[OT] Anthrax protocol issued.

[measl at mfn.org]

Interesting even though OT.

-- 
Yours, 
J.A. Terranson
sysadmin at mfn.org

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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.