Prevention of anthrax
- Kenneth H Wilson, MD
Kenneth H Wilson, MD
- Professor of Medicine, Division of Infectious Diseases
- Duke University Medical Center
The incidence of anthrax in humans has decreased during the past century, and it is now very rare in developed countries including the United States. However, anthrax remains a concern in the developed world because of its potential as an agent of bioterrorism.
The prevention of anthrax will be reviewed here. The microbiology, pathogenesis, epidemiology, clinical manifestations, diagnosis, and treatment of anthrax are discussed separately. (See "Microbiology, pathogenesis, and epidemiology of anthrax" and "Clinical manifestations and diagnosis of anthrax" and "Treatment of anthrax".)
Inhalation anthrax — Individuals exposed to aerosolized Bacillus anthracis are considered to be at risk for inhalation anthrax. Postexposure prophylaxis (PEP) for inhalation anthrax involves antimicrobial agents and vaccination. The recommendations presented here are in agreement with the recommendations of the United States Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics [1-3].
PEP of asymptomatic individuals should start as soon as possible following exposure and ideally within 48 hours because its effectiveness decreases with delay in administration [1,2]. Clinicians should seek advice from public health officials to determine which individuals should receive PEP . When selecting a PEP regimen, the production of toxin, the potential for antimicrobial drug resistance, the frequent occurrence of meningitis, and the presence of latent spores must be taken into account . Individuals exposed to aerosolized B. anthracis are presumed to be at prolonged risk for inhalation anthrax from ungerminated spores retained in their lungs following the initial exposure. The presence of B. anthracis spores requires prolonged antimicrobial prophylaxis (for 60 days).
Individuals with an indication for PEP for inhalation anthrax should receive both :
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- POSTEXPOSURE PROPHYLAXIS
- Inhalation anthrax
- - Antimicrobials
- PEP antimicrobial regimens
- Adverse reactions
- Primate studies
- - Anthrax vaccine for PEP
- - Monoclonal antibodies
- - Immune serum
- Cutaneous or gastrointestinal exposure
- PREVENTION IN THOSE AT RISK FOR EXPOSURE
- Anthrax vaccine in the preexposure setting
- - Administration and adverse effects
- - Indications
- - Pregnancy
- Other vaccines
- Infection control
- SUMMARY AND RECOMMENDATIONS