Generated Narrative: PlanDefinition

url: http://hl7.org/fhir/uv/cpg/anthrax/PlanDefinition/first-vaccine-dose-pregnant-pd

identifier: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/OrderSet

version: 1.1.0

name: Anthrax_Post_Exposure_Prophylaxis_Adults

title: First vaccine pregnant

type: ECA Rule (PlanDefinitionType#eca-rule; PlanDefinitionType#order-set "Order Set")

status: draft

experimental: true

date: 2024-03-01 20:01:31+0000

publisher: HL7 International - Clinical Decision Support WG

contact: HL7 International - Clinical Decision Support WG: http://www.hl7.org/Special/committees/dss/index.cfm

description: Provides information for treating patients greater than or equal to 18 years old exposed to anthrax within the past 60 days, who do not have anthrax. It is divided into two parts: \n- Part #1: For patients that may be symptomatic to flag the need to conduct a full diagnostic evaluation to rule out anthrax before proceeding with post-exposure prophylaxis (PEP) \n- Part #2: For patients who are asymptomatic (not displaying signs and symptoms of anthrax), it provides recommended PEP regimen

UseContexts

jurisdiction: World (m49.htm#001)

purpose: Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series.

usage: Intended for use by clinicians caring for individuals ≥18 years of age in an outpatient setting.

approvalDate: 2019-06-07

lastReviewDate: 2019-06-07

effectivePeriod: 2019-06-07 --> (ongoing)

topic: Anthrax (), Emergency Medicine (), Post-Exposure Prophylaxis ()

author: Alliance to Modernize Healthcare FFRDC:

endorser: Centers for Disease Control and Prevention:

library: Anthrax Post Exposure Prophylaxis (PEP) for Adults FHIRv400 Logic

action

title: Anthrax Post Exposure Prophylaxis 7

trigger

type: data-added

data

Type: Condition
Filter	Value
code	One of these codes: International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) Z20.810: Contact with and (suspected) exposure to anthrax, SNOMED CT (all versions) 170475009: Exposure to Bacillus anthracis (event)

trigger

type: data-added

data

Type: Observation
Filter	Value
code	One of these codes: International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) Z20.810: Contact with and (suspected) exposure to anthrax, SNOMED CT (all versions) 170475009: Exposure to Bacillus anthracis (event), SNOMED CT (all versions) 84387000: Asymptomatic (finding)

condition

kind: applicability

Expressions

-	Language	Expression
*	text/cql	GenerateOrderSet

groupingBehavior: logical-group

selectionBehavior: any

action

title: Antimicrobial medications for anthrax post-exposure prophylaxis

groupingBehavior: visual-group

selectionBehavior: at-most-one

action

action

action

title: Anthrax Vaccination - 1st dose

type: Create (ActionType#create)

definition: #Inline-Vaccine-Request-3

Generated Narrative: ActivityDefinition #Inline-Ciprofloxacin-Request-3

url: http://hl7.org/fhir/uv/cpg/anthrax/ActivityDefinition/Inline-Ciprofloxacin-Request-3

identifier: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/CiprofloxacinRequest

name: Anthrax_Post_Exposure_Prophylaxis_Adults_Ciprofloxacin_Request

title: Anthrax Post Exposure Prophylaxis (PEP) for Adults: Ciprofloxacin Request

status: draft

experimental: true

description: In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged ≥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10–14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). Additionally, the Advisory Committee on Immunization Practices subsequently reviewed all safety data available as of March 2008, including the final results of a retrospective study, and concluded that AVA is safe to administer to anthrax-exposed women during pregnancy. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to vaccination. Pregnant women at risk for inhalation anthrax should receive AVA and antimicrobial drug therapy regardless of pregnancy trimester (Meanye-Delman D et al., Emerg Infect Dis, 20(2), 2014).

