Global & Disaster Medicine

Indonesia, a country of more than 17,000 islands, is exposed to many hazards. A magnitude 9.1 earthquake struck off the coast of Sumatra, Indonesia, on December 26, 2004. It triggered a series of tsunami waves that spread across the Indian Ocean causing damage in 11 countries. Banda Aceh, the capital city of Aceh Province, was among the most damaged. More than 31,000 people were killed. At the time, there were no early warning systems nor evacuation buildings that could provide safe refuge for residents. Since then, four tsunami evacuation buildings (TEBs) have been constructed in the Meuraxa subdistrict of Banda Aceh. Based on analysis of evacuation routes and travel times, the capacity of existing TEBs is examined. Existing TEBs would not be able to shelter all of the at-risk population. In this study, additional buildings and locations for TEBs are proposed and residents are assigned to the closest TEBs. While TEBs may be part of a larger system of tsunami mitigation efforts, other strategies and approaches need to be considered. In addition to TEBs, robust detection, warning and alert systems, land use planning, training, exercises, and other preparedness strategies are essential to tsunami risk reduction.

Posted in Documents, Tsunami| Comments Off

CDC’s Emergency Drugs for US Clinicians and Hospitals

Thursday, June 8th, 2017

CDC

Our Formulary

The following information is provided as an informational resource for guidance only. It is not intended as a substitute for professional judgment. These highlights and any hyperlinks may not include all the information needed to use each respective drug or biologic safely and effectively. See full prescribing information (package insert) or IND protocol for each respective drug or biologic, which accompany the product when it is delivered to the treating physician and/or pharmacist.

The Drug Service formulary is subject to change based on current public health needs, updates to treatment guidelines, and/or drug availability. For historical reference, we have included products no longer supplied by the Drug Service.

Product & Supplier	Indication & Eligibility	How Supplied
Anthrax Vaccine Absorbed (Also known as “AVA”; BioThrax®, Emergent BioSolutions)	For the active immunization for the prevention of disease caused by Bacillus anthracis, in persons 18 through 65 years of age at high risk for exposure Because the risk for anthrax infection in the general population is low, routine immunization is not recommended The safety and efficacy of BioThrax® in a post-exposure setting have not been established.	Suspension for injection in 5 mL multidose vials, each containing 10 doses
Artesunate, intravenous (Supplied to CDC by the Walter Reed Army Institute of Research)	For the treatment of severe malaria in patients who require parenteral (IV) therapy Patient must meet the eligibility criteria in the IND protocol	110 mg; sterile dry-filled powder with phosphate buffer diluent for reconstitution
Benznidazole (Benznidazol, Manufactured by LAFEPE)	For the treatment of American trypanosomiasis (Chagas disease) Patient must meet the eligibility criteria in the IND protocol	100 mg double-scored tablet 12.5 mg dispersible tablet for pediatric use
Botulism Antitoxin Heptavalent (Equine), Types A-G (Also known as “HBAT”; Manufactured by Cangene Corp. – BAT™)	For the treatment of symptomatic botulism following documented or suspected exposure to botulinum neurotoxin	20 mL or 50 mL single-use glass vial May be received frozen or thawed
Diethylcarbamazine (Also known as “DEC”; Supplied to CDC by the World Health Organization; Manufactured by E.I.P.I.C.O.)	For the treatment of certain filarial diseases, including lymphatic filariasis caused by infection with Wuchereria bancrofti, Brugia malayi, or Brugia timori; tropical pulmonary eosinophilia; and loiasis For prophylactic use in persons determined to be at increased risk for Loa loa infection Patient must meet the eligibility criteria in the IND protocol	100 mg tablet
Diphtheria Antitoxin (Equine) (Also known as “DAT”; Manufactured by Instituto Butantan)	For prevention or treatment of actual or suspected cases of diphtheria Patient must meet the eligibility criteria in the IND protocol	1 mL single-use ampule containing 10,000 units
Eflornithine (Also known as “DFMO”; Supplied to CDC by the World Health Organization; Manufactured by Sanofi Aventis – Ornidyl®)	For the treatment of second-stage African trypanosomiasis (sleeping sickness) caused by Trypanosoma brucei gambiense, with involvement of the central nervous system	20 g/100 mL hypertonic solution for IV infusion Must be diluted with Sterile Water for Injection before use
Melarsoprol (Supplied to CDC by the World Health Organization; Manufactured by Sanofi Aventis – Arsobal®)	For the treatment of second-stage African trypanosomiasis (sleeping sickness), with involvement of the central nervous system Patient must meet the eligibility criteria in the IND protocol	5 mL glass ampule containing 180 mg/5 mL (36 mg/mL)
Nifurtimox (Supplied to CDC by the World Health Organization; Manufactured by Bayer – Lampit®)	For the treatment of American trypanosomiasis (Chagas disease) Patient must meet the eligibility criteria in the IND protocol	120 mg double-scored tablet
Sodium Stibogluconate (Manufactured by GlaxoSmithKline, UK – Pentostam®)	For the treatment of leishmaniasis Patient must meet the eligibility criteria in the IND protocol	Solution for injection in 100 mL multidose bottle 100 mg pentavalent antimony (Sb) per mL
Suramin (Supplied to CDC by the World Health Organization; Manufactured by Bayer – Germanin)	For the treatment of first-stage African trypanosomiasis (sleeping sickness) caused by Trypanosoma brucei rhodesiense, without involvement of the central nervous system Patient must meet the eligibility criteria in the IND protocol	1 gram of suramin for injection in a 10 mL vial (100 mg/mL solution of suramin sodium) Must be reconstituted with 10 mL Sterile Water for Injection before use
Vaccinia Vaccine (Also known as the “Smallpox Vaccine”; Manufactured by Sanofi Aventis – ACAM2000®)	For active immunization against smallpox disease for persons determined to be at high risk for smallpox infection	Lyophilized powder reconstituted with diluent (provided) Contains 100 doses per vial

Product & Supplier

Indication & Eligibility

How Supplied

Anthrax Vaccine Absorbed

(Also known as “AVA”; BioThrax®, Emergent BioSolutions)

For the active immunization for the prevention of disease caused by Bacillus anthracis, in persons 18 through 65 years of age at high risk for exposure

Because the risk for anthrax infection in the general population is low, routine immunization is not recommended

The safety and efficacy of BioThrax® in a post-exposure setting have not been established.

