# Presentation: 695972

## Preventing Anthrax After Exposure: Options

**Julie Louise Gerberding, MD MPH**
**Acting Deputy Director**
**National Center for Infectious Diseases**
**Centers for Disease Control and Prevention**
- Presented during program “CDC Responds: Treatment Options for Postal and Other Workers Exposed to Anthrax,” Friday, December 21, 2001

## Fact:

- 	To date, no cases of inhalational anthrax have occurred among 10,000 persons for whom post-exposure antimicrobial treatment was recommended or made available.

## Key Questions

- Do spores persist after antibiotics, and if so, will  inhalational anthrax develop?
- Does adding vaccination / extra days of antibiotics  decrease the chance of inhalational anthrax
- among exposed people who took all 60 days of antibiotics?
- among exposed people who did not take all 60 days of antibiotics?

## Preventing Anthrax After Exposure: Options

- Initial recommendation:
- Antibiotics for 60 days
- New Option 1:
- Antibiotics for 100 days
- New Option 2:
- 40 more days antibiotics plus vaccine (3 doses over 4 weeks)

## Anthrax Prevention Treatment Decisions

_**Treatment Risks**_

_**Treatment Benefit**_

**Anthrax Prevention Treatment Decisions**

**?**

## Individual Risk: Tips for WorkersThings that might mean higher risk

- 	_Exposure History_
- Direct contact with anthrax powder
- Presence in the immediate area where anthrax -containing envelope was opened
- Presence in an area with widespread environmental contamination
- Presence in a site where someone acquired inhalational anthrax

## Individual Risk: Tips for Workers Things that might mean higher risk

- 	_Exposure History_
- Working in an area where an anthrax envelope was processed using mechanical postal equipment
- Working in an area where an anthrax envelope was riffled

## Individual Risk: Tips for Workers Things that might mean higher risk

- 	_Not Taking Antibiotics _
- People who couldn’t take all 60 days of antibiotics
- People who missed many doses of antibiotics

## Individual Risk: Tips for Workers Things that might mean lower risk 

- _Exposure History_
- No known direct exposure to anthrax powder
- Presence in an area with only focal contamination
- Short time in contaminated area
- Member of a group with:
- no inhalational anthrax
- delayed antibiotics but no inhalational anthrax

## Facts about Antibiotics

- To date, no cases of inhalation anthrax have occurred among 10,000 persons for whom antibiotic treatment was recommended or made available
- Side effects are common, but not usually serious
- Taking all 60 days of antibiotics is difficult

## Facts about Anthrax Vaccine

- What we know was learned from vaccination of healthy military personnel
- Vaccine is effective, though not 100%
- Vaccine has short-term side effects
- Most are local and go away in days or weeks
- Serious reactions have been rare
- Long-term vaccine evaluation is incomplete

## Vaccine Side Effects

_**Mild Problems**_
- Soreness, redness, or itching where the shot was given (about 1 out of 10 men, about 1 out of 6 women)
- A lump where the shot was given (about 1 person out of 2)
- Muscle aches or joint aches (about 1 person out of 5)
- Headaches (about 1 person out of 5)
- Fatigue (about 1 out of 15 men, about 1 out of 6 women)
- Chills or fever (about 1 person out of 20)
- Nausea (about 1 person out of 20)

## Vaccine Side Effects

_**Moderate Problems**_
- Large areas of redness where the shot was given (up to l person out of 20)
_**Severe Problems**_
- Serious allergic reaction (very rare - less than once in 100,000 doses)

## Preventing Anthrax After Exposure: Options

- Initial recommendation:
- Antibiotics for 60 days
- New Option 1:
- Antibiotics for 100 days
- New Option 2:
- 40 more days antibiotics plus vaccine (3 doses over 4 weeks)

## Post-exposure Treatment Decisions

_**Treatment Risks**_

_**Treatment Benefit**_

**Post-exposure Treatment Decisions**

**?**

## Some Ways to Learn More

- Ask your doctor or other health care provider.
- Contact the Centers for Disease Control and Prevention (CDC):
- Call **1-888-246-2675 **(English)
- Call **1-888-246-2857 **(Español)
- Visit the CDC’s website at
**http://www.bt.cdc.gov**