Bioterrorism Preparedness

Anthrax is a serious infectious disease caused by a bacteria called Bacillus anthracis. It is a disease most commonly seen in animals, especially hoofed animals such as cows, sheep, goats and horses. Humans occasionally become infected with anthrax when they eat meat or handle the wool, hair or bones of an animal infected with anthrax. There are 2000-5000 cases of anthrax worldwide, and about 5 cases a year in the United States. Experts believe that anthrax is among the diseases which could be used as a biological weapon.

The illness a person gets when they are infected with Bacillus anthracis depends on how the bacteria got into the person's body. There are three different types of anthrax disease:

Inhalational anthrax is the most serious form of anthrax and is caused by inhaling anthrax bacteria into the lungs. Initial symptoms usually begin 1-6 days after infection, but can occur as late as 60 days after exposure. Symptoms include fever, headache, cough, difficulty breathing, chills, weakness, and chest discomfort. Without treatment, severe breathing problems and death usually result. Inhalation anthrax is NOT contagious (spread person-to-person).
Cutaneous anthrax is caused when the anthrax bacteria come into direct contact with skin that has a cut or break in it. Cutaneous anthrax begins within 1 to 7 days after exposure and first causes a raised, itchy bump that resembles an insect bite. Within 1-2 days after the appearance of the bump, a small blister develops. This blister then becomes a painless sore with a black center. Lymph glands in the area of the infection may swell.
Intestinal anthrax is caused by eating meat from an animal that has died of anthrax or by drinking other foods or liquids contaminated with anthrax bacteria. It causes nausea, vomiting, fever, pain in the abdomen, and diarrhea. Intestinal anthrax symptoms appear within 1 to 7 days after exposure.

If untreated, each of these forms of anthrax can spread to the blood, brain, or spine and cause severe illness or death.

Testing and diagnosis of anthrax

Law enforcement and Public Health authorities determine if an anthrax threat or suspicious substance represents a credible threat and is potentially dangerous. If so, the letter or parcel involved can tested for anthrax. Treatment of persons exposed in such circumstances is usually postponed until laboratory results are available.

There is no laboratory test to test for anthrax before symptoms begin.

Nasal swabs are sometimes obtained during investigations of confirmed or likely anthrax exposures, but are not useful or available outside of these circumstances. Persons with a documented or likely anthrax exposure ALWAYS receive preventive antibiotics.

Treatment for anthrax

The preventive treatment for anthrax consists of antibiotic treatment for 30-60 days.

Questions about exposure to anthrax

1.	How will I know if I have been exposed to anthrax? Persons are considered exposed to anthrax if they have inhaled or come into direct contact with anthrax bacteria. There are tests to detect anthrax in the environment or substances and these tests will be done as rapidly as possible by Public Health to determine if anthrax is present. Environmental testing to detect anthrax can provide preliminary results within several hours and final results in about 2 days.
2.	What should I do until environmental anthrax test results are available? In most instances the likelihood of true exposure to anthrax is extremely small and no treatment is needed. If evidence suggests that a true anthrax exposure has occurred, Public Health will make recommendations for antibiotic treatment of persons exposed to anthrax until results of laboratory tests are available. Antibiotic treatment should be stopped if environmental tests show no exposure to anthrax has occurred. If a true anthrax exposure is confirmed, antibiotic treatment must continue for the duration specified in Public Health recommendations, usually 30 days or longer.
3.	What can I do to protect others when I have been exposed to anthrax? Take off the clothes you were wearing when you were exposed and place them in a sealed plastic bag. These clothes can either be thrown away, or they can be washed in hot water and soap. People who handle the contaminated clothes before laundering should be sure to wear gloves and protective clothing. Avoid shaking the clothes when placing them in the plastic bag or in the washing machine. Take a shower and clean your skin and hair thoroughly with warm water and soap to remove anthrax bacteria. Once you take these steps, you will pose no risk to others. If you subsequently develop a sore on your skin, cover the sore with clothing or a bandage and see your health care provider immediately. If you are recommended for preventive treatment, please be sure to follow the treatment advice exactly.
4.	What can be done to decontaminate surfaces contaminated with anthrax? The job of cleaning an area contaminated with anthrax will be left to public safety experts.
5.	What should I do if I become ill after confirmed or suspect anthrax exposure? If you develop any of the illness symptoms described above, get medical attention immediately and notify Public Health. Bring this sheet or mention you have been exposed to anthrax when you seek medical care. Report all cases to Public Health by calling 206-296- 4774.