Caribbean Epidemiology Centre

 

CAREC ALERT

November 2, 2001

Update on the anthrax situation and anthrax guidelines

The anthrax situation in the Caribbean

As of November 1, 2001 CAREC has received five letters containing white powder for anthrax testing, three from Trinidad and Tobago and two from Guyana. Four of these powders tested negative for anthrax and test results are pending for one of the letters from Guyana. CAREC also received five highly suspicious sealed envelopes for anthrax testing, four from Trinidad and Tobago and one from the British Virgin Islands. None of these letters were found to contain any powder.

The anthrax situation in the United States

As of October 31, 2001 CDC reported 21 cases of anthrax, 16 confirmed (10 inhalation and 6 cutaneous) and 5 suspected cutaneous cases. Four of the 10 confirmed inhalation anthrax cases died. These cases were reported from media houses, among postal or hospital workers or were consistent with exposures to letters known to be contaminated with anthrax spores. The reports were from Washington DC, New Jersey, New York and Florida.

The global anthrax situation

As of November 1, 2001, while there have been many hoaxes and reported letters and packages with powders, there have not been any confirmed cases of anthrax reported in any country besides the United States.

An update of the Carec anthrax guidelines

Given the continuing global threat of biological terrorism with anthrax, all countries must have a coordinated comprehensive preparedness plan and response protocols to deal with these threats. This plan must include informing the public of who to contact should they receive:

An unopened suspicious letter or package
A letter or package with powder.

This plan must also clearly state who is responsible for:

Unopened suspicious letters or packages
Collection
Opening within 24 hours of receipt
Dealing with these letters or packages if they are opened and found not to contain powder
Dealing with these letters or packages if they are opened and found to contain powder
Letters or packages with powder
Collection
Laboratory testing for anthrax (A certified Class II biological safety cabinet is necessary for all anthrax testing procedures)
Medical management and monitoring for persons with possible exposure to anthrax
Decontamination procedures if necessary
Communication – to the public, to health care providers, to laboratories and to CAREC

Your preparedness plan must address the following scenarios:

Someone reports receiving an unopened suspicious letter or package
Someone reports receiving and opening a suspicious letter or package, which was found not to contain powder
Someone reports receiving and opening a suspicious letter or package, which was found to contain powder

Someone reports receiving an unopened suspicious letter or package

If someone reports receiving an unopened suspicious letter or package they should be advised as recommended in the CAREC Information Sheet for the Public – How to handle Anthrax Threats:

  1. Do NOT shake or empty the contents of any suspicious envelope or package.
  2. PLACE the envelope or package in a plastic bag or some other type of container to prevent leakage of contents.
  3. WASH hands with soap and water.
  4. What to do next…..
If at WORK report to the supervisor, who will call the relevant authority and notify the building security official.
If at HOME call the relevant authority

There is no need for evacuation or medical treatment in this situation.

Someone reports receiving and opening a suspicious letter or package, which was found not to contain powder

If someone reports receiving and opening a suspicious letter or package which was found not to contain powder they should be advised that the risk of anthrax infection is highly unlikely for anyone, including the person who opened the letter or package. There is no need for treatment, decontamination or surveillance.

Someone reports receiving and opening a suspicious letter or package, which was found to contain powder

If someone reports receiving and opening a suspicious letter or package which was found to contain powder they should be advised as recommended in the CAREC Information Sheet for the Public – How to handle Anthrax Threats:

  1. Do NOT shake or empty the contents of any suspicious envelope or package.
  2. PLACE the envelope or package in a plastic bag or some other type of container to prevent leakage of contents.
  3. If any powder has spilled DO NOT try to CLEAN IT UP. TURN OFF fans and air conditioning or ventilation units, do not sweep, vacuum, pour liquid or use anything that would get the powder airborne. COVER the spilled contents immediately with anything (e.g., clothing, paper, trash can, etc.) and do not remove this cover.
  4. LEAVE the room and CLOSE the door, or section off the area to prevent others from entering (i.e., keep others away).
  5. WASH hands with soap and water.
  6. What to do next….
If at WORK report to the supervisor, who will call the relevant authority and notify the building security official.
If at HOME call the relevant authority
  1. REMOVE all contaminated clothing as soon as possible and place in a plastic bag, or some other container that can be sealed. Leave this bag in an isolated area of the building pending laboratory test results.
  2. SHOWER with soap and water as soon as possible. Do Not Use Bleach or Other Disinfectant on Your Skin. These tend to irritate the skin and may result in increased absorption of infectious material.
  3. If possible, list all people who were in the room or area, especially those who had actual contact with the powder. Give this list to the local public health authorities so that proper instructions can be given for medical follow-up.

In this situation, persons who were exposed should be given prophylaxis as recommended in the CAREC Anthrax Fact sheet for Physicians and monitored daily for symptoms of anthrax infection.

The letter or package with the powder should be delivered to the laboratory in your country that is responsible for receiving possible anthrax samples, as outlined in your preparedness plan.

If your laboratory has a certified class II biological safety cabinet, anthrax testing can be conducted as described in the CAREC Laboratory Safety Guidelines for Handling Suspected Anthrax Samples.
If your laboratory does not have a certified class II biological safety cabinet, the sample should be sent to CAREC for testing. The sample should be shipped as dangerous goods as described in CAREC’s Laboratory Safety Guidelines.

If laboratory results are negative for anthrax, antibiotics and surveillance should be stopped immediately and decontamination is not necessary.

If laboratory results are positive for anthrax, the full course of antibiotics should be administered and daily monitoring should be continued as recommended in the CAREC Anthrax Fact Sheet for Physicians. Please note that both doxycycline and ciprofloxacin are recommended for prophylaxis. Anthrax is also sensitive to amoxicillin, chloramphenicol, clindamycin, tetracycline, rifampin, vancomycin and penicillin. However, the use of penicillin only is not recommended. It will also be necessary to decontaminate the environment where the exposure occurred.

 


Caribbean Epidemiology Centre
16-18 Jamaica Boulevard, Federation Park
P.O. Box 164, Port of Spain
Republic of Trinidad and Tobago
Tel: (868) 622-4261, Fax: (868) 622-2792
E-mail: postmaster@carec.paho.org

Page last modified 16 November, 2001