Wisconsin Division of Public Health Disease Surveillance Manual (EpiNet, February 2005)
I. IDENTIFICATION
A. CLINICAL DESCRIPTION: A bacterial illness caused by Bacillus anthracis with acute onset characterized by several distinct clinical forms including:
- Cutaneous (skin lesion evolving over 2-6 days from a papule, through a vesicular stage, to a depressed black eschar).
- Inhalation (a brief prodrome resembling a viral respiratory illness followed by development of hypoxia and dyspnea, with radiographic evidence of mediastinal widening).
- Intestinal (severe abdominal distress followed by fever and signs of septicemia).
- Oropharyngeal (mucosal lesion in the oral cavity or oropharynx, cervical adenopathy and edema, and fever).
B. REPORTING CRITERIA: Clinical diagnosis or clinical suspicion of anthrax.
C. LABORATORY CRITERIA FOR CONFIRMATION:
- Isolation of Bacillus anthracis from a clinical specimen, OR
- Anthrax electrophoretic immunotransblot (EITB) reaction to the protective antigen, and/or lethal factor bands in one or more serum samples obtained after onset of symptoms, OR
- Demonstration of B. anthracis in a clinical specimen by immunoflourescence.
- Fourfold or greater rise in the anthrax ELISA titer between acute and convalescent serum specimens.
D. WISCONSIN CASE DEFINITION: A clinically compatible illness that is laboratory confirmed.
II. ACTIONS REQUIRED / PREVENTION MEASURES
A. WISCONSIN DISEASE SURVEILLANCE CATEGORY I: Report IMMEDIATELY BY TELEPHONE to the patient's local health officer upon identification of a case or suspected case. Complete and mail an Acute and Communicable Disease Case Report (DPH 4151) to the local health officer within 24 hours.
B. EPIDEMIOLOGY REPORTS REQUESTED: Acute and Communicable Diseases Case Report (DPH 4151).
C. PREVENTION MEASURES:
- Educate employees handling potentially contaminated articles about modes of transmission, care of abrasions, controlling dust, and ventilating hazardous industries, especially those that handle raw animal products.
D. PUBLIC HEALTH INTERVENTIONS:
- Source investigation by LHD and BCD/CDES for direct involvement. Search for history of exposure to infected animals or animal products and trace to place of origin.
III. CONTACTS FOR CONSULTATION
A. BCDP / COMMUNICABLE DISEASE EPIDEMIOLOGY SECTION: (608) 261-6387, (608) 266-0749 or (608) 267-9003. (NOTIFY IMMEDIATELY!)
B. WSLH / BACTERIOLOGY UNIT: (608) 263-3421.
IV. RELATED REFERENCES
1. “Anthrax" DPH Disease Fact Sheet Series: View a list of all current Communicable Disease Fact Sheets
2. CDC. Anthrax Basics. (Rev. 12/23/03 ). http://www.bt.cdc.gov/agent/anthrax/index.asp
3. Heymann DL, ed. ANTHRAX. In: Control of Communicable Diseases Manual. 18 th ed. Washington , DC : American Public Health Association, 2004:20-25.
4. Pickering LK, ed. Anthrax. In: Red Book: 2003 Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village , IL : American Academy of Pediatrics, 2003:196-199.