Disease-specific networks

Mission statementTo strengthen global disease-specific networks

of experts and laboratories able toprovide technical support to response activities

in Member States, particularly developing countries,related to the natural occurrence, accidental release,

or deliberate use of biological agentsthat affect health.

E P I D E M I C A L E R T A N D R E S P O N S E

Anthrax: Project objectives

1 To establish a global network of anthrax experts andlaboratories with defined anthrax capabilities

2 To establish standard procedures relating to anthraxand disseminate information

3 To set up and implement training and quality assurance

E P I D E M I C A L E R T A N D R E S P O N S E

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

E P I D E M I C A L E R T A N D R E S P O N S E

Current Anthrax Working Group

E P I D E M I C A L E R T A N D R E S P O N S E

ArgentinaAustraliaCanadaChinaColombiaEnglandFranceGeorgiaGermanyIndiaIndonesiaItalyNepalPhilippinesRussian FederationSouth AfricaThailandTurkeyUnited States of America

31 experts in 19 countries

E P I D E M I C A L E R T A N D R E S P O N S E

• Expanding the group?

• Is such a network useful?

• Is it feasible to maintain a such a network?

1b. A global network of laboratorieswith defined anthrax capabilities

• Develop an inventory of capabilities of reference publichealth and veterinary laboratories in Member States

• Obtain an understanding of the current gaps

• Support activities to fill them, particularly inlaboratories in developing countries

E P I D E M I C A L E R T A N D R E S P O N S E

E P I D E M I C A L E R T A N D R E S P O N S E

Name of laboratory Address City

Postal codeCountry Telephone

Fax EmailWeb site

Name of director of the laboratory

TitleTelephone Fax

Email

Name of person responsible for anthrax activities

Title

Telephone Fax

Email

World Health Organization

Disease-Specific Networks: AnthraxQuestionnaire for Laboratories

Communicable Disease Surveillance and Response Global Alert and Response

1. Contact details

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?

Advanced technology tests

Antimicrobial sensitivity tests

Routine and confirmatory culture

Spore visualization in environmental samples

Capsule visualization in clinical specimensIndia ink stain

Polychrome methylene blue stain

Direct fluorescence assay

Phase contrast

Malachite green

Other (please specify)

Haemolysis

Motility

Penicillin sensitivity

Gamma phage lysis

Capsule production in blood (in vitro)

Capsule production on bicarbonate/serum agar plates

Other (please specify)

Multi-disk

MICs

Specific (toxin) antigen ELISA

Time-resolved fluorescence (TRF) testing

Polymerase chain reaction (PCR)

Molecular characterization

Other (please specify)

Other (please specify)

Other (please specify)

World Health OrganizationGlobal Alert and Response

Communicable Disease Surveillance and Response

Disease-Specific Networks: AnthraxQuestionnaire for Laboratories

1. Contact detailsName 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 healthpreparedness forand response to

the threat of epidemics

Mission statementTo strengthen global disease-specific networks

of experts and laboratories able toprovide technical support to response activities

in Member States, particularly developing countries, related to the natural occurrence, accidental release,

or deliberate use of biological agentsthat affect health.

World Health OrganizationGlobal Alert and Response

Communicable Disease Surveillance and Response

Office internationaldes épizooties Food and Agriculture

Organization of the United Nations

Working Groupmembers

WHO Regional OfficesWHO CSR Lyon

Collaboration: reaching the laboratories

E P I D E M I C A L E R T A N D R E S P O N S E

WHO Global Salm-Surv

European Union

WHO Collaborating Centres

Anthrax questionnaires

Completed questionnaires(27 March 03)

68 received from 51 countries

E P I D E M I C A L E R T A N D R E S P O N S E

Argentina MalaysiaAustralia MauritaniaAustria MauritiusBelgium NepalBurundi MoroccoCameroon NetherlandsChile New ZealandChina PhilippinesColombia PolandCosta Rica Republic of Moldova Croatia Romania

Cyprus Senegal

Czech Republic SlovakiaDemocratic Republic of the Congo SloveniaEritrea South AfricaFinland Sudan

France SwitzerlandGeorgia Syrian Arab RepublicGermany TunisiaIndia TurkeyIndonesia UkraineItaly United KingdomJapan USAJordan YugoslaviaLatvia ZimbabweLithuania

