Clinical Practice Guidelines Example Implementation Guide - Anthrax Post-Exposure Prophylaxis
1.1.0 - ci-build
Clinical Practice Guidelines Example Implementation Guide - Anthrax Post-Exposure Prophylaxis
1.1.0 - ci-build
Clinical Practice Guidelines Example Implementation Guide - Anthrax Post-Exposure Prophylaxis, published by HL7 International - Clinical Decision Support WG. This guide is not an authorized publication; it is the continuous build for version 1.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/cpg-example-anthrax/ and changes regularly. See the Directory of published versions
| Official URL: http://cqframework.org/cpg-example-anthrax/PlanDefinition/second-vaccinedose-antimicrobial-notpregnant-pd | Version: 1.1.0 | |||
| Draft as of 2024-11-18 | Computable Name: Anthrax_Post_Exposure_Prophylaxis_Adults | |||
| Other Identifiers: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/OrderSet | ||||
Usage:Age Range: 18 to ?, Clinical Venue: Outpatient environment, Clinical Focus: Contact with and (suspected) exposure to anthrax, Clinical Focus: Exposure to Bacillus anthracis (event), Clinical Focus: Asymptomatic (finding) |
||||
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
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.
Generated Narrative: PlanDefinition second-vaccinedose-antimicrobial-notpregnant-pd
url: PlanDefinition Second vaccine antimicrobial not pregnant
identifier: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/OrderSet
version: 1.1.0
name: Anthrax_Post_Exposure_Prophylaxis_Adults
title: Second vaccine antimicrobial not pregnant
type: ECA Rule
status: Draft
experimental: true
date: 2024-11-18 16:44:02+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
| Code | Value[x] |
| UsageContextType age: Age Range | 18-? |
| UsageContextType venue: Clinical Venue | Outpatient environment |
| UsageContextType focus: Clinical Focus | Contact with and (suspected) exposure to anthrax |
| UsageContextType focus: Clinical Focus | Exposure to Bacillus anthracis (event) |
| UsageContextType focus: Clinical Focus | Asymptomatic (finding) |
jurisdiction: World
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 4
trigger
type: Data Added
data
type: Condition
codeFilter
path: code
code: International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) Z20.810: Contact with and (suspected) exposure to anthrax, SNOMED CT 170475009: Exposure to Bacillus anthracis (event)
trigger
type: Data Added
data
type: Observation
codeFilter
path: code
code: International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) Z20.810: Contact with and (suspected) exposure to anthrax, SNOMED CT 170475009: Exposure to Bacillus anthracis (event), SNOMED CT 84387000: Asymptomatic (finding)
condition
kind: Applicability
Expressions
Language Expression CQL GenerateOrderSet groupingBehavior: Logical Group
selectionBehavior: Any
action
title: Antimicrobial medications for anthrax post-exposure prophylaxis
groupingBehavior: Visual Group
selectionBehavior: At Most One
action
title: First line antimicrobial medications for anthrax post-exposure prophylaxis
groupingBehavior: Visual Group
selectionBehavior: At Most One
Actions
Type Definition[x] Create ActivityDefinition Ciprofloxacin Request Create ActivityDefinition Doxycycline Request action
title: Second line antimicrobial medications for anthrax post-exposure prophylaxis
groupingBehavior: Visual Group
selectionBehavior: At Most One
Actions
Type Definition[x] Create ActivityDefinition Levofloxacin Request Create ActivityDefinition Moxifloxacin Request Create ActivityDefinition Clindamycin Request action
title: Anthrax Vaccination - 2nd dose
type: Create
definition: ActivityDefinition Anthrax Post Exposure Prophylaxis (PEP) for Adults: Vaccine Request
Generated Narrative: ActivityDefinition #CiprofloxacinRequest
url: ActivityDefinition Ciprofloxacin Request
identifier: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/CiprofloxacinRequest
name: Anthrax_Post_Exposure_Prophylaxis_Adults_Ciprofloxacin_Request
title: 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] UsageContextType age: Age Range 18-? UsageContextType venue: Clinical Venue Outpatient environment UsageContextType focus: Clinical Focus Contact with and (suspected) exposure to anthrax UsageContextType focus: Clinical Focus Exposure to Bacillus anthracis (event) UsageContextType focus: Clinical Focus Asymptomatic (finding) 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: Ciprofloxacin 500 MG Oral Tablet
quantity: 120(unit ORTAB from http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm) (Details: Orderable Drug Form codeORTAB = 'Oral Tablet')
Dosages
Text AdditionalInstruction PatientInstruction Timing Route Method One every 12 hours for 60 days 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 Swallow - dosing instruction imperative (qualifier value)
Generated Narrative: ActivityDefinition #DoxycyclineRequest
