PBHE427 Epidemiology

Question

Answer

Botulism is a rare but serious illness caused by a toxin that causes severe morbidity and even mortality. Botulism has drawn attention in the recent past as a potential tool for bioterrorism that aims to cause mass mortality when applied on a large scale (Jansen et al., 2014). The present paper discusses botulism and describes the agents of the disease, the ways in which it might be used for bioterrorism and examples of terrorist events using this particular agent. Further, the implications for advance practice nurse APRN practice is highlighted that can be applied for encountering an individual or community affected by this disease. In addition, emergency and longer-term concerns along with recommended interventions are also pointed out.

The causative agent of Botulism in the toxin made by Clostridium botulinum and sometimes Clostridium butyricum and Clostridium baratii bacteria. These bacteria are present in a number of sources; however, they are not common to cause disease conditions. Under certain circumstances, the spores of the bacteria grow and secrete toxins that are lethal. The toxin acts in the body by attacking the nerves, thereby making the muscles weak. Muscles that are responsible for controlling the mouth, face, throat and eyes are mainly affected. Botulism also weakens the muscles involved in breathing. As a result, the individual suffers difficulty in breathing and might eventually die (cdc.gov, 2017).

Botulism and bioterrorism have been linked by a rich pool of literature in the recent few years as botulism toxin is a potential biological agent for destruction (Jansen et al., 2014). After the 9/11 attack in the US, the possibility of using biological agents by terrorists have been in prominence. The toxin had always been on the list of important bioweapon candidate agents. The reason for this is the high levels of toxicity that it presents. The bioterrorists find the toxin agent convenient to use since the bacteria can be grown in an easy manner. In addition, the toxin can be produced in large quantities rapidly. This is why it is a significant candidate for the bioterrorist's arsenal. As opined by Adler and Franz (2016) the agent has received much public attention after investigators found a vial of the bacteria in Iraq after the demise of Saddam Hussein. In 1991, after the end of the Gulf War, the country had put forward a claim that they had produced huge quantities of the toxin. If such were the case, it would have been adequate to kill the entire human population on earth.

Literature points out that nurses have a significant role in the multidisciplinary team who is supposed to care for a patient receiving treatment for botulism. Nurses are to be prepared further through training and education so that they can handle situations of crisis in a more advanced and effective manner. The common response received from study participants in due course of research is that since nurses are to spend a considerable amount of time with the patients, they are in a position to assess the patient condition in a better manner and deliver best interventions. Nurses also play a role in guiding patients with different forms of exercise that patients can benefit from (Keller et al., 2017).  Nurses are involved in the care process at the initial stages and therefor are able to identify the impairments of the patient and the issues that are faced by the wider community.

The use of botulinum toxin as a biological weapon mainly occurs by aerosolization, and through intentional contamination of food and water supplies. Patients are to be managed through standard precautions (Weant et al., 2014). Health care professionals, including nurses, are to undertake needs assessment for defining complications that arise due to botulism. Interventional opportunities would come up on the basis of such assessment. For having a substantial impact on the community, interventional strategies must be planned and based on best evidence. These are also to be complementary, comprehensive and reinforcing (Jansen et al., 2014).

References

Adler, M., & Franz, D. R. (2016). Toxicity of Botulinum Neurotoxin by Inhalation: Implications in Bioterrorism. In Aerobiology (pp. 167-185).

Botulism (2017). Cdc.gov. Retrieved 9 November 2017, from https://www.cdc.gov/botulism/

Jansen, H. J., Breeveld, F. J., Stijnis, C., & Grobusch, M. P. (2014). Biological warfare, bioterrorism, and biocrime. Clinical Microbiology and Infection, 20(6), 488-496.

Keller, J., Cover, K., Snider, A., Buckley, M. L., & Lutmerding, M. R. (2017). Central Ohio’s Regional Response to the Largest Botulism Outbreak in 30 Years. Prehospital and Disaster Medicine, 32(S1), S52-S53.

Weant, K. A., Bailey, A. M., Fleishaker, E. L., & Justice, S. B. (2014). Being prepared: bioterrorism and mass prophylaxis: Part II. Advanced emergency nursing journal, 36(4), 307-317.