All independent variables with 0. Sex, age, educational status, residence, occupation, attitude towards anthrax, health education about anthrax and anthrax infection history in animals were the independent variables included in the final model. Finally, variables with p -values of less than 0.
Hugh-Jones M, Blackburn J. The ecology of Bacillus anthracis. Mol Asp Med. Article Google Scholar. Hudson MJ, et al. Bacillus anthracis balancing innocent research with dual-use potential. Int J Med Microbiol. Awareness and attitude toward zoonoses with particular reference to anthrax among cattle owners in selected rural communities of Zimbabwe.
Vector Borne Zoonotic Dis. Hudson JA. Acidophilic and thermophilic Bacillus strains from geothermal heated Antarctic soil. FEMS Microbiol.
Microbial bioterrorism. Google Scholar. Animal carcass and eyelid anthrax: a case report. Turk J Pediatr. PubMed Google Scholar. Assessment of community Knowledge, attitude and practice on zoonotic disease in and around Dodola town, west Arsi zone, Ethiopia. Risk factors for human Anthrax among contacts of Anthrax-infected livestock in Kazakhstan.
Am J Trop Med Hyg. Prioritizing zoonotic diseases in Ethiopia using a one health approach. One Health. Human and animal anthrax in Ethiopia: a retrospective record review Ethiop Vet J. Anthrax surveillance data analysis for one health approach intervention. Ethiopia: Amhara region; Perception of the public on the common zoonotic diseases in Jimma, Southwestern Ethiopia.
Int J Med Med Sci. Kafkas J Med Sci. Chacha NI. Knowledge, attitude and practice of anthrax among community members, health and veterinary workers in Maragua, Kenya.
Swai ES. Tanzan J Health Res. Elibariki R, Mwakapeje. Prevention, detection, and response to anthrax outbreak in Northern Tanzania using one health approach: A case study of Selela ward in Monduli district. Int J One Health. Available at www. Tu Tu Zaw Win. Constraints and opportunities to improve livestock production and health, and reduce zoonotic risks in small-scale native chicken, cattle and small ruminant farms in the central dry zone of Myanmar.
Shirima RR, et al. J Anim Vet Adv. A meta-analysis of studies of the health belief model with adults. Health Educ Res. Rosenstock IM. The health belief model and preventive health behavior. Health Educ Monogr. Download references. We would like to thank University of Gondar for the ethical clearance. The authors would also like to thank data collectors for their collaboration. And finally our appreciation will also go to Sekota Town administration and agricultural office, Bahir Dar City administration for material support.
You can also search for this author in PubMed Google Scholar. KS, AM, NNY, TD, conceived the study, developed the tool, coordinated data collection, and carried out the statistical analysis and drafted the manuscript. TD and MS conceived the study and reviewed the drafted manuscript. Ensure the confidentiality of medical information. Part of the workplace medical program includes medical monitoring. Establish a medical monitoring program to monitor persons exposed to BA for signs and symptoms of anthrax.
The intent is to detect adverse effects on a worker's health at an early stage when prevention is possible or treatment is most effective. An effective medical screening program for anthrax includes:. Employers need to develop a plan to inform affected workers about available options for preventing anthrax and the risk and benefits of each option. Information about when exposure monitoring is required should also be included.
Inhalation exposure to a high concentration of BA spores may result in rapid death. Therefore, treat as a medical emergency any exposure to aerosolized powder potentially containing or known to contain BA spores.
After receiving clearance for re-occupancy, PPE and medical measures to prevent anthrax are no longer required. However, employers may find it prudent to implement a precautionary program of medical monitoring to ensure that anthrax is no longer a threat.
Any worker who thinks he or she may have been exposed to BA—including through handling a contaminated object or package, cleaning a contaminated environment, or contacting a sick animal — should take the following precautions:. Specific guidance for healthcare workers, below, also describes BA exposure resulting from contact with contaminated patients e. Healthcare workers HCWs in hospitals, clinics, and other settingsmay have exposure to BA resulting from contact with spores that may contaminate a patient's skin, clothing, or personal effects, or through contact with contaminated equipment.