Suspension for injection in 5 mL multidose vials, each containing 10 doses

Artesunate, intravenous

(Supplied to CDC by the Walter Reed Army Institute of Research)

For the treatment of severe malaria in patients who require parenteral (IV) therapy

Patient must meet the eligibility criteria in the IND protocol

110 mg; sterile dry-filled powder with phosphate buffer diluent for reconstitution

Benznidazole

(Benznidazol, Manufactured by LAFEPE)

For the treatment of American trypanosomiasis (Chagas disease)

Patient must meet the eligibility criteria in the IND protocol

100 mg double-scored tablet

12.5 mg dispersible tablet for pediatric use

Botulism Antitoxin Heptavalent (Equine), Types A-G

(Also known as “HBAT”; Manufactured by Cangene Corp. – BAT™)

For the treatment of symptomatic botulism following documented or suspected exposure to botulinum neurotoxin

20 mL or 50 mL single-use glass vial

May be received frozen or thawed

Diethylcarbamazine

(Also known as “DEC”; Supplied to CDC by the World Health Organization; Manufactured by E.I.P.I.C.O.)

For the treatment of certain filarial diseases, including lymphatic filariasis caused by infection with Wuchereria bancrofti, Brugia malayi, or Brugia timori; tropical pulmonary eosinophilia; and loiasis

For prophylactic use in persons determined to be at increased risk for Loa loa infection

Patient must meet the eligibility criteria in the IND protocol

100 mg tablet

Diphtheria Antitoxin (Equine)

(Also known as “DAT”; Manufactured by Instituto Butantan)

For prevention or treatment of actual or suspected cases of diphtheria

Patient must meet the eligibility criteria in the IND protocol

1 mL single-use ampule containing 10,000 units

Eflornithine

(Also known as “DFMO”; Supplied to CDC by the World Health Organization; Manufactured by Sanofi Aventis – Ornidyl®)

For the treatment of second-stage African trypanosomiasis (sleeping sickness) caused by Trypanosoma brucei gambiense, with involvement of the central nervous system

20 g/100 mL hypertonic solution for IV infusion

Must be diluted with Sterile Water for Injection before use

Melarsoprol

(Supplied to CDC by the World Health Organization; Manufactured by Sanofi Aventis – Arsobal®)

For the treatment of second-stage African trypanosomiasis (sleeping sickness), with involvement of the central nervous system

Patient must meet the eligibility criteria in the IND protocol

5 mL glass ampule containing 180 mg/5 mL (36 mg/mL)

Nifurtimox

(Supplied to CDC by the World Health Organization; Manufactured by Bayer – Lampit®)

For the treatment of American trypanosomiasis (Chagas disease)

Patient must meet the eligibility criteria in the IND protocol

120 mg double-scored tablet

Sodium Stibogluconate

(Manufactured by GlaxoSmithKline, UK – Pentostam®)

For the treatment of leishmaniasis

Patient must meet the eligibility criteria in the IND protocol

Solution for injection in 100 mL multidose bottle

100 mg pentavalent antimony (Sb) per mL

Suramin

(Supplied to CDC by the World Health Organization; Manufactured by Bayer – Germanin)

For the treatment of first-stage African trypanosomiasis (sleeping sickness) caused by Trypanosoma brucei rhodesiense, without involvement of the central nervous system

Patient must meet the eligibility criteria in the IND protocol

1 gram of suramin for injection in a 10 mL vial (100 mg/mL solution of suramin sodium)

Must be reconstituted with 10 mL Sterile Water for Injection before use

Vaccinia Vaccine

(Also known as the “Smallpox Vaccine”; Manufactured by Sanofi Aventis – ACAM2000®)

For active immunization against smallpox disease for persons determined to be at high risk for smallpox infection

Lyophilized powder reconstituted with diluent (provided)

Contains 100 doses per vial

Top of Page

Anthrax Vaccine Adsorbed

Anthrax Vaccine Adsorbed (AVA) is indicated for the active immunization for the prevention of disease caused by Bacillus anthracis, in persons 18 through 65 years of age at high risk for exposure. The safety and efficacy of AVA in a post-exposure setting have not been established.

CDC provides anthrax vaccine for laboratory workers conducting research under federally funded projects who require preexposure vaccination based on their occupational risk.

Preexposure vaccination is recommended for laboratorians at risk for repeated exposure to fully virulent B. anthracis spores, such as those who 1) work with high concentrations of spores with potential for aerosol production; 2) handle environmental samples that might contain powders and are associated with anthrax investigations; 3) routinely work with pure cultures of B. anthracis; 4) frequently work in spore-contaminated areas after a bioterrorism attack; or 5) work in other settings where repeated exposures to B. anthracis aerosols may occur. Read more[PDF – 36 pages](https://www.cdc.gov/mmwr/pdf/rr/rr5906.pdf).

More Information for Clinicians

CDC’s Anthrax Vaccination Website

Educational Toolkit for Clinicians (from Department of Defense Anthrax Immunization Program)

Vaccine Information Statement (VIS) for Anthrax Vaccine[PDF – 2 pages](https://www.cdc.gov/vaccines/hcp/vis/vis-statements/anthrax.pdf)

Full Prescribing Information for BioThrax®

How to Request

Anthrax vaccine must be administered by or under the supervision of the physician who registers with CDC.

