[OT] Anthrax protocol issued.
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.
on Sun, Oct 14, 2001 at 12:48:21PM -0500, measl@mfn.org (measl@mfn.org) wrote:
Interesting even though OT.
-- Yours, J.A. Terranson sysadmin@mfn.org
--------------------------------- Guidelines for Responding to Anthrax Threats
Anthrax Threats (Letters, Packages, etc.) 7 Notify local law enforcement and the Federal Bureau of Investigation (FBI) [Atlanta Field Office, 404-679-9000, 24/7].
Reference?
Could you please try posting *legible* content? This is utterly
unreadable.
--
Karsten M. Self
On Sun, 14 Oct 2001, Karsten M. Self wrote:
Could you please try posting *legible* content? This is utterly unreadable.
How about you go fuck yourself? Your constant bitching about formatting is old. I have posted it as I received it - ugly, from a windblow$ luser. If you have so much trouble reading EVERY goddamn post here, why don't you just killfile us all? -- Yours, J.A. Terranson sysadmin@mfn.org If Governments really want us to behave like civilized human beings, they should give serious consideration towards setting a better example: Ruling by force, rather than consensus; the unrestrained application of unjust laws (which the victim-populations were never allowed input on in the first place); the State policy of justice only for the rich and elected; the intentional abuse and occassionally destruction of entire populations merely to distract an already apathetic and numb electorate... This type of demogoguery must surely wipe out the fascist United States as surely as it wiped out the fascist Union of Soviet Socialist Republics. The views expressed here are mine, and NOT those of my employers, associates, or others. Besides, if it *were* the opinion of all of those people, I doubt there would be a problem to bitch about in the first place... --------------------------------------------------------------------
on Sun, Oct 14, 2001 at 04:58:07PM -0500, measl@mfn.org (measl@mfn.org) wrote:
On Sun, 14 Oct 2001, Karsten M. Self wrote:
Could you please try posting *legible* content? This is utterly unreadable.
How about you go fuck yourself?
I'm always willing to learn from a master of the art.
Your constant bitching about formatting is old. I have posted it as I received it - ugly, from a windblow$ luser.
A minute with vi will clean it up markedly. It's a common courtesy.
Naturally, the intersection of same with cpunks returns a small set.
Peace.
--
Karsten M. Self
On Sunday, October 14, 2001, at 02:58 PM, measl@mfn.org wrote:
On Sun, 14 Oct 2001, Karsten M. Self wrote:
Could you please try posting *legible* content? This is utterly unreadable.
How about you go fuck yourself?
Your constant bitching about formatting is old. I have posted it as I received it - ugly, from a windblow$ luser.
If you have so much trouble reading EVERY goddamn post here, why don't you just killfile us all?
I agree with Measl. I sent "Karsten M. Self" (if that's his real name) to the cornfield for his worthless contributions and willful ignorance. I got the "Anthrax protocol issued" post just fine. Maybe it's because I have "Show MIME" disabled. Maybe "Karsten M. Self" is complaining because he has MIME enabled. (Which is presumably why we keep getting his MIME signatures attached to his mail, and which lne.com thoughtfully removes.) Fact is, straight ASCII text is the lingua franca of the Net (note that "lingua franca" was NOT italicized in some non-ASCII 128 font). What is lost in not having accent agraves and umlauts and Farsi language fonts is more than made up for by having the "straight 128" ASCII character set. --Tim May "You don't expect governments to obey the law because of some higher moral development. You expect them to obey the law because they know that if they don't, those who aren't shot will be hanged." - -Michael Shirley
on Sun, Oct 14, 2001 at 05:07:45PM -0700, Tim May (tcmay@got.net) wrote:
On Sunday, October 14, 2001, at 02:58 PM, measl@mfn.org wrote:
On Sun, 14 Oct 2001, Karsten M. Self wrote:
Could you please try posting *legible* content? This is utterly unreadable.
Your constant bitching about formatting is old. I have posted it as I received it - ugly, from a windblow$ luser.
I agree with Measl. I sent "Karsten M. Self" (if that's his real name) to the cornfield for his worthless contributions and willful ignorance.
I got the "Anthrax protocol issued" post just fine. Maybe it's because I have "Show MIME" disabled. Maybe "Karsten M. Self" is complaining because he has MIME enabled.
Nope. Pulling the same lne.com feed Tim is. There were a number of odd
nonstandard characters (resolved as <ctrl>+ S, R, and W, mostly "smart
quotes"), and in general poor linewrapping / spacing. That <ctrl>-S
character is particularly annoying to root out on a GNU/Linux system.
My general list formatting preferences are pretty vanilla:
- 72 character lines.
- Postfix (reply-after-quote) response.
- Attribution lines corresponding to quoted content.
