Disease-specific networks Mission statement To strengthen global disease-specific networks of experts and laboratories able to provide technical support to response activities in Member States, particularly developing countries, related to the natural occurrence, accidental release, or deliberate use of biological agents that affect health.
Anthrax: Project objectives 1 To establish a global network of anthrax experts and laboratories with defined anthrax capabilities 2 To establish standard procedures relating to anthrax and disseminate information 3 To set up and implement training and quality assurance
1a. A global network of anthrax experts Working Group members provide advice on: reference public health and veterinary laboratories key people responsible for dangerous public health pathogens other anthrax experts existing networks questionnaire, guidelines, training materials strategy
Current Anthrax Working Group Argentina Australia Canada China Colombia England France Georgia Germany India Indonesia Italy Nepal Philippines Russian Federation South Africa Thailand Turkey United States of America 31 experts in 19 countries
Expanding the group? Is such a network useful? Is it feasible to maintain a such a network?
1b. A global network of laboratories with defined anthrax capabilities Develop an inventory of capabilities of reference public health and veterinary laboratories in Member States Obtain an understanding of the current gaps Support activities to fill them, particularly in laboratories in developing countries
1. Contact details Name of laboratory Address City Postal code Country Telephone Fax Email Web site World Health Organization Communicable Disease Surveillance and Response Global Alert and Response Disease-Specific Networks: Anthrax Questionnaire for Laboratories World Health Organization Global Alert and Response Communicable Disease Surveillance and Response Disease-Specific Networks: Anthrax Questionnaire for Laboratories Name of director of the laboratory Title Telephone Fax Email Name of person responsible for anthrax activities Title Telephone Fax Email 2. Your laboratory is affiliated to: Ministry of Health Ministry of Agriculture Other ministries (please specify) Universities Private laboratories Other (please specify) 3. Which of the following are used for identification of B. anthracis in your laboratory? Capsule visualization in clinical specimens India ink stain Polychrome methylene blue stain Direct fluorescence assay Other (please specify) Spore visualization in environmental samples Phase contrast Malachite green Other (please specify) Routine and confirmatory culture Haemolysis Motility Penicillin sensitivity Gamma phage lysis Capsule production in blood (in vitro) Capsule production on bicarbonate/serum agar plates Other (please specify) Antimicrobial sensitivity tests Multi-disk MICs Other (please specify) Advanced technology tests Specific (toxin) antigen ELISA Time-resolved fluorescence (TRF) testing Polymerase chain reaction (PCR) Molecular characterization Other (please specify) 1. Contact details Name of laboratory Address City Post code Country Telephone Fax Email Web site Director of the laboratory Title (Prof., Dr, Mr, Mrs, Miss) Telephone Fax Email Person responsible for anthrax activities Title (Prof., Dr, Mr, Mrs, Miss) Telephone Fax Email 2. Your laboratory is affiliated to: Ministry of Health Ministry of Agriculture Other ministries (please specify) Universities Private laboratories Other (please specify) Disease-specific networks: improving public health preparedness for and response to the threat of epidemics Mission statement To strengthen global disease-specific networks of experts and laboratories able to provide technical support to response activities in Member States, particularly developing countries, related to the natural occurrence, accidental release, or deliberate use of biological agents that affect health. World Health Organization Global Alert and Response Communicable Disease Surveillance and Response
Collaboration: reaching the laboratories Office international des épizooties Food and Agriculture Organization of the United Nations WHO Global Salm-Surv Working Group members European Union WHO CSR Lyon WHO Collaborating Centres WHO Regional Offices
Anthrax questionnaires Argentina Australia Austria Belgium Burundi Cameroon Chile China Colombia Costa Rica Croatia Cyprus Czech Republic Democratic Republic of the Congo Eritrea Finland France Georgia Germany India Indonesia Italy Japan Jordan Latvia Lithuania Malaysia Mauritania Mauritius Nepal Morocco Netherlands New Zealand Philippines Poland Republic of Moldova Romania Senegal Slovakia Slovenia South Africa Sudan Switzerland Syrian Arab Republic Tunisia Turkey Ukraine United Kingdom USA Yugoslavia Zimbabwe Completed questionnaires (27 March 03) 68 received from 51 countries
Collaboration with other networks, avoiding duplication Collaboration between veterinary and public health labs Improving surveillance and reporting Keeping labs involved and information about the labs up to date Expanding the network and helping to strengthen regional networks Restricted-access web site