UseContexts

-	Code	Value[x]
*	Age Range (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code age = 'Age Range', stated as 'Age Range')	18-?
*	Clinical Venue (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code venue = 'Clinical Venue', stated as 'Clinical Venue')	Outpatient environment (SNOMED CT#440655000)
*	Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'Clinical Focus')	Contact with and (suspected) exposure to anthrax (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#Z20.810)
*	Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'Clinical Focus')	Exposure to Bacillus anthracis (event) (SNOMED CT#170475009)
*	Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'Clinical Focus')	Asymptomatic (finding) (SNOMED CT#84387000)

purpose: Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series.

usage: Intended for use by clinicians caring for individuals ≥18 years of age in an outpatient setting.

approvalDate: 2019-06-07

lastReviewDate: 2019-06-07

effectivePeriod: 2019-06-07 --> (ongoing)

topic: Anthrax (), Emergency Medicine (), Post-Exposure Prophylaxis ()

author: Alliance to Modernize Healthcare FFRDC:

endorser: Centers for Disease Control and Prevention:

kind: MedicationRequest

product: FIRST CHOICE: Ciprofloxacin 500 MG Oral Tablet (RxNorm#309309 "Ciprofloxacin 500 MG Oral Tablet")

quantity: 120(unit ORTAB from http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm) (Details: http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm code ORTAB = 'Oral Tablet')

Dosages

-	Text	AdditionalInstruction	PatientInstruction	Timing	Route	Method
*	One every 12 hours for 60 days	Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester. (), CONTRAINDICATIONS: Diagnosis of myasthenia gravis and taking tizanidine. (), CAUTIONS: If patient is taking blood thinners, oral antidiabetic drugs, seizure drugs, theophylline, drugs that prolong QT interval, duloxetine (Cymbalta), zolpidem (Ambien), clozapine or any other drug that may interact and cause serious side effects, consider another antibiotic regimen. (), Provide patient education on medications. ()	Take with full glass of water	Once per 12 hours	Oral Route (SNOMED CT#26643006)	Swallow - dosing instruction imperative (qualifier value) (SNOMED CT#421521009)

Generated Narrative: ActivityDefinition #Inline-Doxycycline-Request-3

url: http://hl7.org/fhir/uv/cpg/anthrax/ActivityDefinition/Inline-Doxycycline-Request-3

identifier: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/DoxycyclineRequest

name: Anthrax_Post_Exposure_Prophylaxis_Adults_Doxycycline_Request

title: Anthrax Post Exposure Prophylaxis (PEP) for Adults: Doxycycline Request

status: draft

experimental: true

description: In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged ≥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10–14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). Additionally, the Advisory Committee on Immunization Practices subsequently reviewed all safety data available as of March 2008, including the final results of a retrospective study, and concluded that AVA is safe to administer to anthrax-exposed women during pregnancy. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to vaccination. Pregnant women at risk for inhalation anthrax should receive AVA and antimicrobial drug therapy regardless of pregnancy trimester (Meanye-Delman D et al., Emerg Infect Dis, 20(2), 2014).

UseContexts

-	Code	Value[x]
*	Age Range (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code age = 'Age Range', stated as 'Age Range')	18-?
*	Clinical Venue (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code venue = 'Clinical Venue', stated as 'Clinical Venue')	Outpatient environment (SNOMED CT#440655000)
*	Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'Clinical Focus')	Contact with and (suspected) exposure to anthrax (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#Z20.810)
*	Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'Clinical Focus')	Exposure to Bacillus anthracis (event) (SNOMED CT#170475009)
*	Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'Clinical Focus')	Asymptomatic (finding) (SNOMED CT#84387000)

purpose: Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series.

usage: Intended for use by clinicians caring for individuals ≥18 years of age in an outpatient setting.

approvalDate: 2019-06-07

lastReviewDate: 2019-06-07

effectivePeriod: 2019-06-07 --> (ongoing)

topic: Anthrax (), Emergency Medicine (), Post-Exposure Prophylaxis ()

author: Alliance to Modernize Healthcare FFRDC:

endorser: Centers for Disease Control and Prevention:

kind: MedicationRequest

product: SECOND CHOICE: doxycycline hyclate 100 MG Oral Tablet (RxNorm#1650143 "doxycycline hyclate 100 MG Oral Tablet")

quantity: 120(unit ORTAB from http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm) (Details: http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm code ORTAB = 'Oral Tablet')

