ANTI-EPIDEMIC MEASURES AT THE LIQUIDATION OF BIOLOGICAL TERRORIST ATTACK CONSEQUENCES
N. N. Golovchenko, L.M. Korotkin*
FU "Medbioextrem" for Ministry of Health, * JSC "Biopreparat"
Escalation of terrorist activity, taking place in the last decade in many regions of the Globe, forced the World Community to consolidate the efforts in order to prevent the possibility of falling into the hands of terrorists of mass destruction weapon. After aviation attack to the building of World Trade Center in New York and the events of the delivery by post of anthrax spores on the territory of USA, it has become apparent, that the policy of dual standards, flirting with International terrorism, the attempts to use it in own interests are fraught with serious errors and problems in future.
Today, the problems of biological terrorism worry the US and all World Community no less than nuclear terrorism. Although as a result of post attack in US, only 5 people died, more than 100 millions of dollars have been spent to reveal the origin and to liquidate the after-effects. Psychological effect of anthrax delivery surpassed all scenarios predicted.
To the great extent, the possibility to reduce material and moral losses as a result of terrorist attacks depends on the availability in the country of the united state system of the prevention and liquidation of the emergency situations of natural and technogenic character. One of the components of the system is specialized units of different level, trained for the implementation of anti-epidemiological measures, directed to the localization of biological contamination hotbeds and liquidation of bio-terrorist attack after-effects.
The hotbed of biological contamination is a territory subjected to the direct effect of BWA, that create the danger of infectious disease proliferation. The hotbed can effect during the period of the BWA life in the environment and with the existing infected patients, exposing the danger for the social surroundings.
Peculiarities of the contamination hotbed at biological effect will be the following:
- mass infection of people (mainly by aerogenic way or through gastrointestinal tract ), formation of the multiple hotbeds as a result of the pathogen transfer mechanism activation;
- significant duration of the infectious effect of the infection sources; absence of the population protection from the contact with the infected patients and the environment, that are the source of the infection.
The peculiarities listed, define the specificity for the organization of anti-epidemic measures at the localization and liquidation of epidemic hotbed. As a whole, these measures do not differ from those, that have been performing in case of coming especially dangerous infectious diseases to the territory of Russia.
A complex of anti-epidemic measures includes:
Sanitary- epidemiological reconnaissance (inspection) and specific indication in the hotbed, that should be performed immediately after the receiving of the information about bio-terrorism attack. Group for sanitary-epidemiological reconnaissance includes: epidemiologist, specialist on infections, assistant of epidemiologist (bacteriologist- lab assistant), medical orderly (if necessary, the group will include zoologist or parasitologist).
Sanitary-epidemiological reconnaissance provides the solution of the several problems:
Firstly, to clear up the reasons of the specific disease origin- sources of the infection (determination of the location and signs of the bio-terrorism attack), the ways of the infection transfer and all factors promoting to the infestation.
Secondly, determination of the possibility for further proliferation of the infection, hotbed boundaries (environmental objects, that could be contaminated, revealing of the persons subjected to the infestation0, the sampling for laboratory investigation.
Thirdly, compilation of the plan and later on, the realization of measures for rapid localization and liquidation of the disease hotbed.
Sanitary-epidemiological reconnaissance should result in the following:
- revealing of the patients and persons, suspected to the specific disease, their isolation and hospitalization;
- deployment of infectious hospitals, isolators, observators, etc.;
- organization of the infectious patient curing;
- revealing of the persons subjected to the risk of infection and carrying out the prophylactic measures to them;
- performance of disinfection-deratization measures;
- introduction of the regime-limitation measures.
Timely, full and qualitative performance of measures listed above, will allow to localize the hotbed, to minimize irretrievable, sanitary losses and material damage. All measures in the hotbed are to be performed in close cooperation with the organs and institutions of MVD, FSB, MCHS, administration of the institutions, organs of self-government.
Sanitary-epidemiological reconnaissance is considered completed after the comprehensive solution of all tasks set.
After sanitary-epidemiological reconnaissance, epidemiological observation should be performed for the hotbed till its closing. Epidemiological observation is a constituent part of the sanitary-epidemiological reconnaissance.
Indication of BWA should be performed according to the single scheme. It should provide two mutually complementary stages of the study:
- analysis of native materials from the zone of destruction, using rapid methods;
- the study of the same materials by the same methods after the preliminary biological proliferation (growing).
Using of this scheme of indication provides simultaneous study of the large number of the samples and the receiving results in a short period of time. When the information about the biological agent applied is not available, each sample is to be studied for a large number of pathogens of the especially dangerous diseases included in the list. When the information of the biological agent applied is available, purposeful study is to be performed according to the scheme for this agent.
Total supervision for the measures in epidemiological hotbed is accomplished by sanitary-anti-epidemiological committee (SAC). The committee is set up by the decision made by administration of the territory (region, city, land, republic). SAC is headed by the Head of Administration or its deputy. Chief sanitary physician on administration territory is appointed as Deputy of SAC chairman. SAC is formed by the members of territorial organs and institutions of healthcare , MVD, MCHS, FSB, transport service, military units, trade, agriculture, pharmacy, etc. In order to organize the works in the hotbed , the Head of hotbed is appointed by decision of SAC. Anti-epidemiological headquarters is established for the Head of the hotbed and the Head of headquarters is appointed. The following groups are established for the headquarters:
- sanitary-epidemiological reconnaissance ;
- observation for the observance of anti-epidemiological regime and the requirements to biological safety;
- medical observation for the population;
- pathologo-anatomical, etc.
