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DHS issues updated guidance for responding to a wide-area anthrax attack

Once scenario involves an
anthrax attack using crop dusters

DHS has issued an updated version of its previously-published guidance for protecting first responders during the first week following a wide-area aerosol anthrax attack.

“Protective measures addressed in the guidance include medical countermeasures (i.e., drugs, vaccine), personal protective equipment (PPE), and other possible work practices,” explains a Federal Register notice published by DHS on Oct. 22.

The original version of this new DHS report, which is now entitled Guidance for Protecting Responders’ Health During the First Week Following a Wide-Area Aerosol Anthrax Attack, was published in 2009. Since then, the department has solicited feedback from the public and received comments from a variety of respondents, including academics, responders, political leaders and government agencies. The latest version has incorporated many of those comments and the latest thinking on how to respond to an anthrax attack.

In its new guidance, DHS works with a hypothetical scenario in which a wide-area aerosol anthrax attack has occurred in a large U.S. city. In this scenario, B. anthracis spores would be released from a ground-based vehicle (such as a truck-mounted sprayer) or an airborne vehicle (such as a crop duster). “The affected area could encompass hundreds of square miles and could potentially expose hundreds of thousands of people to spores, which, once inhaled, could cause extensive illness and death in the affected population,” says the DHS guidance.

To counter such threats, current recommendations call for a “post-exposure prophylaxis” (PEP) regime that includes the timely administration of a minimum of a 60-day course of oral antimicrobial drugs, in combination with three doses of anthrax vaccine adsorbed,” says the guidance.

Typically, these drugs are administered before an anthrax attack and are not currently licensed for “post-exposure use,” the guidance explains. However, during an emergency declared by the Secretary of Health and Human Services, the Food and Drug Administration could issue an “emergency use authorization” to administer such vaccines immediately after an attack.

The guidance describes the urgent need to distribute antimicrobial drugs promptly after an attack, and explains how various jurisdictions are considering the establishment of either community Points of Dispensing (PODs) or a “postal model” for rapid distribution.