Webcast Transcript
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.)
Segment 6 of 10
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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.
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?”
Dr. Khan:
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. Caine:
Dr. Khan, one other
question that got asked is, “Do we know what the treatment outcomes
and survival rates for children exposed to anthrax?”
Dr. Khan:
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.
Dr. Caine:
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?
Dr. Khan:
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.
Dr. Caine:
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.
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