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 Because of the potential for exposure to
anthrax, medical measures to prevent anthrax should be taken. The
medical measures differ depending on the type of worker and duration
of exposure. There are three types or categories of workers or
others who may be exposed to anthrax:
In addition to
the medical measures to prevent exposure to anthrax, and the medical
surveillance programs required in the HAZWOPER (29
CFR 1910.120) and respiratory
protection regulations, the occupational health and safety plan (HASP)
should also include the following two major components to protect
workers:
Additional information regarding medical
surveillance can be found at the following site:
| Short-Term
Response Workers |
 Exposures are limited to
a single episode or a few episodes within a brief period (less
that 30 days). Local emergency medical personnel, police, and
firefighters who are not expected to re-enter contaminated
areas for longer periods of time fall into this category.
Short-term response workers should be:
- Adequately immunized with anthrax vaccine, or
- Placed on appropriate prophylactic antibiotics at the time of
their first exposure and continue for 60 days after their last
exposure. Because experimental data indicate that viable spores
may persist in the lungs for 100 days after exposure, an option
is the use of antibiotics for 100 days after exposure.
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| Long-Term
Response Workers |
 These individuals have
repeated exposures over longer periods of time (30 days or
more). Environmental response team members and
decontamination workers fall into this category. They
may work at multiple sites (such as industrial hygienists
conducting environmental sampling) or at a single site (such
as contractors performing decontamination work).
Long-term response workers should be:
- Adequately immunized with anthrax vaccine before
exposure if they are at high risk of repeated exposures.
- Placed on appropriate prophylactic antibiotics, if necessary,
for considerably longer than the 60 days recommended for
short-term workers. Because experimental data indicate that
viable spores may persist in the lungs for 100 days after
exposure, an option is the use of antibiotics for 100 days after
exposure.
- If the vaccine series is started after exposure has occurred,
antibiotic prophylaxis should be continued during the first
three doses to provide protection until an adequate immune
response has developed.
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| Occupants,
Workers, or Visitors at a Site Contaminated with Anthrax |
 Postal or office workers
or maintenance and housekeeping personnel would fall into this
category. The medical program for this group should have two
phases: the immediate post-exposure period and the period
after a previously contaminated site has been cleared for
unrestricted entry and occupancy. Initial medical screening
should be done to identify exposed persons who should avoid
taking antibiotics.
Medical measures during the immediate post-exposure period:
- Individuals should be placed on appropriate prophylactic
antibiotics at the time of their first exposure and
continue for 60 days after their last exposure. Because
experimental data indicate that viable spores may persist
in the lungs for 100 days after exposure, an option is the
use of antibiotics for 100 days after exposure.
Once a previously contaminated site has been cleared for
re-occupancy, personal protection and medical measures to prevent
anthrax are presumably no longer necessary. However, a precautionary
program of medical monitoring may be prudent to assure that anthrax
is no longer a threat. The program should be designed and
administered under the supervision of a licensed physician.
Medical measures after a previously contaminated site has been
cleared for unrestricted entry and occupancy should include:
- Initial medical history to screen for high-risk conditions
(such as compromised immunity, skin conditions)
- Counseling of high-risk persons
- Around-the-clock access to medical coverage for anthrax-like
symptoms
- Confidentiality of medical information
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Medical
screening and follow-up care for anthrax and
medical complications related to preventive measures |
 The
purpose of occupational health surveillance in the workplace is to
improve the effectiveness of the occupational health and safety
program by systematically collecting and analyzing information that
pertains to at-risk workers.
The program for
monitoring exposed persons includes:
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Medical screening program
The medical screening program is the use of examinations
or tests to detect adverse effects on a worker's health at
an early stage when prevention is possible or treatment is
most effective. It should include:
- Baseline medical screening to identify pre-existing
conditions that may affect an individual workers fitness
for duty, and who should avoid antibiotics or vaccines.
- Periodic evaluations to reassess fitness for duty and
to detect symptoms of the development of anthrax or
adverse effects related to preventive measures (such as
antibiotics).
- Final evaluation when it is no longer necessary for a
worker to re-enter a contaminated site, to identify
changes from the baseline and any new risk factors.
- Medical monitoring program for adverse
work-related health effects
The medical monitoring program for adverse effects
related to antibiotic use should include the following so that
an informed decision appropriate for the affected individual can
be made:
- Plans to inform affected workers about available options for
preventing anthrax
- Risks and benefits of each option
- Exposure Monitoring (such as incidents of
breaches in PPE)
There are no validated methods for monitoring a person's
exposure to Bacillus anthracis.
There are useful epidemiologic tools that can be used, but these
should not be used to assess a person's exposure or to make
decisions about the use of antibiotics or vaccine. These tools
include:
Inhalation exposure to a high concentration
of Bacillus anthracis spores may rapidly
result in death. Therefore, exposure to aerosolized powder
known or highly suspected to be contaminated with Bacillus
anthracis spores should be treated as a medical emergency.
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Knowledge
and Information that Workers Need to Prevent
Anthrax and Medical Complications Related to Preventive Measures |
In
addition to HAZWOPER training (29
CFR 1910.120), response workers will
also need additional knowledge and information about anthrax and the
medical measures that can protect them. It should be stressed that
for preventive measures to be effective, individual workers must
fully understand them and use them correctly. All response workers
should receive training to:
- Recognize and report early symptoms and signs of anthrax,
- Understand the importance of immediate medical attention,
- Know how to access emergency medical care,
- Know about potential adverse effects and interactions with
food and drugs if taking antibiotics, and
- Understand the potential adverse effects of vaccine and the
amount of time necessary to develop an immune response if using
the vaccine as a preventive measure.
The validity and reliability of symptom
reports are only as good as the exposed person's knowledge and
understanding of the characteristics of anthrax and risks for
developing the disease. Successful treatment of anthrax will depend
on the individual's understanding of the need for immediate medical
attention should symptoms occur and knowledge of how to access
emergency medical care. Therefore, hazard awareness training is an
important component of the medical program.
The following links include more detailed
information on Medical Program Requirements:
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