Special Considerations for Prophylaxis for and Treatment of Anthrax in Pregnant and Postpartum Women

Dana Meaney-Delman

, Marianne E. Zotti, Andreea A. Creanga, Lara K. Misegades, Etobssie Wako, Tracee A. Treadwell, Nancy E. Messonnier, Denise J. Jamieson, and Workgroup on Anthrax in Pregnant and Postpartum Women

Author affiliations: Author affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Abstract

In August 2012, the Centers for Disease Control and Prevention, in partnership with the Association of Maternal and Child Health Programs, convened a meeting of national subject matter experts to review key clinical elements of anthrax prevention and treatment for pregnant, postpartum, and lactating (P/PP/L) women. National experts in infectious disease, obstetrics, maternal fetal medicine, neonatology, pediatrics, and pharmacy attended the meeting, as did representatives from professional organizations and national, federal, state, and local agencies. The meeting addressed general principles of prevention and treatment for P/PP/L women, vaccines, antimicrobial prophylaxis and treatment, clinical considerations and critical care issues, antitoxin, delivery concerns, infection control measures, and communication. The purpose of this meeting summary is to provide updated clinical information to health care providers and public health professionals caring for P/PP/L women in the setting of a bioterrorist event involving anthrax.

In 2001, the United States experienced a bioterrorist attack involving Bacillus anthracis spore dissemination via the postal service (1). Anthrax continues to be a high-priority threat agent and remains a major focus of national emergency preparedness planning (2). As part of a comprehensive plan for anthrax readiness, it is important to plan for the needs of pregnant, postpartum, and lactating (P/PP/L) women because of their unique immunology and physiology (3) and the complexities of balancing maternal and fetal risks.

Methods for Guideline Development

In August 2012, the Centers for Disease Control and Prevention (CDC), in partnership with the Association of Maternal and Child Health Programs, held a meeting titled Anthrax: Special Considerations for Pregnant and Postpartum Women to review evidence, solicit individual expert opinion, and discuss clinical recommendations for prophylaxis and treatment of anthrax specific to obstetric populations. In preparation for the meeting, 2 systematic reviews were conducted; the first summarized the worldwide experience of 20 cases of anthrax in P/PP/L women (4), and the second evaluated the safety and pharmacokinetics of 14 antibiotics recommended for anthrax prophylaxis and treatment (5). Before the meeting, the CDC convened 5 workgroups: vaccines, antibiotic prophylaxis and treatment, other treatments and clinical considerations, health care planning, and communications. Workgroup members (Technical Appendix

[PDF - 246 KB - 7 pages]) participated in a series of pre-meeting conference calls to determine key issues.

In August 2012, a total of 77 experts (Technical Appendix

[PDF - 246 KB - 7 pages]) participated in a 2.5-day meeting to discuss the proposed CDC recommendations. Following the meeting, a clinical document was created by CDC subject matter experts; review and input were provided by workgroup participants. This information updates previously published CDC guidelines for P/PP/L women (6,7) and aligns with updated recommendations for nonpregnant adults (8).