HCWs may also be at risk of inhaling BA spores that are re-aerosolized put back into the air from contaminated patients or if they are in an area where a BA release has occurred. In addition to the General Guidance, applicable to all workers, provided at the beginning of this page, OSHA recommends the following controls for HCWs serving as first receivers of patients potentially exposed to BA.
HCWs and their employers involved in emergency response operations outside healthcare facilities should also consult the First Responders section of this web page. Because anthrax is not generally transmissible from person to person, the engineering controls typically making up the first line of defense for other infectious agents usually are not required when treating patients with possible BA exposure.
The exception is when there is visible evidence of powder on the patient that requires decontamination. In such cases, isolate the patient in an airborne infection isolation room AIIR until decontamination is completed. Morgues often have ventilation isolation to prevent mixing of airflow with other area systems and are a good option for use as decontamination rooms. Use barriers, such as sheets or disposable coveralls, to prevent spread of the BA spores until completion of decontamination procedures.
This is discussed further in the "Administrative controls" section, below. For small-scale i. This includes changing gloves after direct patient care and before touching anything else; washing hands thoroughly with non-antibacterial or -antimicrobial soap at completion of direct patient contact and procedures; and decontamination, disinfection and proper disposal of PPE, bedding and other items potentially contaminated by a patient.
See the General Guidance section for more information on standard precautions. Follow contact precautions, as well, particularly if the patient has uncontained drainage from skin lesions. If the patient requires decontamination, restrict the number of personnel entering the room until completion of decontamination procedures.
In addition to using AIIRs, first-receiver facilities may also consider implementing policies that include covering contaminated patients in an outer garment e. Clean and disinfect rooms and bedside equipment of patients with anthrax infections using the same procedures used for all patients as an element of recognized good infection control practices, unless the amount of environmental contamination indicates a need for special cleaning.
See the General Guidance for cleaning and disinfection for recommendations on disinfection of environmental surfaces and noncritical patient care equipment potentially contaminated with BA. When handling cases of cutaneous anthrax, sterilize surgical tools immediately after use and incinerate dressings. The CDC Guideline for Disinfection and Sterilization in Healthcare Facilities, provides practices for disinfection and sterilization of surfaces and equipment in healthcare settings.
Handle all waste as regulated medical waste and place it in red biohazard bags. Under the HMR, waste potentially contaminated with BA, including PPE and other materials associated with patient care activities, generally does not contain a Category A infectious substance unless it includes cultures of BA.
In cases requiring contact precautions, put on PPE when entering a patient care area and discard it prior to exiting. For medical and support staff not directly involved in patient contact, wear gloves even though the risk of transmission is low.
OSHA's non-mandatory Best Practices for Hospital-Based First Receivers of Victims from Mass Casualty Incidents Involving the Release of Hazardous Substances offers recommendations for selecting respiratory protection to protect HCWs during the receipt of contaminated victims from mass casualty incidents occurring at locations other than the hospital. See the General Guidance section for information on worker training.
Department of Labor Diagnostic and research samples may contain viable BA bacteria and spores—including at high concentrations, in some cases. Exposure can result in severe infections. While a laboratory-acquired infection with anthrax is rare, blood, drainage from skin lesions, cerebrospinal brain and spinal cord fluid, pleural membranes that line the lungs fluid, and sputum may all contain BA. Follow good infection control practices to prevent or minimize transmission of anthrax as specified in the general guidance above.
Decontaminate working surfaces, including those within biosafety cabinets, after each use and dispose of supplies and equipment in proper receptacles. Avoid touching the face, including any mucous membranes, such as the eyes, nose, or mouth, or any exposed skin with hands gloved or ungloved.
