EPI UPDATE

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1. Update: Recommendations for visitors or employees who were in the Hart Senate
    building on October 15, 2001

CDC Health Alert

Distributed Via CDC Health Alert Network

October 19, 2001

Time expanded to include visitors up to 7:00 PM in the Hart Senate Office Building

People who were on the 5^th or 6^th floor, SE wing, of the Hart Senate Building, Washington, D.C. between 9:00 AM – 7:00 PM on October 15, 2001, should receive 60 days of prophylaxis for possible anthrax exposure because it is believed that these individuals were potentially exposed to the bacteria. These individuals should not be given nasal swabs as a preliminary test for exposure to anthrax. Nasal swabs are primarily being used for epidemiological investigation, not for individual diagnosis, prophylaxis, or treatment.

The Capitol Physicians Office has offered to provide the appropriate drug for anyone (staff or visitor) who was in this area on October 15, 2001, during the specified time. The D.C. Department of Health has set up a call center at (202 442-9196) for treatment information as well as general inquiries. These guidelines may change over the next few days and we will update them as needed based on continuing results. Individuals who were in the specified area of the Hart Senate Building on October 15, 2001 between 9:00 AM – 7:00 PM and are presently in another state/county should contact their state/county health department or CDC for information on treatment.

Studies are ongoing in the capital area to assess whether additional people will need prophylaxis. At the current time there is no indication that additional people who visited other areas of the Hart Senate Building or the capital need to be on prophylaxis or to have nasal swabs.

 

CDC Health Advisory

Purpose: To update public and private labs and others on rapid anthrax test.

Hand-held assays (sometimes referred to as "Smart Tickets") are sold commercially for the rapid detection of Bacillus anthracis. These assays are intended only for the screening of environmental samples. First responder and law enforcement communities are using these as instant screening devices and should forward any positive samples to authorities for more sensitive and specialized confirmatory testing. The result of these assays should not be used to make decisions about patient management or prophylaxis. The utility and validity of these assays are not known.

At this time, CDC does not have enough scientific data to recommend the use of these assays. The analytical sensitivity of these assays is limited by the technology, and data provided by manufacturers indicate that a minimum of 10,000 spores is required to generate a positive signal. This number of spores would suggest a heavy contamination of the area (sample). Therefore a negative result does not rule out a lower level of contamination. Data collected from field use also indicate specificity problems with some of these assays. Some positive results have been obtained with spores of the non-anthrax Bacillus bacteria that may be found in the environment.

For these reasons, CDC has been asked to evaluate the sensitivity and specificity of the commercially available rapid, hand-held assays for B. anthracis. When this study is completed, results will be made available. Conclusions from this study are not expected in the near future.

 

3. Interim recommendations for post-exposure prophylaxis for prevention of inhalational
         anthrax after intentional exposure to Bacillus anthracis

 

Reprinted from the CDC, MMWR/Vol. 50/No.41 October 19, 2001

Category Initial Therapy Duration

 

Adults Ciprofloxacin 500mg po BID 60 days

(including pregnant females or

and immunocompromised persons) Doxycycline 100 mg po BID 60 days

 

Children Ciprofloxacin 10-15 mg/kg po Q12hr 60 days

or

Doxycycline:

>8 yrs and > 45 kg: 100mg po BID

>8 yrs and < 45 kg: 2.2 mg/kg po BID

£ 8 yrs: 2.2 mg/kg po BID

* Ciprofloxacin dose should not exceed 1 gram per day in children.

 

** Post-exposure prophylaxis is indicated to prevent inhalational anthrax after a confirmed or suspected aerosol exposure. When no information is available about the antimicrobial susceptibility of the implicated strain of B. anthracis, initial therapy with ciprofloxacin or doxycycline is recommended for adults and children. Use of tetracyclines and flouroquinolones in children has adverse effects. The risks for these adverse effects must be weighed carefully against the risk for developing life-threatening disease. As soon as penicillin susceptibility of the organism has been confirmed, prophylactic therapy for children should be changed to oral amoxicillin 80 mg/kg of body mass/day, divided every eight hours (not to exceed 500 mg three times daily).

B. anthracis is not susceptible to cephalosporins or to trimethoprim/sulfamethoxazole, and these agents should not be used for prophylaxis. CDC is assisting other states and local areas in assessing anthrax exposures. Additional information about anthrax and the public health response is available at http://www.bt.cdc.gov. This information was current as of 4pm, eastern daylight time, October 17, 2001.

 

Some immunizers may still be waiting for their initial deliveries of vaccine, and this may be due to the fact that FDA has yet to release any of Wyeth-Ayerst’s vaccine. Evans Medical and Aventis-Pasteur are on schedule with their orders. The CDC recommends providers needing vaccine get on as many distributor and manufacturer waiting lists as possible. Wyeth-Ayerst is not taking any more orders, but Aventis-Pasteur and Evans Medical will take new orders on a waiting list. Providers can also contact their state influenza vaccine contact, listed on the CDC website at http://www.cdc.gov/nip/Flu/Vaccine-supply.htm#State. The CDC reported that Evans Medical will produce an additional 500,000 doses, which will bring the cumulative anticipated total to 79.6 million doses.

Some providers are receiving partial orders. The CDC is recommending that partial vaccine order distribution be handled by first vaccinating the high risk clients followed by other clients in November or later in the season. 

Reports of vaccine overpricing by distributors have been received again this season. The CDC is interested in collecting specifics of this type of activity. Exorbitant price quotes can be faxed to Karina Carr at 405-840-1343.

Anticipated delays in the delivery of influenza vaccine this flu season constitute emergency medical reasons, within the meaning of Section 503(c)(3)(B)(iv) of the Food, Drug, and Cosmetic Act (FDC Act), as determined by FDA. It is therefore permissible under the FDC Act for a hospital or health care entity to redistribute influenza vaccine to alleviate shortages this flu season.

When redistribution occurs, the hospital or health care entity that is redistributing influenza vaccine, should document and maintain the following information:

• vaccine brand name

• manufacturer and distributor

• lot number

• number of doses transferred

• recipient's name and address

In any such redistribution, the influenza vaccine and its transfer must comply with FDA's current good manufacturing requirements. Information on proper handling, storage, and shipping can be found on page 5 of the manual, http://www.cdc.gov/nip/publications/vac_mgt_book.pdf.

The weekly disease table for week 41 is not available. Table will be updated next week.