Dosages

-	Text	AdditionalInstruction	PatientInstruction	Timing	Route	Method
*	One every 12 hours for 60 days	Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester. (), CAUTIONS: If patient is taking blood thinners, oral antidiabetic drugs, seizure drugs, or any other drug that may interact and cause serious side effects, consider another antibiotic regimen. (), Provide patient education on medications. ()	Take with full glass of water	Once per 12 hours	Oral Route (SNOMED CT#26643006)	Swallow - dosing instruction imperative (qualifier value) (SNOMED CT#421521009)

Generated Narrative: ActivityDefinition #Inline-Levofloxacin-Request-3

url: http://hl7.org/fhir/uv/cpg/anthrax/ActivityDefinition/Inline-Levofloxacin-Request-3

identifier: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/LevofloxacinRequest

name: Anthrax_Post_Exposure_Prophylaxis_Adults_Levofloxacin_Request

title: Anthrax Post Exposure Prophylaxis (PEP) for Adults: Levofloxacin Request

status: draft

experimental: true

description: In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged ≥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10–14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). Additionally, the Advisory Committee on Immunization Practices subsequently reviewed all safety data available as of March 2008, including the final results of a retrospective study, and concluded that AVA is safe to administer to anthrax-exposed women during pregnancy. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to vaccination. Pregnant women at risk for inhalation anthrax should receive AVA and antimicrobial drug therapy regardless of pregnancy trimester (Meanye-Delman D et al., Emerg Infect Dis, 20(2), 2014).

UseContexts

-	Code	Value[x]
*	Age Range (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code age = 'Age Range', stated as 'Age Range')	18-?
*	Clinical Venue (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code venue = 'Clinical Venue', stated as 'Clinical Venue')	Outpatient environment (SNOMED CT#440655000)
*	Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'Clinical Focus')	Contact with and (suspected) exposure to anthrax (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#Z20.810)
*	Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'Clinical Focus')	Exposure to Bacillus anthracis (event) (SNOMED CT#170475009)
*	Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'Clinical Focus')	Asymptomatic (finding) (SNOMED CT#84387000)

purpose: Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series.

usage: Intended for use by clinicians caring for individuals ≥18 years of age in an outpatient setting.

approvalDate: 2019-06-07

lastReviewDate: 2019-06-07

effectivePeriod: 2019-06-07 --> (ongoing)

topic: Anthrax (), Emergency Medicine (), Post-Exposure Prophylaxis ()

author: Alliance to Modernize Healthcare FFRDC:

endorser: Centers for Disease Control and Prevention:

kind: MedicationRequest

product: Levofloxacin 750 MG Oral Tablet (RxNorm#311296)

quantity: 60(unit ORTAB from http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm) (Details: http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm code ORTAB = 'Oral Tablet')

Dosages

-	Text	AdditionalInstruction	Timing	Route	Method
*	One every day for 60 days	Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester. ()	Once per 1 days	Oral Route (SNOMED CT#26643006)	Swallow - dosing instruction imperative (qualifier value) (SNOMED CT#421521009)

Generated Narrative: ActivityDefinition #Inline-Moxifloxacin-Request-3

url: http://hl7.org/fhir/uv/cpg/anthrax/ActivityDefinition/Inline-Moxifloxacin-Request-3

identifier: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/MoxifloxacinRequest

name: Anthrax_Post_Exposure_Prophylaxis_Adults_Moxifloxacin_Request

title: Anthrax Post Exposure Prophylaxis (PEP) for Adults: Moxifloxacin Request

status: draft

experimental: true

description: In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged ≥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10–14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). Additionally, the Advisory Committee on Immunization Practices subsequently reviewed all safety data available as of March 2008, including the final results of a retrospective study, and concluded that AVA is safe to administer to anthrax-exposed women during pregnancy. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to vaccination. Pregnant women at risk for inhalation anthrax should receive AVA and antimicrobial drug therapy regardless of pregnancy trimester (Meanye-Delman D et al., Emerg Infect Dis, 20(2), 2014).

