Courtesy of www.usflag.org
MARK B. LEVIN, M.D.
JOHN M. COTTON, M.D.
TIMOTHY J. PATRICK-MILLER, M.D.
LOUIS J. TESORO, M.D.
HELEN M. ROSE, M.D.
THE PEDIATRIC GROUP, P.A.
66 Mt. Lucas
Road, Princeton, N.J. 08540-2733 tel: (609) 924-4892, fax: (609) 921-9380
website: www.pedgroup.com
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BIOTERRORISM and CHEMICAL TERRORISM III
October 29, 2001
In consultation with our infectious disease consultants who have participated in the meetings between the NJ State Infectious Disease Society and the NJ Department of Health, we are offering further guidelines for rational behavior regarding anthrax and the upcoming influenza season.
1. With respect to Nasal cultures for anthrax:
Nasal cultures are used purely for epidemiological research.
They are not to be used for individual patient treatment
decisions because they merely indicate presence of an organism,
not presence of disease. There can be false negatives and they do
not quantitate level of colonization (inhalation disease requires
8,000-30,000 inhaled spores). Cultures are performed in
contaminated areas to define the extent of the area of
contamination (also termed a "hot zone"). Any person having
been in a hot zone should get antibiotic treatment
regardless of culture results. Any person not having
been in a hot zone should not get treatment
because they are not at risk for the disease. The decision to
treat an individual hinges on direct exposure to a contaminated
environment.
Fomites (inanimate objects that are in contact with a
contaminated object) do NOT transmit the disease. So, for
example, exposure to mail having been sorted in or passed through
the Trenton or Hamilton post offices does not constitute a reason
for treatment. Likewise, families of exposed postal workers are
not treated unless they themselves were in the sorting room of
the post office (a defined hot zone)
Helpful links: The Centers for Disease Control: http://www.bt.cdc.gov/DocumentsApp/faqanthrax.asp
The NJ State Department of
Health and Human Services: http://www.state.nj.us/health/er/index.html
2. With respect to the corollary issue of influenza:
Influenza does not cause anthrax, nor is it a predisposing
factor for anthrax. The symptoms of influenza may be similar
enough with those of anthrax that physicians may have a difficult
time differentiating between the two on purely clinical grounds
(symptoms and examination). A test, taking only minutes to
perform and requiring minimal nasal mucus, can accurately
diagnose influenza and differentiate influenza from other
diseases, thereby lessening confusion. If patient who has not
been in a hot zone presents with flu-like symptoms, they should
be treated clinically, as in the past, and the simple laboratory
test can be performed, if needed.
Influenza vaccine is manufactured starting in the previous
year's influenza outbreak. Typically, a predetermined number of
doses is manufactured for the subsequent season depending on the
number of doses that was required for the previous season. Those
children who must be immunized are those with underlying
diseases or conditions that put them at high risk for
complications or hospitalization from influenza. Other children
do not necessarily need to be immunized.
We must reiterate that the best approach to dealing with these issues is a calm rational analysis of current events with a sound knowledge base in infectious disease behavior. Try not to let media hype and misstatements by politicians stir you into unreasonable actions. We will continue to keep abreast of any developing situations and will advise our patients of any changes in our recommendations.
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