Anthrax Q and A

  1. I thought this Anthrax question and answer article was very informative and decided to post it.
    Michele


    Anthrax Q & A
    Kevin G. Briggs
    Monday, Oct. 1, 2001
    The following question-and-answer sheet was prepared by Kevin G. Briggs, former president of the America Civil Defense Association and current director of the U.S. Disaster Preparedness Institute. His new book, "Preparing for Terrorism," will be released shortly.


    Due to recent concerns and the growing interest in biological/chemical warfare preparedness and mitigation, we have extracted the following article from a recent issue of the Journal of Civil Defense in an effort to assist you in your preparations for a potential biological attack on the United States.



    Frequently Asked Questions About Anthrax
    Question 1:

    Is the U.S. prepared for anthrax attacks?

    Answer 1:

    Generally, no. An anthrax attack can occur very quietly without any bombs going off or any observable "clouds" being present. Our abilities to detect anthrax rapidly are very limited at present, so the first sign that an attack occurred could be thousands of people rushing to the hospital after a few days of exposure. Most states rate biological attacks as one of their weakest preparedness areas.

    Question 2:

    Why worry about anthrax attacks?

    Answer 2:

    Many are concerned that U.S.-based terrorists with ties to Iraq or Osama bin Laden might try to unleash a biological attack against the U.S. population in response to any major U.S. anti-terrorism initiative or military actions.

    Question 3:

    Is this a credible threat?

    Answer 3:

    This is an unknown. We know that Iraq has hidden and lied about much of its biological warfare program. We do know that Iraq has claimed to have produced, and subsequently destroyed (so it says), roughly 9,000 liters of anthrax.

    In addition, it has admitted testing anthrax and other agents as part of its biowarfare program. As a result of this and other perceived threats, former Secretary of Defense Cohen decided to vaccinate all active duty and reserve personnel against anthrax.

    He shifted $500 million to new chemical and biological preparedness programs. Former President Clinton also added roughly $10 billion to the budget (in January 1999) into preparing for weapons of mass destruction terrorism - largely to help mitigate biowarfare attacks.

    The bottom line is that Iraq has the technical expertise and demonstrated capability to support anthrax terrorism. Whether it or other terrorist organizations have successfully placed (or attempted to place) terrorists in the U.S. with anthrax is unknown - or at least unknown to the American public.

    Many other countries have known or suspected biological warfare programs. Information and expertise from Russia's extensive biowarfare programs are likely to have leaked out to several other nations and terrorist groups.

    Question 4:

    How big a problem is anthrax?

    Answer 4:

    Anthrax weapons can be produced that can have the same killing capability as nuclear weapons for a fraction of the cost and expertise. For example, the Oak Ridge National Laboratory did a comparison of costs of various threats and came up with the following:


    Weapon Lethality Versus Cost


    From the late Dr. Conrad Chester
    Oak Ridge National Laboratory

    Weapons compared to cost for killing most people within a square-mile area


    Conventional cluster bomb weapons: up to millions of dollars

    Neutron bomb: roughly $2 million

    One ton of GB nerve agent: up to $100,000

    1 kilogram of anthrax (2.2 lb): less than $50

    Question 5:

    How deadly is anthrax?

    Answer 5:

    According to the late Dr. Chester of Oak Ridge National Laboratory, cultured anthrax has roughly 2 x 105 lethal doses per gram. Anthrax in a slurry has roughly 107 lethal doses per gram. Powdered Anthrax has roughly 108 lethal doses per gram.

    Former Secretary of Defense Cohen illustrated this point on TV by saying that a five-pound bag of anthrax, if properly dispersed, could kill perhaps half of the population of Washington, D.C.

    Dr. Harold Strunk, who retired from the U.S. military and has extensive experience with anthrax, stated that a sugar cube quantity of anthrax could theoretically kill 100 million people. He pointed out that in reality, the number of people potentially killed by this amount of anthrax is much less because of the problems of dispersal within a population.

    Question 6:

    How would an anthrax attack occur?

    Answer 6:

    According to the late Dr. Chester, the best method of spreading lethal anthrax is through spraying the spores into the wind, where it is subsequently inhaled and begins to multiply. Dr. Chester, while at Oak Ridge National Labs, looked at many anthrax attack scenarios, which resulted, in part, with the following estimations:

    Scenario 1: A single-operator terrorist with a truck-mounted 55-gallon drum of anthrax and sprayer could cause tens of thousands of deaths within a city.

    Scenario 2: A sophisticated and well-trained technical terrorist group with four medium-sized planes (DC-3 size) were shown to potentially kill 35 percent of the U.S. population with one night flight spraying anthrax over key population centers.

    Question 7:

    Some experts say anthrax is difficult to disperse through air and sunlight. Is this true?

    Answer 7:

    Presumably the terrorists would be trained on what the best weather conditions are for dispersing anthrax spores and how to effectively produce an aerosol laden with anthrax spores. According to experts, this would typically be done at night or on an overcast day with a gentle breeze so that the sun would not kill off the spores before they are inhaled. Terrorists can certainly wait for the right weather conditions to exist. According to studies performed by the Oak Ridge Labs and the U.S. Congressional Office of Technology Assessment, a well-executed attack can kill thousands to many millions. The Defense Department has formally stated that a large portion of a city could be killed in a well-executed anthrax attack (see http://www.anthrax.osd.mil/Flash_interface/default.html).

    Question 8:

    How vulnerable is the food supply to anthrax?

