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PUBHEPI 2410 Epidemiology

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1.Smallpox is a disease that is no longer around. There is not been a documented case of smallpox since 1977. It is concerning of the possibility that if someone had a portion of the virus that could be released harming people.There are many stages of smallpox including incubation period, initial symptoms, early rash, pustular rash and scabs, sloughing of scabs and absence of scabs. During the incubation period people are not contagious and this would be similar to the period When someone had received a vaccination. Initial symptoms would be similar to flulike symptoms with fever and body aches. This only lasts for a couple days. The early rash stage lasts about four days and is the most contagious portion of the infection. The rash starts with small spots on the tongue and mouth which eventually change into sores. From the mouth that spreads to the skin throughout the face and down the body this portion usually takes 24 hours for spread. Of this phase the sores fill with fluid. This leads to the pustular rash which becomes scabs and continues to be contagious. This will last for about 10 days. 

It's unlikely to be used as a biological attack but still a possibility. It would be useful for advanced practice nurses to be aware that there is a vaccination for this disease. Should an outbreak occur individuals that were exposed would need vaccinated. Also possibly choosing to be vaccinated ahead of time would be beneficial in being able to provide care in the event there was an outbreak and remain healthy, though this is not something routinely offered. After receiving this vaccination, you do need to be quarantined for up to 18 days. You are monitored for fever and symptoms of smallpox after receiving the vaccination. This is not a vaccination that is routinely given but rather to some people in the military and those that actively research smallpox. As healthcare providers APRNs may be in the front line for vaccination if an outbreak occurred to assist in helping care for those that are infected and because caring for the ill will also increase exposure. Also being aware of what the disease looks like and progresses, so it can be promtly reported is important as an APRN.

2.Ricin, a category B bioterrorism agent is found naturally in castor beans. Ricin can be derived from the end waste of castor beans during the process of making castor oil. Ricin can be in the form of powder, pellet or mist. Ricin is tasteless, odorless and can be a resilient substance that under harsh temperatures. An amount as small as 500ug inhaled or injected can kill an adult. After exposure of Ricin either through inhalation, ingestion or injection death can occur within 36-72 hours. Signs and symptoms of Ricin poisoning are dependent on the mode of exposure. Currently there isn't an antidote for Ricin poisoning (CDC, 2015).

In this time and age, bioterrorism remains a topic of much discussion and importance. Adequate preparedness and interventions play a key role in preventing outbreaks of bioterrorism agents. The APRN may encounter a case of Ricin poisoning in the emergency department and should be prepared to adequately detect and treat the symptoms associated with exposure. Proper identification of the agent in a timely matter is crucial to the containment of a possible outbreak. The APRN should be familiar with policies and procedures in place in an event of a bioterrorism attack.
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