Unit 5– Infectious Biological Agents

This lesson will provide an introduction to infectious biological agents. The lesson will focus on performing
biological risk assessment, including recognizing routes of infection, pathogenicity and risk group
identification. We will cover the basics of Biosafety including practices, procedures, specialized facilities,
and safety equipment to mitigate risk from infectious agents. By the end of this unit students will be able to:

• Classify biohazards into the appropriate risk group categories

• Understand the regulations related to infectious biological agents
• Recognizing and evaluating the risks of infectious biological agents
• Recommend and implement controls in the workplace to prevent exposure to biohazards
• Understand the role of the immune system

Microorganisms

Biological agents that can cause infections and diseases include bacteria, viruses, insects, plants, birds,
animals, and humans. These agents are responsible for a range of health effect ranging from skin irritation
and allergies to infections (e.g. tuberculosis, AIDS), cancer and even death.

Before SARS-CoV-2, the novel coronavirus that causes COVID-19, when we thought about workplaces
where human pathogens or toxins are handled or stored, we thought of public health laboratories, teaching
and research laboratories, diagnostic laboratories in hospitals, and vaccine production plants. We also
considered workplaces, where someone may be exposed to infectious biological material, including
healthcare related front-line roles like nurses, doctors, paramedics, and diagnostic laboratories. Rarely do
we consider that an infectious agent would be carried by another animal or vector and may be transmitted
to people.

COVID-19 has drastically changed the way we think about exposure and transmission of infectious disease.
The public has had a crash course in virology, virus transmission and pathogenicity. Public spaces and
workplaces have become potential environments for exposure. It has also increased awareness regarding
zoonotic diseases.

□ Watch - Microorganisms
Regulation of Biohazards

Health Canada is responsible for helping Canadians maintain and improve their health. The Public Health
Agency of Canada (PHAC) has been created to deliver on the Government of Canada’s commitment to
helping protect the health and safety of all Canadians. Its activities focus on preventing chronic diseases,
like cancer and heart disease, preventing injuries and responding to public health emergencies and
infectious disease outbreaks.

The Canadian Food Inspection Agency (CFIA) provides regulations that protect Canadians from
preventable health risks related to food and zoonotic diseases.

Pathogenicity, Virulence & Evaluating Toxicity

Pathogenicity is defined as the absolute ability of an infectious agent to cause disease/damage in a host.
An infectious agent is either pathogenic or not. Pathogens can adversely affect human health in a variety of
ways, ranging from relatively mild, allergic reactions to serious medical conditions, even death.

Virulence is the ability of a pathogen or microbe to infect or damage a host.

Some factors to consider:

• Length of the illness/disease associated with the infectious agent in humans and animals
• Symptoms of the disease, including severity and prevalence
• The mortality rate of the disease
• Variations of the disease and clinical presentations
• Predisposing factors – list of conditions or cofactors that may predispose to infection, disease, or
more severe disease (e.g. pregnancy, immune status)
Classification of Biohazards

The classification system is based on whether:

• The agent is pathogenic to humans

• The agent is transmissible to the community
• There is effective treatment or prophylaxis available

Risk to
Community

Risk Group
Classification

Risk to Individual
Pathogen Safety Data Sheets (PSDSs) are technical documents that describe the hazardous properties of a
human pathogen and provide recommendations for work involving these agents in a laboratory setting.
These are great source of information about infectious agents.
Route of Exposure and Transmission

Routes of transmission describes the various ways in which the infectious agent ca be transmitted from
one host to another

• Ingestion
• Injection (including vectors)
• Inhalation (airborne or aerosols)
• Absorption (mucous membrane/skin contact)

Infection via droplets or particles in the air

Droplet and airborne infections are part of the direct transmission path, occurring via infected humans or
animals. Pathogenic droplets that are produced during speaking, sneezing or coughing reach the mucous
membranes of the upper respiratory tract, where they propagate. The larger droplets can only travel short
distances while some small particles may remain suspended in the air for longer. Coronaviruses and
influenza viruses are transmitted this way and why mandatory masks have been implemented to prevent
transmission.

Contact infection

Pathogens are transmitted directly or indirectly, primarily via hands. Direct contact transmission occurs
when there is direct physical (or sexual) contact between an infected person or animal and a non-infected
person. There is no intermediate host. Herpes simplex virus (HSV), which causes herpes on lips, uses this
path to infect the host. Indirect contact infection occurs between a non-infected person and the
environment, for example, objects. The pathogens reach the host, for instance, via open wounds or
mucous membranes. One form of indirect contact infection is the fecal-oral route (i.e. via the excretions of
infected persons). One example of this transmission path is the norovirus, which may lead to severe
diarrhea.

