{"id":10058,"date":"2025-03-01T14:02:34","date_gmt":"2025-03-01T19:02:34","guid":{"rendered":"https:\/\/dhss.delaware.gov\/dph\/dhan105\/"},"modified":"2025-03-02T00:46:20","modified_gmt":"2025-03-02T05:46:20","slug":"dhan105","status":"publish","type":"page","link":"https:\/\/dhss.delaware.gov\/dph\/php\/alerts\/dhan105\/","title":{"rendered":"php\/alerts\/dhan105 ~  Division of Public Health &#8211; &#8211; Health Alert  &#8211; Delaware Health and Social Services &#8211; State of Delaware"},"content":{"rendered":"<div data-swiftype-index=\"true\">\n\n\n\n  <br>\n\n\n\n  <div class=\"container\" id=\"main_header\"> \n\n    <!-- BEGIN readspeaker div -->\n\n    <div class=\"rs_skip rsbtn rs_preserve\" id=\"readspeaker_button1\">\n\n      <a accesskey=\"L\" class=\"rsbtn_play\" href=\"https:\/\/app-na.readspeaker.com\/cgi-bin\/rsent?customerid=7262&#038;lang=en_us&#038;readid=main_content&#038;url=https:\/\/dhss.delaware.gov\/dph\/php\/alerts\/dhan105.html\" title=\"Listen to this page using ReadSpeaker\">\n\n        <span class=\"rsbtn_left rsimg rspart\"><span class=\"rsbtn_text\"><span>Listen<\/span><\/span><\/span>\n\n        <span class=\"rsbtn_right rsimg rsplay rspart\"><\/span>\n\n      <\/a>\n\n    <\/div>\n\n    <!-- END readspeaker div -->\n\n\n\n    \n\n    <header class=\"pull-left\">\n\n      <h1>Delaware Health Alert Network #<!--[type=EDIT name=\"DHAN Number\"]-->105 <!--[END]--> <\/h1>\n\n      <h2> <!--[type=EDIT name=\"DHAN Date\"]-->October 3, 2005 8:25 am <!--[END]--> <\/h2>\n\n    <\/header>\n\n  <\/div><br>\n\n \n\n  <div class=\"container\">\n\n    <div class=\"row\">\n\n      <div class=\"col-md-3\" id=\"leftCol\">\n\n        <div class=\"panel-group\" id=\"accordion\">\n\n          <div class=\"panel sectionmenu_panel\">\n\n            <div class=\"panel-heading\">\n\n              <p class=\"panel-title\"><a class=\"agency_nav\" data-parent=\"#accordion\" data-toggle=\"collapse\" href=\"#collapseOne\"><strong><i class=\"fa fa-align-justify fa-fw\"><\/i> Public Health Menu<\/strong><\/a><\/p>\n\n            <\/div>\n\n\n\n            <div class=\"panel-collapse collapse in\" id=\"collapseOne\">\n\n              <div class=\"panel-body\" id=\"clf_nav\">\n\n                  <ul class=\"nav nav-stacked nav-pills-clf\" id=\"agency_sidebar\">\n    <li><a href=\"\/dph\/\"><h2>Home <i class=\"fa fa-home fa-fw\"><\/i><\/h2><\/a><\/li>\n    <li class=\"toplevel\"><a data-parent=\"#agency_sidebar\" data-toggle=\"collapse\" href=\"#HomeMenu\"><h2>About <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\n      <ul class=\"panel-collapse collapse\" id=\"HomeMenu\">\n        <li><a href=\"\/dph\/about.html\">About DPH<\/a><\/li>\n        <li><a href=\"\/dph\/sections.html\">Sections &#038; 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AREA, SEPTEMBER 30, 2005<!--[END]-->\n\n<\/h2>\n\n\n\n<!--[type=HTMLEDIT name=\"Content\"]-->\n\n\n\n<p>\n\n\n  The Division of Public Health is forwarding this Health Advisory from the Centers for Disease Control and Prevention. To contact DPH\n\n\n  about this Health Advisory, call 1-888-295-5156. This number is answered during normal business hours, and during non-business hours for\n\n\n  emergencies.