Public Health Response Activities
State and local public health departments will be responsible for many activities during a glanders public health emergency. While these activities are similar regardless of the type of emergency, the specifics will influence planning.
Glanders transmission can occur through inhalation of respiratory droplets that spread from infected animals, inhalation of an aerosolized form of the bacteria, or through ingestion of contaminated food or water. It is very rare for people to get the disease from another person. Though glanders does not normally spread person-to-person, interviewers should ask patients about anyone they have spent time with during the previous 21 days, especially those who have similar symptoms. Positive identification of other people with symptoms will help investigators find the source of exposure. It is also important to identify others who may have been exposed so they can begin post-exposure prophylaxis or treatment of glanders.
When interviewing symptomatic individuals, interviewers should follow standard and airborne precautions.
Enhanced Surveillance and Case Reporting
Once an emergency has been announced, local and state public health authorities will need to identify individuals who have glanders. Federal and state public health authorities will use information gathered through enhanced surveillance and case reporting to monitor the extent of the emergency and effectiveness of response efforts. State and local preparedness efforts should include enhanced surveillance plans to:
- Ensure rapid identification and reporting of additional cases after initial case confirmation
- Estimate the population at risk
- Identify unexpected epidemiological features of the outbreak
- Evaluate the characteristics and extent of the outbreak
Prepare for effective surveillance and case reporting during an emergency by:
- Creating materials to educate medical, veterinary, and public health workers about glanders
- Developing or adapting information management systems to monitor calls and reports received
- Designating a centralized location for reporting probable and confirmed glanders cases
- Identifying and testing emergency notification systems and ensuring that on-call staff has appropriate access to communication resources, such as cell phones and laptops
Currently, there are no FDA-approved therapeutic agents with the indication of post-exposure prophylaxis or treatment of glanders. However, in a public health emergency, CDC will recommend and provide certain antimicrobials through emergency use authorization (EUA). State health departments will be responsible for coordinating with CDC to ensure any medical countermeasures released from the Strategic National Stockpile (SNS) for post-exposure prophylaxis and/or treatment of glanders under EUAs are distributed to local areas that need them. During an emergency, state and local public health departments will need to communicate regularly with CDC and share information to determine where medicines and supplies are needed.
Glanders is primarily a disease of solipeds (horses, donkeys, and mules) and is notifiable to the World Organisation for Animal HealthExternal (OIE). Glanders has been eradicated in the United States since the 1940s, so any confirmed cases would require investigation. Any veterinarian who suspects an animal may have glanders should notify the appropriate public health authorities, as animals may be a sentinel to a broader exposure. Similarly, if humans were ever diagnosed with glanders in an area, susceptible animals would also be at risk. If there are confirmed cases of human glanders in an area, veterinarians should suspect glanders in animals with symptoms listed below. Animals susceptible to glanders include:
- Read the full post-exposure prophylaxis recommendations for glanders in Emerging Infectious Diseases
- Read how to manage an accidental laboratory exposure which may require post-exposure prophylaxis to B. mallei
- Solipeds (horses, donkeys, mules)
- Guinea pigs
- Field mice
Cattle, swine, and chickens appear to be resistant to glanders.
Symptoms in animals include:
- Chill and high fever
- Depression, loss of appetite, and emaciation
- Watery nasal discharge
- Nodules and ulcers in the nasal passage
Accurate and timely communication with different audiences will support a successful response to a glanders emergency. CDC and other federal partners will communicate about national-level efforts and will assist state and local efforts. State and local public health authorities will be responsible for communicating to people within their jurisdictions about the response efforts that affect them.
Examples of targeted communication efforts are:
- Alerting laboratory workers of the potential for working with specimens containing B. mallei. Include actionable information on what to do to prevent exposure and how to respond to an accidental exposure.
- Alerting healthcare facilities and healthcare workers within a specific area to be suspicious that patients with certain symptoms might have glanders.
- Alerting veterinarians within a specific area to be suspicious that some pets, large animals, and livestock with certain symptoms might have glanders.
- Informing residents and visitors in areas of known or suspected exposure they may have been recently exposed to the germs that cause glanders. Alerts and messages should give them instructions on how, where, and when to seek medical care. Include information about the risk to household pets, large animals, and livestock.
- Providing regular updates to the public about the emergency and response efforts with the aim of giving people actionable, useful information to help themselves, their loved ones, and their pets get medical care, if needed.
Preparing to communicate effectively during a glanders emergency is similar to preparing for any public health emergency:
- Be ready to answer questions from the media and the public about glanders. Make sure you have knowledgeable people on staff who are able to talk to the media and the public. CDC’s Crisis & Emergency Risk Communications website has training and educational materials to help you prepare.
- Make arrangements to establish a telephone hotline.
- Identify the media outlets to use to inform the public about actions they should take if they were exposed to the germs that cause glanders. Keep in mind how to reach and communicate with people in the community with functional, language, or cognitive needs.
- Review rapid-alert communication systems to ensure rapid communication capability between the state and local public health and medical communities. Upgrade the systems if necessary.
- Clearly identify the relative roles of state and local public affairs offices.
- Prepare sample alert messages for the community and other partners. Format these messages for different media, including broadcast, print, web, and social media.
- Translate messages into different languages spoken in the community. Confirm accuracy and cultural appropriateness of the messages.
During a glanders emergency, local and state public health agencies should coordinate with healthcare facilities treating patients with glanders to ensure facilities have adequate supplies, such as ventilators. The state medical countermeasures coordinator can communicate with CDC to request additional supplies from the Strategic National Stockpile as necessary. The Strategic National Stockpile works with governmental and nongovernmental partners to upgrade the ability to respond to a national public health emergency, ensuring that federal, state, and local agencies are ready to receive, stage, and distribute products.