Contact the CDC Drug Service for more information.

Top of Page

Artesunate, Intravenous

Artesunate is in the class of medications known as artemesinins, which are derivatives from the “qinghaosu” or sweet wormwood plant (Artemisia annua). Artesunate is not currently licensed by FDA but is made available in the United States under a CDC-sponsored IND protocol for treatment of documented cases of severe malaria(https://www.cdc.gov/malaria/about/index.html) that require parenteral therapy. Read more(https://www.cdc.gov/malaria/diagnosis_treatment/artesunate.html).

More Information for Clinicians

Diagnostic assistance for malaria is available through DPDx.

How to Request

Clinicians who wish to obtain artesunate for severe malaria should contact the CDC Malaria Hotline at 770-488-7788 (M-F, 8am-4:30pm, Eastern time) or, after hours, the CDC Emergency Operations Center (EOC) at 770-488-7100, and request to speak with a CDC Malaria Branch clinician. A Malaria Branch clinician will provide clinical consultation by telephone and, if indicated, authorize the emergency release of artesunate from one of the CDC Quarantine Stations located in major airports around the nation, ensuring delivery to any location in the United States within hours.

Requests for unapproved uses cannot be granted.

For non-emergency questions related to artesunate IV, contact the CDC Drug Service.

Top of Page

Benznidazole

Benznidazole is a 2-nitroimidazole trypanocidal agent that was introduced in 1971 for the treatment of Trypanosoma cruzi infection—i.e., Chagas disease, also known as American trypanosomiasis(https://www.cdc.gov/parasites/chagas/). Benznidazole is one of two drugs available from CDC for the treatment of Chagas disease (the other is nifurtimox). In the United States, the need to have drugs available for treating Chagas disease has been increasing, largely because of implementation of T. cruzi blood-donor screening in 2007, which has identified chronically infected persons (mainly Latin American immigrants) who might benefit from treatment and has heightened awareness of Chagas disease.

More Information for Clinicians

Evaluation and Treatment of Chagas Disease in the United States: A Systematic Review (JAMA 2007: 298:2171-81)

Screening and Treatment of Chagas Disease in Organ Transplant Recipients in the United States: Recommendations from the Chagas in Transplant Working Group (American Journal of Transplantation, 2011: 672–680)

Diagnostic assistance for American trypanosomiasis is available through DPDx.

How to Request

Contact the CDC Drug Service for more information.

Questions regarding treatment of Chagas disease should be directed to CDC Parasitic Diseases Inquiries (404-718-4745; email chagas@cdc.gov) M-F 7:30am-4pm EST.

For emergencies (for example, acute Chagas disease with severe manifestations, Chagas disease in a newborn, or Chagas disease in an immunocompromised person) outside of regular business hours, call the CDC Emergency Operations Center (770-488-7100) and ask for the person on call for Parasitic Diseases.

Top of Page

Botulism Antitoxin Heptavalent (Equine), Types A-G

Botulism Antitoxin Heptavalent (HBAT) contains equine-derived antibody to the seven known botulinum toxin types (A-G). HBAT is composed of <2% intact immunoglobulin G (IgG) and ≥90% Fab and F(ab’)2 immunoglobulin fragments. These fragments are created by the enzymatic cleavage and removal of Fc immunoglobulin components in a process sometimes referred to as despeciation. HBAT is supplied on an emergency basis for the treatment of persons thought to be suffering from botulism and works by neutralizing unbound toxin molecules. In 2010, HBAT became the only botulism antitoxin available in the United States for naturally occurring non-infant botulism.

It is available only from CDC because of its limited use and its relatively short expiration date. The antitoxin is stored at CDC Quarantine Stations located in major airports around the nation, ensuring delivery to any location in the United States within hours.

BabyBIG® (botulism immune globulin) remains available for infant botulism through the California Infant Botulism Treatment and Prevention Program.

More Information for Clinicians

Clinical Guidance

How to Request

Clinicians who suspect a diagnosis of botulism in a patient should immediately call their state health department’s 24-hour telephone number(https://www.cdc.gov/mmwr/international/relres.html) to maintain effective botulism surveillance and to facilitate rapid detection of outbreaks. The state health department will contact CDC to arrange for a clinical consultation by telephone and, if indicated, release of botulism antitoxin. State health departments requesting botulism antitoxin should contact the CDC Emergency Operations Center (EOC) at 770-488-7100. Read more(https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5232a8.htm).

For non-emergency questions concerning botulism antitoxin, contact the CDC Drug Service.

Top of Page

Diethylcarbamazine (DEC)

DEC is an antihelminthic agent used for treatment of lymphatic filariasis (caused by infection with Wuchereria bancrofti, Brugia malayi, or Brugia timori), tropical pulmonary eosinophilia, and loiasis(https://www.cdc.gov/parasites/loiasis/); DEC also has prophylactic benefit for Loa loa infection. DEC has been used worldwide for more than 50 years. In the past, Wyeth-Ayerst Laboratories made DEC available as a licensed drug; in the late 1990s, because of unavailability of a bulk chemical supplier, Wyeth-Ayerst discontinued distribution of DEC in the United States.

More Information for Clinicians

Diagnostic assistance for filarial diseases is available through DPDx.

How to Request

Contact the CDC Drug Service for more information.

Questions regarding treatment of filarial diseases should be directed to CDC Parasitic Diseases Inquiries (404-718-4745; email parasites@cdc.gov) M-F 7:30am-4pm EST.

