[OT] Anthrax protocol issued.

[Karsten M. Self]

Cleaned up.

on Sun, Oct 14, 2001 at 12:48:21PM -0500, measl at mfn.org (measl at mfn.org)
wrote:
> Interesting even though OT.
>
> --
> Yours,
> J.A. Terranson
> sysadmin at 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 <kmself at ix.netcom.com>       http://kmself.home.netcom.com/
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