Anthrax

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Anthrax is a bacterial infection caused by Bacillus anthracis. It usually affects cloven-hoofed animals, such as cattle, sheep, and goats, but it can occasionally spread to humans. Anthrax is almost always fatal in animals, but it can be successfully treated in humans if antibiotics are given soon after exposure. In humans, anthrax is usually contracted when spores are inhaled or come in contact with the skin. It is also possible for people to become infected by eating the meat of contaminated animals. Anthrax, a deadly disease in nature, gained worldwide attention in 2001 after it was used as a bioterrorism agent in the United States. Until the 2001 attack, only 18 cases of anthrax had been reported in the United States in the previous 100 years.

Anthrax occurs naturally. The first reports of the disease date from around 1500 B.C., when it is believed to have been the cause of the fifth Egyptian plague described in the Bible. Robert Koch first identified the anthrax bacterium in 1876 and Louis Pasteur developed an anthrax vaccine for sheep and cattle in 1881. Anthrax bacteria are found in nature in South and Central America, southern and eastern Europe, Asia, Africa, the Caribbean, and the Middle East. Anthrax cases in the United States are rare, probably due to widespread vaccination of animals and the standard procedure of disinfecting animal products such as cowhide and wool. Reported cases occur most often in Texas, Louisiana, Mississippi, Oklahoma, and South Dakota.

Anthrax spores can remain dormant (inactive) for years in soil and on animal hides, wool, hair, and bones. There are three forms of the disease, each named for its means of transmission: cutaneous (through the skin), inhalation (through the lungs), and intestinal (caused by eating anthraxcontaminated meat). Symptoms appear within several weeks of exposure and vary depending on how the disease was contracted.

Cutaneous anthrax is the mildest form of the disease. Initial symptoms include itchy bumps, similar to insect bites. Within two days, the bumps become inflamed and a blister forms. The centers of the blisters are black due to dying tissue. Other symptoms include shaking, fever, and chills. In most cases, cutaneous anthrax can be treated with antibiotics such as penicillin. Intestinal anthrax symptoms include stomach and intestinal inflammation and pain, nausea, vomiting, loss of appetite, and fever, all becoming progressively more severe. Once the symptoms worsen, antibiotics are less effective, and the disease is usually fatal.

Inhalation anthrax is the form of the disease that occurred during the bioterrorism attacks of October and November 2001 in the eastern United States. Five people died after being exposed to anthrax through contaminated mail. At least 17 other people contracted the disease but survived.

One or more terrorists sent media organizations in Florida and New York envelopes containing anthrax. Anthrax-contaminated letters also were sent to the Washington, D.C. offices of two senators. Federal agents were still investigating the incidents as of May 2002 but admitted they had no leads in the case. Initial symptoms of inhalation anthrax are flu-like, but breathing becomes progressively more difficult. Inhalation anthrax can be treated successfully if antibiotics are given before symptoms develop. Once symptoms develop, the disease is usually fatal.

The only natural outbreak of anthrax among people in the United States occurred in Manchester, New Hampshire, in 1957. Nine workers in a textile mill that processed wool and goat hair contracted the disease, five with inhalation anthrax and four with cutaneous anthrax. Four of the five people with inhalation anthrax died. By coincidence, workers at the mill were participating in a study of an experimental anthrax vaccine. No workers who had been vaccinated contracted the disease.

Following this outbreak, the study was stopped, all workers at the mill were vaccinated, and vaccination became a condition of employment. After that, no mill workers contracted anthrax. The mill closed in 1968. However, in 1966 a man who worked across the street from the mill died from inhalation anthrax. He is believed to have contracted it from anthrax spores carried from the mill by the wind. The United States Food and Drug Administration approved the anthrax vaccine in 1970. It is used primarily for military personnel and some health care workers. During the 2001 outbreak, thousands of postal workers were offered the vaccine after anthrax spores from contaminated letters were found at several post office buildings.

The largest outbreak worldwide of anthrax in humans occurred in the former Soviet Union in 1979, when anthrax spores released from a military laboratory infected 77 people, 69 of whom died. Anthrax is an attractive weapon to bioterrorists. It is easy to transport and is highly lethal. The World Health Organization (WHO) estimates that 110 lb (50 kg) of anthrax spores released upwind of a large city would kill tens of thousands of people, with thousands of others ill and requiring medical treatment.

The Geneva Convention, which established a code of conduct for war, outlawed the use of anthrax as a weapon in 1925. However, Japan developed anthrax weapons in the 1930s and used them against civilian populations during World War II. During the 1980s, Iraq mass produced anthrax as a weapon.

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Belluck, Pam. "Anthrax Outbreak of '57 Felled a Mill but Yielded Answers." The New York Times (Oct. 27, 2001).

Bia, Frank, et al. "Anthrax: What You—And Your Patients—Need To Know Now." Consultant (Dec. 2001):1797–1804.

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Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA USA 30333 (404)639-3534, Toll Free: (888) 246-2675, Email: cdcresponse@ashastd.org, >http://www.cdc.gov<

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