Interesting even though OT. -- Yours, J.A. Terranson sysadmin@mfn.org --------------------------------- Guidelines for Responding to Anthrax Threats Anthrax Threats (Letters, Packages, etc.) · Notify local law enforcement and the Federal Bureau of Investigation (FBI) [Atlanta Field Office, 404-679-9000, 24/7]. · Double bag the letter or package in plastic bags using latex gloves and a particulate (or TB) mask. · Ensure that all persons who have touched the letter (package) wash their hands with soap and water. · Ensure that all persons who have touched the letter (package) remain on site until emergency personnel arrive; list all persons who physically handled the letter (package) and provide the list to authorities. · Notify local, district, and state public health (see contact numbers at the end of this document). · Substances in letters can be tested at the Georgia Public Health Laboratory (GPHL) at the request of the FBI. · Decisions about the need for decontamination and initiation of antibiotic prophylaxis should be made in consultation with public health officials. In most circumstances, the decision to initiate prophylaxis can be delayed until the presence or absence of Bacillus anthracis can be determined. · CDC currently does NOT recommend the use of nasal swab specimens as part of evaluating anthrax threats/implied threats or evaluating concerned citizens who think they may have been exposed to anthrax. · For further information see: http://www.cdc.gov/mmwr/preview/mmwrhtml/00056353.htm Asymptomatic Persons WITHOUT Known Exposure to Anthrax (Worried wellincludes low risk threats) · Provide reassurance about the low risk for infection without known exposure and education about anthrax as an agent in bioterrorism; · Recommend referral to private health care provider for further concerns and/or diagnostics as deemed appropriate. Currently, no screening tests are available for the detection of anthrax infection in the absence of symptoms. Nasal swabs may be useful as an epidemiologic tool when a confirmed case is identified but are not routinely used for diagnosis or screening. CDC currently does NOT recommend the use of nasal swab specimens as part of evaluating anthrax threats/implied threats or evaluating concerned citizens who think they may have been exposed to anthrax. Asymptomatic Persons WITH Known Exposure to Anthrax or to Credible Anthrax Threats · Conduct individual risk assessment in coordination with public health officials and refer to private health care provider if post-exposure prophylaxis is necessary. Currently, no screening tests are available for the detection of anthrax infection in the absence of symptoms. Although data are limited, nasal swabs may be useful if performed early (within 0-24 hours) following known or credible inhalation exposure to B. anthracis. · In this situation, decontamination of patients and their clothing is NOT routinely recommended. · Patients should be educated regarding clinical symptoms of anthrax infection and advised to seek medical attention immediately if they develop fever or flu-like illness. · Postexposure Prophylaxis (PEP) Recommendations : (Inglesby, et al. Anthrax as a Biological Weapon: Medical and Public Health Management, JAMA 1999; 281 (No. 18): 1735-45.) - Adults: Initially ciprofloxacin 500 mg orally q 12 hrs. Optimal PEP for adults (once susceptibility is known) amoxicillin 500 mg orally q 8 hrs or doxycycline 100 mg orally q 12 hrs. - Children: Initially ciprofloxacin 20-30 mg/kg per day orally divided into 2 daily doses, not to exceed 1 g/d. Optimal PEP for children (once susceptibility is known) if child <20 kg, administer amoxicillin 40 mg/kg divided into 3 doses q 8 hrs; if child > or = 20 kg give amoxicillin 500 mg orally q 8 hrs. - Postexposure prophylaxis should be continued for 60 days. - Postexposure prophylaxis may be discontinued if laboratory studies and investigation have ruled out the presence of B. anthracis. Hospitalized Patients with Symptoms Compatible with Anthrax · Immediately notify local, district, and state public health officials so that rapid epidemiologic investigation can be initiated. · Confirm the diagnosis: Obtain the appropriate laboratory specimens based on clinical form of anthrax (inhalational, gastrointestinal, or cutaneous) suspected. - Specimens for possible cutaneous anthrax: vesicular fluid (Gram stain & culture) and/or blood cultures - Specimens for possible gastrointestinal anthrax: vomitus, feces, and/or blood cultures - Specimens for possible inhalational anthrax: nasal swab, blood, CSF, and/or sputum cultures - For further information on specimen collection and handling, refer to protocol Laboratory Procedures for the identification of Bacillus anthracis. · Note: A widened mediastinum on chest radiograph with respiratory distress in a previously healthy patient with antecedent flu-like illness is highly suspect for advanced inhalational anthrax. · Initial microbiologic testing for presumptive anthrax diagnosis should be performed in hospital clinical laboratories according to the protocol Laboratory Procedures for the identification of Bacillus anthracis.. · The Georgia Public Health Laboratory serves as a reference laboratory and can confirm suspect bacterial isolates but are not equipped to routinely culture primary clinical specimens (blood, sputum, etc.) except in emergency situations or if the hospital clinical laboratory is unable to perform the presumptive tests.