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Guidelines in Response to Anthrax Threats ]
Surveillance guidelines in response to anthrax threats
Given the recent global threat of biological terrorism with anthrax, the public health infrastructure in all countries must be prepared to prevent the illnesses that may result from exposure to anthrax. Preparedness activities need to focus on:
Detection and diagnoses of illnesses caused by biological terrorism, including exposure to anthrax, is a complex process that involves numerous partners and activities. Meeting this challenge will require special emergency preparedness at all levels. CAREC will assist in the provision of public health guidelines, providing technical assistance to all countries in the development of coordinated preparedness plans and response protocols to meet the challenge. All countries will require a comprehensive plan.
Early detection of exposure and prevention of disease is essential to ensure a prompt response to an exposure to anthrax. A major element in facilitating early detection is to have a heightened awareness and index of suspicion among the general population, as well as among all health care providers. Vaccines are not recommended for the general population.
If someone reports opening a parcel or letter with contents suspicious for anthrax (e.g. powder), the comprehensive public health response should include an epidemiological investigation, medical management and prophylaxis for affected persons (see attached guidelines for physicians). If necessary, initiation of disease prevention or environmental decontamination measures should be put in place.
There is no screening test available for the detection of anthrax infection in an asymptomatic person. In general, the use of nasal swabs to evaluate an anthrax threat is discouraged. The use of nasal swabs in recent investigations in Florida and NYC has been for epidemiological purposes only, in order to determine who was at highest risk of exposure in situations where there is a confirmed case. The results have been used to guide further investigation and to determine the source of exposure. The results cannot be used to determine preventive therapy. The sensitivity and specificity and clinical value of nasal swab testing are unknown.
The one exception, where nasal swabs may be useful, is in the situation where there is a highly credible exposure potential and there is no discrete environmental source to test. An example is that of a person who got a "blast" of powder in the face - and the powder was cleaned up before there was any police involvement and was subsequently irretrievable for laboratory testing."
Samples of white powder suspicious for anthrax or clinical samples if indicated, should be sent to your public health laboratory for testing. Please refer to the enclosed laboratory procedures for the identification of Bacillus anthracis.
In the event of a possible exposure to anthrax, the following should be done:
Communication must take place at all levels:
CDC Biological and chemical Terrorism: Strategic plan for preparedness and response. MMWR, April 21, 2000 / Vol. 49 / No. RR-4
Caribbean Epidemiology Centre
Page last modified 22 October, 2001