Generated Narrative: PlanDefinition first-vaccine-dose-antimicrobial-pregnant-pd

url: PlanDefinition First vaccine antimicrobial pregnant

identifier: Anthrax_Post_Exposure_Prophylaxis_FHIRv102_CQL_v110/OrderSet

version: 1.1.0

name: Anthrax_Post_Exposure_Prophylaxis_Adults

title: First vaccine antimicrobial pregnant

type: ECA Rule

status: Draft

experimental: true

date: 2024-11-18 16:43:41+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:

UseContexts

jurisdiction: World

purpose:

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 6

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 Anthrax Post Exposure Prophylaxis (PEP) for Adults: Ciprofloxacin Request
*	Create	ActivityDefinition Anthrax Post Exposure Prophylaxis (PEP) for Adults: 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 Anthrax Post Exposure Prophylaxis (PEP) for Adults: Levofloxacin Request
*	Create	ActivityDefinition Anthrax Post Exposure Prophylaxis (PEP) for Adults: Moxifloxacin Request
*	Create	ActivityDefinition Anthrax Post Exposure Prophylaxis (PEP) for Adults: Clindamycin Request

action

title: Anthrax Vaccination - 1st dose

type: Create

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

Generated Narrative: ActivityDefinition #Inline-Ciprofloxacin-Request-2

​url: http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Ciprofloxacin-Request-2

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]
*	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: FIRST CHOICE: 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	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	Swallow - dosing instruction imperative (qualifier value)

Generated Narrative: ActivityDefinition #Inline-Doxycycline-Request-2

​url: http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Doxycycline-Request-2

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]
*	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: SECOND CHOICE: 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	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	Swallow - dosing instruction imperative (qualifier value)

Generated Narrative: ActivityDefinition #Inline-Levofloxacin-Request-2

​url: http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Levofloxacin-Request-2

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]
*	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	Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester.	Once per 1 days	Oral Route	Swallow - dosing instruction imperative (qualifier value)

Generated Narrative: ActivityDefinition #Inline-Moxifloxacin-Request-2

​url: http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Moxifloxacin-Request-2

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]
*	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	Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester.	Once per 1 days	Oral Route	Swallow - dosing instruction imperative (qualifier value)

Generated Narrative: ActivityDefinition #Inline-Clindamycin-Request-2

​url: http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Clindamycin-Request-2

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]
*	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	Pregnant women at risk for inhalation anthrax should receive antimicrobial drug therapy regardless of pregnancy trimester.	2 per 8 hours	Oral Route	Swallow - dosing instruction imperative (qualifier value)

Generated Narrative: ActivityDefinition #Inline-Vaccine-Request-2

​url: http://cqframework.org/cpg-example-anthrax/ActivityDefinition/Inline-Vaccine-Request-2

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: 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

DoseAndRates

-	Dose[x]
*	0.5 mL (Details: UCUM codemL = 'mL')