NEW YORK, May 11 (Reuters Health) -- Detailed recommendations for responding to an anthrax attack were issued by the Working Group on Civilian Biodefense on Tuesday.
Next month the committee will publish its recommendations on responding to a smallpox attack, according to Dr. Donald A. Henderson, co-author of the report in The Journal of the American Medical Association.
"After that we will issue reports on botulinum toxin, plague, tularemia, and hemorrhagic fever such as Ebola and Marburg virus," he said in an interview.
The federal government has "responded pretty quickly to the need for development of a public health infrastructure," said Henderson, a professor of epidemiology at Johns Hopkins University School of Public Health in Baltimore, Maryland. "The funds have been made available to the Centers for Disease Control and Prevention to develop a network of sophisticated labs -- at least one in every state -- where specimens could be rapidly tested so that one could make the diagnosis of a biologic attack.... Also, this summer, there will be seven or eight courses offered to train physicians to deal with these organisms." This system is already in place in some states, including California, said Henderson.
The Working Group on Civilian Biodefense consists of 21 representatives from academic medical centers, government, military, public health, and emergency management agencies.
The group notes that the first notice of an anthrax outbreak could be an increase in the cases of severe illness with flu-like symptoms, but with a mortality rate on the order of 80%.
At this point there should be immediate notification of the health department, which could then arrange for definitive testing at the US Army Medical Research Institute of Infectious Diseases, Fort Derrick, Maryland.
The group does not recommend population-wide vaccination, although vaccination of key personnel should be considered. If the vaccine supply was great enough, post-exposure vaccination should also be considered.
Other recommendations from the group include:
-- Prepare to give early antibiotic therapy. Delays in treatment increase mortality.
-- To control infection, standard barrier isolation is recommended, as is cremation of the bodies of people who die of anthrax.
-- People who come in direct contact with any substance that could be anthrax are advised to thoroughly wash skin and clothing and initiate antibiotic therapy until the substance is identified.
The authors note that most experts agree that manufacture of a lethal anthrax aerosol is unlikely without access to advanced biotechnology.
SOURCE: The Journal of the American Medical Association 1999;281:1735-1745.
