chemicals off a wall, for example, and an integrated vacuum system could suck them up.
"Either way, you’ve done your job," Fox says.
The porous nature of structural materials complicates chemical decontamination perhaps more than it does radiological cleanup. That’s because chemicals can soak deeper in —beyond the reach of laser steam-cleaning — then seep out over time after the surface has been cleansed. But the INL team thinks it can overcome this difficulty, too. The answer: heat.
Focusing microwaves on a point behind pooled contaminant, Fox says, could create heat radiation that drives the chemical back out to the surface. The technology to do this is already available, since industry uses microwaves to cure concrete. The INL researchers will look at the effectiveness of this technique in future experiments.
Using lasers to decontaminate buildings and other infrastructure may sound futuristic. But in researching ways to strengthen our response to potential incidents, Fox and his team are adapting established laser technology. Lasers have been used in cleanup capacities for more than a decade. Dentists employ them, for example, to kill periodontal bacteria and quash mouth infections. Doctors use them to remove tattoos. And lasers have recently become a common way to restore precious artwork.
Laser technology can also scale up to perform large-scale decontamination jobs. Some cleanup and restoration firms, such as adapt laser system, are already using lasers to scrub soot off building facades. Further, these industrial operations often use automated lasers, demonstrating that laser work can be done remotely. This would minimize risks to remediation personnel responding to a terrorist attack.
Fox stresses that laser decontamination is a tool in the proof-of-principle stage, not a panacea. But this tool shows great promise, and Fox is happy to keep testing out its usefulness.
"I’m willing to shine my laser at anything," he says.
......................
Scott Farrar
84th Chemical Battalion |
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Stuff / Military Humor / What's the final product of this synthesis? |
on: Mar 9th, 2010, 12:27pm |
| Started by Roderick_Farrar | Last post by Roderick_Farrar |
What is the final product of this involved synthesis?
Ingredients:
1. 532.35 cm3 gluten
2. 4.9 cm3 NaHCO3
3. 4.9 cm3 refined halite
4. 236.6 cm3 partially hydrogenated tallow triglyceride
5. 177.45 cm3 crystalline C12H22O11
6. 177.45 cm3 unrefined C12H22O11
7. 4.9 cm3 methyl ether of protocatechuic aldehyde
8. Two calcium carbonate-encapsulated avian albumen-coated protein
9. 473.2 cm3 theobroma cacao
10. 236.6 cm3 de-encapsulated legume meats (sieve size #10)To a 2-L jacketed round reactor vessel (reactor #1) with an overall heat-transfer coefficient of about 100 Btu/F-ft2-hr add one, two, and three with constant agitation.
In a second 2-L reactor vessel with a radial flow impeller operating at 100 rpm add four, five, six, and seven until the mixture is homogeneous.
To reactor #2 add eight followed by three equal portions of the homogeneous mixture in reactor #1. Additionally, add nine and ten slowly with constant agitation. Care must be taken at this point in the reaction to control any temperature rise that may be the result of an exothermic reaction.
Using a screw extrude attached to a #4 nodulizer place the mixture piece-meal on a 316SS sheet (300 x 600 mm). Heat in a 460K oven for a period of time that is in agreement with Frank & Johnston's first order rate expression (see JACOS, 21, 55), or until golden brown.
Once the reaction is complete, place the sheet on a 25 deg. C heat-transfer table allowing the product to come to equilibrium.
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Stuff / Military Humor / chemical warfare instructor |
on: Mar 9th, 2010, 12:17pm |
| Started by Roderick_Farrar | Last post by Roderick_Farrar |
An instructor in chemical warfare asked soldiers in his class: "Anyone knows the formula for water?"
"Sure. That's easy," said one man.
"What is it?"
"H, I, J, K, L, M, N, O."
"What, what?" reasked the instructor.
"H to O," explained the chemistry expert.
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Medical CBRN/WMD Items of Interest / Medical WMD Items of Interest / Medical WMD Items of Interest wk of 28 Feb 10 |
on: Mar 9th, 2010, 11:49am |
| Started by Roderick_Farrar | Last post by Roderick_Farrar |
Courtesy of Dr Glen Reeves.
