Anthrax Response Considerations

The following materials are specifically intended for emergency managers and first responders. The first section contains background information on Anthrax as well as threat assessment issues. The second segment addresses response guidelines for localities faced with possible contamination incidents.

Anthrax Background

Facts About Anthrax

Anthrax is a bacterial disease caused by Bacillus anthracis. Robert Koch identified the bacterium in 1876. Anthrax occurs in domesticated and wild animals such as goats, sheep, cattle, horses, and deer. The bacteria can live in soil, water, and on or in dead animals. Anthrax cannot be seen with the naked eye. During unfavorable conditions, such as when nutrients and water are depleted, the bacteria form specialized "resting" cells called endospores (spores). These spores can be inhaled, enter the gastrointestinal tract, or enter a laceration where they can regenerate and cause illness.

How Does the Bacteria Cause Illness?

The illness Anthrax is an acute infection of the skin, lungs, or gastrointestinal tract. Anthrax can be contracted by handling contaminated materials such as wool, hides, blood, and by purposeful dissemination (Anthrax-contaminated letters and packages). Anthrax is not contagious from one person to another.

There are three major forms of the illness Anthrax: The cutaneous or skin form of Anthrax is contracted by contamination of open wounds with the spores or the bacteria. The illness may first appear as a rash or blister that may resemble a brown-recluse spider bite. This sore progresses to a painful ulcer with a black area in the center. This form of Anthrax can be treated effectively with antibiotics. This form represents 95% of the cases of Anthrax in humans. With treatment, mortality is about 1%. Inhalation Anthrax is contracted by inhaling (breathing in) air-entrained spores. This can occur during the opening of a contaminated package or by dispensing within a closed system, such as an air-conditioning system. The illness first appears with 'flu-like' symptoms such as fever, malaise (lack of energy), fatigue, cough, or mild chest discomfort generally within 1 to 7 days. These symptoms are generally followed by severe respiratory distress. This form of the illness can be treated with antibiotics if prompt treatment is initiated before significant symptoms occur. Gastrointestinal Anthrax is contracted by ingesting contaminated meat that has not been properly cooked. Symptoms of this type of exposure include intense stomach pain, vomiting and diarrhea. Most cases of gastrointestinal Anthrax appear within 48 hours of consumption of the contaminated products. This type of Anthrax is extremely rare in the United States as animals are vaccinated in high-risk areas. This form of Anthrax can be treated with antibiotics if prompt treatment is initiated.

(Source: www.cnn.com)

To contract Anthrax, you must either:

Inhale the Anthrax spores

Get Anthrax spores or bacteria in open wounds or cuts, or

Eat Anthrax-contaminated products.

How is Anthrax a threat?

Many facilities in communities around the country have received Anthrax threat letters. Most of these threat letters were empty envelopes that turned out to be hoaxes. To determine if a real threat exists, a threat assessment must be conducted, which largely involves common sense. If you see powder on the table in a restaurant, for example, it is probably spilled sugar or salt, not Anthrax.

To understand the threat, we must also examine the likely targets that would be of interest to terrorists. Likely targets include:

Particular buildings such as the IRS and FBI offices as well as military installations are also considered likely targets.

Other considerations

• Enclosed Spaces — Biological agents that are released indoors will result in higher concentrations, which will increase the number of victims.
  
  
• Large Crowds — Large crowds, regardless of the release location, may ensure that there will be a high number of casualties and news coverage by the media.
  
  
• Critical Systems and Infrastructure — This can include targets such as electric power and drinking water supplies.
  
  
• Facilities of Special interest to the Terrorist — Targets such as animal research, the news media, government offices, abortion clinics, and religious sites such as churches. The first step in dealing with a potential biological incident is to determine if a threat and target exists. Once you have determined that you may in fact be dealing with an incident, the following guidelines should be used.

Guidelines for First Responders

Responders should consider the threat potential when sizing up a suspicious powder incident.

• If there is no threat received (verbal, written, etc.) and no reason for any hazardous materials to be there — treat it as solid waste. (Remember, just because it isn't Anthrax does not mean that it may not be harmful. Good size-up is critical. If there are outward warning signs and detection clues that indicate it may be a hazardous material, call the VEOC at 1-800-468-8892.)
  
  
• If no threat has been received and some other reasonable explanation exists (coffee creamer, donut sugar, corn starch on magazines, etc.) — treat it as solid waste and have the material cleaned up with a mild bleach solution, if warranted.
  