2. Standard procedures Establish standard procedures relating to anthrax and disseminate information Guidance on anthrax: frequently asked questions What is anthrax? What's happening right now? Is there just one type of anthrax? How is it treated or prevented? Is there a vaccine? Can I catch it from someone else? I feel like I have a cold. Could it be anthrax? Fact Do Sheet I have N to 264 go to a hospital to get tests? I October am worried 2001 about anthrax. Should I take antibiotics just in case? ANTHRAX What do I do if I get a suspicious package or letter? Overview What constitutes a suspicious letter or parcel? Anthrax is primarily a disease of herbivorous mammals, although other What mammals should I do if I receive an anthrax threat by mail? and some birds have been known to contract it. Humans generally acquire the disease directly or indirectly from infected animals, or occupational exposure to infected or contaminated animal products. Control in livestock is therefore the key to reduced incidence. There are no documented cases of person Q. What to person is anthrax? transmission. The disease s impact on animal and human health A. Anthrax can is a bedisease caused by a bacterium called Bacillus anthracis. It is a disease devastating. WHO has produced Guidelines for the surveillance which and control has existed of for hundreds of years and which still occurs naturally in both animals anthrax in humans and animals. and humans in many parts of the world, including Asia, southern Europe, sub-sahelian The causative agent of anthrax is the bacterium, Bacillus anthracis, Africa the spores and parts of of Australia. Anthrax bacteria can survive in the environment by forming which can survive in the environment for years or decades, awaiting spores. uptake In by its most the common natural form, it creates dark sores on the skin, from which it next host. derives its name. Anthrax is Greek for coal. The disease still exists in animals and humans in most countries of Q. sub-sahelian What's happening right now? Africa and Asia, in several southern European countries, in the A. Americas, WHO posts and updated situation reports whenever there is an outbreak of anthrax or any certain areas of Australia. Disease outbreaks in animals also occur other sporadically infectious in disease on its Web site. other countries. Q. Is there just one type of anthrax? There are 3 types of anthrax in humans: cutaneous anthrax, acquired when a spore A. There are three types of anthrax, each with different symptoms: enters the skin through a cut or an abrasion; gastrointestinal tract anthrax, contracted from eating contaminated food, primarily meat from an animal Cutaneous, that or died skin, anthrax is the most common form. It is usually contracted when a of the disease; and pulmonary (inhalation) anthrax from breathing person in with airborne a break in their skin, such as a cut or abrasion, comes into direct contact with anthrax spores. anthrax spores. The resulting itchy bump rapidly develops into a black sore. Some people The cutaneous form accounts for 95% or more of human cases globally. can then All 3 develop types headaches, muscle aches, fever and vomiting. Cutaneous anthrax must of anthrax are potentially fatal if not treated promptly. be treated quickly. Appropriate medical evaluation and treatment are essential. Prevention Gastrointestinal anthrax is caught from eating meat from an infected animal. It causes Prevention of anthrax in both humans and animals is based on control initial measures symptoms in similar to food poisoning but these can worsen to produce severe livestock in endemic areas, such as the safe disposal of anthrax abdominal carcasses pain, andvomiting of blood and severe diarrhoea. Appropriate medical evaluation vaccination of at-risk herds. The most efficient method of disposal is and incineration treatment are in essential. a manner that ensures heat sterilization of the underlying soil. In The practice, most severe localform of human anthrax is called inhalation or pulmonary anthrax. conditions in many endemic countries make these simple control measures Though the difficult rarest, it is the form of human anthrax causing the most current concern. This to implement. In industrialized countries, prevention lies in good agricultural form of the disease and is caused when a person is directly exposed to a large number of industrial hygiene. anthrax spores suspended in the air, and breathes them in. The first symptoms are similar Vaccines are available for animals and humans. However in humans to those their of a common use cold, but this can rapidly progress to severe breathing difficulties should be confined to high-risk groups, such as those occupationally and exposed shock. Appropriate and medical evaluation and treatment are essential. in some military settings. Patient isolation is not required and there are no quarantine requirements. Dressings and other contaminated materials should be disposed of, preferably by incineration. Treatment
3. Training and quality assurance Develop a training module on anthrax diagnosis Hold an anthrax workshop for one laboratory from each of several WHO regions
Quality assurance Establish an external quality assurance programme with trained laboratories Establish a reagent bank of selected anthrax diagnostic materials Develop a restricted-access web site for communication, ordering of reagents, and reporting of external quality assurance results
Practical worksheets: topics Priorities Target audiences Anthrax workshop Strategy and scope of QA programme Standards Safety issues Costs