After-hours emergencies: 1-770-488-7100

Top of Page

Diphtheria Antitoxin (Equine)

Diphtheria antitoxin (DAT) is used to prevent or treat diphtheria by neutralizing the toxins produced by Corynebacterium diphtheriae. DAT is a sterile, aqueous solution of the refined and concentrated proteins, chiefly globulins, containing antibodies obtained from the serum of horses that have been immunized against diphtheria toxin. DAT is available under an IND protocol sponsored by CDC and is released only for actual or suspected cases of diphtheria(https://www.cdc.gov/diphtheria/about/index.html). The antitoxin is stored at CDC Quarantine Stations located in major airports around the nation, ensuring delivery to any location in the United States within hours.

More Information for Clinicians

CDC’s Vaccine-Related Topics: Diphtheria Antitoxin(https://www.cdc.gov/diphtheria/dat.html)

How to Request

Clinicians who suspect a diagnosis of respiratory diphtheria can obtain DAT by contacting the Emergency Operations Center at 770-488-7100. They will be connected with the diphtheria duty officer, who will provide clinical consultation and, if indicated, initiate the release of diphtheria antitoxin.

For non-emergency questions concerning diphtheria antitoxin, contact the CDC Drug Service.

Top of Page

Eflornithine

Eflornithine is an antitrypanosomal agent that inhibits the enzyme ornithine decarboxylase. Antitrypanosomal treatment is indicated for all persons diagnosed with African trypanosomiasis (sleeping sickness)(https://www.cdc.gov/parasites/sleepingsickness/); the choice of therapy depends on the infecting subspecies of the parasite and on the stage of the infection. Eflornithine is considered the drug of choice for the treatment of second-stage Trypanosoma brucei gambiense (West African) infection, with involvement of the central nervous system. It is not effective against T. b. rhodesiense (East African) infection (see melarsoprol). Although the manufacturer, Aventis, maintains its US licensure, eflornithine is not commercially available in the United States.

More Information for Clinicians

Human African trypanosomiasis, WHO

Diagnostic assistance for African trypanosomiasis is available through DPDx.

How to Request

Contact the CDC Drug Service for more information.

Questions regarding treatment of African trypanosomiasis should be directed to CDC Parasitic Diseases Inquiries (404-718-4745; email parasites@cdc.gov) M-F 7:30am-4pm EST.

For emergencies outside of regular business hours, call the CDC Emergency Operations Center (770-488-7100) and ask for the person on call for Parasitic Diseases.

Top of Page

Melarsoprol

Melarsoprol is an organoarsenic compound with trypanocidal effects that has been used outside the United States since 1949. Antitrypanosomal treatment is indicated for all persons diagnosed with African trypanosomiasis (sleeping sickness)(https://www.cdc.gov/parasites/sleepingsickness/); the choice of therapy depends on the infecting subspecies of the parasite and on the stage of the infection. Melarsoprol is used for the treatment of second-stage infection (involving the central nervous system). It is the only available therapy for second-stage Trypanosoma brucei rhodesiense (East African) infection, whereas eflornithine typically is used for second-stage T. b. gambiense (West African) infection.

More Information for Clinicians

Human African trypanosomiasis, WHO

Diagnostic assistance for African trypanosomiasis is available through DPDx.

How to Request

Contact the CDC Drug Service for more information.

Questions regarding treatment of African trypanosomiasis should be directed to CDC Parasitic Diseases Inquiries (404-718-4745; email parasites@cdc.gov) M-F 7:30am-4pm EST.

For emergencies outside of regular business hours, call the CDC Emergency Operations Center (770-488-7100) and ask for the person on call for Parasitic Diseases.

Top of Page

Nifurtimox

Nifurtimox is a nitrofuran analog that was introduced in 1965 for the treatment of Trypanosoma cruzi infection—i.e., Chagas disease, also known as American trypanosomiasis(https://www.cdc.gov/parasites/chagas/). Nifurtimox is one of two drugs available from CDC for the treatment of Chagas disease (the other is benznidazole). In the United States, the need to have drugs available for treating Chagas disease has been increasing, largely because of implementation of T. cruzi blood-donor screening in 2007, which has identified chronically infected persons (mainly Latin American immigrants) who might benefit from treatment and has heightened awareness of Chagas disease.

More Information for Clinicians

Evaluation and Treatment of Chagas Disease in the United States: A Systematic Review (JAMA 2007: 298:2171-81)

Diagnostic assistance for American trypanosomiasis is available through DPDx.

How to Request

Contact the CDC Drug Service for more information.

Questions regarding treatment of Chagas disease should be directed to CDC Parasitic Diseases Inquiries (404-718-4745; email chagas@cdc.gov) M-F 7:30am-4pm EST.

Top of Page

Sodium Stibogluconate

Sodium stibogluconate (Pentostam®) is a pentavalent antimony compound used for treatment of leishmaniasis(https://www.cdc.gov/parasites/leishmaniasis). The three main clinical syndromes in humans are visceral, cutaneous, and mucosal leishmaniasis. Pentostam is a well-established antileishmanial agent that has been used in many countries of the world for more than half a century.

More Information for Clinicians

Recommendations for Treating Leishmaniasis with Sodium Stibogluconate (Pentostam) and Review of Pertinent Clinical Studies (Am J Trop Med 1992:46(3):296-306)[PDF, 11 pages]

Diagnostic assistance for leishmaniasis is available through DPDx.

Practical Guide for Laboratory Diagnosis of Leishmaniasis[PDF, 4 pages](https://www.cdc.gov/parasites/leishmaniasis/resources/pdf/cdc_diagnosis_guide_leishmaniasis.pdf)

How to Request

Contact the CDC Drug Service for more information.

Questions regarding treatment of leishmaniasis should be directed to CDC Parasitic Diseases Inquiries (404-718-4745; email parasites@cdc.gov) M-F 7:30am-4pm EST.