Never eat, drink, smoke, or apply cosmetics in the laboratory. Adhere to applicable federal, state, and local regulations when disposing of laboratory waste. Note: Federal regulations require laboratories in healthcare facilities to retain the on-site capability of destroying discarded cultures and stocks if they isolate any microorganism or toxin identified as a Select Agent from a clinical specimen.
Healthcare facilities transferring the isolated cultures to a facility registered to accept such agents, including BA , in accordance with federal regulations are exempt from the requirement. State medical waste regulations may prevent this transfer if the cultures are determined to be medical waste since most states regulate the inter-facility transfer of untreated medical wastes. Immediately report to management, any incidents or accidents involving potential or actual exposure to anthrax, as well as development of symptoms consistent with cutaneous or inhalation anthrax.
Implement appropriate protocols for handling, storing, and shipping specimens and ensure adherence by all laboratory workers. The following CDC guidelines may provide additional details on packaging and shipping procedures for anthrax samples:.
Laboratories should ensure that their facilities and precautions meet the appropriate Biosafety Level BSL for the type of work conducted in the lab. Increasing BSLs involves more worker training, higher levels of containment of samples and other sources of pathogens, specially designed air handling systems, additional worker PPE, and other stricter controls.
For example, BSL-2 practices limit access to laboratories and other controlled work areas during work operations and during use of biosafety cabinets BSCs or other containment equipment for certain procedures.
At BSL-3, in addition to controlling access to laboratories and work areas, all work involving infectious materials is conducted in BSCs or other containment equipment.
The following sections from BMBL guidance may be particularly relevant to employers and workers if their workplaces contain BA:. Also, see the recommendations on disinfection of environmental surfaces and noncritical patient-care equipment potentially contaminated with BA contained in the General Guidance section. Train workers on proper laboratory safety and health procedures and adherence to guidelines; test competency of workers in appropriate implementation of these procedures and guidelines, including appropriate use of engineering controls and PPE; conduct refresher training on a routine basis; and verify consistent adherence to the safety and health procedures and guidelines.
In addition to the recommendations outlined in the General Guidance section, engineering controls, administrative controls, work practices, and PPE needed when working with samples known to contain or suspected of containing BA vary between clinical and research laboratories.
The following sections on Clinical and Research Laboratories outline controls specific for each setting. Use Class II BSCs or other containment equipment for all procedures with potential for infectious aerosol or splash creation.
Class II BSCs use airflow into the front of the cabinet to keep potentially contaminated air and materials i. For all centrifugation, use aerosol-tight rotors and open within the BSC after each run. BSL-2 is appropriate for handling moderate-risk agents that cause human disease of varying severity by ingestion or through percutaneous or mucous membrane exposure. Conduct clinical laboratory work on samples from patients with suspected or confirmed anthrax at BSL-2, as a minimum.
Use BSL-2 practices for work on samples from patients with suspected or confirmed anthrax. PPE for clinical laboratory workers handling BA specimens include gloves vinyl or nitrile and laboratory coats.
Use eye protection e. Almost all if not all work that could generate aerosols should be done in an appropriate BSC; use appropriate respiratory protection if aerosol generation outside of a containment device is possible. As per BSL-2 precautions, train laboratory personnel in handling pathogenic agents with supervisors competent in handling infectious agents and associated procedures. Train all laboratory personnel on any additional procedures developed by the employer for safely handling clinical specimens from patients with known or suspected anthrax and research specimens.
This includes training on the communication procedures in effect between the clinical and laboratory staff to ensure timely notification and proper labeling of known or suspected BA-contaminated specimens. Use Vertebrate Animal Biosafety Level Criteria ABSL-2 practices, containment equipment, and facilities for studies involving experimentally infected laboratory rodents. Use Class III BSCs for work involving high concentrations of cultures, for screening environmental samples especially powders from anthrax-contaminated locations, and for activities with a high potential for aerosol production.
