EPIDEMIOLOGY/COMMUNICABLE EPIDEMIOLOGY/COMMUNICABLE DISEASE PROJECTDISEASE PROJECT

Sheryl Super RNSheryl Super RNMetropolitan State University of Metropolitan State University of

Denver Denver Nursing 4000Nursing 4000Spring 2014Spring 2014

IntroductionIntroduction A gram positive rod shaped bacteria A gram positive rod shaped bacteria

found naturally in the environment is found naturally in the environment is called bacillus anthracis. The called bacillus anthracis. The bacteria produce spores which can bacteria produce spores which can lie dormant for decades. When the lie dormant for decades. When the bacteria enter an animal or human bacteria enter an animal or human being, they become active growing being, they become active growing cells. The cells multiply and produce cells. The cells multiply and produce toxins, which is the disease anthrax.toxins, which is the disease anthrax.

IntroductionIntroduction Animals become infected when they Animals become infected when they

breathe contaminated plants, soil, or breathe contaminated plants, soil, or water. Animals can be vaccinated water. Animals can be vaccinated against anthrax. People become against anthrax. People become infected when they breathe in infected when they breathe in spores, eat contaminated food, drink spores, eat contaminated food, drink contaminated water, or when spores contaminated water, or when spores enter a cut or scrape on their skin.enter a cut or scrape on their skin.

IntroductionIntroduction Anthrax is not contagious like a cold Anthrax is not contagious like a cold

or flu. I became interested in or flu. I became interested in anthrax when I learned that men in anthrax when I learned that men in the United States used to become the United States used to become infected from their shaving brushes infected from their shaving brushes made out of cow hairs, and when I made out of cow hairs, and when I learned anthrax can be used as a learned anthrax can be used as a terrorist weapon.terrorist weapon.

EpidemiologyEpidemiology Anthrax is currently very rare in the United States. It Anthrax is currently very rare in the United States. It

is recommended that livestock in the United States is recommended that livestock in the United States are vaccinated for anthrax yearly. are vaccinated for anthrax yearly.

Anthrax spores typically take 1 to 6 days to become Anthrax spores typically take 1 to 6 days to become activated, but some spores can remain in the body activated, but some spores can remain in the body for 60 days or more before they become activated.for 60 days or more before they become activated.

2001 is the last time there were any cases of 2001 is the last time there were any cases of anthrax in the United States. Powdered anthrax anthrax in the United States. Powdered anthrax spores were sent through the United States postal spores were sent through the United States postal service as a weapon. 22 people were infected. Five service as a weapon. 22 people were infected. Five of the 22 people died.of the 22 people died.

EpidemiologyEpidemiology

enter a human

cells activate and release toxins

Bacillus Anthracis

Chain of infectionChain of infection Risk categories include: Risk categories include: Working with animal hair, hides or Working with animal hair, hides or

wool.wool.

Eating raw or undercooked meat.Eating raw or undercooked meat.

Injecting drugs.Injecting drugs.

Chain of infectionChain of infection There are four routes of entry by which There are four routes of entry by which

humans obtain anthrax. humans obtain anthrax. Cutaneous, entering from a cut or scrape on Cutaneous, entering from a cut or scrape on

the skin. the skin. Gastrointestinal, entering when raw or Gastrointestinal, entering when raw or

undercooked contaminated meat is eaten.undercooked contaminated meat is eaten. Inhalation, entering from inhalation of Inhalation, entering from inhalation of

spores.spores. Injection, entering when drugs are injected.Injection, entering when drugs are injected.

Patho-physiologyPatho-physiology Cutaneous Anthrax Symptoms:Cutaneous Anthrax Symptoms:

A small group of blisters or bumps A small group of blisters or bumps that may itch appear.that may itch appear.

A painless ulcer with a black center A painless ulcer with a black center appears later, most often on the appears later, most often on the face, neck, arms or hands.face, neck, arms or hands.

Swelling can occur around the ulcer.Swelling can occur around the ulcer.

Patho-physiologyPatho-physiology Gastrointestinal Anthrax Symptoms: Gastrointestinal Anthrax Symptoms: Diarrhea which may be bloodyDiarrhea which may be bloody FaintingFainting Fever and chillsFever and chills Flushing of faceFlushing of face HeadacheHeadache HoarsenessHoarseness Nausea and vomitingNausea and vomiting Red eyesRed eyes Sore throatSore throat Stomach painStomach pain Swelling of abdomenSwelling of abdomen Swelling of neck or neck glandsSwelling of neck or neck glands

Patho-physiologyPatho-physiology Inhalation Anthrax Symptoms:Inhalation Anthrax Symptoms: Body achesBody aches Chest discomfortChest discomfort ConfusionConfusion CoughCough DizzinessDizziness FatigueFatigue Fever and chillsFever and chills HeadacheHeadache Nausea and vomitingNausea and vomiting Shortness of breathShortness of breath Stomach painsStomach pains SweatsSweats

Patho-physiologyPatho-physiology Injection Anthrax Symptoms:Injection Anthrax Symptoms: A small group of blisters or bumps A small group of blisters or bumps

that may itch appear at injection site.that may itch appear at injection site. A painless ulcer with a black center A painless ulcer with a black center

appears later, most often on the appears later, most often on the face, neck, arms or hands.face, neck, arms or hands.

