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Physician Information

October 30, 2001

TESTING FOR ANTHRAX AND USE OF POST EXPOSURE PROPHYLACTIC ANTIBIOTICS IN NEW JERSEY


The recent bioterrorist attack causing an outbreak of anthrax in several states, including New Jersey, has stressed the resources of the public health care system. Part of that stress is a result of some misconceptions on the part of health care providers and the public that must be addressed to eliminate the inappropriate use of tests and antibiotics that could lead to adverse effects among patients. This memo addresses those issues and is directed at health care providers to assist them in their efforts to manage their patients in a medically sound approach, given our current knowledge.

The NJDHSS discourages the use of nasal swabs for assessing patients concerned about exposure to anthrax as they are not a clinically useful tool. The use of nasal swabs in recent investigations in Florida, NYC, DC, and New Jersey has been for epidemiologic purposes, in order to help determine where suspicious letters were handled in the work area around a confirmed case. The results have been used to guide further investigation and to determine the source of exposure, and to make overall recommendations on prophylaxis for persons involved at the site regardless of individual nasal swab test results.

There is no screening test available for the detection of anthrax infection in an asymptomatic person. The sensitivity and specificity and clinical value of nasal swab testing for an individual patient are unknown. The presence of anthrax spores in the nose only indicates recent exposure and has no predictive value regarding the number of spores inhaled or infectious status of the individual. In addition, nasal swab tests may be reported preliminarily as positive for Bacillus species but may ultimately be negative for B. anthracis when tested in the State Lab.

Serologic tests are available at reference laboratories such as the CDC, but are only performed in symptomatic individuals with a clinical picture consistent with inhalational or cutaneous disease. Serology is not used as a screening or preliminary test in individuals. Preliminary tests in symptomatic individuals being evaluated for anthrax, should instead focus on blood cultures (BEFORE antibiotic therapy).

The New Jersey Department of Health and Senior Services (NJDHSS) continues to strongly urge physicians NOT to prescribe post exposure prophylactic antibiotics for persons who are not among the groups recommended for this. At this time, those recommended for PEP are the following:

  1. Postal workers or business visitors to the work areas at the Route 130 Mail Processing Facility in Hamilton
  2. Postal workers at the West Trenton Postal Facility in Ewing Twsp.

Although we recognize the heightened concern regarding the threat of bioterrorism with the unfolding events of the past several weeks, antibiotic therapy in asymptomatic individuals should be limited to persons with a known risk exposure.

Prophylactic antibiotics at this time should be limited to persons with a known documented anthrax exposure, or if prophylaxis has been recommended by local, state or federal public health authorities as part of an ongoing investigation at a specific worksite. Clinicians seeing patients who say they may have been exposed to anthrax should assess the individual risk of exposure. If concerned that a high-risk exposure has occurred, please call the NJDHSS at the Emergency Operations Center at 609-538-6030 for medical consultation, BEFORE making treatment recommendations.

Use of prophylactic antibiotics is not without risk. Inappropriate use of antibiotics may result in serious adverse effects (e.g., Clostridium difficile colitis, allergic reactions, interactions with other medications) and will lead to increased antibiotic resistance among microorganisms causing common bacterial infections (e.g., otitis media, pneumonia).

 
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Department of Health and Senior Services
P. O. Box 360
Trenton, NJ 08625-0360

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