\n\n\n<\/p>\n\n\n<h2 class=\"text-center\">\n\n\n  This is an official<br>\n\n\n  CDC Health Advisory\n\n\n<\/h2>\n\n\n<p>\n\n\n  Distributed via Health Alert Network<br>\n\n\n  September 30, 2005, 19:40 EDT (07:40 PM EDT)<br>\n\n\n  CDCHAN-00238-05-09-30-ADV-N\n\n\n<\/p>\n\n\n<h3 class=\"text-center\">\n\n\n  Presence of low levels of <em>Francisella tularensis<\/em> in the<br>\n\n\n  Washington D.C. area, September 30, 2005\n\n\n<\/h3>\n\n\n<p>\n\n\n  CDC has become aware that from September 24<sup>th<\/sup> through September 25<sup>th<\/sup> environmental air monitors in SW Washington\n\n\n  D.C., more specifically the Capitol Mall area, signaled the low level presence of <em>Francisella tularensis<\/em>, the bacterium that\n\n\n  causes Tularemia, also known as &#8220;rabbit fever.&#8221;\n\n\n<\/p>\n\n\n<p>\n\n\n  <strong>At this time, public health agencies have no reports of any related human or animal illnesses. This announcement is a\n\n\n  precautionary measure to assure that clinicians are aware of the situation and are able to recognize, test and report any suspected cases\n\n\n  to the appropriate medical and public health authorities.<\/strong>\n\n\n<\/p>\n\n\n<p>\n\n\n  This is a national alert because the Capitol Mall area is a highly-trafficked tourist destination, and on Saturday, September\n\n\n  24<sup>th<\/sup>, was the site of several very well attended outdoor events.\n\n\n<\/p>\n\n\n<h4>\n\n\n  Clinical Presentations\n\n\n<\/h4>\n\n\n<p>\n\n\n  The clinical presentations most likely to occur after an aerosol exposure to <em>F. tularensis<\/em> are pneumonic, oculoglandular and\n\n\n  oropharyngeal. The usual incubation period is 3-5 days, but in rare instances can be longer. The disease is not communicable from person\n\n\n  to person and can be effectively treated with readily available antimicrobials.\n\n\n<\/p>\n\n\n<h4>\n\n\n  Preliminary Case Definition\n\n\n<\/h4>\n\n\n<p>\n\n\n  Onset from Monday September 26<sup>th<\/sup> through October 5<sup>th<\/sup> of an acute febrile illness associated with at least one of\n\n\n  the following:\n\n\n<\/p>\n\n\n<ul>\n\n\n  <li>conjunctivitis with preauricular lymphadenopathy (oculoglandular)\n\n\n  <\/li>\n\n\n  <li>stomatitis or pharygitis or tonsillitis and cervical lymphadenopathy (oropharyngeal)\n\n\n  <\/li>\n\n\n  <li>cough, shortness of breath, pleuritic chest pain (pneumonic)\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<p>\n\n\n  which is not otherwise explained in a resident or visitor to the National Capitol Region on Saturday or Sunday, September 24-25.\n\n\n<\/p>\n\n\n<h4>\n\n\n  Human Diagnostic Specimens\n\n\n<\/h4>\n\n\n<p>\n\n\n  Clinical specimens may include:\n\n\n<\/p>\n\n\n<ul>\n\n\n  <li>Bronchial\/tracheal washes or aspirates, sputum, trans-thoracic lung aspirates, or pleural fluid collection\n\n\n  <\/li>\n\n\n  <li>Swabs of visible lesions or affected areas (e.g., conjunctiva or pharynx)\n\n\n  <\/li>\n\n\n  <li>Aspirates from lymph nodes\n\n\n  <\/li>\n\n\n  <li>Whole blood or blood cultures are acceptable specimens, but are generally positive in cases of severe illness only.\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<h4>\n\n\n  Laboratory Testing (Culture)\n\n\n<\/h4>\n\n\n<p>\n\n\n  <strong>Microbiology laboratory personnel should be alerted when <em>F. tularensis<\/em> is clinically suspected, so that appropriate\n\n\n  laboratory precautions can be taken.