Swelling can occur around the ulcer.Swelling can occur around the ulcer. Abscesses deep under the skin at Abscesses deep under the skin at

injection site.injection site.

Patho-physiology Patho-physiology SUSPECTED CASE:SUSPECTED CASE:

An illness suggestive of a clinical An illness suggestive of a clinical form of anthrax.form of anthrax.

No epidemiologic or laboratory No epidemiologic or laboratory evidence.evidence.

Patho-physiologyPatho-physiology PROBABLE CASE:PROBABLE CASE: Epidemiological link to a documented Epidemiological link to a documented

exposure.exposure. B. anthracis B. anthracis DNA evidence found in clinical DNA evidence found in clinical

specimens.specimens. A positive result from QuickELISATM Anthrax-A positive result from QuickELISATM Anthrax-

PA kit.PA kit. Detection of Lethal Factor (LF) found in clinical Detection of Lethal Factor (LF) found in clinical

specimens.specimens. A positive result from RedLine Alert test.A positive result from RedLine Alert test.

Patho-physiologyPatho-physiology CONFIRMED CASE:CONFIRMED CASE: A clinically compatible illness along with one of A clinically compatible illness along with one of

the following:the following: Culture and identification of Culture and identification of B. anthracis B. anthracis from from

clinical specimens.clinical specimens. Demonstration of Demonstration of B. anthracis B. anthracis in tissues by in tissues by

immunohistochemical staining.immunohistochemical staining. Evidence of four-fold rise in antibodies to Evidence of four-fold rise in antibodies to

protective antigen using IgG ELISA testingprotective antigen using IgG ELISA testing Documented environmental exposure AND Documented environmental exposure AND

evidence of evidence of B. anthracis B. anthracis DNA from clinical DNA from clinical specimens.specimens.

Patient SafetyPatient Safety AFTER EXPOSURE:AFTER EXPOSURE:

Ciprofloxacin is taken for 60 days. Common side effects are Ciprofloxacin is taken for 60 days. Common side effects are anxiety, agitation, blurred vision, dizziness, drowsiness, insomnia, anxiety, agitation, blurred vision, dizziness, drowsiness, insomnia, nausea, nightmares and vomiting.nausea, nightmares and vomiting.

Doxycycline is taken for 60 days. Common side effects are Doxycycline is taken for 60 days. Common side effects are diarrhea, nausea, skin rash, upset stomach and vaginal yeast diarrhea, nausea, skin rash, upset stomach and vaginal yeast infection.infection.

AFTER ANTHRAX TOXINS ARE RELEASED IN THE BODY:AFTER ANTHRAX TOXINS ARE RELEASED IN THE BODY:

Antitoxin used with:Antitoxin used with: Other treatment options such as continuous fluid drainage and Other treatment options such as continuous fluid drainage and

mechanical ventilation breathing.mechanical ventilation breathing.

It is a reportable disease.It is a reportable disease.

Patient SafetyPatient Safety VACCINATION:VACCINATION: Anthrax Vaccine Adsorbed (AVA) protects Anthrax Vaccine Adsorbed (AVA) protects

against cutaneous and inhalation against cutaneous and inhalation anthrax.anthrax.

For at risk adults (ages 18-65) BEFORE For at risk adults (ages 18-65) BEFORE exposure.exposure.

Not approved for use AFTER exposure.Not approved for use AFTER exposure. 5 injections are given intramuscularly 5 injections are given intramuscularly

over 18 months.over 18 months.

Chain of infection/Patient Chain of infection/Patient SafetySafety

At risk adults include:At risk adults include: Some laboratory workers who work Some laboratory workers who work

with anthrax.with anthrax. Some workers who handle animals or Some workers who handle animals or

animal products.animal products. Some members of the military.Some members of the military.

Patient SafetyPatient Safety People who should not receive the People who should not receive the

vaccine:vaccine:

History of previous allergic reaction History of previous allergic reaction to an AVA dose.to an AVA dose.

History of allergic reaction to any History of allergic reaction to any component of AVA.component of AVA.

Pregnant women.Pregnant women.

Patient SafetyPatient Safety Emergency use of AVA:Emergency use of AVA:

AFTER EXPOSURE.AFTER EXPOSURE. 3 injections of AVA in 30 days.3 injections of AVA in 30 days. 60 days of antibiotics.60 days of antibiotics.

Chain of Infection/Patient Chain of Infection/Patient SafetySafety

Bacillus anthracis Bacillus anthracis can be used as a can be used as a weapon.weapon.

It is easily found is nature, can be It is easily found is nature, can be produced in a laboratory, and can be produced in a laboratory, and can be stored for a long time.stored for a long time.

It could be used to sicken and kill crops, It could be used to sicken and kill crops, livestock and people.livestock and people.

It could be released into water and food.It could be released into water and food.

Patient SafetyPatient Safety Bacillus anthracisBacillus anthracis is designated as a is designated as a

Tier 1 toxin. It is at the highest level Tier 1 toxin. It is at the highest level of risk for misuse with significant of risk for misuse with significant potential for mass casualties, potential for mass casualties, devastation to critical infrastructure, devastation to critical infrastructure, the economy, and public confidence.the economy, and public confidence.

It takes only a small amount of It takes only a small amount of anthrax to infect a large number of anthrax to infect a large number of people.people.

REFERENCESREFERENCES www.cdc.gov/anthrax/www.cdc.gov/anthrax/ www.rxlist.comwww.rxlist.com