url: ActivityDefinition Doxycycline Request
identifier: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/DoxycyclineRequest
name: Anthrax_Post_Exposure_Prophylaxis_Adults_Doxycycline_Request
title: 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] UsageContextType age: Age Range 18-? UsageContextType venue: Clinical Venue Outpatient environment UsageContextType focus: Clinical Focus Contact with and (suspected) exposure to anthrax UsageContextType focus: Clinical Focus Exposure to Bacillus anthracis (event) UsageContextType focus: Clinical Focus Asymptomatic (finding) 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: doxycycline hyclate 100 MG Oral Tablet
quantity: 120(unit ORTAB from http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm) (Details: Orderable Drug Form codeORTAB = 'Oral Tablet')
Dosages
Text AdditionalInstruction PatientInstruction Timing Route Method One every 12 hours for 60 days 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 Swallow - dosing instruction imperative (qualifier value)
Generated Narrative: ActivityDefinition #LevofloxacinRequest
url: ActivityDefinition Levofloxacin Request
identifier: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/LevofloxacinRequest
name: Anthrax_Post_Exposure_Prophylaxis_Adults_Levofloxacin_Request
title: 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] UsageContextType age: Age Range 18-? UsageContextType venue: Clinical Venue Outpatient environment UsageContextType focus: Clinical Focus Contact with and (suspected) exposure to anthrax UsageContextType focus: Clinical Focus Exposure to Bacillus anthracis (event) UsageContextType focus: Clinical Focus Asymptomatic (finding) 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
quantity: 60(unit ORTAB from http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm) (Details: Orderable Drug Form codeORTAB = 'Oral Tablet')
Dosages
Text AdditionalInstruction Timing Route Method One every day for 60 days none Once per 1 days Oral Route Swallow - dosing instruction imperative (qualifier value)
Generated Narrative: ActivityDefinition #MoxifloxacinRequest
url: ActivityDefinition Moxifloxacin Request
identifier: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/MoxifloxacinRequest
name: Anthrax_Post_Exposure_Prophylaxis_Adults_Moxifloxacin_Request
title: 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] UsageContextType age: Age Range 18-? UsageContextType venue: Clinical Venue Outpatient environment UsageContextType focus: Clinical Focus Contact with and (suspected) exposure to anthrax UsageContextType focus: Clinical Focus Exposure to Bacillus anthracis (event) UsageContextType focus: Clinical Focus Asymptomatic (finding) 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
quantity: 60(unit ORTAB from http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm) (Details: Orderable Drug Form codeORTAB = 'Oral Tablet')
Dosages
Text AdditionalInstruction Timing Route Method One every day for 60 days none Once per 1 days Oral Route Swallow - dosing instruction imperative (qualifier value)
Generated Narrative: ActivityDefinition #ClindamycinRequest
url: ActivityDefinition Clindamycin Request
identifier: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/ClindamycinRequest
name: Anthrax_Post_Exposure_Prophylaxis_Adults_Clindamycin_Request
title: 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] UsageContextType age: Age Range 18-? UsageContextType venue: Clinical Venue Outpatient environment UsageContextType focus: Clinical Focus Contact with and (suspected) exposure to anthrax UsageContextType focus: Clinical Focus Exposure to Bacillus anthracis (event) UsageContextType focus: Clinical Focus Asymptomatic (finding) 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
quantity: 360(unit ORTAB from http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm) (Details: Orderable Drug Form codeORTAB = 'Oral Tablet')
Dosages
Text AdditionalInstruction Timing Route Method Two tablets every 8 hours for 60 days none 2 per 8 hours Oral Route Swallow - dosing instruction imperative (qualifier value)
Generated Narrative: ActivityDefinition #Inline-Vaccine-Request-8
url: http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Vaccine-Request-8
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] UsageContextType age: Age Range 18-? UsageContextType venue: Clinical Venue Outpatient environment UsageContextType focus: Clinical Focus Contact with and (suspected) exposure to anthrax UsageContextType focus: Clinical Focus Exposure to Bacillus anthracis (event) UsageContextType focus: Clinical Focus Asymptomatic (finding) 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
product: Anthrax vaccine
dosage
text: 0.5mL
additionalInstruction: Epinephrine solution (1:1000) should be available for immediate use in the event that an anaphylactic reaction occurs.
route: Subcutaneous route
DoseAndRates
Dose[x] 0.5 mL (Details: UCUM codemL = 'mL')