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Updated Recommendations for Management

Thomas V. Inglesby, MD; Tara O'Toole, MD, MPH; Donald A. Henderson, MD, MPH; John G. Bartlett, MD; Michael S. Ascher, MD; Edward Eitzen, MD, MPH; Arthur M. Friedlander, MD; Julie Gerberding, MD, MPH; Jerome Hauer, MPH; James Hughes, MD; Joseph McDade, PhD; Michael T. Osterholm, PhD, MPH; Gerald Parker, PhD, DVM; Trish M. Perl, MD, MSc; Philip K. Russell, MD; Kevin Tonat, DrPH, MPH; for the Working Group on Civilian Biodefense

JAMA. 2002;287:2236-2252.

Objective  To review and update consensus-based recommendations for medical and public health professionals following a Bacillus anthracis attack against a civilian population.

Participants  The working group included 23 experts from academic medical centers, research organizations, and governmental, military, public health, and emergency management institutions and agencies.

Evidence  MEDLINE databases were searched from January 1966 to January 2002, using the Medical Subject Headings anthrax, Bacillus anthracis, biological weapon, biological terrorism, biological warfare, and biowarfare. Reference review identified work published before 1966. Participants identified unpublished sources.

Consensus Process  The first draft synthesized the gathered information. Written comments were incorporated into subsequent drafts. The final statement incorporated all relevant evidence from the search along with consensus recommendations.

Conclusions  Specific recommendations include diagnosis of anthrax infection, indications for vaccination, therapy, postexposure prophylaxis, decontamination of the environment, and suggested research. This revised consensus statement presents new information based on the analysis of the anthrax attacks of 2001, including developments in the investigation of the anthrax attacks of 2001; important symptoms, signs, and laboratory studies; new diagnostic clues that may help future recognition of this disease; current anthrax vaccine information; updated antibiotic therapeutic considerations; and judgments about environmental surveillance and decontamination.

Author Affiliations: The Center for Civilian Biodefense Strategies (Drs Inglesby, O'Toole, Henderson, Bartlett, and Perl) and the Schools of Medicine (Drs Inglesby, Bartlett, and Perl) and Public Health (Drs O'Toole and Henderson), Johns Hopkins University, Department of Health and Human Services (Drs Ascher, and Russell and Mr Hauer), Baltimore, and US Army Medical Research Institute of Infectious Diseases, (Drs Eitzen, Friedlander, and Parker), Frederick, Md; Centers for Disease Control and Prevention, Atlanta, Ga (Drs Hughes, McDade, and Gerberding); Center for Infectious Disease Research and Policy, University of Minnesota School of Public Health, Minneapolis (Dr Osterholm); and the Office of Emergency Preparedness, Department of Health and Human Services, Rockville, Md (Dr Tonat).

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