UseContexts

-	Code	Value[x]
*	Age Range (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code age = 'Age Range', stated as 'Age Range')	18-?
*	Clinical Venue (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code venue = 'Clinical Venue', stated as 'Clinical Venue')	Outpatient environment (SNOMED CT#440655000)
*	Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'Clinical Focus')	Contact with and (suspected) exposure to anthrax (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#Z20.810)
*	Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'Clinical Focus')	Exposure to Bacillus anthracis (event) (SNOMED CT#170475009)
*	Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'Clinical Focus')	Asymptomatic (finding) (SNOMED CT#84387000)

purpose: Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series.

usage: Intended for use by clinicians caring for individuals ≥18 years of age in an outpatient setting.

approvalDate: 2019-06-07

lastReviewDate: 2019-06-07

effectivePeriod: 2019-06-07 --> (ongoing)

topic: Anthrax (), Emergency Medicine (), Post-Exposure Prophylaxis ()

author: Alliance to Modernize Healthcare FFRDC:

endorser: Centers for Disease Control and Prevention:

kind: MedicationRequest

product: moxifloxacin HCl 400 MG Oral Tablet (RxNorm#311787)

quantity: 60(unit ORTAB from http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm) (Details: http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm code ORTAB = 'Oral Tablet')

Dosages

-	Text	AdditionalInstruction	Timing	Route	Method
*	One every day for 60 days	Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester. ()	Once per 1 days	Oral Route (SNOMED CT#26643006)	Swallow - dosing instruction imperative (qualifier value) (SNOMED CT#421521009)

Generated Narrative: ActivityDefinition #Inline-Clindamycin-Request-3

url: http://hl7.org/fhir/uv/cpg/anthrax/ActivityDefinition/Inline-Clindamycin-Request-3

identifier: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/ClindamycinRequest

name: Anthrax_Post_Exposure_Prophylaxis_Adults_Clindamycin_Request

title: Anthrax Post Exposure Prophylaxis (PEP) for Adults: Clindamycin Request

status: draft

experimental: true

description: In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged ≥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10–14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). Additionally, the Advisory Committee on Immunization Practices subsequently reviewed all safety data available as of March 2008, including the final results of a retrospective study, and concluded that AVA is safe to administer to anthrax-exposed women during pregnancy. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to vaccination. Pregnant women at risk for inhalation anthrax should receive AVA and antimicrobial drug therapy regardless of pregnancy trimester (Meanye-Delman D et al., Emerg Infect Dis, 20(2), 2014).

UseContexts

-	Code	Value[x]
*	Age Range (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code age = 'Age Range', stated as 'Age Range')	18-?
*	Clinical Venue (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code venue = 'Clinical Venue', stated as 'Clinical Venue')	Outpatient environment (SNOMED CT#440655000)
*	Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'Clinical Focus')	Contact with and (suspected) exposure to anthrax (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#Z20.810)
*	Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'Clinical Focus')	Exposure to Bacillus anthracis (event) (SNOMED CT#170475009)
*	Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'Clinical Focus')	Asymptomatic (finding) (SNOMED CT#84387000)

purpose: Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series.

usage: Intended for use by clinicians caring for individuals ≥18 years of age in an outpatient setting.

approvalDate: 2019-06-07

lastReviewDate: 2019-06-07

effectivePeriod: 2019-06-07 --> (ongoing)

topic: Anthrax (), Emergency Medicine (), Post-Exposure Prophylaxis ()

author: Alliance to Modernize Healthcare FFRDC:

endorser: Centers for Disease Control and Prevention:

kind: MedicationRequest

product: clindamycin HCl 300 MG Oral Capsule (RxNorm#284215)

quantity: 360(unit ORTAB from http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm) (Details: http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm code ORTAB = 'Oral Tablet')