    Answer 8:

    Anthrax spores can fall upon food in either a dedicated attack on the food supply or as a secondary effect of an airborne release. If ingested in a sufficient dose, then an intestinal form of anthrax can occur that can be lethal for somewhere between 25 percent and 60 percent of those infected - if it is conventional anthrax for which we have clinical data resulting from the few cases where people ate infected meat. However, if the antibiotic supplies are limited, or a more drug-resistant strain is used, then a higher percentage of deaths would likely be expected.


    Question 9:

    What should be done at the governmental level?

    Answer 9:

    Educate the public on the threat and how to counter it. This should include candid (but sanitized) information on any known attempted threats that have occurred in the past. The public deserves to know what is fact and what is fiction with the many rumors that have spread. (For example, USA Today and other news outlets reported a few years ago that there were several attempts by terrorists with biological warfare agents from Iraq who were successfully thwarted as they tried to enter our country - and some news sources said that some actually did enter.)

    Public education should also include how to prepare in advance to limit your exposure during any future biowarfare attack, as well as instructing medical personnel on how to treat this disease (see the USPDI website for some practical recommendations).

    Learn more about the Russian and other strains of anthrax and develop new vaccines and antibiotics as required. Research on new non-drug-based antibiotics, such as the ASAP Solution being studied at BYU, should be accelerated. Expand the current vaccination program for people who live in high-threat areas or in high-risk professions. For example, a vaccination program similar to what is required of the military could be offered on a voluntary basis to medical personnel and Ffirst responders to blast/chem/bio/radiation scenes.

    Encourage Congress to increase the vaccine production capabilities in the U.S. (currently only one company in the U.S. produces the vaccine) so that concerned citizens can be vaccinated, not just U.S. military personnel, and to allow for rapid mass immunizations should a large terrorist biowarfare attack occur.

    Continue research on rapid detection devices for anthrax and other biological weapons and distribute these for real-time, 24-hour monitoring of major urban areas.

    Increase the quantity of stockpiled antibiotics as well as the number of dispersal locations to respond to anthrax and other biowarfare attacks. Hours of delay in receiving antibiotics can translate to thousands or millions of additional deaths. Antibiotic stockpiles should be readily available to the medical community without having to wait 12 or more hours. Low-cost disposable respirator masks and latex gloves should also be stockpiled, as the current supplies (especially of respirators) could be quickly depleted and lead to many unnecessary deaths and prolonged social disruption.

    Train and immunize emergency services personnel on how to identify/treat/triage biowarfare victims and how to limit the further spread of anthrax and other biological agents.

    Upgrade intelligence, customs and law enforcement capabilities to thwart potential biological terrorists without infringing on citizens' rights.

    Question 10:

    What can the average American do to be prepared?

    Answer 10:

    Here are some practical steps to consider:

    There is an extremely low risk of biological attack if you live far outside a major urban area. Hence, if you live tens of miles outside a major city, you probably do not need to do much to be prepared other than have food, water, power, and medical supplies, etc., stored up in case of long infrastructure outages due to biological attacks. Some low-cost medical supplies, such as disposable HEPA or N95 respirators and some latex gloves, would be needed if a highly infectious bio-warfare agent was used.

    If you live in or near a large urban area, you should learn how to make bio-safe rooms at your home and place of business (see www.usdpi.org for details). If you learn of an attack that is imminent or has occurred in your area:

    Go inside your home or business and close your windows. Prepare a bio-safe room and don a HEPA or N95-style respirator mask, if available.

    Monitor the radio or TV and seek medical advice immediately. The USDPI website provides information resources on what the military and others recommend for anthrax and other biowarfare agents. If there is a known attack and you have previously been recommended to do so by your doctor, begin taking a safe dose of antibiotics. Be careful, because there is some wrong information out there produced by popular so-called biowarfare experts. This literature can be dangerous when it comes to dosages, especially as it pertains to mapping vet dosages of animals to humans.
    If you really believe you've been exposed, you need to seek professional advice and antibiotic treatments immediately. If you wait until clear symptoms appear (normally after one to six days after exposure), in the case of anthrax, it will probably be too late to save yourself. However, be careful not to overreact to false warnings or rumors of attacks.

    Dead animals or people who have died from anthrax should not be cut into but buried quickly and deeply or cremated to reduce spore spread, which occurs with exposure to air. Those treating suspected anthrax patients should wash their hands frequently and take preventive antibiotics [though sick human to well human transmission is unlikely].


    Try to obtain vaccinations for anthrax if really concerned. (Note: These are not currently available to the general public, only the military and certain other fields, like veterinarians). You can write to your congressman to see if Congress can work to make this an option to the average American. There are a lot of issues surrounding the effectiveness of the vaccination program. One argument is that if an attack occurs with a genetically engineered special strain of anthrax (as with the Russian versions), the vaccine will not help much. The counter argument is that in many scenarios, especially one with a less sophisticated adversary, the vaccine may prove helpful in reducing your risk.
    Last edit by Chellyse66 on Oct 5, '01
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  2. 6 Comments

  3. by   eventsnyc
    Thank you Chellyse!

    Best wishes,
    Christina
  4. by   Chellyse66
    Because of the report of the Anthrax case in Florida I wanted to bump this thread higher and add this article.

    Floridian contracts deadly anthrax
    Rare case thought to be isolated

    BY LESLEY CLARK, MANNY GARCIA AND DAVID KIDWELL lclark@herald.com

    A 63-year-old Palm Beach County man was critically ill in a Lake Worth hospital late Thursday with an inhaled form of anthrax, an extremely obscure and deadly strain of a rare disease that some nations are believed to store for use as a weapon.

