I know that many of you are concerned about the disease anthrax and want to know more about how to protect yourself or minimize the risk. In addressing this subject, let’s get the bad news out of the way first and then end on some positive notes.
First
a little background and the bad news:
Anthrax is caused by a bacterium called Bacillus anthracis which exists as a actively growing vegetative form in an infected patient or animal, but can form dormant microscopic egg shaped spores under proper culture conditions or in the environment. The spores are very stable, can survive for long periods (many years) in the environment and can withstand heat up to boiling temperature (100°C) and drying, thereby allowing them to be dried to form a powder. The spores can be used by a terrorist as a powder or as a suspension of spores. It is not terribly difficult to prepare the spores and in a proper facility, spores can be produced more easily in a stable form than can most other biological threat materials.
As for the disease, cutaneous anthrax only occurs in humans and results when spores or vegetative cells enter a break in the skin. The lesion starts as like a raised papule or pimple but soon forms fluid filled vesicles or blisters around it. This is a distinguishing trait to look for. Later the affected area becomes larger and turns dark to ultimately form a black scab. The scab is so black that it looks like a piece of coal, and hence the term “anthrax”, the Greek word for “coal”. Death from cutaneous anthrax almost never occurs in Western countries and is easily treated with antibiotics.
Inhalation anthrax results from inhalation of spores. The reason that it is usually fatal is that by the time the disease is recognized as being anthrax, the patient is often too far into the progression of the disease to be saved. Early symptoms of anthrax are flu-like with sore throat, high fever, fatigue but is often distinguished from other respiratory illnesses by the virtue that anthrax usually does not cause runny noses or highly productive coughs as seen in cases of pneumonia, colds, or the flu.
OK,
now for some good news:
1. Of all the biological threats, Bacillus anthracis spores are among the easiest to detect and monitor for. This has been important in our monitoring of people with nasal swabs and in the clean up of buildings.
2. Ciprofloxacin (a quinolone antibiotic) is NOT the only antibiotic that is effective against naturally occurring strains. All the strains isolated recently have been fully susceptible other quinolones and to many other antibiotics such as penicillin, tetracycline, and doxycycline. If there is a known exposure, there is essentially a 100% survival rate if antibiotics are begun within 24 h and probably a high survival rate if within 2 to 3days.
3. Anthrax is not a disease of birds, amphibians, reptiles, and rarely a disease in carnivorous meat eating animals. Humans are intermediate in their susceptibility, between the resistant carnivores and susceptible herbivorous plant-eating animals such as cows, deer and horses. Mice are very susceptible. Remember that anthrax in humans is not contagious. It occurs naturally from Louisiana up through the mid-west to the Northwest Territory in Canada. Human anthrax in these areas is almost unheard of and the disease is a normal occurrence in humans and animals in many parts of the world. Far more people have died from aids or influenza than anthrax, yet we don’t have the same fear of those two diseases. Unlike aids and influenza, anthrax is treatable and far more easily cured when detected early. Media attention has made many Americans very fearful of anthrax.
4. Healthy humans with healthy lungs are thought to be more resistant. Hey, it’s a good time to put down those smokes if you are a smoker. Historically, many victims of inhalation anthrax often had other respiratory problems. Leading a healthy life style is very important in preventing many diseases.
5. Answering the mail: An approach to minimizing your risk is to cut a corner off suspicious envelopes over a pan of diluted household bleach (1 part bleach and 9 parts water) and then attempt to shake out powder. As a favor to your friends and others punch a few holes or cut-off the lower corners of your envelopes before mailing them. This will help reassure the recipient that there are no surprise powders inside. Matter of fact, we Methodists can start a trend across the country by sending all letters with corners cut off or with holes punched. If you get a suspicious powder on you, just use soap and water or wash the area briefly with diluted bleach and then rinse well. Anthrax spores down your drain do not pose a threat.
6. There is evidence from the incident in Sverdlovsk of the former USSR that when a cloud of spores was accidentally released and passed over that city about 21 years ago, those who were asleep in their homes were virtually unaffected. Since it is getting colder, most of us have our windows closed, which reduces potential exposure. Just remember that a release of clouds of biological threats ideally requires atmospheric conditions that hold the threat close to the ground. These conditions usually occur during the early morning hours from about midnight until mid-morning. During most of that time most of us are asleep in our homes with the windows shut. If you are concerned about driving around Washington, DC, having the windows shut and having outside ventilation turn off until mid-day is another measure that may improve your protection if a cloud of biological threat is passing through.
7. Otherwise take comfort that Middletown, MD is upwind of Washington DC. It’s very unlikely that your families will be affected before we get things under control. The most important thing to do is to enjoy your life, live a healthy lifestyle, love one another and pray that God will guide us through these times to become stronger in spirit and in our faith.
John W. Ezzell, Ph.D., Chief
Special Pathogens Sample Testing Laboratory
U.S. Army Medical Research Institute of Infectious Diseases
Fort Detrick, MD
If you think you have been exposed to anthrax, the Frederick County Health Department asks that you not go the FMH Emergency Room, but rather call the health department at 301-694-2165.