  
• If no threat exists, but materials received by someone that could be considered a target (family planning clinic, politician, newspaper, etc.) — treat as a crime scene. Sample the material, if law enforcement wants a sample for evidence, and obtain a sample for identification. Clean up with a mild 10 percent bleach solution. Decon the entry team and allow anyone who came in contact with the material to wash their hands and face. Transport the samples to the lab for identification; involve the VDH and record the name and address of everyone potentially exposed.
  
  
• If a threat is received (written or verbal) and no materials were present, treat it as a crime scene.
  
  
• If a threat is received and materials are involved, treat as a crime scene and follow the third bullet, above.

Note: See the letter from the Director of Technological Hazards. Responders may also want to consult the On-Scene Commander's Guide for Responding to Biological/Chemical Threats and the 2000 Emergency Response Guidebook Number 158 at www.tc.gc.ca/canutec/erg_gmu/search/Guide.asp?Guide=158&lang=en.

Handling of Suspicious Packages or Envelopes

Many facilities in communities around the country have received Anthrax threat letters. Most of these letters were empty envelopes; some have contained a powdery substance. These guidelines are designed to recommend the proper procedures for handling such incidents:

1. Do not shake or empty the contents of a suspicious package or envelope.
   
   
2. Do not carry the package or envelope, show it to others, or allow others to examine it.
   
   
3. Put the package or envelope on a stable surface; do not sniff, touch, taste, or look closely at it or any contents that may have spilled.
   
   
4. Alert others in the area about suspicious package or envelope. Leave the area, close any doors, and take action to prevent spreading potentially infectious material to face or skin. Seek additional instructions for exposed or potentially exposed persons.
   
   
5. If at work, notify a supervisor, a security officer, or law enforcement official. If at home, dial 911 and report to local police.
   
   
6. If possible, create a list of persons who were in the room or area when the suspicious letter or package was recognized and a list of persons who also may have handled the package or letter. Give the list to both local public health authorities and local law enforcement officials.

What Constitutes a Suspicious Letter or Parcel?

Typical characteristics that should trigger suspicion include letters or packages with:

• Excessive postage, no postage or non-canceled postage.
  
  
• No return address or fictitious return address.
  
  
• Improper spelling of addressee names, titles or locations.
  
  
• Unexpected envelopes from foreign countries.
  
  
• Suspicious or threatening messages written on packages.
  
  
• Postmark showing different location than return address.
  
  
• Distorted handwriting or "cut and paste" lettering.
  
  
• Unprofessionally wrapped packages or excessive use of tape, strings, etc.
  
  
• Packages marked as "Fragile - Handle with Care," "Rush - Do Not Delay," "Personal," or "Confidential."

For more information about recognizing suspicious packages, visit the U.S. Postal Service Web site at www.usps.com/news2001/press/serviceupdates.htm.

Q: Is Anthrax contagious?

A: No. Anthrax does not spread from person to person. It is a one-time agent; to catch it, a person must come directly in contact with the bacterium.

Q: Should I take antibiotics to prevent infections?

A: No. Taking unnecessary antibiotics can result in the development of antibiotic-resistant strains of common bacteria. The course of treatment is long (60 days) and many people experience unpleasant side effects.

Q: Should I keep a supply of antibiotics on hand, just in case?

A: No. Antibiotics should only be taken under the supervision of a physician who has done an evaluation to minimize the potential for side effects or interactions with other medication. There is also the "shelf life" of the medication to consider.

Q: Should I get vaccinated for Anthrax?

A: The Centers for Disease Control recommends antibiotics for preventing Anthrax after exposure in the civilian population. Vaccination is not recommended and the vaccine is not available to health care providers or the general public. The CDC does not recommend that physicians prescribe antibiotics for Anthrax at this time. They currently have enough antibiotics to prevent the disease in 2 million persons exposed to Anthrax. Therefore, they could rapidly get preventive medicine to those who may be affected by this disease, which cannot be transmitted between people.

Q: What should individuals do to be prepared?

A: We continue to hear stories of the public buying gas masks and hoarding medicine in anticipation of a possible bioterrorist or chemical attack. The CDC does not recommend either course of action. As Secretary Thompson said recently, people should not be scared into thinking they need gas masks. In the event of a public health emergency, local and state health departments will inform the public about the actions individuals need to take.