- Quoted-line prefix, preferably '> ' or '>'.
- Standard ASCII content, as opposed to extended charactersets, HTML,
or proprietary document formats.
The growing disregard of such conventions in many contexts is a growing
annoyance of the Net.
I happen to prefer signing messages per RFC 2015, and it's largely
habitual. As lne.com de-mimes such attachments, this shouldn't be an
issue for much of this list. I'm not an absolutist on MIME and extended
character sets, believing there are appropriate uses. I'm satisfied
with the recent coverage of this topic here, no need to elaborate.
My point regards formatting: in the majority of cases, a few moments
with a text editor is sufficient to greatly increase readability of of
posted content. I happen to use vim, and can untangle most posts in
under a minute. This is a matter of respect: one person's doing so
saves the remainder the effort. I've noted that the posts I've bounced
to list reformatted tend to gather response where originals don't.
I also prefer to denote cited text via indentation as:
an example of a block
of cited text.
I don't believe these are extraordinary preferences, and even sustpect
Mr. May may agree with me on several.
Peace.
--
Karsten M. Self
Cleaned up. on Sun, Oct 14, 2001 at 12:48:21PM -0500, measl@mfn.org (measl@mfn.org) wrote:
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 well" -- includes 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.
--
Karsten M. Self
On Sun, Oct 14, 2001 at 04:55:45PM -0700, Karsten M. Self wrote: [...]
- 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.
[...]
Does anyone know why the CDC does not recommend using nasal swab specimens
for testing ? Is that because you can only reliably detect inhalational
anthrax that way or is there any other reason ?
Cheers,
Ralf
--
Ralf-P. Weinmann
At 12:01 AM 10/16/2001 +0200, Ralf-P. Weinmann wrote:
On Sun, Oct 14, 2001 at 04:55:45PM -0700, Karsten M. Self wrote:
- 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.
Does anyone know why the CDC does not recommend using nasal swab specimens for testing ? Is that because you can only reliably detect inhalational anthrax that way or is there any other reason ?
Well, I don't know what's the CDC's concerns are, but nasal swabs seem likely to answer one question - "does this person presently have anthrax spores inside their nasal passage?" which is different in several important ways from other questions of interest, including - Has this person been exposed to anthrax bacteria or spores in the last 60 - 90 days? Has this person's immune system created antibodies to the anthrax bacteria? Have this person's lymph nodes become infected? Are toxins being produced? Some people may have anthrax spores in their nose but no infection (perhaps they were exposed to far fewer than the 5-10000 spores needed for inhalational anthrax) and some people may have an infection but no spores in their nose (because they have cutaneous anthrax, or because they blew their nose a lot, or because they're frequent users of powderered inhaled drugs like cocaine or amphetamine and don't have hair inside their noses). So - if the purpose of the test is to determine which people need medical treatment - the test is likely to be misleading, sometimes optimistically, sometimes pessimistically. -- Greg Broiles gbroiles@well.com "We have found and closed the thing you watch us with." -- New Delhi street kids
On Monday, October 15, 2001, at 03:24 PM, Greg Broiles wrote:
Some people may have anthrax spores in their nose but no infection (perhaps they were exposed to far fewer than the 5-10000 spores needed for inhalational anthrax) and some people may have an infection but no spores in their nose (because they have cutaneous anthrax, or because they blew their nose a lot, or because they're frequent users of powderered inhaled drugs like cocaine or amphetamine and don't have hair inside their noses).
Are you claiming that the reason the media have been hit by these anthrax attacks is because most of them are coke whores? I draw the line on the mirror at that. **SNORT!** --Tim May "Gun Control: The theory that a woman found dead in an alley, raped and strangled with her panty hose, is somehow morally superior to a woman explaining to police how her attacker got that fatal bullet wound"
At 04:22 PM 10/15/01 -0700, Tim May wrote:
On Monday, October 15, 2001, at 03:24 PM, Greg Broiles wrote:
Some people may have anthrax spores in their nose but no infection (perhaps they were exposed to far fewer than the 5-10000 spores needed for inhalational anthrax) and some people may have an infection but no spores in their nose (because they have cutaneous anthrax, or because they blew their nose a lot, or because they're frequent users of powderered inhaled drugs like cocaine or amphetamine and don't have hair inside their noses).
Are you claiming that the reason the media have been hit by these anthrax attacks is because most of them are coke whores?
I draw the line on the mirror at that.
**SNORT!**
--Tim May
Forget ciliary damage; imagine anthrax mixed with cocaine. Wouldn't hurt the crack heads though. Most of congress (but not their offspring) would survive.
participants (6)
-
David Honig -
Greg Broiles -
Karsten M. Self -
measl＠mfn.org -
Ralf-P. Weinmann -
Tim May