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What
are the employee medical program requirements?
Because of the potential
for exposure to anthrax, medical measures to prevent
anthrax should be taken. The medical measures differ
depending on the type of worker and duration of
exposure. There are three types or categories of
workers or others who may be exposed to anthrax:
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In addition
to the medical measures to prevent exposure to anthrax,
and the medical surveillance programs required in
the HAZWOPER (29
CFR 1910.120) and
respiratory protection regulations, the occupational
health and safety plan (HASP)
should also include the following two major components
to protect workers:
Additional information
regarding medical surveillance can be found at the
following site: |
| Short-Term
Response Workers |
Exposures
are limited to a single episode or a few episodes
within a brief period (less that 30 days).
Local emergency medical personnel, police,
and firefighters who are not expected to re-enter
contaminated areas for longer periods of time
fall into this category.
Short-term response workers should be:
- Adequately immunized with anthrax vaccine,
or
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- Placed on appropriate prophylactic antibiotics
at the time of their first exposure and continue
for 60 days after their last exposure. Because
experimental data indicate that viable spores
may persist in the lungs for 100 days after
exposure, an option is the use of antibiotics
for 100 days after exposure.
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| Long-Term
Response Workers |
These
individuals have repeated exposures over longer
periods of time (30 days or more). Environmental
response team members and decontamination
workers fall into this category. They
may work at multiple sites (such as industrial
hygienists conducting environmental sampling)
or at a single site (such as contractors performing
decontamination work).
Long-term response workers should be:
- Adequately immunized with anthrax vaccine
before exposure if they are at high risk
of repeated exposures.
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- Placed on appropriate prophylactic antibiotics,
if necessary, for considerably longer than the
60 days recommended for short-term workers.
Because experimental data indicate that viable
spores may persist in the lungs for 100 days
after exposure, an option is the use of antibiotics
for 100 days after exposure.
- If the vaccine series is started after exposure
has occurred, antibiotic prophylaxis should
be continued during the first three doses to
provide protection until an adequate immune
response has developed.
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| Occupants,
Workers, or Visitors at a Site Contaminated with
Anthrax |
Postal
or office workers or maintenance and housekeeping
personnel would fall into this category. The
medical program for this group should have
two phases: the immediate post-exposure period
and the period after a previously contaminated
site has been cleared for unrestricted entry
and occupancy. Initial medical screening should
be done to identify exposed persons who should
avoid taking antibiotics.
Medical measures during the immediate post-exposure
period:
- Individuals should be placed on appropriate
prophylactic antibiotics at the time of
their first exposure and continue for
60 days after their last exposure. Because
experimental data indicate that viable
spores may persist in the lungs for 100
days after exposure, an option is the
use of antibiotics for 100 days after
exposure.
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Once a previously contaminated site has been cleared
for re-occupancy, personal protection and medical
measures to prevent anthrax are presumably no longer
necessary. However, a precautionary program of medical
monitoring may be prudent to assure that anthrax
is no longer a threat. The program should be designed
and administered under the supervision of a licensed
physician.
Medical measures after a previously contaminated
site has been cleared for unrestricted entry and
occupancy should include:
- Initial medical history to screen for high-risk
conditions (such as compromised immunity, skin
conditions)
- Counseling of high-risk persons
- Around-the-clock access to medical coverage
for anthrax-like symptoms
- Confidentiality of medical information
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Medical
screening and follow-up care for anthrax and
medical complications related to preventive measures |
The
purpose of occupational health surveillance in the
workplace is to improve the effectiveness of the
occupational health and safety program by systematically
collecting and analyzing information that pertains
to at-risk workers.
The program
for monitoring exposed persons includes:
- Medical screening
program
The medical screening program is the use
of examinations or tests to detect adverse
effects on a worker's health at an early
stage when prevention is possible or treatment
is most effective. It should include:
- Baseline medical screening to identify
pre-existing conditions that may affect
an individual workers fitness for duty,
and who should avoid antibiotics or
vaccines.
- Periodic evaluations to reassess fitness
for duty and to detect symptoms of the
development of anthrax or adverse effects
related to preventive measures (such
as antibiotics).
- Final evaluation when it is no longer
necessary for a worker to re-enter a
contaminated site, to identify changes
from the baseline and any new risk factors.
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- Medical monitoring program
for adverse work-related health effects
The medical monitoring program for adverse
effects related to antibiotic use should include
the following so that an informed decision appropriate
for the affected individual can be made:
- Plans to inform affected workers about available
options for preventing anthrax
- Risks and benefits of each option
- Exposure Monitoring (such
as incidents of breaches in PPE)
There are no validated methods for monitoring
a person's exposure to Bacillus
anthracis. There are useful epidemiologic
tools that can be used, but these should not
be used to assess a person's exposure or to
make decisions about the use of antibiotics
or vaccine. These tools include:
Inhalation exposure to a
high concentration of Bacillus
anthracis spores may rapidly result in death.
Therefore, exposure to aerosolized powder known
or highly suspected to be contaminated with Bacillus
anthracis spores should be treated as a medical
emergency.
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Knowledge
and Information that Workers Need to Prevent
Anthrax and Medical Complications Related to Preventive
Measures |
In
addition to HAZWOPER training (29
CFR 1910.120), response
workers will also need additional knowledge and
information about anthrax and the medical measures
that can protect them. It should be stressed that
for preventive measures to be effective, individual
workers must fully understand them and use them
correctly. All response workers should receive training
to:
- Recognize and report early symptoms and signs
of anthrax,
- Understand the importance of immediate medical
attention,
- Know how to access emergency medical care,
- Know about potential adverse effects and interactions
with food and drugs if taking antibiotics, and
- Understand the potential adverse effects of
vaccine and the amount of time necessary to
develop an immune response if using the vaccine
as a preventive measure.
The validity and reliability
of symptom reports are only as good as the exposed
person's knowledge and understanding of the characteristics
of anthrax and risks for developing the disease.
Successful treatment of anthrax will depend on the
individual's understanding of the need for immediate
medical attention should symptoms occur and knowledge
of how to access emergency medical care. Therefore,
hazard awareness training is an important component
of the medical program.
The
following links include more detailed information
on Medical Program Requirements: |
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