    With the nation on alert for the threat of biological attacks, federal officials Thursday quickly moved to play down any link between terrorists and the first diagnosed case of anthrax in Florida in 27 years, but nevertheless said there would be ``a very intense investigation'' of the case.

    The patient, Robert Stevens, is a photo editor at The Sun, a tabloid published in Boca Raton. It was unclear late Thursday how Stevens contracted the typically animal-borne disease, and a team of state and federal epidemiologists was tracing his steps.

    U.S. Health Secretary Tommy Thompson took to a lectern at the White House to stress there was no indication of terrorism.

    ``This is an isolated case and it's not contagious,'' Thompson said, just hours after the federal Centers for Disease Control and Prevention confirmed the diagnosis. He added there is ``no evidence [that] terrorism'' was involved.

    ``There's no need for people to fear they are at risk, whether in Florida or North Carolina or elsewhere,'' said CDC Director Dr. Jeffrey P. Koplan. ``There is absolutely no need for panic.''

    But Koplan said a deliberate release of the germ by terrorists is one of several possibilities being looked at. ``We have that on the list,'' he said.

    Stevens' family told health and law enforcement investigators that they had recently traveled to North Carolina to visit a daughter in Charlotte. Stevens and his wife then drove to Duke University in Durham to visit the daughter's boyfriend.

    Federal sources said investigators from the CDC, county and state health agencies and the FBI are tracking Stevens' every movement in North Carolina and Florida from the time he left work on Sept. 26 until he landed in the hospital.

    ``We need to recreate his life for the last seven days,'' an investigator said. ``Check out every place he visited, walked through.''

    State health officials said it's likely Stevens contracted the deadly disease in Florida, based on its incubation period, which ranges from six to 45 days.

    ``We are quite certain that the illness was contracted in this area where the gentleman resided, not from his travels,'' said Dr. Steve Wiersma, an epidemiologist with the Florida Department of Health.

    Anthrax infection typically comes from contact with infected animals, or animal products, including waste and skin. Most commonly, it is contracted by handling the spores.

    Only 18 inhalation cases in the United States were documented in the 20th Century, the most recent in 1976, and the strain is usually fatal. State health officials said ``preliminary findings'' indicate Stevens inhaled the deadly bacteria.

    ``What concerns me is that it has occurred in a part of the United States where this disease does not occur in livestock,'' said Martin Hugh-Jones, an epidemiologist who coordinates the World Health Organization Working Group on Anthrax Research and Control.

    Stevens had a garden, but Hugh-Jones said that was an unlikely place to contract pulmonary anthrax.

    ``You don't get aerosols from soil. You get them from animal wool or animal hair or dirty nasty guys [terrorists] who are damn lucky,'' Hugh-Jones said. ``If this is a bioterrorist event, he's been damn lucky to get one person.''

    Hugh-Jones said there have been anthrax cases in gardeners who used bone meal in their soil, and the bone meal had been processed from an infected animal. In those cases, he said, ``they get skin lesions, not pulmonary anthrax.''

    He said it might be possible to inhale enough anthrax in aerosol form if one were exposed to infected animal wool or hair as it was being removed from a bale and processed. He added that wool mills have strict federal standards for protecting workers.

    With Gov. Jeb Bush traveling to promote a program to help Floridians out of work because of the Sept. 11 terrorist attacks, Lt. Gov. Frank Brogan called for caution.

    CALM APPROACH

    ``We're going to stress a calm and reasoned approach to this particular event,'' Brogan said. ``There is no reason to believe at this juncture that this is anything other than the manifestation of a rare and obviously very serious illness.''

    Officials at JFK Memorial Hospital in Lake Worth said Stevens was admitted at about 2 a.m. Tuesday, after arriving with family at the emergency room. He was unable to speak, but family members told physicians he was confused, had a high fever and was vomiting, said Dr. Larry Bush, an infectious disease specialist at JFK.

    Fluid from a spinal tap was initially diagnosed as bacillus, which is usually a sign of meningitis. Bacillus is fairly rare, so Bush said he sent the results to a state lab, which then sent the material to the CDC in Atlanta, which confirmed anthrax Thursday afternoon.

    The disease is fatal if untreated. Hospital officials said Stevens was receiving penicillin and is on a respirator. He is heavily sedated, but the doctor declined to describe him as comatose. The man's family was said to be with him in the hospital's critical care unit.

    In the United States, a single case of anthrax has been confirmed each year on average over the past 10 years, according to a report by Dr. Arthur M. Friedlander, chief of the Bacteriology Division in the U.S. Army Medical Corps.

    LAST FLORIDA CASE

    The last case in Florida was in 1974, Brogan said. According to news stories at the time, a 22-year-old woman stationed at the Naval Air Station in Jacksonville developed the characteristic anthrax blisters after purchasing bongo drums in Haiti. Goat skins used to make the drums were found to be contaminated with anthrax spores. The woman recovered.

    The bacteria is most deadly when spread by air, making it one of the most feared methods of biological attack. But such cases are rare. In 1979 in Sverdlovsk, Russia, anthrax spores accidentally released from a military research facility reportedly killed dozens of people.

    Thompson said the most recent previous U.S. case of anthrax was earlier this year in Texas. But that case was not pulmonary anthrax -- an especially lethal and rare form of the disease which settles in the lungs.

    The last known pulmonary anthrax case in the United States occurred in 1976, when a California weaver and yarn shop operator died. Health officials attributed the death to inhaling dust long-term from contaminated wool.

