Anthrax Surveillance

Disease surveillance is a cornerstone of public health practice, enabling early detection, rapid characterization, and efficient response to urgent public health threats like anthrax. Healthcare providers and public health practitioners are key partners in effective anthrax surveillance.

Anthrax case definition

The anthrax surveillance case definition provides a set of uniform criteria used to define the disease for public health surveillance. This definition enables public health officials to classify and count cases consistently across jurisdictions. Current and former anthrax case definitions are available at the National Notifiable Diseases Surveillance System (NNDSS) anthrax site.

Historic CDC surveillance data

CDC maintains anthrax surveillance data that are published weekly and annually; these data are available in the NNDSS notifiable infectious disease data tables.

Reporting and notification requirements

Reportability

Anthrax is a reportable disease in all 56 U.S. states and territories. Anthrax cases must be reported to state and territorial jurisdictions when identified by a healthcare provider, hospital, or laboratory. Specific requirements for who must report cases and when to report vary by jurisdiction.

Notifiability

Anthrax is also a nationally notifiable condition (NNC). In 2009, the Council of State and Territorial Epidemiologists (CSTE) developed criteria for timeliness of NNC case notifications [PDF – 43 KB]. CSTE requests immediate case notification for anthrax cases [PDF – 13 KB], for which there are 2 categories:

Immediate, Extremely Urgent: Notification within 4 hours

• Notification criteria: When the source of infection is not recognized or is recognized as a bioterrorism exposure/potential mass exposure; or when the case represents a serious illness of naturally occurring anthrax.
• What to do: The state/territorial epidemiologist (or delegate) should call the CDC Emergency Operations Center (EOC) at (770)-488-7100 within 4 hours of the notification criteria being met.

• Upon receiving notification, a CDC subject matter expert will call back within 1 hour and will send written or email confirmation that the case notification was received.
• Electronic transmission to NNDSS should be done by the next business day (see Data submission below).
  • Changes in case classification (e.g., from suspect to confirmed) should also be submitted by the next business day after the change occurs.

Immediate, Urgent: Notification within 24 hours

• Notification criteria: In the event of a case of naturally occurring or occupational-related anthrax that is responding to treatment.
• What to do: The state/territorial epidemiologist (or delegate) should call the CDC EOC within 24 hours of knowing the notification criteria are met.
• A CDC subject matter expert will call back within 4 hours and will send written or email confirmation that the case notification was received by CDC.
• Electronic transmission to NNDSS should be done by the next regularly scheduled transmission cycle (see Data submission below)
  • Changes in case classification (e.g., from suspect to confirmed) should also be submitted by the next regularly scheduled transmission cycle after the change occurs.

Following Immediate (Urgent or Extremely Urgent) notification:

• For subsequent epidemiologically linked cases: The state/territorial epidemiologist (or delegate) should directly notify the CDC staff who responded to the initial notification, rather than contacting the CDC EOC.
• If a patient is determined to meet case classification criteria during a discussion with CDC, additional notification to the CDC EOC is not needed.

Data submission

National-level monitoring of notifiable conditions helps protect the health of the nation. Information from surveillance notifications shared by health departments can be used to better understand disease occurrence and impacted populations as well as determine appropriate prevention and response strategies.

If a patient meets the criteria as a suspect, probable, or confirmed anthrax case, CSTE requests that general information about the patient and the disease be submitted to NNDSS using NETSS messages or the GenV2 message mapping guide. For timeliness of electronic reporting, see Notifiability, above.

Additional disease-specific data for anthrax cases are collected separately at this time through the following channels:

1. Anthrax RedCAP data dictionary
   Some jurisdictions have their own RedCAP portal for data collection. CDC has developed an anthrax case report form in RedCAP with core and disease-specific data elements.
   Public health jurisdictions can upload the data dictionary from this form into their individual RedCAP portal to enter, export, and submit case data to CDC as a CSV file. Options for data submission of a CSV file exported from RedCAP include:

• • Direct submission into DCIPHER (see below)
  • Submission to a SAMS upload folder, or
  • By using another secure method (e.g., encrypted email or secure FTP)

2. CDC Bacterial Special Pathogens Branch (BSPB) DCIPHER portal
   DCIPHER is a web-based data integration platform that is used by several CDC programs. CDC is now using this platform for anthrax surveillance, linking case data to CDC laboratory and NNDSS data.

1. DCIPHER features fillable forms, and point-and-click visualization and tabulation tools. These tools can be used by both CDC and jurisdictions to rapidly aggregate and visualize case data, share visualizations and simple analyses, and link case data with other data sources to gain a regional or national perspective on an outbreak, event, or historical surveillance data.
2. Access to the BSPB DCIPHER portal is granted via SAMS credentialing. Options for data submission using DCIPHER include:

• • Submission of a data extract from a jurisdictional surveillance system (or RedCAP) as a CSV file. Submitters can upload the CSV file directly into DCIPHER, into a SAMS upload folder, or send using another secure method.
  • Direct entry into a web-based form.

1. Jurisdictions may benefit from using the visualization and tabulation tools within DCIPHER. Jurisdictions can access the BSBP DCIPHER portal regardless of which method (RedCAP or DCIPHER) they use to submit surveillance data.

To request the RedCAP data dictionary, DCIPHER access, or for more information about these systems, contact BSPB at bspb@cdc.gov.