After-hours emergencies: 1-770-488-7100

Top of Page

Suramin

Suramin is a negatively charged, high-molecular-weight sulfated naphthylamine. It was introduced in the 1920s for the treatment of African trypanosomiasis (sleeping sickness)(https://www.cdc.gov/parasites/sleepingsickness/). Suramin generally is considered the drug of choice for first-stage Trypanosoma brucei rhodesiense (East African) infection, without involvement of the central nervous system. Pentamidine typically is used for first-stage T. b. gambiense (West African) infection.

More Information for Clinicians

Human African trypanosomiasis, WHO

Diagnostic assistance for African trypanosomiasis is available through DPDx.

How to Request

Contact the CDC Drug Service for more information.

Questions regarding treatment of African trypanosomiasis should be directed to CDC Parasitic Diseases Inquiries (404-718-4745; email parasites@cdc.gov) M-F 7:30am-4pm EST.

For emergencies outside of regular business hours, call the CDC Emergency Operations Center (770-488-7100) and ask for the person on call for Parasitic Diseases.

Top of Page

Vaccinia Vaccine, “Smallpox Vaccine”

Smallpox vaccine is made of live vaccinia virus derived from plaque purification cloning of Dryvax® (calf lymph vaccine, New York City Board of Health Strain) and grown in African Green Monkey kidney (Vero) cells and tested to be free of adventitious agents. It contains approximately 2.5 – 12.5 x 10⁵ plaque-forming units per dose.

Smallpox was declared globally eradicated in 1980. In 1982, Wyeth Laboratories, the only active manufacturer of licensed vaccinia vaccine in the United States, discontinued production; and, in 1983, distribution to the civilian population was discontinued. Since January 1982, smallpox vaccination has not been required for international travelers, and International Certificates of Vaccination no longer include smallpox vaccination. ACAM2000® is a new-generation smallpox vaccine that was licensed in 2010 for use as a medical countermeasure held by the Strategic National Stockpile.

CDC recommends vaccinia vaccine for laboratory workers who directly handle a) cultures or b) animals contaminated or infected with nonhighly attenuated vaccinia virus, recombinant vaccinia viruses derived from nonhighly attenuated vaccinia strains, or other orthopoxviruses that infect humans (e.g., monkeypox, cowpox, vaccinia, and variola). Other health-care workers (e.g., physicians and nurses) whose contact with nonhighly attenuated vaccinia viruses is limited to contaminated materials (e.g., dressings) and who adhere to appropriate infection control measures are at lower risk for inadvertent infection than laboratory workers. However, because a theoretical risk for infection exists, vaccination can be offered to this group. Read more[PDF – 930KB](https://www.cdc.gov/mmwr/pdf/rr/rr5010.pdf).

More Information for Clinicians

Full Prescribing Information for ACAM2000®[PDF – 11 pages]

ACAM2000® Medication Guide[PDF – 6 pages]

MMWR Notice to Readers: Newly Licensed Smallpox Vaccine to Replace Old Smallpox Vaccine(https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5708a6.htm)

CDC’s Vaccine-Related Topics: Smallpox Vaccine

How to Request

Smallpox vaccine must be administered by or under the supervision of the physician who registers with CDC.

Ancillary supplies, such as bifurcated needles (for administration) and 1 mL tuberculin syringes with 25 gauge x 5/8″ needles (for reconstitution), are supplied with the vaccine.

Contact the CDC Drug Service for more information.

Requests for unapproved uses cannot be granted.

Top of Page

Products No Longer Supplied by Drug Service*

Botulinum Toxoid

Pentavalent (ABCDE) botulinum toxoid is a combination of aluminum phosphate-adsorbed toxoid derived from formalin-inactivated types A, B, C, D, and E botulinum toxins, with formaldehyde and thimerosal used as preservatives. Botulinum toxoid was distributed by CDC under an IND protocol for at-risk persons who were actively working or expected to be working with cultures of Clostridium botulinum or the toxins; in 2011, CDC discontinued its program to supply this vaccine. Read more(https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6042a3.htm).

Botulinum Antitoxin Types AB & E

In March 2010, CDC announced the availability of a new heptavalent botulinum antitoxin (HBAT, Cangene Corporation). HBAT replaced the licensed bivalent botulinum antitoxin AB and an investigational monovalent botulinum antitoxin E (BAT-AB and BAT-E, Sanofi Pasteur), becoming the only botulinum antitoxin available in the United States for naturally occurring non-infant botulism. Read more(https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5910a4.htm).

Vaccinia Immune Globulin (VIG)

Vaccinia immune globulin (VIG) is released from the CDC Strategic National Stockpile, if indicated, for the treatment of complications associated with vaccinia vaccination. Clinicians wishing to obtain VIG should contact the Emergency Operations Center (EOC) at 770-488-7100. They will be connected with CDC medical staff who can assist them in the diagnosis and management of patients with suspected complications of vaccinia vaccination.

*this list is not all-inclusive

Use of trade names is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.

Posted in Botulism, CDC, Chagas Disease, Leishmaniasis, Neglected Tropical Diseases, Smallpox| Comments Off

First Plague Case in New Mexico in 2017

Thursday, June 8th, 2017

New Mexico DOH

Plague Case in Santa Fe County Man

June 5, 2017

First Case in New Mexico in 2017

The New Mexico Department of Health (NMDOH) has confirmed a case of plague in a 63-year-old man from Santa Fe County who is currently hospitalized. Confirmatory testing was conducted at the NMDOH Scientific Laboratory Division. This is the first human case of plague in New Mexico this year.

NMDOH is conducting an environmental investigation at the man’s home to look for ongoing risk and to ensure the health of the immediate family and neighbors. Additionally, staff are going door-to-door to neighbors near the patient’s home to inform them about plague found in the area and educate them on reducing their risk.