    The U.S. Consumer Safety Commission traced the likely source of the disease to hand-spun goat and camel-hair wool imported from Pakistan. The importer was notified, and the product was removed from shelves nationwide.

    GOOD NEIGHBOR

    Stevens and his family live in a modest neighborhood in Palm Beach County. Neighbors said he was often spotted bicycle riding and they described him as a fun-loving guy known to break into a song and dance a little jig when the mood struck him.

    He gardens and shares the proceeds with neighbors, several said.

    ``Bob is just the neighbor of neighbors,'' said Debbie Redmond, who watched the house for the family when they left for North Carolina. ``He helps out everybody. He mows your lawn if it looks like it needs it. He and his wife nurse sick animals back to health. They'd watch your dog if you went out of town. He's just a wonderful guy.''

    His home is within a mile of the Palm Beach County Park Airport in Lantana. That's the same airfield where Mohamed Atta, one of the suspected hijackers who slammed jetliners into the World Trade Center on Sept. 11, rented a plane on four separate occasions in August, according to Marian Smith, owner of Palm Beach Flight Training.

    The neighborhood is also less than 10 miles from the Delray Beach Racquet Club apartment at 755 Dotterel Rd., where several of the hijackers lived. Herald staff writers Lisa Arthur, William Yardley, Larry Lebowitz and Herald researcher Elisabeth Donovan contributed to this story, which was supplemented with Herald wire services.
  5. by   Chellyse66
    ...
  6. by   Chellyse66
    In addition as I am presently listening to www.foxnews.com
    "It was found in the VENTILATION system"

    Sources: 20-plus Daschle staffers test positive for anthrax exposure





    (CNN) - More than 20 people in Senate Majority Leader Tom Daschle's office have tested positive for exposure to anthrax, sources told CNN on Wednesday. More than 200 people had already begun taking the antibiobtic Ciprofloxacin, the drug therapy for the disease, as a precaution.

    Sources had said earlier that a letter mailed to Daschle's office contained "a very potent form" of the bacteria, the senator said Tuesday.

    A government source told CNN the anthrax was "high grade, very virulent and sophisticated."

    "Clearly, they were trying to kill somebody," Daschle, D-South Dakota, told CNN. "What this says to me is that there is an orchestrated effort under way, and that it may hit again. So we need to be ready for it."

    Anthrax has been found in letters sent to NBC News and Daschle, and at the Florida headquarters of a tabloid newspaper whose photo editor is the only victim so far to die.

    A federal official told CNN that investigators may be looking at two separate sources in the anthrax attacks in Florida and New York.

    "It appears we're looking at two situations," that official said.

    Investigators said the letter to Daschle's office was similar to the anthrax-contaminated letter sent to NBC anchor Tom Brokaw in New York. ()

    One law enforcement source said both letters contained references to Allah, the Arabic word for God. The NBC letter also contained threatening language toward the United States and Israel. This source did not confirm whether that language was in the Daschle letter, only that it mirrored the NBC note.

    Public health officials have discovered anthrax in New York, Florida and the District of Columbia in the past two weeks. Tests indicate that at least eight people either have been infected with anthrax or were exposed to the anthrax spores. Tests are pending on five people in Florida who may have been exposed.

    Latest developments
    * A few dozen workers at USA Today's headquarters in Arlington, Virginia, were evacuated after a reporter received what she thought was a suspicious envelope. A spokesman for the company said the woman thought she saw a powdery substance after she opened a corner of the envelope. The envelope was sent to the FBI for tests. Results are expected Wednesday.

    * Parts of eight floors of the Hart Senate Office Building were closed Tuesday to search for anthrax after tests confirmed the letter opened Monday in Daschle's office contained the potentially deadly bacteria. (Full story)

    Offices on the southeast corner of the building between the first and eighth floors were closed for the search, the Capitol physician said. (Full story)

    * Two men have been indicted on federal charges of making false anthrax threats. Both men are from Connecticut, but authorities said there was no apparent connection. U.S. Attorney General John Ashcroft said Tuesday that hoaxes prompted by the anthrax scare will be dealt with strongly. (Full story)

    * U.S. Sen. Charles Schumer, D- New York, said Tuesday a generic version of ciproflaxin, the antibiotic used to treat anthrax, should be made available immediately for government use even though German drugmaker BayerAG holds the patent for the drug. In response, Bayer promised to increase production and make 200 million tablets over the next three months, officials said.(Full story)

    * The Centers for Disease Control and Prevention announced Monday that Ernesto Blanco, a mailroom employee at Boca Raton, Florida, tabloid publisher American Media Inc., was diagnosed with "anthrax disease." Florida health officials insisted more tests were needed for a final diagnosis. Blanco, 73, was a co-worker of Robert Stevens, a photo editor at The Sun, who died of anthrax. A third employee has tested positive for exposure to the bacteria.

    * An American Media spokeswoman said the company would sell its Boca Raton facility and would not reopen in that building because many employees are concerned about returning to work there.

    * Two postal employees near Trenton, New Jersey, have been tested for anthrax after investigators traced anthrax-tainted letters from New York and Washington to a post office sorting facility, sources told CNN Tuesday. Investigators also found traces of anthrax spores at the Boca Raton post office. More than 30 employees there were tested for anthrax, and their tests were all negative.

    * In New York, the 7-month-old child of an ABC news producer tested positive for the cutaneous (skin) version of the disease. The boy is expected to make a full recovery. The infant had visited ABC with a parent September 28.