Class III BSCs are gas-tight enclosures incorporated with gloves, non-opening windows, and mechanisms for decontaminating equipment and samples. Limit access to the animal facility. Use BSL-3 facilities for work involving high concentrations of cultures, for screening environmental samples especially powders from anthrax-contaminated locations, and for activities with a high potential for aerosol production.
BSL-3 work practices build on the BSL-2 work practices and include, among other things, the requirement to place materials potentially infected with BA in durable, leak- proof containers during collection, handling, processing, storage, or transport within a facility. See the Medical Information page for more details. See the Training section, below, for information about worker training. Wear laboratory coats, gowns, or uniforms when working in laboratories handling BA-infected rodents to prevent contamination of personal clothing.
Wear nitrile or vinyl gloves to prevent skin contact with BA-contaminated materials, and when handling animals. Gloves for workers handling animals that may bite should also provide bite protection. Use eye, face, and respiratory protection in rooms containing infected rodents, based on the risk of exposure. PPE for research laboratory workers may include dedicated work clothing, such as surgical scrubs under PPE, dedicated washable footwear, double gloves, face protection, eye protection e.
The WHO resource, Laboratory Biosafety Manual - Third Edition , contains additional practical guidance on biosafety techniques for use in laboratories at all levels. OSHA's Laboratory Safety Guidance contains an entire chapter on biological hazards, including anthrax which employers and laboratory workers may find useful.
CDC Workers involved in emergency response operations to intentional or accidental releases of BA are also at risk of exposure. In addition to the General Guidance , applicable to all workers, and provided at the beginning of this page, OSHA also recommends the following controls for first responders:. Place impermeable physical barriers or use other methods to isolate contaminated areas and objects.
Implement dust control measures, such as water mist, if needed to reduce the risk of re-aerosolization of settled infectious materials. Minimize air flow as much as possible in the patient compartment. Vehicles that have separate driver and patient compartments and can provide separate ventilation to these areas are preferred for transport of these types of patients. If a vehicle without separate compartments and ventilation is used, the outside air vents in the driver compartment should be open, and the rear, exhaust ventilation fans turned on at the highest setting to provide a gradient of negative pressure in the patient care compartment.
Follow standard precautions as well as contact and aerosol precautions, as appropriate, based on work tasks and visible evidence of powder on the patient. If your doctor detects anthrax in your body, the test results will be sent to a public health department laboratory for confirmation. Preventive treatment consists of antibiotics and the anthrax vaccine.
Examples include ciprofloxacin Cipro or doxycycline Doryx, Monodox. Experimental treatments include an antitoxin therapy that eliminates the toxins caused by Bacillus anthracis infection as opposed to attacking the bacteria itself.
Without treatment, the chances of death from anthrax increase. According to the U. You can reduce your risk of anthrax by having the anthrax vaccine. The U. The anthrax vaccine is Discover the causes of diarrhea and appetite loss, including stomach flu, celiac disease, and food poisoning.
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After binding to surface receptors, the PA portion of the complexes facilitates translocation of the toxins to the cytosol, in which EF and LF exert their toxic effects 8.
The toxins have several physiologic effects. Similar challenges with ET produced rapid hypotension associated with sharp and persistent decreases in central venous pressure and systemic vascular resistance. Such changes suggest that both toxins alter the peripheral vasculature, but that LT might also have a direct effect on depressing myocardial function, and ET causes venous and arterial relaxation.
Both toxins were associated with progressive renal and hepatic dysfunction because of direct toxic effects or secondarily to hypoperfusion 9. Gross pathologic lesions observed in non-human primates NHPs used in aerosol challenge models of inhalation anthrax include edema, congestion, hemorrhage, and necrosis in the lungs and mediastinum.
Splenitis and necrotizing or hemorrhagic lymphadenitis involving the mediastinal, tracheobronchial, and other lymph nodes are common Primary pulmonary lesions, including those of pneumonia, are occasionally observed. Autopsy findings for persons who died from inhalation anthrax in Sverdlovsk and in the United States 3 are consistent with findings from the NHP studies. Mediastinal lymph nodes and spleen also showed hemorrhage and necrosis 11 , Early diagnosis of anthrax and initiation of appropriate treatment, particularly administration of a combination of antimicrobial drugs, are critical to improving survival.