"To all,
1. Flu news: Avian influenza (H5N1): Five cases in Egypt were confirmed by the WHO yesterday (4 Mar). All five were from different areas, and all were exposed to sick or dead poultry. One 53 year old man is in critical condition, the rest (ages 1-30) are moderate or stable. Viet Nam has reported three cases, all three from different areas, and at least two exposed to sick or dead poultry or waterfowl. A 38 year old woman has died but the other two, ages 3 and 17, are recovering or have mild breathing difficulties. Case incidence/fatalities now stand at 486/287 as of 4 March.
Swine flu (H1N1): Generally subsiding in the Northern Hemisphere. Most flu cases this season have been from the pandemic H1N1 virus, not the seasonal strains; seasonal strain activity was in fact much lower than typical. FYI, the trivalent vaccine for the next flu season will include the A(H1N1) pandemic 2009 virus, an A(H3N2), and a B strain. The WHO expects that these three will co-circulate in the Northern Hemisphere with the likelihood that the pandemic A (H1N1) will predominate; the usual seasonal A (H1N1) strains are felt to be unlikely to circulate at significant levels.
2. CW mimic used in assassination?: Most of you have heard about the assassination of the reputed terrorist from Hamas, Mahmoud al-Mabhouh, in Dubai, by suffocation.
There apparently were no signs of resistance, as is normally the case in suffocation. A toxicological expert with the Dubai police stated that there were traces of the drug succinylcholine (Suxamethonium(r)) found in the victim. This drug is used to rapidly induce muscle relaxation in anesthesia and emergency care departments, often so the patient can be intubated and placed on respiratory support. (That wasn't the reason it was used here.) The drug is then degraded by plasma butylcholinesterase. Bonus trivia question: what CW agent effects do you think succinylcholine mimics? What might be the antidote?
3. Hantavirus: As mentioned before, hantaviruses are considered a Category C biologic terrorism agent by the CDC. One type, the Puumala virus found more frequently in Europe and Asia, causes hemorrhagic fever with renal syndrome. Because of the severe winter in parts of Russia, the mouse vector has moved indoors into dachas and other human habitations, causing a 90-fold increase in the disease in some regions compared to the seasonal incidence in previous years. In the southwestern US, the hantaviruses (there are several types) cause hantavirus pulmonary syndrome, again with a rodent (usually deer mouse) vector. A death was recorded in Weld County, CO; this was the fifth hantavirus infection ever recorded in this county. Both of these outbreaks are natural in origin.
4. Medical WMD Trivia: Several people identified the incapacitating BW agent as SEB (Staphylococcal enterotoxin B), which is elaborated (naturally!) by the Staphylococcus aureus bacillus and is relatively stable in aerosols, causing incapacitating symptoms at low doses in 80% or more of exposed personnel. Disability can last up to one or two weeks. Symptoms of inhaled SEB are abrupt onset of headache, chills and fever, myalgia, nonproductive cough, shortness of breath, and retrosternal (behind the breastbone) chest pain. (The gastrointestinal symptoms are nausea, vomiting, diarrhea, and cramping pain, of course!) With inhalation exposure, the fever may last 2-5 days and cough persist up to four weeks. So far there are no antitoxins or antibiotics effective against SEB. Congratulations to Pat Lofy, Eric Nelson, Elizabeth Hausner, Suzanne Burnham, and James Madsen! (Drs. Hausner and Burnham are vets; Dr. Madsen's patients, like mine, don't have fur or feathers.)
Dr. Madsen pointed out that SEB is a toxin. Toxins are "chemicals" produced by biological organisms but, as agents, are generally extracted from these organisms and then disseminated.
Accordingly they don't multiply in the body, they don't "infect" casualties, and they are not contagious. So which convention, biological or chemical, should it fall under? (That's not a "trivia" question either; these are the type of questions that give politicians from different countries room to maneuver/waffle and exempt their weapons while banning the other nations'.)
There are some general rules of thumb concerning the medical response, here decontamination, to chemical, biological, and radiological agents. Of the three CBR types (we'll lump radiation hazards from both radiological dispersal/exposure devices and nukes in the same category for now), which are contagious? (Easy!) Which poses the greatest hazard to first responders/first receivers if casualties aren't decontaminated? Decontamination is most effective with liberal amounts of soap and water for any of these, but dilute bleach (sodium hypochlorite) is used (assuming intact skin) may be used for which category? And finally, when you are performing decon which type most often requires you to collect the effluent rather than release it into the environment?
