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Bioterrorism preparedness
Management of persons with potential anthrax exposures
October 27, 2001
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DO NOT isolate the patient. Anthrax is not spread from person to person. |
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There is no need to evacuate the immediate area. |
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Provide support & understanding for patients, their families, and medical staff to prevent panic. |
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Reinforce to patients the rarity of infection without known, confirmed culture-positive exposure. |
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If exposed skin may have come in contact with an unknown substance/powder, recommend washing hands and showering with soap and water only. |
Low Risk Exposure: report, reassure, refrain:
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Definition: asymptomatic patient 1) WITHOUT known exposure to a confirmed culture-positive substance or credible threat associated with a letter, package or other scenario (as determined by law enforcement and Public Health); or 2) with exposure to a substance considered not to pose a credible threat by law enforcement authorities. |
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Report to local law enforcement (911) if a potential threat exists and not already reported. |
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Reassure the patient about the low risk of infection in the absence of a confirmed culture-positive exposure. |
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Refrain from use of nasal swabs for diagnosis of exposure. Nasal swabs and blood serum tests are used as epidemiological tools to characterize an outbreak when there is a confirmed clinical case or exposure. Nasal swabs are not useful diagnostic tools for anthrax exposure in asymptomatic people. |
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Similarly, serologic studies that measure antibody titers to Bacillus anthracis are used as epidemiologic tools. Serologic tests are not indicated for screening or initial diagnostic purposes, and a single positive antibody titer is not diagnostic. To confirm an acute infection, seroconversion in an acute and convalescent serum must be documented. |
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Provide advice to the patient on the signs and symptoms of cutaneous and inhalational anthrax; reassure the patient that cutaneous anthrax can be readily diagnosed and treated. |
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Arrange for follow-up if indicated and if symptoms suggestive of anthrax develop. |
High Risk Exposure: preventive treatment may be indicated:
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Definition: asymptomatic patient with 1) potential aerosol exposure to a suspicious substance involving a credible threat (letter or other scenario) as determined by law enforcement authorities in consultation with Public Health; or 2) exposure to a substance confirmed to be positive for anthrax. |
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Report to local law enforcement and Public Health if not already reported. |
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Reassure patient about the low risk of infection even with exposure to a confirmed, culture-positive environmental sample. |
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Hand washing and showering with soap and water are recommended, decontaminating the patient by means other than washing with soap and water is not indicated or recommended. |
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For confirmed anthrax exposures, see Tables for antibiotic prophylaxis guidelines. |
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If the situation suggests a true potential for aerosol exposure and 1) the threat is deemed credible by law enforcement and Public Health authorities and 2) no substance is available for testing, Public Health will issue recommendations for preventive therapy. |
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In certain highly credible aerosol exposures, Public Health may recommend preventive therapy until anthrax has been ruled out by testing at the WA Public Health Laboratory and/or CDC. |
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