Bioterrorism

Anthrax

What is anthrax?

Facts About Anthrax

cutaneous anthrax
Approximately 20 percent of untreated cases of cutaneous anthrax infections will result in death.

inhalation anthrax
Inhalation anthrax is 90 to 100 percent fatal.

intestinal anthrax
Between 25 and 60 percent of intestinal anthrax infections result in death.

Anthrax is an acute infection caused by a spore-forming bacterium called Bacillus anthracis. Anthrax is most commonly found among wild and domestic cattle, sheep, goats, camels, antelopes, and other herbivores. However, humans can become infected with the disease when exposed to infected animals or their tissue. In addition, anthrax can be a potential threat to humans when used in biological warfare (a state in which infectious agents or toxic chemicals are being used as a weapon of mass destruction).

How prevalent is anthrax?

Anthrax is more common in agricultural regions in developing countries or countries without veterinary public health programs, including regions in South and Central America, Southern and Eastern Europe, Asia, Africa, the Caribbean, and the Middle East. Human exposure to anthrax usually occurs in the workplaces where people are exposed to dead animals and animal products from other countries. Anthrax has been reported among wild livestock in the United States.

How is anthrax spread?

Bacillus anthracis spores can live in soil for many years. The anthrax bacterium can enter a persons body through the skin (cutaneous anthrax), the gastrointestinal tract (intestinal anthrax), or through the nose and mouth (inhalation anthrax):

cutaneous anthrax
The majority of anthrax infections (95 percent) occur when the bacteria enter through a cut or abrasion on the skin. Infection often occurs when handling contaminated wool, hides, leather, or animal hair products (especially goat hair).
intestinal anthrax
Eating undercooked meat from contaminated animals can result in an acute inflammation of the intestinal tract.
inhalation anthrax
Anthrax infection can occur when a person inhales the spores from contaminated animal products.

ANTHRAX IS NOT CONTAGIOUS, ACCORDING TO THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC). DIRECT PERSON-TO-PERSON CONTAMINATION IS EXTREMELY UNLIKELY.

What are the symptoms of anthrax?

The following are the most common symptoms of anthrax. However, each individual may experience symptoms differently. Symptoms may include:

cutaneous (skin) anthrax:
- The infection starts as a raised, itchy bump.
- Within one to two days, the bump develops a vesicle (a small blister), followed by a painless ulcer that is 1 to 3 centimeters in diameter. The ulcer has a characteristic black, necrotic (dying) area in the center.
- The lymph nodes in the area may swell.
intestinal anthrax:
- The infection usually starts with nausea, followed by loss of appetite, vomiting, and fever. Abdominal pain often follows, accompanied by vomiting blood and severe diarrhea.
inhalation anthrax:
- Symptoms may start out resembling the common cold and progress after several days to severe breathing problems and shock.
- The symptoms of anthrax may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How is anthrax diagnosed?

Diagnosis of anthrax will include isolating the bacteria from the blood, skin lesions, or respiratory secretions. The disease can also be diagnosed through the use of specialized blood tests used to measure specific antibodies in the blood of individuals with suspected exposure.

Treatment for anthrax:

Specific treatment for anthrax will be determined by your physician based on:

your age, overall health, and medical history
extent of the condition
your tolerance for specific medications, procedures, or therapies
expectations for the course of the condition
your opinion or preference

Treatment of an anthrax infection with antibiotics is most effective when started early. If persons are exposed to anthrax, antibiotics will be prescribed to prevent infection. The US Food and Drug Administration (FDA) has approved the following antibiotics to treat anthrax:

ciprofloxacin
penicillin
doxycycline

Left untreated, all three forms of anthrax can be fatal.

Preventing anthrax:

To prevent infection, people in countries where anthrax is common should avoid contact with livestock and animal products and eat only thoroughly cooked meat.

About the anthrax vaccine:

An anthrax vaccine exists and is reported to be 93 percent effective. The vaccine is a cell-free filtrate vaccine, which means it contains no dead or live bacteria. Three injections are given two weeks apart, followed by three additional booster injections given at six, 12, and 18 months. Annual booster injections are recommended thereafter. Almost one-third of the vaccine recipients may experience a mild local reaction at the infection site. Severe reactions are rare. The CDC's Advisory Committee on Immunization Practices recommends the vaccine for the following groups:

people who work directly with anthrax in laboratories
people who work with imported animal hides or furs in areas where they may be exposed to anthrax spores
people who handle potentially infected animal products, such as veterinarians who travel to other countries
military personnel deployed in areas where there is a high risk for exposure, such as when the bacteria are used as biological weapons

Pregnant women should only be vaccinated if absolutely necessary. Anthrax vaccines intended for animals should not be used in humans. Always consult your physician for more information.

During our country's current crisis, what should I do if I suspect a mail piece or package is contaminated with anthrax?

As several recent cases of anthrax exposure have been reported as being transmitted through the US mail service with the use of packages and letters, the following safety precautions have been provided by the United States Postal Service:

Do not handle the mail piece or package suspected of contamination.
If you are responsible for handling your company's incoming mail and find something suspicious, immediately notify your supervisor, who then contacts the postal inspection service, local police, safety office, or designated person.
The damaged or suspicious packages should be isolated and the immediate area cordoned off.
Make sure that all persons who have touched the mail piece wash their hands with soap and water.
Contact the postal inspector to report the suspected contaminated mail piece or package.
The postal inspector will assess the threat situation and coordinate all details with the FBI.
Designated officials will notify local, county, and state health departments, and the state emergency manager.
Make a list of all persons who have touched the letter, package, and/or envelope. Include all contact information and provide the complete list to the postal inspector.
Place all items worn when in contact with the suspected mail piece in plastic bags and have them available for law enforcement agents.
As soon as possible, shower with soap and water.
If prescribed antibiotics, take all of the medication prescribed by your physician, unless otherwise instructed.
Notify the Centers for Disease Control and Prevention (CDC) Emergency Response for answers to any questions.

This page was last updated on: March 11, 2008.

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