E P I D E M I C A L E R T A N D R E S P O N S E

• 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

E P I D E M I C A L E R T A N D R E S P O N S E

Fact Sheet N° 264October 2001

ANTHRAXOverviewAnthrax is primarily a disease of herbivorous mammals, although other mammalsand some birds have been known to contract it. Humans generally acquire thedisease directly or indirectly from infected animals, or occupational exposure toinfected or contaminated animal products. Control in livestock is therefore the keyto reduced incidence. There are no documented cases of person to persontransmission. The disease’s impact on animal and human health can bedevastating. WHO has produced Guidelines for the surveillance and control ofanthrax in humans and animals.The causative agent of anthrax is the bacterium, Bacillus anthracis, the spores ofwhich can survive in the environment for years or decades, awaiting uptake by thenext host.The disease still exists in animals and humans in most countries of sub-SahelianAfrica and Asia, in several southern European countries, in the Americas, andcertain areas of Australia. Disease outbreaks in animals also occur sporadically inother countries.There are 3 types of anthrax in humans: cutaneous anthrax, acquired when a sporeenters the skin through a cut or an abrasion; gastrointestinal tract anthrax,contracted from eating contaminated food, primarily meat from an animal that diedof the disease; and pulmonary (inhalation) anthrax from breathing in airborneanthrax spores.The cutaneous form accounts for 95% or more of human cases globally. All 3 typesof anthrax are potentially fatal if not treated promptly.PreventionPrevention of anthrax in both humans and animals is based on control measures inlivestock in endemic areas, such as the safe disposal of anthrax carcasses andvaccination of at-risk herds. The most efficient method of disposal is incineration ina manner that ensures heat sterilization of the underlying soil. In practice, localconditions in many endemic countries make these simple control measures difficultto implement. In industrialized countries, prevention lies in good agricultural andindustrial hygiene.Vaccines are available for animals and humans. However in humans their useshould be confined to high-risk groups, such as those occupationally exposed andin some military settings.Patient isolation is not required and there are no quarantine requirements.Dressings and other contaminated materials should be disposed of, preferably byincineration.Treatment

Guidance on anthrax: frequently asked questionsWhat 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? Do I have to go to a hospital to get tests? I am worried about anthrax. Should I take antibiotics just in case? What do I do if I get a suspicious package or letter? What constitutes a suspicious letter or parcel? What should I do if I receive an anthrax threat by mail? ______________________________________________________________________________

Q. What is anthrax?A. Anthrax is a disease caused by a bacterium called Bacillus anthracis. It is a diseasewhich has existed for hundreds of years and which still occurs naturally in both animalsand humans in many parts of the world, including Asia, southern Europe, sub-SahelianAfrica and parts of Australia. Anthrax bacteria can survive in the environment by formingspores. In its most common natural form, it creates dark sores on the skin, from which itderives its name. Anthrax is Greek for coal.Q. What's happening right now?A. WHO posts updated situation reports whenever there is an outbreak of anthrax or anyother infectious disease on its Web site.Q. Is there just one type of anthrax?A. There are three types of anthrax, each with different symptoms:Cutaneous, or skin, anthrax is the most common form. It is usually contracted when aperson with a break in their skin, such as a cut or abrasion, comes into direct contact withanthrax spores. The resulting itchy bump rapidly develops into a black sore. Some peoplecan then develop headaches, muscle aches, fever and vomiting. Cutaneous anthrax mustbe treated quickly. Appropriate medical evaluation and treatment are essential.Gastrointestinal anthrax is caught from eating meat from an infected animal. It causesinitial symptoms similar to food poisoning but these can worsen to produce severeabdominal pain, vomiting of blood and severe diarrhoea. Appropriate medical evaluationand treatment are essential.The most severe form of human anthrax is called inhalation or pulmonary anthrax.Though the rarest, it is the form of human anthrax causing the most current concern. Thisform of the disease is caused when a person is directly exposed to a large number ofanthrax spores suspended in the air, and breathes them in. The first symptoms are similarto those of a common cold, but this can rapidly progress to severe breathing difficultiesand shock. Appropriate medical evaluation and treatment are essential.

Establish standard procedures relating to anthrax and disseminate information

3. Training and quality assurance

• Develop a training module on anthrax diagnosis

• Hold an anthrax workshop for one laboratory from eachof several WHO regions

E P I D E M I C A L E R T A N D R E S P O N S E

Quality assurance

• Establish an external quality assurance programmewith trained laboratories

• Establish a reagent bank of selected anthrax diagnosticmaterials

• Develop a restricted-access web site forcommunication, ordering of reagents, and reporting ofexternal quality assurance results

E P I D E M I C A L E R T A N D R E S P O N S E

E P I D E M I C A L E R T A N D R E S P O N S E

• Practical worksheets: topics

• Priorities

• Target audiences

• Anthrax workshop

• Strategy and scope of QA programme

• Standards

• Safety issues

• Costs