<\/strong>\n\n\n<\/p>\n\n\n<p>\n\n\n  <em>F. tularensis<\/em> is a fastidious, slow-growing organism that requires cysteine for growth.\n\n\n<\/p>\n\n\n<p>\n\n\n  <em>F. tularensis<\/em> may be cultured on the following:\n\n\n<\/p>\n\n\n<ul>\n\n\n  <li>cysteine supplemented agar including chocolate agar (CA)\n\n\n  <\/li>\n\n\n  <li>cysteine heart agar with 9% chocolatized blood (CHAB)\n\n\n  <\/li>\n\n\n  <li>buffered charcoal yeast extract (BYCE)\n\n\n  <\/li>\n\n\n  <li>Thayer-Martin agar\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<p>\n\n\n  Culture plates should be held for 5-7 days at 35-370C (C0<sub>2<\/sub> is acceptable) and checked for growth daily.\n\n\n<\/p>\n\n\n<p>\n\n\n  <em>F. tularensis<\/em> can be isolated from nutrient enriched specimens (tissues) on sheep blood agar (SBA), but the organism will\n\n\n  usually fail to thrive with passage on SBA. Growth on CHAB provides for presumptive identification of <em>F. tularensis<\/em> as the\n\n\n  organism shows characteristic growth on this media (green, opalescent, raised, shiny colonies at 24-48 hours).\n\n\n<\/p>\n\n\n<p>\n\n\n  Note: Specimens for recovery of live bacteria, should be collected before antibiotics are administered.\n\n\n<\/p>\n\n\n<h4>\n\n\n  Prophylaxis\n\n\n<\/h4>\n\n\n<p>\n\n\n  CDC does not recommend mass or targeted prophylaxis at this time because:\n\n\n<\/p>\n\n\n<ul>\n\n\n  <li>the usual incubation period has passed without an increase in suspicious illnesses in the area, and air sampling since September\n\n\n  25<sup>th<\/sup> has been negative\n\n\n  <\/li>\n\n\n  <li>infection is readily treatable and generally has a low mortality rate with medical care\n\n\n  <\/li>\n\n\n  <li>infection cannot be transmitted to others\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<h4>\n\n\n  Treatment\n\n\n<\/h4>\n\n\n<h5>\n\n\n  Adults\n\n\n<\/h5>\n\n\n<h6>\n\n\n  Preferred choices:\n\n\n<\/h6>\n\n\n<ul>\n\n\n  <li>Streptomycin, 1g IM twice daily\n\n\n  <\/li>\n\n\n  <li>Gentamicin, 5 mg\/kg IM or IV once daily\u2020\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<h6>\n\n\n  Alternative choices:\n\n\n<\/h6>\n\n\n<ul>\n\n\n  <li>Doxycycline, 100 mg IV twice daily\n\n\n  <\/li>\n\n\n  <li>Ciprofloxacin, 400 mg IV twice daily\u2020\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<h5>\n\n\n  Children\n\n\n<\/h5>\n\n\n<h6>\n\n\n  Preferred choices:\n\n\n<\/h6>\n\n\n<ul>\n\n\n  <li>Streptomycin, 15 mg\/kg IM twice daily (should not exceed 2 gm\/d)\n\n\n  <\/li>\n\n\n  <li>Gentamicin, 2.5 mg\/kg IM or IV 3 times daily\u2020\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<h6>\n\n\n  Alternative choices:\n\n\n<\/h6>\n\n\n<ul>\n\n\n  <li>Doxycycline,\n\n\n    <ul>\n\n\n      <li>If weight >= 45 kg, 100 mg IV\n\n\n      <\/li>\n\n\n      <li>If weight < 45 kg, give 2.2 mg\/kg IV twice daily\n\n\n      <\/li>\n\n\n    <\/ul>\n\n\n  <\/li>\n\n\n  <li>Ciprofloxacin, 15 mg\/kg IV twice daily\u2021\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<h5>\n\n\n  Pregnant Women\n\n\n<\/h5>\n\n\n<h6>\n\n\n  Preferred choices:\n\n\n<\/h6>\n\n\n<ul>\n\n\n  <li>Gentamicin, 5 mg\/kg IM or IV once daily\u2020\n\n\n  <\/li>\n\n\n  <li>Streptomycin, 1 g IM twice