Anthrax: What Every Clinician Should Know, Part 2
(November 1, 2001)
(View the webcast on the University of North Carolina School of Public Health site.)
Dr. Ali Khan:
Let me end by introducing our moderator. Dr. Virginia Caine is an assistant professor for infectious diseases at Indiana University Hospital and she is also the health officer for Indianapolis, Indiana. Dr. Caine.
Thank you. Dr. Khan, we’ve got actually some questions that have been e-mailed to us just a moment ago that they’d like to have addressed to you. The first question is, “What precautions should be taken with children and adults to minimize their risks of anthrax exposure and what is the dosing regimen for children?”
CDC has developed a number of recommendations for protection of mainly mailroom workers and that’s where we see diseases occurring. Those recommendations will consist of gloves, gowns, some general hygienic methods for handwashing, and some degree of respiratory precautions as people deal with mail until a number of environmental measures can be put in place, including (potentially) laminar flow hoods, certain types of vacuum cleaners, even potentially irradiation of mail to try to protect the mail stream once and for all as a final measure. Now for prophylaxis we have a number of recommendations that are published. I would like to make the point, currently all the isolates we have received appear to be susceptible to doxycycline and ciprofloxacin and we see them as equivalent drugs for initial use in individuals who we need to prophylax. Be it for 10 days pending environmental testing or be it for 60 days such as Brentwood because there has been documented exposure in that facility and you need to treat for 60 days with a preference towards doxycycline since it is well tolerated and specifically to try and take care of issues of antibiotic resistance. I can be very honest with you—I had one of our officers just recently had an anaphylactic reaction while taking ciprofloxacin. That’s the reason why I hope I’ve made the point of targeted prophylaxis where it is specifically needed for people.
The recommendations for treatment are published in the MMWR; there is a new version of the MMWR that came out today. Those are available at emergency.cdc.gov and in that are the clear recommendations for how to use cipro and how to use doxy, and it includes the recommendations that children can use a similar regimen, be switched over to amoxicillin as needed for prophylaxis.
Dr. Khan, one other question that got asked is, “Do we know what the treatment outcomes and survival rates for children exposed to anthrax?”
In this situation we are lucky in that there have been no children that have gotten inhalational anthrax in the United States. All the disease has been among adults. However, there has been a single child with cutaneous disease. For inhalational disease there have been 10 cases amongst adults, 7 of them have been males. I believe the average age was about 55 or so amongst those individuals. Fortunately, only 4 died, which is in contrast to previous data suggesting that about 9 out of 10 or about 90% of people with inhalational disease should die—would die and that’s kudos to the clinicians, who were early in recognizing this disease and immediately starting prophylaxis. Another reason why we are all here is to try to get that message out to the docs on how to recognize the disease early.
I’d like to open up the questions to studio members in regard to that. Dr. Burroughs.
Dr. Valentine Burroughs:
Thank you, Dr. Caine. Thank you, Dr. Khan, for that excellent presentation.
I’m Valentine Burroughs from the National Medical Association and a practicing physician in New York. What I’m getting, not just from patients but also from my staff, are many, many issues relative to opening the mail within the office and outside of the major institutions. What are we to advise our staffs in the opening of the mail and the handling of suspicious packages?
I think we can reassure people that all of the episodes that we have seen so far, except for potentially one of cutaneous disease and inhalational disease, have not been due to an end recipient of mail opening up the mail and not recognizing what’s in it. We obviously have had people who potentially were the end recipient with powders in them who have become sick, but generally without such powder or threat we have millions of pieces of mail that flow through the system every day and we are not seeing cases of cutaneous or inhalational anthrax. In that way we can help reassure most end users who are getting mail that their mail is actually quite safe.
I just want to jump in there, and I think one of the things you want to really assure your patients is that if they do think that they have a suspicious package or letter and they think that there might be some powdery substance, please don’t open the envelope. You can call your local health department or the legal authorities and they will have somebody there to address those issues. The other thing I think that’s really critical is that we want to have them (if they do think that they have been exposed to any suspicious packages) to just wash their hands with plain soap and water—and please do not use any bleach or disinfectant, but plain soap and water will work very well. And if you are at work or what have you I think you need to notify your supervisor.
- Page last updated November 20, 2002
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