[OT] Anthrax protocol issued.
Karsten M. Self
kmself at ix.netcom.com
Sun Oct 14 16:55:45 PDT 2001
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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