Anthrax meningitis is nearly always fatal, even with treatment Many patients with cutaneous anthrax can be treated as outpatients. However, patients with symptoms or signs of systemic involvement e. Hospitalization is warranted for all patients with systemic cutaneous anthrax; gastrointestinal, injection, or inhalation anthrax; or anthrax meningitis or bacteremia. Initial evaluation of patients suspected of having anthrax Technical Appendix Table 1 should be similar to the standard evaluation for patients with an acute febrile illness and should have an emphasis on obtaining pretreatment blood and other appropriate cultures.
However, failure to fulfill systemic inflammatory response syndrome criteria should not decrease concern for sepsis because patients with systemic anthrax might not initially appear critically ill. Inhalation anthrax can have a prodromal phase followed by a fulminant phase 3. Patients with systemic anthrax have had debilitating symptoms, followed first by transitory improvement and then by precipitous hemodynamic deterioration Because of this potential for sudden decompensation, hospitalized patients should have careful hemodynamic monitoring, including continuous pulse oximetry and telemetry Technical Appendix Table 1.
Chest computed tomography might be needed to identify the characteristic widened mediastinum and pleural effusions as well as common that are inapparent on chest radiographs e. Unless contraindicated, lumbar puncture should be performed to rule out meningitis.
Despite potential pathophysiologic differences between B. Microangiopathic hemolytic anemia, coagulopathy, thrombocytopenia, and hemorrhage commonly occur with anthrax infections; these complications must be aggressively managed, and might pose contraindications to invasive central catheter placement.
Because of the risk for coagulopathy, mechanical rather than pharmacologic prophylaxis is preferred for prevention of deep vein thrombosis. An echocardiogram might be needed to identify pericardial effusions, as reported for 3 of 10 patients postal workers with inhalation anthrax in 3. In addition to the need for mechanical ventilation for respiratory distress or airway protection for persons with altered mental status, some patients with anthrax might require respiratory support for airway edema.
Substantial edema with fatal outcome can occur with cutaneous lesions involving the head, neck, or thorax, and with oropharyngeal lesions Thus, aggressive monitoring for airway compromise is warranted in patients with such lesions.
In inhalation anthrax, although respiratory failure is more consistent with reaccumulating pleural effusions than with adult respiratory distress syndrome, standard mechanical ventilator principles apply Airway pressures may be difficult to interpret if there is loss of pulmonary compliance from excessive chest wall edema or restriction by pleural or peritoneal effusions.
The need for ventilation in some patients and the duration of ventilation in others may be reduced by pleural space drainage. There are no randomized trials of corticosteroid use for human anthrax and no animal data that support its use.
However, several small observational studies of adjunctive corticosteroids for cutaneous anthrax of the head and neck appear to favor their use in such situations 22 , Although there are also limited data on steroid use for documented anthrax meningitis, adjunctive intravenous dexamethasone is the standard of care for patients with suspected bacterial meningitis and should be started at the time of initial antimicrobial drug therapy to prevent neurologic sequelae Several survivors postal workers in received corticosteroids for nonanthrax indications 3.
On the basis of available evidence and absence of apparent side effects unique to treatment for systemic anthrax, adjunctive corticosteroids should be considered in patients who had a history of use of endocrine or corticosteroid therapy; edema, especially of the head or neck; evidence of anthrax meningitis; or vasopressor-resistant shock 16 , High LF concentrations have been detected in pleural fluid 4 and in ascites A.
Boyer, unpub. In addition, pleural fluid drainage has been positively associated with survival in a large case series Drainage of pleural fluid and ascites is believed to improve survival by reducing the toxin level and by decreasing mechanical lung compression.
