Anthrax Letters

Background
Frequently asked questions
Response guidelines
   for the person(s) immediately exposed
   for the first responder
References
For more information
Author

Background

In recent years there have been an increasing number of incidents in which letters alleging to contain anthrax have been sent to health clinics, government offices and other locations. While all such incidents to date have proven to be hoaxes, the threat is real. All incidents must be treated as real until proven otherwise! This will minimize the risk in the event of a real incident and protect the crime scene. The guidelines provided here are related to anthrax threats only and are not all inclusive but provide a reasonable variety of potential situations. Common features of previous anthrax threat letters included: no return address, excess postage, hand written or poorly typed address, misspelling of common words, restrictive marking such as "personal", "confidential", excessive weight or a feeling of a powdery substance. However, it cannot be assumed that future letters will appear at all out of the ordinary. If a threat letter is received, remain calm! Even if the letter or package really does contain anthrax spores, you are not in immediate danger. Anthrax is not transmissible from person to person. If a suspicious letter or package is unopened and no material is leaking out, or if a letter or package is opened and no powder is contained within (but there is a claim of anthrax), the risk of contracting anthrax is extremely low.

Frequently Asked Questions About 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 animals (cattle, sheep, goats, antelopes, bison and other herbivores). Anthrax can also occur in humans when they are exposed to infected animals or tissue from infected animals. Anthrax is found globally.
 
How is anthrax transmitted?
Anthrax infection can occur in three forms: cutaneous (skin), the most common form, inhalation, and gastrointestinal. Bacillus anthracis spores can live in the soil for many years. Humans can become infected with anthrax by handling products from infected animals, by inhaling anthrax spores from contaminated animal products or by eating undercooked meat from infected animals. Anthrax is not transmissible from person to person.
 
What are the symptoms of anthrax?
Symptoms usually occur within 7 days and vary depending on how the disease was contracted.

Cutaneous: Most (about 95%) anthrax infections occur when the bacterium enters a cut or abrasion on the skin. Skin infection begins as a raised itchy bump resembling an insect bite that develops into a vesicle within 1- 2 days and then a painless ulcer, usually 1- 3 cm in diameter, with a characteristic black necrotic center. Lymph glands in the adjacent area may swell. Deaths are rare with appropriate antibiotic treatment but occur in about 20% of untreated cases.

Inhalation: Initial symptoms may resemble a common cold. After several days, the symptoms may progress to severe breathing problems and shock. Inhalation anthrax results in death in greater than 90% of cases, unless promptly treated with appropriate antibiotics.

Intestinal: Gastrointestinal anthrax, characterized by an acute inflammation of the intestinal tract, may follow the consumption of contaminated meat. 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.
 
How is anthrax diagnosed?
Anthrax is diagnosed by isolating Bacillus anthracis from the blood, skin lesions, or respiratory secretions or by measuring specific antibodies in the blood of persons with suspected cases.
 
Is there a treatment for anthrax?
Yes, antibiotic treatment should be initiated as soon as possible. If left untreated, the disease can be fatal.

Response Guidelines

For the Person(s) Immediately Exposed You have opened a letter or package that claims to contain anthrax and has powder inside the envelope. The powder may or may not have spilled out onto your desk, the floor, your hands or your clothing. The key to controlling the situation is not to panic and to limit the exposed area and people.

For the First Responder

You are responding to an incident involving the alleged use of anthrax. Most incidents are hoaxes, however, all must be treated as if real. Whether or not anthrax is present a criminal event has occurred.

References

Approval of Cipro .for Use After Exposure to Inhalational Anthrax (http://www.fda.gov/bbs/topics/ANSWERS/ANSO1030.html) B. Kournikakis, S. J. Armour, C. A. Boulet, M. Spence and B. Parsons, Risk Assessment of Anthrax Threat Letters, Technical Report 2001- 048, Defence Research Establishment Suffield, in press. Bioterrorism Alleging Use of Anthrax and Interim Guidelines for Management - United States, 1998, MMWR, 48 ( 1999 ) 69- 74. (http://www.cdc.gov/mmwr/preview/mmwrhtml/00056353. htm) How to Handle Anthrax Threats in the Office, Indianapolis- Marion County, Emergency Management Agency, Safety Bulletin (http://www.indygov.org/ema/anthrax.safety.Anthrax) WMD Threats: Sample Guidelines, National Domestic Preparedness Office, 15 March 1999. Anthrax Facts, Special Bulletin, National Domestic Preparedness Office, 6 April 1999. Anthrax Fact Sheets, Centers for Disease Control and Prevention, National Center for Infectious Diseases, Division of Bacterial and Mycotic Diseases, November 2000. (http://www.cdc.gov/ncidod/dbmd/diseaseinfo/anthrax_ g.htm)

For more information

S. J. Armour, PhD
Head, Hazard Assessment and Agent Toxicology Group
Defence R&D Canada
Defence Research Establishment Suffield
PO Box 4000 Station Main
Medicine Hat, Alberta T1A 8K6
BUS: 403-544-4634 FAX: 403-544-3388
EMAIL: Joan.Armour@dres.dnd.Ca

Bill Kournikakis, PhD
Head, Preventive Medicine Group
Chemical and Biological Defence Section
Defence R&D Canada
Defence Research Establishment Suffield
PO Box 4000 Station Main
Medicine Hat, Alberta T1A 8K6
BUS: 403-544-4631 FAX: 403-544-3388
EMAIL: Bill.Kournikakis@dres.dnd.Ca
www.dres.dnd.ca


Author

T. Bruce Anderson
Biosafety Officer
Department of Health, Safety and Environment
The University of British Columbia
50 - 2075 Wesbrook Mall
Vancouver, BC V6T 1Z1
http://www.safety.ubc.ca
anderson@safety.ubc.ca
(604) 822-7596 Office
(604) 880-0711 Cell

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