To your health,
Glen
Glen I. Reeves, MD
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Homeland Security / Emergency Response / TICPDE Training Helps Keep Servicemembers Safe |
on: Dec 30th, 2009, 11:43am |
| Started by Roderick_Farrar | Last post by Roderick_Farrar |
12/29/09. For the Article with photos, go to: http://www.dvidshub.net/?script=news/news_show.php&id=43255
CONTINGENCY OPERATING BASE BASRA, Iraq - Twelve soldiers and three sailors conducted a 10-day Toxic Industrial Chemical Protection and Detection Equipment (TICPDE) training exercise here recently. You never know what could pop up," said Army Capt. Leann Yi, 17th Fires Brigade Chemical, Biological, Radiological and Nuclear officer in charge. "In case of any sort of hazardous material, toxic industrial chemical [leak] from a lab or a chemical manufacturing company in our area of responsibility would require the assistance and expertise of this team."
According to Karen Kirkpatrick, a civilian instructor with the training team, the 80-hour course is the same training received by stateside emergency services personnel. This type of training usually is provided to military CBRN specialists prior to deployment. However, with the high operational tempo and the limited number of trained CBRN troops, it is sometimes the first time service members receive this training.
Trainees learn to inventory and operate all of the protection and detection equipment. They rehearse the roles each team will play when working in a hazardous material and toxic industrial chemical environment. Trainees first become familiar with operating their protective suits that are equipped with an independent air supply system.
"It was challenging being in the level 'A' suit. You have limited dexterity and limited visibility because of the condensation in the mask," said Army Sgt. 1st Class Michael Blackwood, a CBRN specialist with the 203rd Military Police Battalion.
Less than two days after the completion of training, Yi's team assisted an explosive ordnance disposal unit with the removal of a missile with 500 pounds of explosives from Basra city.
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Medical CBRN/WMD Items of Interest / Medical WMD Items of Interest / Medical WMD Items of Interest wk of 13 Dec 09 |
on: Dec 30th, 2009, 11:30am |
| Started by Roderick_Farrar | Last post by Roderick_Farrar |
In addition to Dr Glen Reeves articles below, While taking a break from World of Warcraft, I have stumbled across some CBRN relevant info that you might enjoy! Scott Farrar
1. Promising news below about the testing of Protexia, which is a recombinant version of human butyrylcholinesterase (BChE). Like Acetylcholinesterase, BCHE occurs naturally in our blood. The exciting part for CBRN Warriors is that it works as a natural "bioscavenger". BCHE in your blood can quickly absorb and degrade organo-phosphorus poisons ala nerve agents. Protexia is being developed as a pre- and post-exposure treatment for nerve agent exposure; that is-why wait until CBRN first responders have been exposed-you can pre-treat yourself to minimize damage! The article described in link below is a VERY GOOD synopsis of the animal and human testing protocol which is progressing with no noted human problems!
"PharmAthene Presents Phase I Clinical Trial Results and New Therapeutic Animal Model Data for Protexia(R)" ANNAPOLIS, Md., Dec. 7 /PRNewswire-FirstCall/
-- PharmAthene, Inc. (NYSE Amex: PIP), a biodefense company developing medical countermeasures against biological and chemical threats, today announced Phase I clinical trial results for Protexia®, a pegylated recombinant version of human butyrylcholinesterase (rBChE), which has been shown to be effective in animal models in preventing toxicity from exposure to chemical nerve agents.
For the complete article go to http://www.prnewswire.com/news-releases/pharmathene-presents-phase-i-cli nical-trial-results-and-new-therapeutic-animal-model-data-for-protexiar-78678252.html
2. American children in South Korea get new protective masks, By Jon Rabiroff, Stars and Stripes Pacific edition, Wednesday, December 23, 2009. "Infant-child Chemical Agent Protection System? Yes, the continuing threat of attack from North Korea makes for some unique provisions U.S. servicemembers and their families must keep on hand when living in South Korea. "It's just a [matter of] preparation," said Army Capt. Allan Garcia, the 2nd Infantry Division's chemical, biological, radiological and nuclear operations officer. "You just never know what the capability . is of [North Korea]." In hopes of making things a little easier in the event of a chemical attack, 2nd ID officials this month are requiring soldiers with children living in South Korea to pick up new child-friendly protective masks....." Article at http://www.stripes.com/article.asp?section=104&article=66815
Here's Dr Reeves WMD Medical Update!