daily\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<h6>\n\n\n  Alternative choices:\n\n\n<\/h6>\n\n\n<ul>\n\n\n  <li>Doxycycline, 100 mg IV twice daily\n\n\n  <\/li>\n\n\n  <li>Ciprofloxacin, 400 mg IV twice daily\u2020\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<p>\n\n\n  One antibiotic, appropriate for treatment for patient age, should be chosen from among the alternatives. Treatment with streptomycin,\n\n\n  gentamicin, or ciprofloxacin should be continued for 10 days; treatment with doxycycline should be continued for 14-21 days. Persons\n\n\n  beginning treatment with intramuscular (IM) or intravenous (IV) doxycycline, ciprofloxacin can switch to oral antibiotic administration\n\n\n  when clinically indicated.\n\n\n<\/p>\n\n\n<p>\n\n\n  \u2020Not a U.S. Food and Drug Administration-approved use.\n\n\n<\/p>\n\n\n<p>\n\n\n  \u2021Ciprofloxacin dosage should not exceed 1 g\/d in children.\n\n\n<\/p>\n\n\n<h4>\n\n\n  Additional information about Tularemia can be found on the CDC website:<br>\n\n\n  <a href=\"http:\/\/www.bt.cdc.gov\/agent\/tularemia\/\">http:\/\/www.bt.cdc.gov\/agent\/tularemia\/<\/a>\n\n\n<\/h4><!--[END]-->\n\n  \n\n        <div class=\"panel panel-danger\">\n\n          <div class=\"panel-heading\">    \n\n      <h2>Categories of Health Alert messages:<\/h2>\n\n       <\/div>\n\n       <div class=\"panel-body\">\n\n      <ul>\n\n        <li><strong>Health Alert:<\/strong> Conveys the highest level of importance; warrants immediate action or attention.<\/li>\n\n        <li><strong>Health Advisory:<\/strong> Provides important information for a specific incident or situation; may not require immediate action.<\/li>\n\n        <li><strong>Health Update:<\/strong> Provides updated information regarding an incident or situation; unlikely to require immediate action.<\/li>\n\n            <\/ul>\n\n         <div><strong>NOTE: This page is for informational purposes only and dated material (e.g. temporary websites) may not be available.<\/strong><\/div>\n\n          <\/div> \n\n        <\/div><br>  \n\n\n\n      <\/div>\n\n    <\/div>\n\n  <\/div><!-- \/container -->\n\n  <\/div>","protected":false},"excerpt":{"rendered":"<p>Listen Delaware Health Alert Network #105 October 3, 2005 8:25 am Public Health Menu Home About About DPH Sections &#038; Programs Office Locations Contact Info Calendar Services A-Z Services Air &#038; Water Quality Birth, Death, &#038; Marriage Records Clinics Health Data &#038; Statistics Emergency Preparedness Health &#038; Wellness Healthy Homes Healthy Workplaces Laboratory Restaurant Inspections [&hellip;]<\/p>\n","protected":false},"author":8,"featured_media":0,"parent":9294,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-10058","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10058","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/comments?post=10058"}],"version-history":[{"count":1,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10058\/revisions"}],"predecessor-version":[{"id":11234,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10058\/revisions\/11234"}],"up":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/9294"}],"wp:attachment":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/media?parent=10058"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}