EPI
UPDATE
A weekly
publication by the Bureau of Epidemiology
October 11, 2001
“The reason for collecting, analyzing and disseminating information on
a disease is to control that disease.
Collection and analysis should not be allowed to consume resources if
action does not follow.”
--Foege WH et al. Int. J of Epidemiology 1976; 5:29-37.
Steven T. Wiersma, MD, MPH—Bureau Chief
and State Epidemiologist
Don
Ward, Surveillance Section Administrator, Epi Update Managing Editor
Samuel
Crane, MPH, Special Projects Surveillance Coordinator, Epi Update Editor
Bureau of Epidemiology Frequent
Contributors:
|
Kathryn
Snavely, MPH Reportable Disease Manager |
Jodi Baldy,
MPH, Biological
Scientist IV |
|
Ursula E.
Bauer, PhD, Chronic
Disease Epidemiologist |
Lisa Conti,
DVM, MPH, State Public
Health Veterinarian |
Regional
Epidemiologists:
|
Dolly Katz, PhD, MPH, SE Florida |
Roger Sanderson, RN, MA, SW Florida |
Carina Blackmore, MS Vet. Med., PhD,
NE Florida |
Zuber Mulla, PhD MSPH,
Central Florida Carina
Blackmore, MS Vet. Med., PhD, |
Please print out this material and
share with epidemiology staff, county health department directors,
administrators, medical directors, nursing directors, environmental health
directors and others with an interest in information of this type. Thank you.
The
Bureau of Epidemiology is available 24 hours a day, 7 days a week for
consultation at our main number (SunCom 205-4401 or 850/245-4401) PLEASE NOTE: Consultation after 5 p.m.
& on weekends is intended for emergencies.
The Department of Health has a home on the
World Wide Web at http://www.doh.state.fl.us
For
information on diseases and conditions of public health importance go to MyFlorida.com, click on Health and Human
Services, then Consumers--Diseases and Conditions.
In this issue:
1.
FLDOH Guidelines for “Anthrax Contaminated” Parcels
2.
Procedures for Items Deemed “Less Than Credible”
3.
Guidelines for Police/Fire Personnel Picking Up Suspicious
Packages and/or Letters
4.
Active Laboratory Surveillance of B. anthracis
1. Interim Guidelines for the Management of “Anthrax
Contaminated” Parcels
Florida Department of
Health, Bureau of Epidemiology
“The Bureau of Epidemiology developed the following
guidelines for county health departments and other constituents in response to
requests for information regarding the proper handling of suspicious packages”.
Individuals
around the state and nation have received letters alleged to contain
anthrax. While no single recommendation
can cover all circumstances, the following recommendations should apply to most
situations:
Letters or packages that may possibly
contain anthrax or another hazardous substance are of concern to both public
health and law enforcement agencies.
Individuals who are concerned that they
may have been exposed to anthrax or another unknown agent should be assured
that the Department of Health takes these threats seriously and that while
hundreds of such threats have been received in the United States none have
contained an infectious agent such as anthrax.
The typical response should be:
A. The letter or
package should be left alone and the individual in contact with the letter
should leave the vicinity and contact law enforcement. Others should also leave the immediate
vicinity of the letter.
B. The letter or
package should be collected by law enforcement for forensic evidence. Testing can be conducted at the state
laboratory in Tampa, Jacksonville, or Miami. The Department of Agriculture
laboratory in Kissimmee is also a resource.
The result of the testing will be available in time to determine what,
if any, treatment should be implemented.
C. The individual
(s) who open or have contact with the letter or package that contains an
unknown substance should thoroughly wash their hands with soap and water. Persons who have more extensive contact with
an unknown substance should shower and place their clothing in a sealed plastic
bag. Do not remove clothing from the
bag until the results are available to guide cleaning requirements.
D. There is no
need for any decontamination of individuals who have not had direct contact
with the letter or package that contains an unknown substance.
E. Testing of
individuals exposed to an unknown substance for an infectious agent by use of
nasal swabs or blood test is not appropriate.
F. Prophylactic
antibiotic treatment should be based on the results of the laboratory testing
of the letter or package that contains an unknown substance. There is no need to start antibiotics prior
to the analysis of the letter or package.
G. Contact
information of all individuals that may have been exposed should be collected
ASAP. These individuals should be
reassured that they will be contacted as soon as results are known.
Questions concerning the handling of
individuals exposed to threatening letters or packages that may contain anthrax
or other biological agents should be directed to the local county health
department. The Department of Heath,
Bureau of Epidemiology, is available 24 hours a day, 7 days a week for
consultation at the main number (850-245-4401 or SunCom 205-4401).
The
CDC published interim guidelines for the management of bioterrorism alleging
the use of anthrax in the February 05, 1999 issue of the MMWR.
A
copy can be obtained at the following www site. http://www.cdc.gov/mmwr/PDF/wk/mm4804.pdf
2. Procedures for Suspicious Items Deemed Less Than Credible
Florida
Department of Health
Office
of Emergency Operations
October
10, 2001
“Dr. Ellery Gray, Director of the
Office of Emergency Operations, developed the following materials for law
enforcement officials”.
Effective
immediately the following operational procedures will be implemented to deal
with suspicious objects, i.e. envelopes or substances that are deemed LESS THAN CREDIBLE THREATS BY THE FBI.
FBI
must state that the item does not exhibit a criminal intent and they determine
that it is non-threatening.
Local
law enforcement authorities then make a decision:
§
Does the item or
substance pose criminal intent or is it a public safety issue?
§
If NO then the item
is returned to the owner.
If
the answer is YES, they proceed as follows:
§
If it is only
suspected of being of evidentiary nature then it is handled in law enforcement
channels.
If
the answer is YES and they suspect it is of a biological or chemical nature
they proceed as follows:
§
Notify local Hazmat
or Fire department and Bomb Squad
§
Determine
it does not contain a bomb
§
Have Hazmat determine
it is not chemical
§
If suspected to be
biological have Hazmat double bag and seal
§
Then call local
health department
Local
Health Department:
§
Evaluate the risk and
make recommendations.
§
Have local law
enforcement initiate a chain of custody form.
§ Notify the State Department of Health Office of Emergency Operations of their decisions.
§ Notify the department of Health state laboratory that they
are getting ready to send the item or sample.
§ Determine method of transportation, hand deliver in double bag or over-package and send by courier service.
§
After testing is
completed, notify local law enforcement of results.
Department of Health State Laboratory
Upon
receiving notification that an item, substance or sample needs testing, determine
which State Laboratory will be designated to receive it and advise the local
health department to send it to designated State Health Department Laboratory.
§
Receiving laboratory
will sign chain of custody form.
§
Process the material
for testing.
§
Render a report to
the county health department which sent the material.
§
Local Health
Department will notify local law enforcement of the testing results.
3. GUIDELINES FOR POLICE/FIRE PERSONNEL PICKING UP SUSPICIOUS
PACKAGES AND/OR LETTERS