Plague is a bacterial disease of rodents and is generally transmitted to humans through the bites of infected fleas, but can also be transmitted by direct contact with infected animals, including rodents, wildlife and pets. To date, there have been ten dogs and five cats with confirmed plague in New Mexico in 2017. The animals come from Los Alamos, Santa Fe, Bernalillo, Sandoval, Torrance, and Taos counties.

“Plague activity has been widespread in northcentral New Mexico this spring,” said Dr. Paul Ettestad, public health veterinarian for the Department of Health. “Sick or dead rodents and rabbits are being reported from different areas in the state so it is very important to take precautions to avoid rodents and their fleas which can expose you to plague. Pets that are allowed to roam and hunt can bring plague-infected fleas from dead rodents back into the home, putting you and your children at risk.”

To prevent plague, the Department of Health recommends residents:

Avoid sick or dead rodents and rabbits, and their nests and burrows.
Keep pets from roaming and hunting.
Provide safe and effective flea control for pets; if possible, talk with a veterinarian about using an appropriate flea control product on pets as not all products are safe for cats, dogs, or children.
Clean up areas near the house where rodents could live, such as woodpiles, brush piles, junk and abandoned vehicles.
Sick pets should be examined promptly by a veterinarian.
See a healthcare provider about any unexplained illness involving a sudden and severe fever.
Put hay, wood, and compost piles as far as possible from the home.
Don’t leave your pet’s food and water where rodents can get to it.

Symptoms of plague in humans include sudden onset of fever, chills, headache, and weakness. In most cases, there is a painful swelling of the lymph node in the groin, armpit or neck areas which is a sign of the most common form of plague. There are two other forms of plague seen less commonly in which people can have fever, chills, weakness and abdominal pain indicating the type of plague that is in their bloodstream, and sometimes shortness of breath, chest pain and cough indicating pneumonia that can be associated with plague. Plague signs in cats and dogs are fever, lethargy and loss of appetite. There may be a swelling in the lymph node under the jaw of pets. Prompt diagnosis and appropriate antibiotic treatment can greatly reduce the risk of death in people. Healthcare providers who suspect a patient may have plague should promptly report it to the Department of Health on-call epidemiologist using the Reporting & Surveillance hotline at 505-827-0006.

There were four human plague cases identified in New Mexico in 2016. All four cases recovered.

For more information, please visit the Plague section of our website.

Posted in Plague| Comments Off

MERS-CoV – Saudi Arabia, United Arab Emirates, and Qatar

Thursday, June 8th, 2017

CDC

Disease outbreak news
6 June 2017

Between 21 April and 29 May 2017, the National IHR Focal Point of Saudi Arabia reported 25 additional cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection including six fatal cases. On 16 May 2017, the IHR NFP of the United Arab Emirates reported two (2) additional case of MERS-CoV. On 23 May 2017, the National IHR Focal Point of Qatar reported one additional case of MERS-CoV.

Details of the cases

Detailed information concerning the cases reported can be found in a separate document (see link below).

MERS-CoV cases reported between 21 April and 29 May 2017
xlsx, 31kb

Saudi Arabia

Between 21 April and 29 May 2017, 25 cases of MERS-CoV infection were reported in Saudi Arabia including six fatal cases. Twelve of the 25 reported cases during this time period were associated with three simultaneous, yet unrelated clusters of MERS cases. The Ministry of Health is evaluating each case and their contacts and implementing measures to limit further human-to-human transmission. A description of the three clusters is below.

Cluster 1

A cluster of cases has been identified at a hospital in Bisha city, Assir Region. Cases associated with this cluster are:

First identified fatal case: A 71-year-old male reported on 9 May.
Secondary case – Healthcare contact: A 54-year-old male reported to WHO on 13 May.
Secondary case – Healthcare contact: A 57-year-old male reported to WHO on 17 May.

Cluster 2

A cluster of cases has been identified in a hospital in Riyadh city, Riyadh Region. Cases associated with this cluster are:

First identified fatal case: A 55-year-old male reported to WHO on 14 May.
Secondary case – Healthcare contact: A 33-year-old male reported to WHO on 15 May.
Secondary case – Healthcare contact: A 30-year-old female reported to WHO on 15 May.
Secondary case – Healthcare contact: A 25-year-old female reported to WHO on 16 May.
Secondary case – Healthcare contact: A 38-year-old male reported to WHO on 17 May.

Cluster 3

A third cluster was detected at a hospital in Wadi Aldwaser city, Riyadh Region. This outbreak is believed to be over based on the follow-up period of all contacts. The four newly identified cases associated with this outbreak are listed below. In total, five cases were associated with this outbreak: First identified case: A 55-year-old male previously reported to WHO on 19 April (see Disease Outbreak News published on 27 April 2017).

Secondary case – Household contact: A 50-year-old male reported to WHO on 21 April.
Secondary case – Household contact: A 58-year-old male reported to WHO on 21 April.
Secondary case – Healthcare contact: A 31-year-old male reported to WHO on 21 April.
Secondary case – Household contact: A 26-year-old male reported to WHO on 26 April.

United Arab Emirates

On 16 May 2017, two cases of MERS-CoV infection were reported in the United Arab Emirates. Both cases were reported from Al Ain city and both have reported direct links to dromedary camels. The first case that was identified, a 69-year-old male farmer, is in critical condition in hospital and the second case, a 45-year-old male butcher, is asymptomatic and identified during contact tracing of the first case. Contact tracing and dromedary investigations are ongoing.

Qatar

On 23 May 2017, one case of MERS-CoV infection was reported in Qatar. The case, a 29 year old male from Doha has reported frequent contact with dromedary camels. The Department of Health Protection and Communicable Disease Control in the Ministry of Public Health and animal health resources are currently carrying out case investigation and contact tracing.

Globally, since September 2012, WHO has been notified of 1980 laboratory-confirmed cases of infection with MERS-CoV including at least 699 related deaths have been reported.

