Jim Martin, Commissioner      Kathleen E. Toomey, M.D., M.P.H., Division Director

Georgia Department of Human Resources • Division of Public Health

Two Peachtree Street NW • Suite 15-470 • Atlanta, Georgia 30303-3186 • Tel: (404) 657-2700 • Fax: (404) 657-2715

Advice for Healthcare Providers Regarding the Use of Nasal Swabs

Georgia Division of Public Health

October 24, 2001

Currently, no clinical screening tests are available for detecting anthrax infection in the absence of symptoms. The presence of anthrax spores in the nose only indicates environmental exposure and has no predictive value regarding the risk of future development of infection or illness in a particular individual.

The sensitivity, specificity, and clinical value of nasal swab testing for individual exposures are unknown. Recently, nasal swabs have been used as an epidemiologic tool in the anthrax investigations in Florida, N.Y.C, and Washington D.C. In these investigations, nasal swabs were only employed after a confirmed human anthrax case was identified and/or contamination of the environment with Bacillus anthracis was documented. Nasal swab testing served to determine the extent of anthrax exposure in the involved facilities, but was not used to determine which individuals required antibiotic prophylaxis.

Please consult public health officials for assistance if you have questions regarding the appropriateness of using nasal swabs in a given anthrax exposure scenario.

KEY POINTS:

• The Georgia Division of Public Health does not recommend the routine use of nasal swabs for evaluating individuals who are concerned about exposure to anthrax.
• Following an individual’s potential exposure to anthrax, the decision to start antibiotic prophylaxis should be based on a risk assessment evaluation, NOT on nasal swab testing results.
• Currently, there are no data to support the use of nasal swab testing in the clinical setting.

Further details on diagnostic testing and treatment can be found in the attached guidelines. These guidelines will be updated as we receive important new information. For the most recent information, please visit the Georgia Division of Public Health Bioterrorism webpage at: http://health.state.ga.us/programs/emerprep/bioterrorism.shtml