In response to the ongoing threat of anthrax, patients in
California have been presenting to healthcare providers with a
variety of concerns. These have included medical problems that
patients feel may reflect anthrax and exposures that they feel
posed a risk of anthrax infection. Questions have arisen about
the appropriate role of healthcare providers in such
evaluations; answers to these questions are addressed
in this DHS memo developed for distribution to
acute care hospitals.
The California Department of Health Services (DHS), Division of
Communicable Disease Control, has developed the attached
guidelines for those performing medical evaluation and response
to possible anthrax exposure.
Since November 7, 2001, CDC and state and local public health
agencies have identified no new cases of bioterrorism-related
anthrax. Twenty-two cases of anthrax have met the CDC case
definition; 10 were confirmed inhalational anthrax, and 12 (seven
confirmed and five suspected) were cutaneous anthrax.
Investigation of a case of inhalational anthrax in a hospital
stock room worker in New York City found no evidence of anthrax
contamination at the work site or home; the source of exposure is
unknown.
Since the previous report, all patients with bioterrorism-related
anthrax who were hospitalized have been discharged and continue
to recover. The source of the bioterrorist attacks has not been
identified, and additional cases might occur. Public health
authorities, health-care providers, and laboratorians should
remain vigilant for cases of anthrax.
On October 4, 2001, CDC and state and local public health
authorities reported a case of inhalational anthrax in Florida.
Additional cases of anthrax subsequently have been reported from
Florida and New York City.
This report updates the findings of these case investigations,
which indicate that infections were caused by the intentional
release of Bacillus anthracis. This report also includes interim
guidelines for postexposure prophylaxis for prevention of
inhalational anthrax and other information to assist
epidemiologists, clinicians, and laboratorians responding to
intentional anthrax exposures.