    * The CDC said Monday that a letter sent from Malaysia to a Microsoft office in Reno, Nevada, tested negative for anthrax spores at a laboratory in Nevada. Earlier tests had come back positive for anthrax, but health officials had already said the six people who handled the letter were not exposed. Further tests are planned at the CDC in Atlanta, Georgia, to determine definitively whether the letter contains anthrax.
  7. by   Chellyse66
    source: www.newsmax.com
    Anthrax: More Deadly Than Reported
    Col. Byron Weeks, M.D., Ret.
    Monday, Oct. 15, 2001
    Dr. Weeks has had a distinguished medical and military career with the U.S. Air Force Medical Corps. Dr. Weeks began military service as the youngest flight surgeon in the U.S. Air Force during the Korean War. After 15 years of military service, during which he served in senior posts, including Hospital Commander at Bitburg Air Force Base, Germany, Dr. Weeks retired and entered private practice. During the past two decades, he has focused his studies on the threat of biological and chemical agents as weapons of war. Dr. Weeks has lectured and written numerous articles on infectious diseases and biological warfare.



    Anthrax poses a significant threat to Americans and should not be dismissed as an ineffective bio-weapon, as many media are portraying it. Bacillus anthracis, the causative agent of anthrax, is a Gram-positive, spore-forming rod.

    The spores are the usual infective form. Anthrax is primarily a zoonotic (communicable from animals to humans) disease of herbivores, with cattle, sheep, goats and horses being the usual domesticated animal hosts, but other animals may be infected.

    Humans generally contract the disease when handling contaminated hair, wool, hides, flesh, blood and excreta of infected animals and from manufactured products such as bone meal.

    Infection is introduced through scratches, abrasions and wounds, or by inhaling spores, eating insufficiently cooked infected meat, or being bitten by flies.

    The primary concern for intentional infection by this organism is through inhalation after aerosol dissemination of spores. All human populations are susceptible.

    The spores are very stable and may remain viable for many years in soil and water. They resist sunlight for varying periods.

    History and Significance

    Anthrax spores were weaponized by the United States in the 1950s and 1960s, before the old U.S. offensive program was terminated.

    Other countries have weaponized this agent or are suspected of doing so. Anthrax bacteria are easy to cultivate and spore production is readily induced.

    Moreover, the spores are highly resistant to sunlight, heat and disinfectants - properties which could be advantageous when choosing a bacterial weapon.

    Weaponized spores are heartier than ones that Western medical experts have seen before; therefore, the risk from these spores is greater than many may believe.

    Iraq admitted to a United Nations inspection team in August of 1991 that it had performed research on the offensive use of B. anthracis prior to the Persian Gulf War, and in 1995 Iraq admitted to weaponizing anthrax.

    Dr. Ken Alibek, a recent defector from the former Soviet Union's biological weapons program, revealed that the Soviets had produced anthrax in ton quantities for use as a weapon.

    This agent could be produced in either a wet or dried form. Coverage of a large ground area could theoretically be facilitated by multiple spray bomblets containing desiccated spores disseminated from a missile warhead at a predetermined height above the ground.

    Clinical Features

    Anthrax presents as three somewhat distinct clinical syndromes in humans: cutaneous, inhalational and gastrointestinal.

    The cutaneous form (also referred to as a malignant pustule) occurs most frequently on the hands and forearms of persons working with infected livestock.

    It begins as a papule (bump) followed by formation of a fluid-filled vesicle (blister). The vesicle typically dries and forms a coal-black scab (eschar); hence, the term anthrax (from the Greek for coal). This local infection can occasionally disseminate into a fatal systemic infection.

    Gastrointestinal anthrax is rare in humans, and is contracted by the ingestion of insufficiently cooked meat from infected animals.

    Endemic inhalational anthrax, known as woolsorter's disease, is also a rare infection, contracted by inhalation of the spores. It occurs mainly among workers in industrial settings who handle infected hides, wool and furs.

    Inhalational anthrax usually has an incubation period of 1-6 days, although in an outbreak in Sverdlovsk in the Soviet Union, one patient had a six-week interval between exposure and onset. [See note at end for more on outbreak.]

    Because the number of spores needed to kill an animal from inhalational anthrax is much smaller than for a human, animals will be the first to shows symptoms of the disease and die. Thus, the unusual incidence of deaths of dogs, cats and other pets may serve as an early warning of an anthrax outbreak.

    In humans, the mortality of untreated cutaneous anthrax ranges up to 25 percent; in inhalational and intestinal cases, the case fatality rate is 90 percent to 100 percent.

    Diagnosis

    After an incubation period of 1-6 days, presumably dependent upon the strain and number of organisms inhaled, the onset of inhalational anthrax is gradual and nonspecific.

    Fever, malaise and fatigue may be present, sometimes in association with a nonproductive cough and mild chest discomfort. These initial symptoms are often followed by a short period of improvement (from hours to 2-3 days), followed by the abrupt development of severe respiratory distress with sweating, shortness of breath, stridor (sound of respiration when airways are obstructed) and cyanosis (bluish color of skin due to insufficient oxygen in blood).

    Septicemia (blood poisoning), shock and death usually follow within 24-36 hours after the onset of respiratory distress.

    Physical findings are typically non-specific, especially in the early phase of the disease.

    The chest X-ray often reveals a widened mediastinum (chest cavity) with or without pleural effusions late in the disease in about 55 percent of the cases, but typically is without lung infiltrates.

    Pneumonia generally does not occur; therefore, organisms are not typically seen in the sputum. Bacillus anthracis will be detectable by Gram stain of the blood and by blood culture with routine media, but often not until late in the course of the illness.