WHO risk assessment

MERS-CoV causes severe human infections resulting in high mortality and has demonstrated the ability to transmit between humans. So far, the observed human-to-human transmission has occurred mainly in health care settings.

The notification of additional cases does not change the overall risk assessment. WHO expects that additional cases of MERS-CoV infection will be reported from the Middle East, and that cases will continue to be exported to other countries by individuals who might acquire the infection after exposure to animals or animal products (for example, following contact with dromedaries) or human source (for example, in a health care setting). WHO continues to monitor the epidemiological situation and conducts risk assessment based on the latest available information.

WHO advice

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for acute respiratory infections and to carefully review any unusual patterns.

Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in health care facilities. It is not always possible to identify patients with MERS-CoV early because like other respiratory infections, the early symptoms of MERS-CoV are non-specific. Therefore, health-care workers should always apply standard precautions consistently with all patients, regardless of their diagnosis. Droplet precautions should be added to the standard precautions when providing care to patients with symptoms of acute respiratory infection; contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection; airborne precautions should be applied when performing aerosol generating procedures.

Until more is understood about MERS-CoV, people with diabetes, renal failure, chronic lung disease, and immunocompromised persons are considered to be at high risk of severe disease from MERS-CoV infection. Therefore, these people should avoid close contact with animals, particularly dromedary camels, when visiting farms, markets, or barn areas where the virus is known to be potentially circulating. General hygiene measures, such as regular hand washing before and after touching animals and avoiding contact with sick animals, should be adhered to.

Food hygiene practices should be observed. People should avoid drinking raw camel milk or camel urine, or eating meat that has not been properly cooked.

WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.

Posted in MERS-CoV| Comments Off

Legionnaires’ disease kills 25% of those who get it from a health care facility.

Thursday, June 8th, 2017

CDC

Overview

Legionnaires’ disease (LD) is a serious, and often deadly, lung infection (pneumonia). People usually get it by breathing in water droplets containing Legionella germs. People can also get it if contaminated water accidentally goes into the lungs while drinking. Many people being treated at health care facilities, including long-term care facilities and hospitals, have conditions that put them at greater risk of getting sick and dying from LD. Legionella grows best in buildings with large water systems that are not managed effectively. CDC outbreak investigations show that effective water management programs—actions that reduce the risk of Legionella growing and spreading in building water systems—can help prevent problems that lead to LD. Health care facility leaders* should be aware that LD is a risk in their facility and that they can take action to prevent infections.

Health care facility leaders can

Build a team focused on keeping their facility’s water safe.
Create and use a water management program to limit Legionella and other waterborne germs from growing and spreading. cdc.gov/legionella/WMPtoolkit
Work with healthcare providers to identify LD cases early and determine if the cases may be associated with a health care facility.
Report LD cases to local public health authorities quickly and work with them to investigate and prevent additional cases.

*Leaders may include infection control practitioners, facility managers, hospital administrators, quality assurance staff, or others.

Graphics: Preventing the first case and 16 of 21 jurisdictions reported definite cases of health care-associated LD in 2015

Problem

Legionnaires’ disease can occur in your health care facility

Health care facilities may put people at risk for LD when they do not have an effective water management program. These limit germ growth by:

Keeping hot water temperatures high enough.
Making sure disinfectant amounts are right.
Keeping water flowing (preventing stagnation).
Operating and maintaining equipment to prevent slime (biofilm), organic debris, and corrosion.
Monitoring factors external to buildings, such as construction, water main breaks, and changes in municipal water quality.

Contaminated water droplets can be spread by:

Showerheads and sink faucets.
Hydrotherapy equipment, such as jetted therapy baths.
Medical equipment, such as respiratory machines, bronchoscopes, and heater-cooler units.
Ice machines.
Cooling towers (parts of large air-conditioning systems).
Decorative fountains and water features.

Health care facility leaders and providers should be aware that some people are at increased risk for LD:

Adults 50 years or older.
Current or former smokers.
People with a weakened immune system or chronic disease.

Graphic: One health care facility's LD story and what happens next*

Posted in Legionnaire's Disease| Comments Off

Iran: Gunmen stormed the nation’s parliament in Tehran, setting off an explosive, while a suicide bomb went off at the mausoleum of Ayatollah Ruhollah Khomeini; 2 killed, dozens wounded

Wednesday, June 7th, 2017

NY Daily News

https://www.youtube.com/watch?v=_npQgl8RTsk

Posted in Terrorism| Comments Off

Saudi MOH: ‘3 New Confirmed Corona Cases Recorded’

Wednesday, June 7th, 2017

6-6-2017-1.jpg111.jpg

Posted in MERS-CoV| Comments Off

Signaling a major change to its Essential Medicines List (EML), the World Health Organization (WHO) today grouped antibiotics into three categories—access, watch, and reserve—and included recommendations when each should be used to treat 21 common infections.

Wednesday, June 7th, 2017

WHO

WHO updates Essential Medicines List with new advice on use of antibiotics, and adds medicines for hepatitis C, HIV, tuberculosis and cancer

News release

6 June 2017 | Geneva – New advice on which antibiotics to use for common infections and which to preserve for the most serious circumstances is among the additions to the WHO Model list of essential medicines for 2017. Other additions include medicines for HIV, hepatitis C, tuberculosis and leukaemia.

The updated list adds 30 medicines for adults and 25 for children, and specifies new uses for 9 already-listed products, bringing the total to 433 drugs deemed essential for addressing the most important public health needs. The WHO Essential Medicines List (EML) is used by many countries to increase access to medicines and guide decisions about which products they ensure are available for their populations.

“Safe and effective medicines are an essential part of any health system,” said Dr Marie-Paule Kieny, WHO Assistant Director-General for Health Systems and Innovation. “Making sure all people can access the medicines they need, when and where they need them, is vital to countries’ progress towards universal health coverage.”

