Personal Protective Equipment and Risk Exposure Characterization for
Naturally Occurring Anthrax
Abstract
In regions of the world where anthrax is endemic, humans are at risk of
infection from contact with infected animals and contaminated animal
products. The World Health Organization proposed recommendations, based
on then current evidence, for personal protective equipment (PPE) use
when performing clinical, laboratory, and field work activities
involving collection and handling of specimens from humans, animals, and
environments potentially contaminated with Bacillus anthracis.
However, it is often unclear how these recommendations apply under field
settings in low-resource countries, leading to inadequate protection and
subsequent exposures of veterinary, medical, and public health
professionals investigating anthrax outbreaks. To illustrate how
existing recommendations can be applied to reduce the risk of exposures
in endemic regions with limited resources, while balancing access to
PPE, CDC subject matter experts (field epidemiologists working on
anthrax outbreak response, control and capacity building activities
around the globe) reviewed current recommendations, existing data from
human anthrax case reports and anthrax prevention studies, and discussed
professional judgment based on years of personal field experiences. To
develop a risk assessment for exposures to naturally occurring anthrax,
the group evaluated exposure mechanisms in settings such as the
laboratory, clinical practice (animal and human), environmental specimen
collection, and foodborne exposures, and provided examples of simplified
anthrax-exposure risk characterization scenarios and illustrations of
post-exposure prophylaxis (PEP) practices. Although these
practice-informed examples and risk exposure scenarios are most
applicable in endemic regions with limited resources, they may be
applied anywhere that B. anthracis occurs naturally, to assess
whether PEP and monitoring are indicated.