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Anthrax: Special Considerations for
Pregnant and Postpartum Women
Public Health Considerations for
Pregnant Women
Marianne E Zotti, DrPH, MS, FAAN
Lead Epidemiologist
Emergency Preparedness and Response Program
Applied Sciences Branch/Division of Reproductive Health
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
Outline

Background regarding pregnant women

Division of Reproductive Health (DRH) Response in Recent
Pandemic H1N1 Influenza (pH1N1)

DRH Program for Emergency Preparedness and Response

Anthrax project

Model for public health response
Pregnant Women and Catastrophic Events

Classified as ‘at-risk individuals’

Post-event data often not
collected

Disproportionate burden known
for some infectious diseases
A Joint Effort: 2008 Pandemic Flu
Preparedness Planning

Was the first formal collaboration between DRH & NCBDDD

Convened internal & external experts

Identified pregnancy as a critical area

Identified critical pregnancy, postpartum and infant topics
 Antiviral prophylaxis & therapy
 Vaccine use
 Non-pharmacologic interventions & healthcare planning
 Communications to pregnant women & healthcare providers
 Intrapartum & newborn issues
Initially posted at www.cdc.gov on April 28, 2009
DRH Program for Emergency Preparedness
and Response

Purpose: Prepare DRH to respond to reproductive health needs of the US
population after natural or man-made catastrophic events by:
 Gathering epidemiologic/surveillance data to guide action
 Developing recommendations and tools to guide public health
response specific to pregnant and lactating women and newborns
 Developing a plan to reduce fertility risks, infertility, or inadequate
contraception
 Developing a plan to communicate with clinical, public health and
government partners and pregnant women regarding
preparedness and response
 Developing a human resources preparedness plan for DRH
Anthrax in Pregnant and
Postpartum Women

Purpose: discuss issues related to Anthrax in pregnant and
postpartum women and newborns

Is a collaborative project with health care providers,
professional and public health organizations, federal
partners, and within CDC

FY 2011: involved a literature review and a meeting of local
experts to discuss how to enhance use of CDC guidance

FY 2012: National expert meeting

FY 2013: Development of guidance documents and
communication strategy and materials
This project is supported by funds made available from the Centers for Disease Control and Prevention, Office for Public Health
Preparedness and Response, the Division of Reproductive Health, and the Anthrax Management Team.
What’s Different from pH1N1?

Anthrax is usually not transmitted from person to person

US society has little experience with anthrax in humans

Few US medical and public health care providers have
experience managing anthrax in humans

No literature about inhalational anthrax among pregnant or
postpartum women

Medication and vaccine regimes may be long and
complicated

A bioterrorism event brings many unknowns

Public health will have a critical role in distribution of
vaccines and medications
Pregnant/postpartum
(P/PP) woman and her
family
Evaluate risk to self, fetus/infant, and
family; Identify and use appropriate
prevention and treatment modalities
P/PP woman
and Family
Local Community
Local Community
P/PP woman and
Family
Support appropriate risk assessment
and use of appropriate prevention
and treatment modalities. Facilitate
public health response efforts in
local areas.
Health Care Provider
Local Community
P/PP woman and
Family
Health Care Providers
Provide medical care to P/PP
women, and receive training
pertaining to anthrax and public
health response. Facilitate public
health response efforts in local areas.
Local Public Health
Health Care Provider
Local Community
P/PP woman and
Family
Local Public Health
Disperse national guidance and
messages for the public using
culturally appropriate methods and
channels. Facilitate public health
response efforts in local areas.
CDC Partner Organizations
State Public Health
Local Public Health
Health Care Provider
Local Community
P/PP woman
and Family
CDC Partner Organizations
State Public Health
Disperse national guidance, training,
and messages for the public to
providers and local partners.
Facilitate public health response
efforts in local areas.
National Public Health
CDC Partner
Organizations State
Public Health
Local Public Health
Health Care Provider
Local Community
P/PP woman
and Family
National Public Health
Develop scientific guidance and
messages related to anthrax care
and treatment in pregnant and
postpartum (P/PP) women.
Disseminate guidance and messages
through national channels.
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the
Centers for Disease Control and Prevention.