New advice: 3 categories of antibiotic

In the biggest revision of the antibiotics section in the EML’s 40-year history, WHO experts have grouped antibiotics into three categories – ACCESS, WATCH and RESERVE – with recommendations on when each category should be used. Initially, the new categories apply only to antibiotics used to treat 21 of the most common general infections. If shown to be useful, it could be broadened in future versions of the EML to apply to drugs to treat other infections.

The change aims to ensure that antibiotics are available when needed, and that the right antibiotics are prescribed for the right infections. It should enhance treatment outcomes, reduce the development of drug-resistant bacteria, and preserve the effectiveness of “last resort” antibiotics that are needed when all others fail. These changes support WHO’s Global action plan on antimicrobial resistance, which aims to fight the development of drug resistance by ensuring the best use of antibiotics.

WHO recommends that antibiotics in the ACCESS group be available at all times as treatments for a wide range of common infections. For example, it includes amoxicillin, a widely-used antibiotic to treat infections such as pneumonia.

The WATCH group includes antibiotics that are recommended as first- or second-choice treatments for a small number of infections. For example, the use of ciprofloxacin, used to treat cystitis (a type of urinary tract infection) and upper respiratory tract infections (such as bacterial sinusitis and bacterial bronchitis), should be dramatically reduced to avoid further development of resistance.

The third group, RESERVE, includes antibiotics such as colistin and some cephalosporins that should be considered last-resort options, and used only in the most severe circumstances when all other alternatives have failed, such as for life-threatening infections due to multidrug-resistant bacteria.

WHO experts have added 10 antibiotics to the list for adults, and 12 for children.

“The rise in antibiotic resistance stems from how we are using – and misusing – these medicines,” said Dr Suzanne Hill, Director of Essential Medicines and Health Products. “The new WHO list should help health system planners and prescribers ensure people who need antibiotics have access to them, and ensure they get the right one, so that the problem of resistance doesn’t get worse.”

Other additions

The updated EML also includes several new drugs, such as two oral cancer treatments, a new pill for hepatitis C that combines two medicines, a more effective treatment for HIV as well as an older drug that can be taken to prevent HIV infection in people at high risk, new paediatric formulations of medicines for tuberculosis, and pain relievers. These medicines are:

two oral cancer medicines (dasatinib and nilotinib) for the treatment of chronic myeloid leukaemia that has become resistant to standard treatment. In clinical trials, one in two patients taking these medicines achieved a complete and durable remission from the disease;
sofosbuvir + velpatasvir as the first combination therapy to treat all six types of hepatitis C (WHO is currently updating its treatment recommendations for hepatitis C);
dolutegravir for treatment of HIV infection, in response to the most recent evidence showing the medicine’s safety, efficacy, and high barrier to resistance;
pre-exposure prophylaxis (PrEP) with tenofovir alone, or in combination with emtricitabine or lamivudine, to prevent HIV infection;
delamanid for the treatment of children and adolescents with multidrug-resistant tuberculosis (MDR-TB) and clofazimine for children and adults with MDR-TB;
child-friendly fixed-dose combination formulations of isoniazid, rifampicin, ethambutol and pyrazinamide for treating paediatric tuberculosis; and
fentanyl skin patches and methadone for pain relief in cancer patients with the aim of increasing access to medicines for end-of-life care.

Note to Editors

The WHO Model list of essential medicines was launched in 1977, coinciding with the endorsement by governments at the World Health Assembly of “Health for all” as the guiding principle for WHO and countries’ health policies.

Many countries have adopted the concept of essential medicines and have developed lists of their own, using the EML as a guide. The EML is updated and revised every two years by the WHO Expert Committee on the Selection and Use of Essential Medicines.

The meeting of the 21st Expert Committee was held 27–31 March 2017 at WHO Headquarters. The Committee considered 92 applications for about 100 medicines and added 55 to the EML (30 to the general EML and 25 to the children’s EML).

Members of the Expert Committee

For more information, please contact:

Simeon Bennett
WHO Department of Communications
Telephone: +41 22 791 4621
Mobile: +41 79 472 7429
Email: simeonb@who.int

Tarik Jašarević
WHO Department of Communications
Telephone: +41 22 791 5099
Mobile: +41 79 367 6214
Email: jasarevict@who.int

Posted in WHO| Comments Off

Archive for June, 2017

Tsunami evacuation buildings and evacuation planning in Banda Aceh, Indonesia

Abstract

Anthrax Vaccine Adsorbed

More Information for Clinicians

How to Request

Artesunate, Intravenous

More Information for Clinicians

How to Request

Benznidazole

More Information for Clinicians

How to Request

Botulism Antitoxin Heptavalent (Equine), Types A-G

More Information for Clinicians

How to Request

Diethylcarbamazine (DEC)

More Information for Clinicians

How to Request

Diphtheria Antitoxin (Equine)

More Information for Clinicians

How to Request

Eflornithine

More Information for Clinicians

How to Request

Melarsoprol

More Information for Clinicians

How to Request

Nifurtimox

More Information for Clinicians

How to Request

Sodium Stibogluconate

More Information for Clinicians

How to Request

Suramin

More Information for Clinicians

How to Request

Vaccinia Vaccine, “Smallpox Vaccine”

More Information for Clinicians

How to Request

Products No Longer Supplied by Drug Service*

Botulinum Toxoid

Botulinum Antitoxin Types AB & E

Vaccinia Immune Globulin (VIG)

Details of the cases

Saudi Arabia

Cluster 1

Cluster 2

Cluster 3

United Arab Emirates

Qatar

WHO risk assessment

WHO advice

Overview

Problem

New advice: 3 categories of antibiotic

Other additions

Note to Editors

For more information, please contact:

Categories

Recent Posts

Archives

Admin