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Health Advisory

Last updated: October 16, 2017, 1:40 pm

How to help North Bay Wildfire Victims:

Wildfire relief organizations prefer monetary donations at this time. For safety reasons, and to avoid blocking emergency traffic, please don’t bring donations to areas affected by wildfires.

Places to donate in Contra Costa:

The Bay Area Air Quality Management District has declared a health advisory due to heavy smoke from the North Bay Fires. For more information visit http://www.baaqmd.gov/

Anthrax


Epidemiology

  • Anthrax can be transmitted by inhalation, ingestion, or inoculation (inhalation is the most likely during a bioterrorist attack)
  • The spore form of anthrax is highly resistant to physical and chemical agents; spores can persist in the environment for years
  • Anthrax is not transmitted from person to person

Clinical

  • Incubation period is 1-5 days (range up to 43 days)
  • Inhalation anthrax presents as acute hemorrhagic mediastinitis
  • Biphasic illness, with initial phase characterized by nonspecific flu-like illness followed by acute phase characterized by acute respiratory distress and toxemia (sepsis)
  • Chest x-ray findings: Mediastinal widening in a previously healthy patient in the absence of trauma is pathognomonic for anthrax
  • Mortality rate for inhalation anthrax approaches 90%, even with treatment. Shock and death within 24 - 36 hours

Laboratory Diagnosis

  • Laboratory specimens should be handled in a Biosafety Level 2 facility (e.g. California state Microbial Diseases Laboratory)
  • Gram stain shows gram positive bacilli, occurring singly or in short chains, often with squared off ends (safety pin appearance). In advanced disease, a gram stain of unspun blood may be positive
  • Distinguishing characteristics on culture include: non-hemolytic, non-motile, capsulated bacteria that are susceptible to gamma phage lysis
  • ELISA and PCR tests are available at national reference laboratories

Patient Isolation

  • Standard barrier isolation precautions. Patients do not require isolation rooms
  • Anthrax is not transmitted person to person

Treatment

  • Prompt initiation of antibiotic therapy is essential
  • Antibiotic susceptibility testing is KEY to guiding treatment
  • Ciprofloxicin (400 mg IV q 12 hr) is the antibiotic of choice for penicillin-resistant anthrax or for empiric therapy while awaiting susceptibility results
  • All patients should be treated with anthrax vaccine if available; antibiotic treatment should be continued until 3 doses of vaccine have been administered (day 0, 14 and 28). If vaccine is unavailable, antibiotic treatment should be continued for 60 days.

Prophylaxis

  • If vaccine is available, all exposed persons (as determined by local and state health depts) should be vaccinated with 3 doses of anthrax vaccine (days 0, 14 and 28)
  • Start antibiotic prophylaxis immediately after exposure with ciprofloxicin (500 mg po q 12 hrs) or doxycycline (100 mg po q 12 hrs). (If strain is penicillin-susceptible, therapy can be modified to penicillin or amoxicillin.)
  • Antibiotic prophylaxis should be continued until 3 doses of vaccine have been administered; if vaccine is unavailable, antibiotics should be continued for 60 days.

Thanks to Santa Clara County for information provided on this page


´╗┐Physicians who need to report a suspected public health emergency should contact the Public Health division immediately at 925-313-6740; or after hours, call the sheriff's dispatch at 925-646-2441 and ask for the Health Officer On Call.

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