Infection via blood and tissue

The transmission of pathogens from the environment to humans is referred to as indirect contact infection,
e.g. via needle stick injuries. Hepatitis B, for instance, is passed on in this way. However, disease-causing
microorganisms may also be transmitted via body secretions, e.g. saliva, sweat, pus, or semen. HIV, for
example, is transmitted through sexual contact.

Infection via contaminated water and food

Indirect contact transmission occurs when there is no direct contact between carriers or infection and
newly infected persons, for example, via contaminated water or contaminated food. The cause of typhus,
Salmonella typhi, is transmitted this way. Another example is the bacterium Vibrio cholera, the cause of
cholera disease.
Zoonotic Diseases

Zoonosis refers to diseases that can be passed between animals and humans. They are sometimes called
zoonotic diseases. Animals can carry harmful germs, such as bacteria, fungi, parasites, and viruses. These
are then shared with humans and cause illness. Zoonotic diseases range from mild to severe, and some
can even be fatal. SARS-CoV-2 is a zoonotic disease and is suspected to have originated from the human
consumption of contaminated animal meat.

Before the introduction of new hygiene regulations around 100 years ago, zoonotic diseases such as bovine
tuberculosis, bubonic plague, and glanders caused millions of deaths. They are still a major problem in
developing countries.

Common ways people can get infected with germs that can cause zoonotic diseases to include:

• Direct contact: coming into contact with the saliva, blood, urine, nasal secretions, feces or other
body fluids of an infected animal. Examples include petting or touching animals, and bites or
scratches
• Indirect contact: coming into contact with areas where animals live and roam, or objects or
surfaces that have been contaminated with germs
• Vectorborne: being bitten by mosquito, tick, flea, or another vector
• Foodborne: from eating contaminated food

Infectious dose

Some pathogens require very few infectious particles to cause infections while others require a large
number of infectious particles to cause infections. A pathogen’s infectious dose (ID) is one of many factors
that are considered when a biological hazard analysis is performed.

The infectious dose is the number of organisms or concentration of organisms required to cause disease
(typically ID50) – to cause infection in 50% exposure to that dose) in the natural host(s). For example, Ebola
is highly infectious and it is believed that the ID50 is only a few virus particles.
Immune System Protection

The immune system is constantly working to protect the body from infection, injury, and disease. The
immune system must recognize foreign invaders and abnormal cells such as viruses, bacteria, parasites,
mod, allergens and cancer cells distinguish them from the body’s healthy cells. Autoimmune diseases
happen when the body mounts an immune response against its own tissues instead of a foreign invader.
Allergies occur when an individual’s immune system reacts to substances in the environment that are
tolerated by most people. In some cases, immunization/vaccines are available to offer increased immune
protection against pathogens.

The immune response is split into two functional divisions: innate and acquired immunity.

Innate immunity is the first line of defense against foreign invaders. Innate immunity involves immediate,
nonspecific responses to pathogens.
Adaptive immunity (also called acquired immunity) is the second line of defense against foreign invaders.
Acquired immunity involves a complex, targeted response to a specific pathogen. Exposure to a pathogen
stimulates the production of certain immune cells that mark the pathogen for destruction. Upon first
exposure, it takes several days or weeks to develop the acquired immune response, but the involved
immune cells “remember” the encounter and respond quickly upon subsequent exposure to the same
pathogen.
Biosafety Containment Levels

When you are working directly with infectious biological agents, such as in a research laboratory, the Public
Health Agency defines different containment levels that are required to handle the biological material
safely. These containment levels (CL) define the minimum precautions necessary to work with different
classes of infectious agents safely. The levels of containment range from the lowest (CL1) to the highest
(CL4). The Center for Disease Control (CDC) classifies the biological safety levels as BSL1-BSL4, although
the language is different the requirements are the same.

□ Watch – Biosafety Containment Levels

Exposure Controls and Personal Protection

To minimize risks and provide a safe work environment, a risk assessment should be performed to evaluate
what could go wrong by determining the likelihood that an undesirable incident (e.g. injury, exposure) may
occur and the consequences (e.g. infection of disease) if that undesirable incident were to occur. Training
on the proper use of equipment is a very important factor in maintaining a safe working environment.
Once we have recognized and evaluated the hazards associated with the biological agents present in the
workplace we can implement controls to prevent and mitigate the risk of exposure. It is important to know
the route of transmission for the pathogen that you are working with in order to understand what measures
to put in place. This video is not specifically related to the workplace but includes some good practices for
protecting people from infection.

□ Watch – Infectious Diseases - Controls

Some of the elements in a biosafety program include:

• Proper ventilation
• Biological safety cabinet
• Sealed safety rotors in centrifuges
• Training
• Auditing
• Appropriate disinfectants
• Appropriated waste disposal
• PPE – glove, eye protection, lab coats, or Tyvek suits, respiratory protection

A good reference for Biological safety is the Canadian Biosafety Standards 3rd Edition