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Current communications from Sate
of Alabama Department of Health, CDC, or AMA:
October 16, 2001
TO: Alabama Physicians
FROM: Jon E. Sanford, MD, President
Medical Association of the State of Alabama
SUBJECT: Medical Response to Bioterrorism
In order to provide physicians with accurate,
reliable information on responding to bioterrorism, the Medical
Association of the
State of Alabama is working with the Alabama Department of Public
Health and the American Medical Association.
Attached is a letter (see below) from J.
P. Lofgren, MD, State Epidemiologist for the Alabama Department
of Public Health regarding Dealing
with Anthrax Concerns.
The following information from the American
Medical Association provides you with several sources of information.
They are:
1. AMA expands resources on biological
and chemical agents
To help physicians monitor the latest developments
with the anthrax situation in Florida, the AMA has added new
items to its
disaster relief and medical preparedness resources Web site.
Included are frequent updates from the Centers for Disease Control
and Prevention, a May 12, 1999 JAMA article, "Anthrax as
a Biological Weapon," a message about anthrax from the AMA
to
physicians, and additional resources on biological and chemical
agents. These and other links continually are being added to
the site
at http://www.ama-assn.org/ama/pub/category/6206.html
* * * * * * * * * * * *
2. JAMA articles on biological weapons now available to public
Responding to the growing concern about the potential for biological
terrorism, The Journal of the American Medical
Association (JAMA) has made the full text of articles on this
subject available free to the public. Beginning in May 1999,
JAMA
published a series of articles that outlined recommendations
for medical and public health professionals following the use
of five
kinds of biological weapons against a civilian population - smallpox,
anthrax, plague, botulinum toxin and tularemia. Read the
articles at http://jama.ama-assn.org
* * * * * * * * * * * *
3. AMA urges global ban of biological weapon
development Stressing that all countries face the threat of a
biological attack, the
AMA last week introduced a declaration at the annual meeting
of the World Medical Association (WMA) that condemns the research,
development, production or use of biological weapons as morally
and ethically unacceptable. The AMA proposal calls upon the WMA
and its constituent members to promote the establishment of an
international consortium to monitor the threat of biological
weapons, identify actions likely to prevent the proliferation
of bioweapons, and develop a coordinated plan for monitoring
the
worldwide emergence of infectious diseases. Learn more at http://www.ama-assn.org/ama/pub/article/2403-5338.html
Additionally, the Medical Society of the
State of New York has invited physicians across the nation to
access its website which
has much information regarding bioterrorism. The website address
is www.mssny.org.
MASA is working also with the Alabama Department
of Health to coordinate physicians in responding to disasters
in the
state. As this comes together, you will be notified as to how
you can place your name on a response list.
Look for more information in your Alabama
M.D. and the MASA
website (www.masalink.org).
If you have any questions, e-mail
MASA's Executive Director, Cary Kuhlmann, at cary@masalink.org.
Attached letter:
State of Alabama Department of
PUBLIC HEALTH
Donald E. Williamson, MD
State Health Officer
October 15, 2001
Dear Physician:
Re: Dealing with Anthrax Concerns
Reports of anthrax cases in Florida and
New York City concern the public. In the last week, public officials
have also responded to hundreds of false alarms caused by folks
worried by "suspicious" substances (e.g., powders in
envelopes). To help you, we offer the following:
Anthrax does not spread from one person
to another.
Nasal swabs: Do not take nasal swabs from
asymptomatic patients. Nasal swabs were done in Florida as part
of the public health investigation, but, per CDC, no screening
test, including nasal swabs, serology or blood cultures, is clinically
helpful in evaluating asymptomatic patients.
Prescription of prophylactic antibiotics:
Do not prescribe antibiotics for prophylaxis of anthrax unless
public health authorities confirm anthrax in a specific incident
and recommend prophylactic antibiotics.
The following paragraphs present different scenarios and our
recommendations.
Asymptomatic patient
- without a story of exposure: This might include patients who
have visited New York or Florida.
- with a story of exposure to something but no investigation
by law authorities was done:
- with a story of exposure investigated by law authorities but
no environmental sample was collected by the FBI for testing:
· Reassure the patient of the low risk of such exposures.
· Do not perform a nasal swab.
· Do not prescribe antibiotics.
Asymptomatic patient with potential exposure
to a possible environmental source, a sample of which was forwarded
by the FBI for testing by the public health laboratory in Montgomery:
· Do not prescribe antibiotics empirically. Await results
of testing by the public health department.
· Do not perform a nasal swab.
Asymptomatic patient with exposure to a
situation proven by public health authorities to contain anthrax:
· Consult with us concerning recommendations for prophylactic
antibiotics.
· Do not perform a nasal swab.
Asymptomatic patient who visited the Rockefeller
Center recently:
· The New York City Department of Health is recommending
that the ONLY individuals who may be candidates for antibiotic
prophylaxis are those who spent time on the 3rd floor of 30 Rockefeller
Center between September 19th and September 25th. (This is a
change from the letter faxed to Emergency Departments on Sunday.)
· If patient was on that floor between those dates, consult
with us.
· Individuals who were not on that floor between those
dates were not exposed.
· Do not perform a nasal swab.
Symptomatic patient with symptoms compatible
with anthrax:
· The decision to treat depends on the credibility of
exposure and nature of symptoms. We will be happy to consult.
· Treatment of anthrax requires intravenous antibiotics,
generally necessitating hospitalization, and would have to be
started while diagnostic tests are pending.
· Confirm the diagnosis by obtaining the appropriate laboratory
specimens based on the clinical form of anthrax that is suspected
(inhalational, cutaneous, or gastrointestinal).
- Inhalational anthrax: nasal swab, blood, CSF, and/or sputum.
Blood and CSF are best.
- Cutaneous anthrax: vesicular fluid and/or blood
- Gastrointestinal anthrax: vomitus, feces, and/or blood
Clinical cultures for anthrax should be
processed by your routine laboratories. If isolates suspicious
for B. anthracis are found, they can be forwarded to our public
health laboratory for confirmation. Before sending isolates please
call 1-334-260-3400.
The following may help you reassure a patient:
o To get into the lungs, anthrax must be in very small particles.
It is very difficult and requires a great deal of technical skill
and special equipment to make anthrax spores into a fine aerosol.
Anthrax spores in an envelope are not likely to produce small
enough particles to get into the lung.
o Cutaneous anthrax is not generally deadly. Even if material
containing anthrax contacts the skin, antibiotics should not
be given but the patient should be watched for the appearance
of skin lesions that would then be cultured and treated.
You may contact us 24 hours a day by calling 1-800-338-8374 or
1-334-206-5347.
We intend to post explanations for the
above recommendations at www.alapubhealth.org.
Sincerely,
J. P. Lofgren, M.D.
State Epidemiologist
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