Anthrax

Overview:

Anthrax is a serious infectious disease caused by gram-positive, rod-shaped bacteria known as Bacillus anthracis. Anthrax is found naturally in soil and commonly affects domestic and wild animals around the world. Although it is rare in the United States, people can get sick with anthrax if they come into contact with infected animals or contaminated animal products. Contact with anthrax can cause severe illness in both humans and animals. Anthrax is not contagious, which means you cannot catch it like the cold or flu. It can also be used as a biological weapon.

Mode of Transmission:

Direct contact, inhalation, or ingestion

Examples of Transmission:

Cutaneous anthrax
- Occurs after anthrax spores touch a cut or scrape on the skin
- The most common type of anthrax infection in animal workers
Inhalation anthrax
- Occurs when anthrax spores are inhaled
- The inhaled spores grow and release toxic substances causing disease
- This form of the disease occurred in 2001 as a result of anthrax being mailed as a weapon
Gastrointestinal anthrax
- Eating undercooked meat contaminated with anthrax

Prevention:

Anthrax vaccine is only available to military personnel and those at increased risk of contracting anthrax. As with any potential epidemic biologic exposure, patients should be decontaminated in the field whenever possible, and paramedical health care workers should wear masks and gloves. If protection is needed from exposure, responders are advised to use splash protection, gloves, and a full-face respirator with high-efficiency particulate air (HEPA) filters (level C) or self-contained breathing apparatus (SCBA) (level B).

Precautions:

Universal Precautions, and N95 mask

Signs and Symptoms:

The symptoms of anthrax will vary depending upon which form of the disease is present:

Cutaneous anthrax - Symptoms begin in 1 to 7 days and healing takes 2 to 4 weeks

Initially an itchy but painless sore develops on the skin.
The sore then forms a blister and eventually a black ulcer

Complications:

20% may die without treatment since the infection can spread to the blood. The death rate is < 1% with treatment

Inhalation anthrax - Symptoms begin in in 1 to 7 days but may take up to a month

- Fever, Malaise
- Headache
- Cough
- Shortness of breath and chest pain
- Shock

Complications:

Death occurs in 75% even with treatment

Gastrointestinal anthrax - Symptoms begin 1-7 days after exposure

- Fever
- Abdominal pain
- Diarrhea (sometimes bloody)
- Sores in the mouth
- Nausea and/or vomiting

Complications:

Death occurs in >50% of those who do not receive antibiotic treatment but is <40% with treatment.

Exposure Determination:

There is no screening test for anthrax. There is no available test that can tell you if you have been exposed or carry the bacteria. The only way exposure can be determined is through a public health investigation. Nasal swabs and environmental tests, are tests used only to determine the extent of exposure in a given building or workplace. Anthrax is diagnosed by culturing Bacillus anthracis from blood, skin lesions or respiratory secretions or by measuring specific antibodies in the blood of persons with suspected cases.

Immediately Following Exposure:

Persons who are potentially contaminated should wash with soap and water, not bleach solutions. Clothing and evidence/materials should be placed in plastic bags (triple). If the contamination is confirmed, then a 1:10 dilution of household beach may be used to decontaminate any materials and surfaces not sufficiently cleaned by soap and water. Exposed persons should immediately go the ED for medical evaluation. Notify the ED prior to the exposed person’s arrival so they are properly set up to handle this type of exposure.

General Post Exposure Treatment:

Post-exposure preventive antibiotics may be given to exposed individuals who have not yet developed symptoms. Anthrax can be treated with various antibiotics, including penicillin, doxycycline and ciprofloxacin. Antibiotics are effective against the bacteria but not against the toxins which cause the complications of the infection. Despite early treatment, persons infected with inhalational, gastrointestinal, or meningeal anthrax have a very poor prognosis.

The CDC has issued updated guidelines on anthrax post exposure prophylaxis (PEP) and treatment in non-pregnant and pregnant adults. Recommendations include the following:

All individuals exposed to aerosolized B anthracis spores should receive a full 60 days of PEP antimicrobial drugs, regardless of their vaccination status
Ciprofloxacin, levofloxacin, and doxycycline are approved by the FDA for PEP for inhalation anthrax in adults aged 18 years or older; ciprofloxacin and doxycycline are first-line treatments
Treatment for anthrax meningitis should include at least 3 antimicrobial drugs with activity against B anthracis, at least 1 of which should have bactericidal activity, and at least 1 of which should be a protein synthesis inhibitor
Uncomplicated cutaneous anthrax can be treated with a single oral agent; fluoroquinolones (ciprofloxacin, levofloxacin, and moxifloxacin) and doxycycline are equivalent first-line drugs

2 PM Plan of Action:

Immediate transport to the Emergency Department for medical evaluation. Notify the hospital immediately of the situation so they are adequately prepared.

2 AM Plan of Action:

Immediate transport to the Emergency Department for a medical evaluation. Notify the hospital immediately of the situation so they are adequately prepared.

Paperwork Required:

OC Public Health Communicable Disease Exposure Form (policy 330.96) with Fire incident number on top. Must be faxed while still in the hospital Fax: (714) 564-4050

OC Public Health Communicable Disease Exposure Form:

The City “Report of Employee Injury” form
Medical Service Order- RM -67 (when medical care is required)
Sharps Injury Log

Immediate telephonic reporting of suspected disease exposure must be made to OCHCA Epidemiology even prior to laboratory confirmation. Telephone: (714) 834-8180. For urgent reports on holidays, weekends, or after regular work hours, contact the public health official on call at (714) 628-7008