Melioidosis Emergency Planning: How Hospitals and Health Agencies Would Respond

Melioidosis is caused by the bacterium Burkholderia pseudomallei. CDC's planning guidance describes how health care facilities, community groups and federal, tribal, state and local agencies would work together if an emergency were ever caused by the release of the bacteria. Hospitals and other facilities would be called on to diagnose, treat and care for patients.

Investigating cases

Every case should be investigated to learn where, when and how the patient was exposed. People can be exposed by:

• breathing in contaminated dust or water droplets;
• contact with contaminated soil or water, especially by swallowing it or through skin scrapes.

Person-to-person spread is very rare.

Some people who fell ill soon after exposure — before an emergency was recognized — may have been misdiagnosed, so facilities may need to help health departments review charts and contact people who need testing and treatment. Epidemiologists will interview patients about:

• travel to areas where melioidosis is common, over their lifetime and in the previous 21 days;
• places they've been locally in the previous 21 days;
• contact with imported animals or commercial products;
• people they've spent time with in the previous 21 days, especially anyone with similar symptoms.

Finding other sick people helps track down the source and gets them into treatment. Interviewers don't need protective equipment.

Sharing resources

State and local health agencies should make sure treating hospitals have enough supplies, such as ventilators. The Strategic National Stockpile works with partners so agencies can receive, stage and distribute products. States coordinate with CDC to send any stockpiled medicines for prevention or treatment where they're needed, and hospitals request extra supplies through their state health department's Medical Countermeasures Coordinator.

Treatment

There are no FDA-approved drugs specifically for preventing melioidosis after exposure or for treating it; in an emergency, CDC would recommend and provide certain antibiotics under emergency use authorization. Every patient needs an appropriate antibiotic course:

Some patients need intensive care, including ventilator support.

Infection control

Health workers should use standard precautions. Melioidosis isn't considered to spread person to person through the air or respiratory droplets outside laboratories; only a few cases of person-to-person spread are documented, and skin punctures are probably the most common natural route of infection. Equipment and surfaces should be disinfected and sterilized through routine practices.

Enhanced surveillance

Once an emergency is declared, health authorities classify cases as probable or confirmed using the national case definition. Enhanced surveillance and reporting help to:

• find and report new cases quickly;
• estimate how many people are at risk;
• spot unexpected features of the outbreak and measure its extent;
• judge whether the response is limiting spread.

To prepare, agencies can educate medical and public health workers about melioidosis and its potential as a bioweapon, set up systems to track calls and reports, designate a central reporting point for cases, and test emergency notification systems and on-call staff communications.

Sources

Based on "Healthcare Response Planning and Enhanced Surveillance," melioidosis, Centers for Disease Control and Prevention; a work of the United States government in the public domain.