1. First case of Marburg VHF in US:
No cause for immediate worry; it occurred two years ago when a woman from Colorado traveled to Uganda for a two-week safari, which included a trip to the Python Cave, where bats roost. Upon her return to the US, she developed an unexplained febrile illness requiring hospitalization. She had taken antimalarial prophylaxis. Upon development of diarrhea she self-administered ciprofloxacin, but developed a diffuse rash and stopped. Testing of early convalescent serum demonstrated no evidence of VHF or other infection. She was diagnosed as having acute hepatitis with nausea and vomiting of unknown etiology. She was treated with doxycycline for possible leptospirosis. She was discharged but had a slow recovery over a one year period because of persistent abdominal pain, fatigue, and "mental fog." Six months later she heard of a fatal case of Marburg VHF in a Dutch tourist who had visited the same cave. She requested repeat testing, and this time was shown to have RNA fragments of Marburg virus (though reverse-transcriptase polymerase chain reaction (RT-PCR) testing was negative, and real-time RT-PCR testing was equivocal. None of six of her tour companions had evidence of prior Marburg viral infection. Although cases of arenavirus VHF (Lassa) have been imported into the US, this is the first ever case of a filovirus (Ebola, Marburg) VHF infection reported.
Moral of the story: not everyone exposed to a VHF virus contracts the disease. Moral number two: beware of fruit bats bearing VHF, and don't crawl around in their roosting areas (not a problem in North America that I know of).
Trivia question from the story: the patient self-administered ciprofloxacin for her illness, and was prescribed doxycycline. Both of these medications are effective in treatment and/or prophylaxis in other WMD exposures. What are they?
2. Flu news:
Avian influenza (H5N1): A man in Vietnam contracted HPAI last month and died, bringing the WHO case/fatality numbers to 445/263 as of 11 December. He had been exposed to poultry in the home. Results of the investigation are still pending.
Swine flu (2009 H1N1): The good news is that flu activity in the US continues to decline. The bad news is that the possibility of a third wave (US) or a second wave (Ukraine) of increased swine flu cases exists, according to the respective secretary/minister of health in these countries. In a UK report on several studies it was shown that neuraminidase inhibitors (oseltamivir, zanamivir) have only slightly over 60% effectiveness in treating laboratory confirmed influenza and little or none in asymptomatic influenza. They also did not reduce the rate of infection of the lower respiratory tract. The reason may be that this type of drug (neuraminidase inhibitors) binds to the virus and prevents attachment to the cells and adsorption; once the virus is adsorbed the drugs have no effect. Principal factors predisposing patients to severe lower respiratory tract infection are asthma (and presumably other chronic pulmonary diseases) and, less so, obesity. (Not sure what the mechanism is for the latter factor.)
A possible bit of good news: a Canadian randomized trial of N95 respirators vs. ordinary surgical face masks conducted in nurses providing care to patients with febrile respiratory illnesses showed the incidence of laboratory-confirmed flu was similar (23%) in both news. Since surgical masks are cheaper and easier to fit, that's good news. The bad news is that the researchers describe a "distressingly low acceptance of flu vaccination by healthcare workers" (only around 30%).
3. Medical WMD Trivia Question:
The three CW weapons (mustard, lewisite, arsine) found in DC that are slated for destruction next year have some things in common, but several differences. Lewisite is immediately irritating to the skin, eyes, and airways; mustard causes these symptoms hours after exposure (depending upon quantity and route), while arsine is non-irritating. (Instead it is rapidly absorbed into the blood stream where it can cause hemolysis and resultant kidney destruction, hypoxia, and cell membrane destruction. Most organs are eventually affected.) Both lewisite and arsine contain arsenic. The former is considered an organic arsenical, the latter is arsenic hydride.) Lewisite is the only one that has a specific countermeasure, mercaptrol or British Anti-Lewisite, which works as a chelating agent. Only mustard has actually been used in wartime, accidentally in WWII and intentionally in WWI and the Iran-Iraq war in the 1980s. The former Soviet Union had a binary CW weapon consisting of sulfur mustard and lewisite but never used it. Congratulations to Kate Hooten for getting the answers to this question!