These data support the need for early and aggressive drainage of any clinically or radiographically apparent pleural effusions; chest tube drainage is recommended over thoracentesis because many effusions will require prolonged drainage. Thoracotomy or video-assisted thoracic surgery might be required to remove gelatinous or loculated collections. Ascites should also be drained and monitored for reaccumulation; continuous drainage might be required.
Surgery might be contraindicated or indicated, depending on the type of anthrax. Surgery for cutaneous anthrax can lead to dissemination and poor outcome. Surgery is contraindicated for acute disease, with the exception of tracheotomy for airway obstruction and surgical intervention for large or circumferential extremity lesions causing compartment syndrome.
Surgery may be indicated for gastrointestinal anthrax to identify and address potentially fatal complications, such as bowel ischemia, necrosis, and perforation For injection anthrax, surgery is used to obtain diagnostic specimens to differentiate the infection from necrotizing fasciitis and to remove the necrotic nidus of infection, which may be a toxin and spore reservoir.
Surgery for injection anthrax should be more limited than that for necrotizing fasciitis, and resection should be performed only to healthy tissue. Compression of soft tissues can be released by incision, excision, or fasciotomy and might be required for treatment of compartment syndrome Diathermy dissection is advised to optimize hemostasis.
The approach to prevention and treatment of anthrax differs from that for other bacterial infections. The production of toxin, potential for antimicrobial drug resistance, frequent occurrence of meningitis, and presence of latent spores must be taken into account when selecting postexposure prophylaxis PEP or a combination of antimicrobial drugs for treatment of anthrax. In addition, most data on which these antimicrobial drug options are based predate the availability of many of the antimicrobial drugs discussed and are drawn from limited animal studies.
Among patients with inhalation anthrax during —, antimicrobial drug combination therapy was more likely to be curative than antimicrobial drug monotherapy There is also a theoretical benefit for combined use of bactericidal and protein synthesis inhibitor agents. Bactericidal agents have immediate killing effect. However, the high rates of illness and death seen with anthrax are caused, in part, by B.
In vitro toxin production is inhibited earlier by protein synthesis inhibitors than by bactericidal agents 29 ; this characteristic is associated with clinical benefit in streptococcal toxic shock and clostridial sepsis. Combination antimicrobial drug regimens were used in all 8 survivors of inhalation anthrax during —; five survivors were also treated with a protein synthesis inhibitor 4 , 26 , Patients hospitalized for systemic anthrax should be immediately treated with a combination of broad-spectrum intravenous antimicrobial drug treatment pending confirmatory test results because any delay may prove fatal.
Naturally occurring B. Thus, cephalosporins are contraindicated. In addition, multidrug resistance in naturally occurring B. This finding increases concern that a B. Thus, penicillin-based antimicrobial drug use requires a high index of suspicion for emergence of resistance. Thus, meningitis must be considered in all cases of systemic anthrax, and antimicrobial drugs used to treat possible meningitis must have good penetration of the central nervous system CNS. The presence of a spore form of B.
Thus, persons exposed to aerosolized B. In addition, if antimicrobial drug treatment is initiated soon after exposure, animal studies suggest the acquired immune response might be blunted and not be protective This finding suggests the need to continue antimicrobial drug therapy for 60 days to clear germinating organisms. PEP of asymptomatic persons should ideally start as soon as possible after exposure because its effectiveness decreases with delay in implementation.
To ensure adequate and continued protection, everyone exposed to aerosolized B. No safety data are available for levofloxacin use beyond 30 days; thus, oral ciprofloxacin and doxycycline are recommended as first-line antimicrobial drugs for PEP.
Alternative antimicrobial drugs that might be used for PEP if first-line agents are not tolerated or are unavailable include levofloxacin and moxifloxacin; amoxicillin and penicillin VK if the isolate is penicillin susceptible; and clindamycin. The antimicrobial drug linezolid cannot be used for extended periods.
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