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Communicable and Environmental Disease Services

Guidelines for Medical Providers for Handling Anthrax and Biological Agent Threats

Since the recent occurrence of anthrax in Florida and New York City, there has been substantial public concern and publicity about potential bioterrorism. The Centers for Disease Control and Prevention has developed guidelines that are meant to help you in dealing with patients who are concerned about anthrax exposures or who may have suggestive symptoms.

The Tennessee Department of Health and the CDC are not recommending serologic testing or nasal cultures for persons who present solely with flu-like illness or are simply "worried" about the possibility of becoming exposed to anthrax. These tests are only being used in epidemiologic investigations where anthrax exposure has been confirmed.

Anthrax testing may be arranged at the Tennessee Department of Health State Laboratory for a hospitalized patient who shows radiographic evidence of a widened mediastinum or a clinical presentation suggestive of anthrax. In such situations, the local and state health departments should be notified immediately. In addition, the State Laboratory is working with law enforcement agencies to test suspicious letters and packages for possible bioterrorism agents.

The Tennessee Emergency Management Agency (615-741-0001), Tennessee Bureau of Investigation, local law enforcement, FBI and health department officials should be notified when a threat letter or package incident occurs. In general, chemoprophylaxis of contacts may be delayed until the culture test results provide evidence for the presence or absence of Bacillus anthracis.

It is important that medical providers maintain a high index of suspicion for diseases that could indicate bioterrorism, such as anthrax, smallpox, tularemia, or Q fever. Click here for a complete list of bioterrorism agents and notifiable diseases. The CDC bioterrorism web page is another useful resource at www.bt.cdc.gov.

Please contact your local health department for questions or to report incidents. For additional information, during business hours or for after-hours emergencies, you may contact the Communicable and Environmental Disease Services Section at (615) 741-7247.