{"id":10354,"date":"2025-03-01T14:07:44","date_gmt":"2025-03-01T19:07:44","guid":{"rendered":"https:\/\/dhss.delaware.gov\/dph\/dhan378\/"},"modified":"2025-03-02T00:53:54","modified_gmt":"2025-03-02T05:53:54","slug":"dhan378","status":"publish","type":"page","link":"https:\/\/dhss.delaware.gov\/dph\/php\/alerts\/dhan378\/","title":{"rendered":"php\/alerts\/dhan378 ~  Division of Public Health  &#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\/dhan378.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\"]-->378 <!--[END]--> <\/h1>\n\n      <h2> <!--[type=EDIT name=\"DHAN Date\"]-->October 25, 2017 1:34 pm <!--[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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This new strain of <em>B. cereus<\/em> \n\n\n\n\n\nwas named <em>Bacillus cereus<\/em> biovar <em>anthracis<\/em> (<em>B. cereus<\/em>\u00a0bv <em>anthracis<\/em>).<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<h2>Background<\/h2>\n\n\n\n\n\n\n\n\n\n\n\n<p>Currently, <em>B. cereus<\/em> bv <em>anthracis<\/em> has only been found in a few animals (wild \n\n\n\n\n\nchimpanzees, gorillas, elephant and goats) in a few countries in West and Central Africa \n\n\n\n\n\n(C\u00f4te d\u2019Ivoire, Cameroon, Central African Republic and Democratic Republic of Congo). \n\n\n\n\n\nHowever, it should be noted that <em>B. cereus<\/em> bv <em>anthracis<\/em> has all of the virulence \n\n\n\n\n\ndeterminants and the biothreat potential to pose a severe threat to public health as does <em>B. anthracis<\/em>, \n\n\n\n\n\nthe causative agent of anthrax. In October 2016, the U.S. Department of Health and Human Services (HHS) \n\n\n\n\n\nadded <em>B. cereus<\/em> bv <em>anthracis<\/em> to the HHS select agents and toxins list because \n\n\n\n\n\n<em>B. cereus<\/em> bv <em>anthracis<\/em> presents the same threat to public health and national \n\n\n\n\n\nsecurity as <em>B. anthracis<\/em>.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<h2>Recommendations\/Reporting<\/h2>\n\n\n\n\n\n\n\n\n\n\n\n<h3>General Information<\/h3>\n\n\n\n\n\n\n\n\n\n\n\n<p><em>B. cereus<\/em> bv <em>anthracis<\/em> isolates share several phenotypic features of both \n\n\n\n\n\n<em>B. anthracis<\/em> and <em>B. cereus<\/em>, but differ with regard to motility and their resistance \n\n\n\n\n\nor sensitivity to penicillin. <em>B. cereus<\/em> is a Gram-positive, rod-shaped, aerobic (facultatively anaerobic), \n\n\n\n\n\nmotile, beta hemolytic bacterium commonly found in the soil and in raw, dried, and processed foods, \n\n\n\n\n\nparticularly uncooked rice. A few strains of this organism have been known to cause foodborne illness in humans.\n\n\n\n\n\n The heat-stable bacterial spores are known to survive initial boiling of food, especially rice, and can \n\n\n\n\n\n subsequently germinate, multiply, and produce toxins when left unrefrigerated. <em>B. cereus<\/em> is the \n\n\n\n\n\n cause of \u201cfried rice syndrome,\u201d as the bacteria are classically contracted from fried rice dishes \n\n\n\n\n\n that have been sitting at room temperature for hours. But the typical <em>B. cereus<\/em> organism should \n\n\n\n\n\n not be confused with <em>B. cereus bv anthracis because B. cereus bv anthracis <\/em>isolates are non-hemolytic, \n\n\n\n\n\n (like <em>B. anthracis)<\/em>, and motile, like <em>B. cereus<\/em>.