Embedded into the paragraph on chelation decorporation of cobalt and polonium was a question on what chelating agents are actually in the Strategic National Stockpile (administered by the CDC) and what incorporated isotopes are they used against. The answers are calcium and zinc diethylenetriaminepentaacetic acid (a.k.a. DTPA), which is useful against transuranic isotopes (primarily plutonium and americium), and Prussian blue, which is useful against cesium and thallium. (There's an artist pigment called Prussian blue; make sure you use the medicinal version!) Congratulations to Dr. John Lanza for getting this!
Interestingly, I read an article in the press (UK Guardian) this week implying that the former president of Chile (Frei Montalva) had been poisoned with multiple injections of medicines containing. Six men have been charged with murder or accomplice to murder. The person actually suspected of administering the poison was murdered in Uruguay some time ago. He was a chemist who had reportedly done work for the Pinochet regime on anthrax, sarin, and botulinum toxin.
This will be the last Medical WMD Items of Interest letter this year. I will try to write the next one the first week in January (but not New Year's Day!) Have a Merry Christmas and a Happy and WMD-free New Year!
Glen
Glen I. Reeves, MD
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Medical CBRN/WMD Items of Interest / Medical WMD Items of Interest / Medical WMD Items of Interest wk of 15 Nov 2009 |
on: Nov 23rd, 2009, 2:32pm |
| Started by Roderick_Farrar | Last post by Roderick_Farrar |
[Courtesy of Dr Glen Reeves MD]
1. Emergency responders guidance: OSHA has just published a handbook on best practices for protecting EMS (emergency medical service) responders to all incidents, including WMD. This is of particular pertinence to those responding to RDD (radiological dispersal device), IND (improvised nuclear device in this context, not "investigational new drug"), or chemical agent releases, as these incidents rapidly produce casualties, requiring EMS response. The handbook covers how to detect hazardous materials (but does mention there is no ideal single detector for CB agents) and describes the type of personal protective equipment (PPE) to use. If responding to an incident where the hazard is unknown, Level A PPE with SCBA (complete respiratory protection) is used; if no skin hazard is suspected, Level B PPE with SCBA is OK. Both offer similar respiratory protection. In review of chemical incidents to date, they found that when responders were injured by chemicals this was due to liquid or solid spills in 30% of the incidents, while vapor (inhalation) caused 67% of the injuries. The most common adverse symptoms reported were respiratory related, followed by dizziness. Of course, for BW agents (aside from ricin injection or botulism inhalation) the release is usually surreptitious and the time to awareness of illness or injury hours or days, so emergency responders aren't usually called out for these incidents. (But see trivia question below.) This is an important book for those involved in emergency incident response. Click on http://osha.gov/Publications/OSHA3370-protecting-EMS-respondersSM.pdf for your personal copy of the OSHA EMS handbook.
2. Flu news: Avian influenza (H5N1 HPAI): The WHO has just today confirmed a case of H5N1 avian-origin influenza in a 21 year old Egyptian male. He had been exposed to sick poultry. He became symptomatic (fever, cough, difficulty breathing) on 11 Nov and was admitted to the hospital and started on Tamiflu® the 15th. Currently he is stable. This raises the WHO case/fatality numbers to 443/262, the first increase since 24 Sep.
Swine flu (2009 H1N1): The State of Virginia reported that a 14-year-old boy may have contracted Guillain-Barre Syndrome (GBS). He became ill about 18 hours post vaccination for swine flu. GBS is an acute, usually rapidly progressive neurological disease characterized by ascending (usually starts in legs, goes up to arms) flaccid paralysis and mild distal sensory loss. Unfortunately the weakness affects the muscles of respiration, and prompt aggressive medical treatment is needed. It is thought to be autoimmune in nature; i.e. the body develops an inflammatory response against its own tissues, here the nervous system. It can start after an otherwise trivial infectious disorder, surgery, or vaccination, as happened in the swine flu vaccination program in 1976. Approximately one additional case of GBS per 100,000 people vaccinated were noted then. Normally about one excess case per million vaccinations have been noted in other seasonal influenza vaccination programs. So far this season five other cases of GBS post vaccination have been reported to the CDC; about 40 million doses of swine flu vaccine have been administered. Bottom line: the risks from influenza still far outweigh those from the vaccine, particularly if you are pregnant, over 65, under 5, under 19 and regularly taking aspirin, or any age with certain underlying chronic diseases.
