Anthrax

What is Anthrax?

Anthrax is an acute infectious disease caused by the spore-forming bacterium Bacillus anthracis. Anthrax most commonly occurs in wild and domestic lower vertebrates (cattle, sheep, goats, camels, antelopes, and other herbivores), but it can also occur in humans when they are exposed to infected animals or tissue from infected animals.

Why has anthrax become a current issue?

Because anthrax is considered to be a potential agent for use in biological warfare, the Department of Defense (D0D) has begun mandatory vaccination of all active duty military personnel who might be involved in conflict.

How common is anthrax and who can get it?

Anthrax is most common in agricultural regions where it occurs in animals. These include South and Central America, Southern and Eastern Europe, Asia, Africa, the Caribbean, and the Middle East. When anthrax affects humans, it is usually due to an occupational exposure to infected animals or their products. Workers who are exposed to dead animals and animal products from other countries where anthrax is more common may become infected with B. anthracis (industrial anthrax). Anthrax in wild livestock has occurred in the United States, but it is rare.

How is anthrax transmitted?

Anthrax infection can occur in three forms: cutaneous (skin), inhalation, and gastrointestinal. B. anthracis spores can live in the soil for many years, and humans can become infected with anthrax by handling products from infected animals or by inhaling anthrax spores from contaminated animal products. Anthrax can also be spread by eating undercooked meat from infected animals. It is rare to find infected animals in the United States.

What are the symptoms of anthrax?

Symptoms of disease vary depending on how the disease was contracted, but symptoms usually occur within 7 days.

• Cutaneous:  Most (about 95%) anthrax infections occur when the bacterium enters a cut or abrasion on the skin, such as when handling contaminated wool, hides, leather or hair products (especially goat hair) of infected animals. Skin infection begins as a raised itchy bump that resembles an insect bite but within 1-2 days develops into a vesicle and then a painless ulcer, usually 1-3 cm in diameter, with a characteristic black necrotic (dying) area in the center. Lymph glands in the adjacent area may swell. About 20% of untreated cases of cutaneous anthrax will result in death. Deaths are rare with appropriate antimicrobial therapy.

• Inhalation:  Initial symptoms may resemble a common cold. After several days, the symptoms may progress to severe breathing problems and shock. Inhalation anthrax is usually fatal.

• Intestinal:  The intestinal disease form of anthrax may follow the consumption of contaminated meat and is characterized by an acute inflammation of the intestinal tract. Initial signs of nausea, loss of appetite, vomiting, fever are followed by abdominal pain, vomiting of blood, and severe diarrhea. Intestinal anthrax results in death in 25% to 60% of cases.

Where is anthrax usually found?

Anthrax can be found globally. It is more common in developing countries or countries without veterinary public health programs. Certain regions of the world (South and Central America, Southern arid Eastern Europe, Asia, Africa, the Caribbean, and the Middle East) report more anthrax in animals than others.

Can anthrax be spread from person-to-person?

Direct person-to-person spread of anthrax is extremely unlikely to occur. Communicability is not a concern in managing or visiting with patients with inhalational anthrax.

Is there a way to prevent infection?

In countries where anthrax is common and vaccination levels of animal herds are low, humans should avoid contact with livestock and animal products and avoid eating meat that has not been properly slaughtered and cooked. Also, an anthrax vaccine has been licensed for use in humans. The vaccine is reported to be 93% effective in protecting against anthrax.

HOW TO HANDLE ANTHRAX

Many facilities in communities around the country have received anthrax threat letters. Most were empty envelopes; some have contained powdery substances. The purpose of these guidelines is to recommend procedures for handling such incidents.

Do not Panic

1. Anthrax organisms can cause infection in the skin, gastrointestinal system, or the lungs. To do so, the organism must be rubbed into abraded skin, swallowed, or inhaled as a fine, aerosolized mist.  Disease can be prevented after exposure to the anthrax spores by early treatment with the appropriate antibiotics.  Anthrax is not spread from one person to another person.

2. For anthrax to be effective as a covert agent, it must be aerosolized into very small particles. This is difficult to do, and requires a great deal of technical skill and special equipment. If these small particles are inhaled, life-threatening lung infection can occur, but prompt recognition and treatment are effective.

Suspicious unopened letter or package marked with threatening message such as "Anthrax":

1. Do not shake or empty the contents of any suspicious envelope or package.

2. PLACE the envelope or package in a plastic bag or some other type of container to prevent leakage of contents.

3. If you do not have any container, then COVER the envelope or package with anything (e.g., clothing, paper, trash can, etc.) and do not remove this cover.

4. Then LEAVE the room and CLOSE the door, or section off the area to prevent others from entering (Le., keep others away).

5. WASH your hands with soap and water to prevent spreading any powder to your face.

6. What to do next...

• If you are at HOME, then report the incident to local police.
• If you are at WORK, then report the incident to local police, and notify your building security official or an available supervisor.

7. LIST all people who were in the room or area when this suspicious letter or package was recognized. Give this list to both the local public health authorities and law enforcement officials for follow-up investigations and advice.

Envelope with powder and powder spills out onto surface:

1. DO NOT try to CLEAN UP the powder. COVER the spilled contents immediately with anything (e.g., clothing, paper, trash can, etc.) and do not remove this cover!

2. Then LEAVE the room and CLOSE the door, or section off the area to prevent others from entering (Le., keep others away).

3. WASH your hands with soap and water to prevent spreading any powder to your face.

4. What to do next...

• If you are at HOME, then report the incident to local police.

• If you are at WORK, then report the incident to local police, and notify your building security official or an available supervisor.

5. REMOVE heavily contaminated clothing as soon as possible and place in a plastic bag, or some other container that can be sealed. This clothing bag should be given to the emergency responders for proper handling.

6. SHOWER with soap and water as soon as possible. Do Not Use Bleach Or Other Disinfectant On Your Skin.

7. If possible, list all people who were in the room or area, especially those who had actual contact with the powder. Give this list to both the local public health authorities so that proper instructions can be given for medical follow-up, and to law enforcement officials for further investigation.

Question of room contamination by aerosolization:

For example: small device triggered, warning that air handling system is contaminated, or warning that a biological agent released in a public space.

1. Turn off local fans or ventilation units in the area.

2. LEAVE area immediately.

3. CLOSE the door, or section off the area to prevent others from entering (Le., keep others away).

4. What to do next...

• If you are at HOME, then dial "911" to report the incident to local police and the local FBI field office.

• If you are at WORK, then dial "911" to report the incident to local police and the local FBI field office, and notify your building security official or an available supervisor.

5. SHUT down air handling system in the building, if possible.

6. If possible, list all people who were in the room or area. Give this list to both the local public health authorities so that proper instructions can be given for medical follow-up, and to law enforcement officials for further investigation.

How to identify suspicious packages and letters

Some characteristics of suspicious packages and letters include the following...

• Excessive postage

• Handwritten or poorly typed addresses

• Incorrect titles

• Title, but no name

• Misspellings of common words

• Oily stains, discolorations or odor

• No return address

• Excessive weight

• Lopsided or uneven envelope

• Protruding wires or aluminum foil

• Excessive security material such as masking tape, string, etc.

• Visual distractions

• Ticking sound

• Marked with restrictive endorsements, such as "Personal" or "Confidential"

• Shows a city or state in the postmark that does not match the return address.

All information was extracted from the "Centers for Disease Control and Prevention", Government Web Site, www.cdc.gov/