Dosages

-	Text	AdditionalInstruction	Timing	Route	Method
*	Two tablets every 8 hours for 60 days	Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester. ()	2 per 8 hours	Oral Route (SNOMED CT#26643006)	Swallow - dosing instruction imperative (qualifier value) (SNOMED CT#421521009)

Generated Narrative: ActivityDefinition #Inline-Vaccine-Request-3

url: http://hl7.org/fhir/uv/cpg/anthrax/ActivityDefinition/Inline-Vaccine-Request-3

identifier: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/VaccineRequest

name: Anthrax_Post_Exposure_Prophylaxis_Adults_Vaccine_Request

title: Anthrax Post Exposure Prophylaxis (PEP) for Adults: Vaccine Request

status: draft

experimental: true

description: In 2009, the US Advisory Committee on Immunization Practices recommended in addition to antimicrobial therapy, a 3-dose series of Anthrax Vaccine Adsorbed (AVA) BioThrax (Emergent BioSolutions Inc., Rockville, MD, USA) for long-term protection after exposure to anthrax in individuals without any previous vaccine. After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. ACIP recommends a post exposure regimen of 60 days of appropriate antimicrobial prophylaxis (covered previously) combined with 3 subcutaneous doses of AVA (administered at 0, 2, and 4 weeks post exposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged ≥18 years who have been exposed to aerosolized B. anthracis spores. In general, the peak serologic response to anthrax vaccine occurs 10–14 days after the third dose. (Wright, J.G et al., Morbidity and Mortality Weekly Report, July 23, 2010 / 59(RR06); 1-30). Additionally, the Advisory Committee on Immunization Practices subsequently reviewed all safety data available as of March 2008, including the final results of a retrospective study, and concluded that AVA is safe to administer to anthrax-exposed women during pregnancy. In the setting of an anthrax event that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to vaccination. Pregnant women at risk for inhalation anthrax should receive AVA and antimicrobial drug therapy regardless of pregnancy trimester (Meanye-Delman D et al., Emerg Infect Dis, 20(2), 2014).

UseContexts

-	Code	Value[x]
*	Age Range (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code age = 'Age Range', stated as 'Age Range')	18-?
*	Clinical Venue (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code venue = 'Clinical Venue', stated as 'Clinical Venue')	Outpatient environment (SNOMED CT#440655000)
*	Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'Clinical Focus')	Contact with and (suspected) exposure to anthrax (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#Z20.810)
*	Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'Clinical Focus')	Exposure to Bacillus anthracis (event) (SNOMED CT#170475009)
*	Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'Clinical Focus')	Asymptomatic (finding) (SNOMED CT#84387000)

purpose: Provides clinicians with information for quickly assessing individuals exposed to anthrax unrelated to occupational exposure, for example in bioterrorism events, and provides the recommended post-exposure prophylaxis (PEP) regimen for asymptomatic patients. Includes immediate treatment with antimicrobials and vaccine and follow-up administration of subsequent vaccines to complete the recommended 3-dose vaccination series.

usage: Intended for use by clinicians caring for individuals ≥18 years of age in an outpatient setting.

approvalDate: 2019-06-07

lastReviewDate: 2019-06-07

effectivePeriod: 2019-06-07 --> (ongoing)

topic: Anthrax (), Emergency Medicine (), Post-Exposure Prophylaxis ()

author: Alliance to Modernize Healthcare FFRDC:

endorser: Centers for Disease Control and Prevention:

kind: ImmunizationRecommendation

code: Anthrax vaccination (SNOMED CT#49598002; SNOMED CT#170338000 "First anthrax vaccination")

product: Anthrax vaccine (Vaccine Administered Code Set (CVX)#24)

dosage

text: 0.5mL

additionalInstruction: Pregnant women at risk for inhalation anthrax should receive the anthrax vaccine regardless of pregnancy trimester. (), Epinephrine solution (1:1000) should be available for immediate use in the event that an anaphylactic reaction occurs. ()

route: Subcutaneous route (SNOMED CT#34206005)

doseAndRate