Number of the groups and specialists is determined by specific situation
and depends on the volume of works resulted of the outbreak. Supervisors of
the groups are the members of anti-epidemiological headquarters.
SAC is constantly functioning organ and its decisions are obligatory for the execution by all organs, institutions and citizens of the administrative territory, irrespective of the forms of property and departmental affiliation.
Taking into account, that practically every infectious disease begins with the rise of the temperature, this fact is of paramount importance for the revealing of the patients and persons with the suspicion to the infectious disease. The attention should be paid to the state of visible mucous and skin integument. At the same time, it is necessary to bear in mind that cholera in most case does not cause the rise of temperature. In this case it is necessary to reveal the persons with intestine dysfunction.
For the hospitalization of patients, suspected to specific disease and contacting with them, the hospital for patients, provisory hospital and isolator are deployed. Persons with the established diagnosis to specific disease are to be hospitalized to hospital for patients. Persons with the suspicion to the specific infectious disease are to be hospitalized to the provisory hospital. Persons contacting with the patient or with the material, suspicious for the content of the pathogen of the specific infectious disease are to be hospitalized into the isolator.
Necessarily, the observator is deployed for hospitalization and observation of the persons who needs to leave the hotbed boundaries. The observation has been performing during maximal incubation period.
Regime of work for each institution is determined by its purpose and pathogen properties. As a rule, barrack location is implemented for the employees of hospital for the patients, provisory hospital working in plague hotbed, smallpox and other contagious especially hazard infections. Personnel of hospitals, isolator and observator should be under constant medical observation.
As a rule, at biological terrorist attack the infection of the population occurs with large doses of the pathogen, therefore first of all is necessary to perform rapid prophylactic curing with antibiotics or other preparations with etiotropic effect. At the determination of the pathogen type, specific active or passive immunization should be performed (vaccines, anatoxins, serum, immune globulin). With the aim of rising non-specific resistance of an organism, enhancement of the protective effect of the rapid and specific prophylactic measures, the preparations with immune-correcting effect should be used. In the first place, rapid prophylaxis should be made for the persons of risk group, contacting with the patients and also for the specialists of the formations, engaged in the implementation of the measures on the localization and liquidation of the hotbed.
Timely and proper disinfection, disinsectization, and deratization that should be performed by specially trained brigades with the application of permitted means and methods plays an important role in the complex of anti-epidemiological measures directed to the localization and liquidation of epidemiological hotbed. Order and volume for the performance of these measures depend on current epidemiological situation and pathogen properties.
In case of infectious disease proliferation threat outside of the epidemiological hotbed, by SAC decision, regime-limitation measures should be introduced- quarantine or observation.
Quarantine- the isolation for the specified period for the persons being in epidemiological hotbed, and the discontinuation of the contact with the territory adjacent to the hotbed. Quarantine provides:
- full isolation of epidemiological hotbed with the armed guard;
- strict control of the entrance and exit for the population and stores from quarantine zone;
- a ban for transit passage through the hotbed;
- observation of the persons going out from quarantine zone;
- active revealing of patients, their hospitalization and curing;
- limitation of communication between different groups of the population in the hotbed ;
- performance of the required anti-epidemiological, prophylactic, sanitary-hygienic, epizootological and other measures;
- performance of rapid and specific prophylaxis;
- performance of the sanitary-explanatory work, etc.
In some cases, the quarantine can be substituted to the observation, that also foresees the performance of the same measures as in quarantine, except the guard and observation of the persons, going out from the hotbed.
Introduction of quarantine should be accompanied by simultaneous introduction
of observation regime in all administrative territories adjacent with quarantine
zone. The guarding of quarantine territory is provided by the forces and means
of Ministry of Internal Affairs of Russia. In case of need, the subdivisions
of the Ministry of Defense of Russia are engaged. In order to provide the
control at the exit of the hotbed for the population and transport of cargo,
control-passage points (CPP) are deployed. CPP include sanitary-control points
(SCP). SCP should be deployed by the forces of healthcare institutions with
the obligatory availability of the isolator. Rights, duties and volume of
the measures performed by SCP should be specified by the "Statute of
Medical and prophylactic institutions, sanitary-epidemiological service institutions and the formations, engaged in the localization and liquidation of the epidemiological hotbed are subjected to the special regime of work, that can include:
- barrack location for the specialists of individual subdivisions;
- using of the adequate individual protection means;
- performance of disinfections measures in the places of mass accumulation of people.
Closing of epidemiological hotbed is accomplished by the order of SAC, not earlier than the expiration of the incubation period of the disease. This period is determined from the moment of the isolation for the last patient and after the performance of the final disinfections. The corresponding act should be complied.
||Proceedings of First
Russian Workshop on Biological Security
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