    Approximately 50 percent of cases are accompanied by hemorrhagic meningitis, and therefore organisms may also be identified in cerebrospinal fluid.

    Only vegetative encapsulated bacilli are present during infection; spores are not found within the body unless it is opened to ambient air.

    Bacilli and toxin appear in the blood late on day 2 or early on day 3 post-exposure. Toxin production parallels the appearance of bacilli in the blood and tests are available to rapidly detect the toxin. Concurrently with the appearance of anthrax, the WBC (white blood cell) count becomes elevated and remains so until death.

    Medical Management

    Almost all inhalational anthrax cases in which treatment was begun after patients were significantly symptomatic have been fatal, regardless of treatment.

    Penicillin has been regarded as the treatment of choice, with 2 million units given intravenously every 2 hours. Tetracyclines and erythromycin have been recommended in penicillin-allergic patients.

    The vast majority of naturally occurring anthrax strains are sensitive to penicillin in vitro (in the laboratory). However, Russia has developed new strains that are resistant to penicillin, tetracyclines, erythromycin and probably other antibiotics, through laboratory manipulation of organisms.

    All naturally occurring strains tested to date have been sensitive to erythromycin, chloramphenicol, gentamicin, and ciprofloxacin (cipro).

    In the absence of antibiotic sensitivity data, empiric intravenous antibiotic treatment should be instituted with cipro at a dose of 400-800 mg IV twice daily at the earliest signs of disease.

    U.S. military policy (FM 8-284) currently recommends ciprofloxacin (400 mg IV every 12 hours) or doxycycline (200 mg IV load, followed by 100 mg IV every 12 hours) as initial therapy, with penicillin (4 million units IV every 4 hours) as an alternative once sensitivity data is available.

    Published recommendations from a public health consensus panel recommends ciprofloxacin as initial therapy.

    Recommended treatment duration of the active case is 60 days, and should be changed to oral therapy as clinical condition improves.

    Supportive therapy for shock, fluid volume deficit and inadequacy of airway may all be needed.

    Standard precautions are recommended for patient care.

    There is no evidence of direct person-to-person spread of disease from inhalational anthrax.

    After an invasive procedure or autopsy, the instruments and area used should be thoroughly disinfected with a sporicidal (spore-killing) agent such as formaldehyde. Sodium or calcium hypochlorite can be used, but with the caution that the activity of hypochlorites is greatly reduced in the presence of organic material.

    Prophylaxis (Prevention)

    Vaccine: A licensed vaccine (Anthrax Vaccine Adsorbed) made solely by BioPort Corp. is derived from sterile culture fluid supernatant taken from an attenuated strain.

    Therefore, the vaccine does not contain live or dead organisms. However, because of numerous severe immunologic reactions to this vaccine, I cannot recommend it.

    Antibiotics: Both military doctrine and a public health consensus panel recommend prophylaxis with ciprofloxacin (500 mg orally twice a day) as the first-line medication in a situation with anthrax as the presumptive agent.

    Ciprofloxacin recently became the first medication approved by the FDA for prophylaxis after exposure to a biological weapon (anthrax).

    Bioweaponized anthrax is very likely to be resistant to alternatives such as doxycycline (100 mg orally twice a day) or amoxicillin (500mg orally every 8 hours).

    Should an attack be confirmed as anthrax, antibiotics should be continued for at least 4 weeks in all those exposed.

    Optimally, patients should have medical care available upon discontinuation of antibiotics, from a fixed medical care facility with intensive care capabilities and infectious disease consultants.

    References:

    "Biohazard" by Ken Alibek, M.D., Ph.D.

    USAMRIID: Manual of Biological Warfare


    NOTE:

    In April 1979, an anthrax outbreak in the Soviet city of Sverdlovsk, roughly 850 miles east of Moscow, killed 66 of 94 infected people. The first victim died after 4 days; the last one died 6 weeks later.

    The Soviet government claimed the deaths were caused by intestinal anthrax from tainted meat. It was not until 1992 that President Boris Yeltsin admitted the outbreak was the result of military activity at a suspected Soviet biological weapons facility located in the city.
  8. by   Chellyse66
    Anthrax as a Weapon of
    Terrorism and Difficulties Presented
    in Response to its Use

    From COUNTER TERRORISM and SECURITY REPORTS, DJ has the privilege of re-producing this fine article on one of the most dangerous chemicals

    In the wake of the Persian Gulf War, Oklahoma City bombing and use of sarin by Aum Shinrikyo in Tokyo, the potential use of nuclear, biological and chemical (NBC) weapons by terrorists within the United States has come to the attention of the print and electronic media. As recently as June 14, 1998, 60 Minutes ran a story concerning the use of anthrax as a weapon in major cities such as New York and Boston. Earlier this year, Secretary William Cohen appeared on the This Week programme using a 5 lb. bag of sugar to demonstrate the amount of anthrax bacillus necessary to devastate a major metropolitan city.

    While much information is being presented about the threat of anthrax as a weapon of mass destruction, little information is being disseminated concerning the reasons why anthrax can be used as a weapon or how to respond to its use. While anthrax is in its simplest term, a hazardous material, it is a disease that has had a long standing presence in human history. This article is an effort to consolidate the mass of information concerning anthrax from multiple unclassified sources.