<\/p>\n\n\n\n\n\n \n\n\n\n\n\n<h3>Diagnosis<\/h3>\n\n\n\n\n\n<p>Subject matter experts at the Centers for Disease Control and Prevention (CDC), the American Society for \n\n\n\n\n\nMicrobiology (ASM), and the Association of Public Health Laboratories (APHL) are working to develop testing \n\n\n\n\n\nalgorithms for <em>B. cereus<\/em> bv <em>anthracis.<\/em><\/p>\n\n\n\n\n\n\n\n\n\n\n\n<p>Sentinel laboratories should continue using the existing ASM Sentinel Level Clinical Laboratory Guidelines for \n\n\n\n\n\nSuspected Agents of Bioterrorism and Emerging Infectious Diseases, <em>Bacillus anthracis<\/em> \n\n\n\n\n\n(<a href=\"https:\/\/www.asm.org\/images\/PSAB\/LRN\/Anthrax316.pdf\">http:\/\/www.asm.org\/images\/PSAB\/LRN\/Anthrax316.pdf<\/a>) \n\n\n\n\n\nto rule out or refer isolates of <em>Bacillus spp<\/em>. that produce non-hemolytic colonies with a ground glass \n\n\n\n\n\nappearance and are non-motile. Until new guidelines are available, the following recommendations should be considered:<\/p>\n\n\n\n\n\n<ol>\n\n\n\n\n\n<li>Suspect <em>Bacillus spp<\/em>. isolates that are large Gram-positive rods and weakly or non-hemolytic (at 24 hours \n\n\n\n\n\nor less) should be tested for motility and catalase production. Semi-solid medium is recommended for motility for consistent \n\n\n\n\n\nresults.<\/li>\n\n\n\n\n\n\n\n\n\n\n\n<li>Isolates that are positive for catalase and motility should be investigated further by contacting the patient\u2019s \n\n\n\n\n\nattending physician to determine if the patient has an anthrax-like illness or if the patient has a clinical infection \n\n\n\n\n\ncompatible with this organism.<\/li>\n\n\n\n\n\n\n\n\n\n\n\n<li>If the isolate is deemed significant, the local LRN reference laboratory (such as the Delaware Public Health Laboratory) \n\n\n\n\n\nshould be contacted and the isolate forwarded for further testing. If the sentinel laboratory is unable or unwilling to \n\n\n\n\n\ncontact the patient\u2019s physician, notify the local LRN reference laboratory and provide the physician\u2019s contact \n\n\n\n\n\ninformation and laboratory testing results.<\/li>\n\n\n\n\n\n<\/ol>\n\n\n\n\n\n\n\n\n\n\n\n<h3>Clinicians<\/h3>\n\n\n\n\n\n\n\n\n\n\n\n<p>Until new guidelines are available, the following recommendations should be considered:<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<h4>Ordering Testing<\/h4>\n\n\n\n\n\n\n\n\n\n\n\n<p><em>B. cereus<\/em> is commonly isolated in the laboratory and is typically considered to be non-pathogenic, but <em>B. cereus<\/em> bv <em>anthracis<\/em> \n\n\n\n\n\nis different. To reduce the burden of unnecessary rule-out testing of all <em>B. cereus<\/em> isolates and to ensure that \n\n\n\n\n\n<em>B. cereus<\/em> bv <em>anthracis<\/em> infection is properly identified when present, clinicians are asked to do the following:<\/p>\n\n\n\n\n\n<ol>\n\n\n\n\n\n<li>Notify the laboratory when you order testing on a patient who presents with anthrax-like symptoms.<\/li>\n\n\n\n\n\n<li>Include a patient travel history with the laboratory test requisition form.<\/li>\n\n\n\n\n\n<li>Elicit a history of consumption of dead wildlife<\/li>\n\n\n\n\n\n<li>Report suspect cases to the Division of Public Health. See below for contact information.