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Journal of the American Academy of Dermatology
Volume 52, n° 6
pages 1077-1081 (juin 2005)
Doi : 10.1016/j.jaad.2005.02.047

Performance of a rapid dermatology referral system during the anthrax outbreak

John T. Redd, MD, MPH, FACP a, , Chris Van Beneden, MD, MPH b, Nicholas A. Soter, MD c, Eric Hatzimemos, JD , David E. Cohen, MD, MPH c
a From the Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office, US Centers for Disease Control and Prevention (CDC), Atlanta 
b Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, CDC 
c The Ronald O. Perelman Department of Dermatology, New York University School of Medicine 

Reprint requests: John T. Redd, MD, MPH, FACP, Prevention Branch, Division of Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention; Chief, Viral Hepatitis and Chronic Liver Disease Section, Infectious Diseases Branch, Indian Health Service Division of Epidemiology, 5300 Homestead Rd NE, Albuquerque, NM 87110.

Atlanta, Georgia, and New York, New York


The bioterrorism-related anthrax outbreak generated unanticipated demand for dermatologic services. In this study we sought to perform rapid, efficient, cost-effective evaluation of patients suspected of having cutaneous anthrax. During the outbreak, we developed an anthrax evaluation system featuring clinical field examination by nondermatologist physicians, followed by rapid referral of selected high-risk patients to a centralized dermatology center. We excluded anthrax in 29 previously screened high-risk patients. All were examined within 24 hours, costing $272.07 per patient. Diagnoses were established quickly (median, same day; range, 0-15 days). Among 2259 at-risk postal workers, 144 (6.4%) self-identified new (≤14 days) skin lesions and were examined in the field; 8 (5.6%) were referred to our system. Our system was not the only local dermatologic resource available during the outbreak. A system featuring initial nondermatologist examination with minimal laboratory evaluation, followed by rapid centralized referral of high-risk patients, functioned efficiently in this outbreak.

The full text of this article is available in PDF format.
  Mr Hatzimemos was Assistant Council to the Mayor, Office of the Mayor, City of New York, at the time of the anthrax outbreak.

© 2005  American Academy of Dermatology, Inc.@@#104156@@
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