    Anthrax in History

    The disease of anthrax infections has a long history with mankind. It is a bacterium that primarily effects grazing animals, such as sheep, cattle, goats and horses. Anthrax was known to ancient cultures, and is described to have killed 40,000 horses and 100,000 cattle in the possession of the Huns during their movement across Eurasia in 80 AD. As a considerable bane to the European livestock trade, throughout the 18th and 19th century, much effort was put into the identification and prevention of anthrax in animals. Anthrax (scientific name Bacillus anthracis) was the first microorganism identified as the cause of a specific disease by Dr. Robert Koch in 1876. Later that year Dr. Koch was growing Anthrax bacillus in his laboratory. Within the decade, Louis Pasteur for use in livestock developed a viable anthrax vaccine.

    World War I saw the possible introduction of anthrax as a weapon against livestock and transportation animals. A clandestine biological research laboratory was set up in Baltimore, MD by the German government in 1915. A number of suspected uses of anthrax by the German government during World War I were alleged, but not well documented. Japan, Great Britain, and the United States all proceeded with research into the use of anthrax bacillus as a weapon in World War II. While no combatants used anthrax during this war, the Anthrax bacillus was both tested on animals and allied prisoners. Weapon delivery systems were also developed. The former Soviet Union also developed a biological research programme during the Cold War. The accidental release of anthrax from a secret bio-weapons research facility in Sverdlovsk, USSR resulted in the death of 66 of 77 diagnosed cases.

    With the establishment of a biological weapons research facility in al-Hakim, Iraq, in 1988, concerns over the use of anthrax during the Persian Gulf War resulted in US troops to be vaccinated. It is not believed that anthrax was used by the Iraqi armed forces.

    In 1993, the Aum Shrinkyo cult attempted to release anthrax spores in downtown Tokyo one month prior to the nerve gas attack. This incident marks the first instance of anthrax to be used as a weapon against a civilian population.

    Anthrax as a Disease

    Anthrax is caused by bacteria that are a rod shaped organism, Bacillus anthracis. Anthrax is a non-motile organism between 1-5 micrometers in length. Upon exposure to air, anthrax forms a spore, which can become airborne to cause infection to exposed individuals. Anthrax spore can cause disease by coming in contact with abraded skin or wounds; inhalation; or ingestion. As anthrax reproduces, it releases three virulence factors: lethal factor, edema factor and antiphagocytic factor. Each of these substances enhances the destruction of cells and resists the immune system. Damage to the body depends on which organ system the anthrax spore colonizes. Antibiotics have long been used to treat skin anthrax and have been shown to be effective in the laboratory against the anthrax bacillus. While effective against the bacillus, antibiotics do not reduce the amount of virulence factor in victims. Even with antibiotic treatment, the virulence factors continue to cause damage within the body.

    Skin (cutaneous) anthrax is a disease that starts with the spore colonizing the skin through an abrasion, cut or wound. After exposure to the spore, one to five days will pass before the presentation of symptoms (the incubation period). The disease starts as a small lesion, which grows into a puss-filled blister (a vesicle). The vesicle then turns coal black scab (an eschar). Symptoms include fever, malaise and headache. The eschar heals within two-three weeks with treatment. Mortality of cutaneous anthrax victims range from 20-25% without treatment, less than one percent with treatment.

    Pulmonary anthrax starts with inhalation of anthrax spores. The US Army estimates that inhalation of 8,000-50,000 spores can cause infection. After an incubation period of one to seven days, an exposed individual develops flu-like symptoms {malaise, fatigue, myalgia (body ache), fever and non-productive cough} that persist for two to three days. After a levelling of symptoms or improvement, severe respiratory distress with symptoms of dyspnea (difficulty breathing), stridor (grating sound on inspiration that is associated with upper respiratory obstruction), cyanosis (bluish colour in skin due to lack of O2 exchange due to lung damage), increased chest pain, tachycardia (excessively rapid heart rate) and diaphoresis (excessive sweating) develop. Fifty percent of victims will develop meningitis. Within twenty-four to thirty-six hours, the victim experiences the rapid onset of shock and subsequent death. Inhalation anthrax has a mortality of 95-100% despite antibiotic treatment.

    Ingestion anthrax has an incubation period of 2-5 days. Symptoms include nausea, vomiting fever and severe abdominal pain. Ingestion anthrax has a mortality of 95-100% despite antibiotic treatment.

    The Occurrence Worldwide of Anthrax

    Anthrax exists in soil as a spore. Under certain condition, the anthrax spore can remain viable in soil for decades. After conducting open-air anthrax weapons research on Gruinard Island in Scotland in 1941, the British government banned human entry for over fifty years.

    Anthrax occurs worldwide, reported in 82 countries. Human cases of anthrax are reported regularly in countries in the Middle East, Africa and the former Soviet Union. Cases of animal anthrax in the United States occur in Texas, Louisiana, Mississippi, Oklahoma and South Dakota. Cattle, sheep, goats and horses are the chief animal hosts. Infections can occur from contact with contaminated carcasses, hides, wool, hair, blood, excreta, bones; and consuming uncooked, contaminate meat. Workers in the clothing, yarn, insulation material, saddle pads and fertilizer industries are noted as reported cases of occupational anthrax. Anthrax spores have also been shown to be spread by houseflies. Anthrax is not known to be transmitted by person-to-person contact.