3. Ricin antidote: The UK Defence Science and Technology Laboratory (Dstl) has developed an antidote against ricin that may be effective up to 24 hours post exposure. It should be out in a couple of years. As mentioned before, Georgi Markov, a Bulgarian dissident, was murdered in 1978 when an assailant used an umbrella to inject a ricin-containing pellet into his leg. He developed high fever and severe gastroenteritis and died three days later.
4. Medical WMD Trivia: Congratulations to Drs. Paul Blake, Larry Karch, Gene Nelson, and Byron Ristvet for providing not only the answers but several instructive comments to last week's Medical WMD Trivia question. Immediately after a nuclear device is detonated, activation products are generated from neutron activation of the bomb materials and surrounding environment. The half-lives of these products are generally much shorter than those of fission products. One major exception is cobalt-60, created from activation of cobalt-59 (naturally found in soil and other materials) which decays to stable nickel-60 by emitting two high-energy gamma rays (1.17 and 1.33 MeV) in the process. Half-life is 5.26 years (I had to know this for my boards! Cobalt machines used to be a mainstay of radiation teletherapy treatment, but linear accelerators are used nowadays.) Fission products are much more numerous than activation products and have as a rule longer half-lives. The two long-lived isotopes associated with cancer and chronic radiation sickness in the Techa River region of Russia, downstream from the Mayak (Plutonium) Production Association, are cesium-137 (half life slightly over 30 years) and strontium-90 (half-life almost 29 years). Cesium is used in intracavitary implants for treatment of cancer of the uterus. It emits a gamma ray of 0.66 MeV. Strontium-90 produces a beta particle and is used in the postoperative treatment of pterygia (Greek pterygion, "wing-like"), which are non-malignant growths of the conjunctiva that sometimes extend over the iris and pupil, interfering with vision. The strontium-90 applicator gives a high dose to the conjunctival bed to prevent recurrence post surgical removal, but the dose to the lens of the eye is low, as the intervening cornea and lens chamber absorb most of the radiation. However, the beta particles do go up to 30 feet or more in air. I know this because another radiation oncology resident and myself performed an experiment to see if a G-M counter that far away could pick up the radiation when the strontium-90 applicator was removed from its shielding; it can. (In retrospect I should have talked Bob Baglan into holding the G-M counter while I pointed the applicator at him/it, instead of vice versa.) After Chernobyl radioactive iodines caused thousands of thyroid cancers in children. Fortunately only ten or so (maybe more by now) persons have died from this. However, the half-life of iodine-131 is only around eight days, so the major long-term hazard now is cesium.
Note that when you add the isotope numbers (137 plus 90, 131 plus 90, etc.) you get sums near 235 and 239, which are the isotope numbers for weapon fuel uranium and plutonium respectively (minus a few neutrons). When you plot the amounts of each fission product vs. its isotope number, you get two peaks around 89 and 135 with a dip in between; this is a biphasic curve, not a normal distribution like I would naively suspect. Thanks to Dr. Byron Ristvet for pointing this out. Dr. Paul Blake mentioned that besides fission products and activation products there is an exposure risk from actinides (e.g. U, Pu), though this is much less than that from the first two. Dr. Larry Karch mentioned that first responders and casualties are overall more at risk from fission products than activation products, particularly the farther you get from ground zero. They are also at risk from inhalation products, which would include the actinides. The good news is that activation products, although generating a lot of decay gammas initially, rapidly decrease in intensity and shrink the "danger zones" for first responders.
Expanding upon the risks to first responders: as stated in the first paragraph, emergency responders usually aren't called out to biological incidents. When they are, however, what do you suppose the greatest route of transmission of infectious agent from the casualty to the first responder is? (Hint: the answer is in the OSHA handbook cited above!)
To your health,
Glen
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