<\/li>\n\n\n\n\n\n<li>If you have questions about testing, contact the Delaware Public Health Laboratory at 302-223-1520<\/li>\n\n\n\n\n\n<\/ol>\n\n\n\n\n\n\n\n\n\n\n\n<h4>Reporting<\/h4>\n\n\n\n\n\n\n\n\n\n\n\n<p>Report all cases of suspected <em>B. cereus<\/em> bv <em>anthracis<\/em> infection to the DPH Office of \n\n\n\n\n\nInfectious Disease Epidemiology via phone at 302-744-4990, 24 hours a day at 1-888-295-5156, by fax at 302-223-1540, \n\n\n\n\n\nor by email at <a href=\"mailto:reportdisease@delaware.gov\">reportdisease@delaware.gov<\/a>.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<h2>Additional Information<\/h2>\n\n\n\n\n\n\n\n\n\n\n\n<ol>\n\n\n\n\n\n<li class=\"xsmalltext\">Federal Register, Wednesday, September 14, 2016, 81:63138-63143. Also available at: \n\n\n\n\n\n<a href=\"https:\/\/www.federalregister.gov\/documents\/2016\/09\/14\/2016-22049\/possession-use-and-transfer-of-select-agents-and-toxins-addition-of-bacillus-cereus-biovar-anthracis\">https:\/\/www.federalregister.gov\/documents\/2016\/09\/14\/2016-22049\/possession-use-and-transfer-of-select-agents-and-toxins-addition-of-bacillus-cereus-biovar-anthracis<\/a><\/li>\n\n\n\n\n\n\n\n\n\n\n\n<li class=\"xsmalltext\">American Society For Microbiology Statements and Testimony, Monday, February 13, 2017. Also available at\u00a0 <a href=\"https:\/\/www.asm.org\/index.php\/statements-and-testimony\/item\/5900-b-cereus-biovar-anthracis\">https:\/\/www.asm.org\/index.php\/statements-and-testimony\/item\/5900-b-cereus-biovar-anthracis<\/a><\/li>\n\n\n\n\n\n\n\n\n\n\n\n<li class=\"xsmalltext\">Antonation KS, Gr\u00fctzmacher K, Dupke S, Mabon P, Zimmermann F, Lankester F, et al. (2016) <em>Bacillus cereus<\/em> Biovar Anthracis Causing Anthrax in Sub-Saharan Africa\u2014Chromosomal Monophyly and Broad Geographic Distribution. PLoS Negl Trop Dis10(9): e0004923. <a href=\"https:\/\/doi.org\/10.1371\/journal.pntd.0004923\">https:\/\/doi.org\/10.1371\/journal.pntd.0004923<\/a><\/li>\n\n\n\n\n\n\n\n\n\n\n\n<li class=\"xsmalltext\">Hoffmann, Constanze; Zimmermann, Fee; Biek, Roman; Kuehl, Hjalmar; Nowak, Kathrin; Mundry, Roger; Agbor, Anthony; Angedakin, Samuel; Arandjelovic, Mimi (2017-08-03). &#8220;Persistent anthrax as a major driver of wildlife mortality in a tropical rainforest&#8221;. Nature. 548 (7665): 82\u201386. ISSN\u00a00028-0836. doi:10.1038\/nature23309.<\/li>\n\n\n\n\n\n\n\n\n\n\n\n<li class=\"xsmalltext\">Christopher A. Sanford; Elaine C. Jong (5 August 2008). The Travel and Tropical Medicine Manual. Elsevier Health Sciences. pp.\u00a0469\u2013. ISBN\u00a01-4377-1069-7.<\/li>\n\n\n\n\n\n<\/ol>\n\n\n\n\n\n<p>************************************<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<p>You are receiving this email because you are a registered member of the Delaware Health Alert Network.\n\n\n\n\n\nIf you are not a member and would like to subscribe, please register at <a href=\"https:\/\/healthalertde.org\">https:\/\/healthalertde.org<\/a><\/p><!--[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 #378 October 25, 2017 1:34 pm 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-10354","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10354","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=10354"}],"version-history":[{"count":1,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10354\/revisions"}],"predecessor-version":[{"id":11530,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10354\/revisions\/11530"}],"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=10354"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}