    Treatment of Anthrax

    Anthrax is readily susceptible to numerous antibiotics. Table 1 is a list of antibiotics that have shown activity against anthrax. The antibiotics in bold print are those most referenced for treatment of anthrax. Penicillin G has long been the drug of choice used for the treatment of

    Table 1 Antibiotics with Activity versus Anthrax

    aureomycin immune
    cefazolin serum
    cephalothin methicillin
    chloramphenical nafcillin
    chloromycetin oxacillin
    ciprofloxacin penicillin G
    clindamycin sulfadiazine
    doxycycline terramycin
    erythromycin tetracycline
    gentamicin vancomycin
    imipenem

    anthrax. A treatment regimen of penicillin G of 2 million units given intravenously every two hours is recommended for the treatment of inhalation anthrax. The US military favours the use of a drug combination of 400 mg of ciprofloxacin given intravenously every eight to twelve hours, given with an initial dose of 200 mg of doxycycline intravenously, followed by a dose of 100 mg of doxycycline intravenously every eight to twelve hours.

    Prevention of Disease

    The primary method for preventing anthrax in exposed individuals is the use of the vaccine. This vaccine consists of anthrax bacillus that is attenuated (weakened), unencapsulated, and nonproteolytic strain. This process allows for the immune system to recognize the bacillus as a foreign body without causing infection. Repeated exposure to the vaccine strengthens the im-une response to the bacillus over time.

    First introduced in 1971 and manufactured by the Michigan Department of Public Health, the anthrax vaccine was designed for use in workers in the animal hide handling industry. This vaccine has been adapted for use in the military as protection against exposure to anthrax spore used as a weapon. Table 2 lists the dosing schedule for the vaccine. A 0.5-ml dose is given subcutaneously over this interval, providing an immunized person with immunity after one and a half years. A booster of 0.5 ml is given annually to maintain immunity. If an individual fails to receive the annual booster, the vaccination cycle must be started again in order to maintain immunity.

    Table 2 Dose Schedule for Anthrax Vaccine

    Initial dose
    2 weeks
    4 weeks
    6 months
    12 months
    18 months

    There are several drawbacks to using a vaccine. First, immunized personnel must maintain the annual schedule of booster immunizations or lose immunity. Second, immunity to exposure to anthrax is not conferred immediately upon the first dose, but only after an 18-month course of injections. Emergency response personnel must receive the full course of injections to confer immunity. With rapid turnover of personnel, keeping a cadre of anthrax immunized individuals will be difficult. Third, the anthrax vaccine does not confer absolute immunity. Of all personnel immunized, 91% should have immunity to exposure to anthrax. Fourth, a vaccine will not be proof against an overwhelming exposure to anthrax spores. A vaccine acclimates the immune system to immediately recognize anthrax bacillus as a foreign body. If the dose of anthrax spore is great enough, the immune system can be overwhelmed, overtaxing its ability to fight off the infection. Lastly, the anthrax vaccine is approved for use by the US Food and Drug Administration for use in the prevention of cutaneous anthrax. Its efficacy in human beings to provide immunity to inhaled anthrax spores has not been proven. However, the use of this vaccine is the only current viable option to confer some immune response activity in vaccinated individuals.

    Another method for providing protection against exposure to anthrax infection is to use antibiotics in preventative (prophylactic) doses. Experimental evidence in animals has indicated that antibiotic treatment one day after exposure to spore anthrax can provide protection against death. Doses of 500 mg of ciprofloxacin and 100 mg of doxycycline given twice a day orally over the course of four weeks, with the start of anthrax vaccine can be effective. If no vaccine is available, an increase to twelve to sixteen weeks of antibiotics is recommended.

    Decontamination

    Materials that are contaminated with anthrax bacillus or spore must be decontaminated. Spores can be destroyed by: steam under pressure (autoclave) for one hour; dry heat above 159 C; or boiling water for 30 minutes with disinfectants. Table 3 lists chemicals that have been used as anthrax bacillus and spore disinfectants. Animals who died of anthrax infection have been traditionally either cremated or deeply buried with quicklime.

    Table 3 Anthrax Disinfectants

    chloride solution
    peracetic acid 3%
    formaldehyde 10% in water
    potassium permanganate
    hydrogen peroxide 3%
    sodium hypochlorite 0.5%
    iodine.

    Problems of Anthrax Use as a Weapon

    Anthrax release in a population centre would pose a number of problems for emergency response and remediation personnel. Appropriate personal protective equipment is essential to prevent infection in responders. The Centres for Disease Control classifies working with infected animals as an Animal Biohazard 3 rating, which requires special facilities and personal protective equipment. Similar measures would be necessary to control remediator exposure to anthrax spore.

    Since anthrax is persistent in the environment, contamination of soil would require special treatment. Gruinard Island, the location of the British anthrax experiments remained restricted to human entry for over fifty years. Similar decontamination procedures would be necessary for open soil and park space contaminated with anthrax spore.

    Buildings with operating fresh air intakes of the heating, ventilation and air-conditioning (HVAC) system must be assumed to be contaminated if within the estimated plume of an anthrax spore release. All ductwork, interior rooms, air filters and related HVAC system machinery would have to be disinfected or disposed of to prevent the spread of spores.

    Drug delivery logistics are also a problem with anthrax exposure. Please note that the recommended medications to combat anthrax infections are to be delivered intravenously. Administration of these medications require trained medical personnel, IV tubes, IV fluids, IV bags and other related equipment.

    Conclusions

    Anthrax has been researched and developed as a weapon of mass destruction since World War I. the technology for growing anthrax in the laboratory and vaccination of animals is over one hundred years old. With the perceived ease of production in the laboratory, the use of anthrax by terrorists as a weapon is a viable threat. A combination of understanding of the potential threat, response, and treatment of disease would serve to contain the impact of the use of anthrax spore as a weapon.

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