1. Can Coins and Paper Money Transmit Bacillus anthracis? Khalifa Sifaw Ghenghesh Dept. of Medical Microbiology Faculty of Medicine Tripoli University Tripoli-Libya

2. INTRODUCTION Bacillus anthracis l Agent of anthrax: Cutaneous anthrax Inhalation anthrax Gastrointestinal anthrax l Spore former >>> survive for decades. l Agent of biological warfare. l Weapon of biological terrorism.

3. THE PROBLEM

4. Can coins and paper money be used as a vehicle for spreading B. anthracis in the community? l We should not expect that terrorists will choose the agents for which we are prepared (Institute of Medicine. 1999. Chemical and Biological Terrorism. National Academy Press, Washington, DC.). l We should not also expect that they will choose the methods we are familiar with for spreading such agents.

5. Factors in Favor of the Hypothesis

6. Staphylococi Isolated from Used Paper Money in Libya according to their source ---------------------------------------------------------------------------------------- Source No. No. (%) positive for: studied S. aureus S. epidermidis ---------------------------------------------------------------------------------------- Shops 4424(55) 7(16) Vegetable market 308(27%) 5(17) Cafeteria 3415(44)14(41) Photocopy center 1510(67) 4(27) Others 43 5(12) 8(19) Total 16662(37)38(23)

7. Staphylococi Isolated from Used Paper Money in Libya according to their value ValueNo. No. (%) positive for: (dinar)studiedS. aureus S. epidermidis ---------------------------------------------------------------------------------------- 1/4 35 15(43) 5(14) 1/2 27 13(48) 6(22) 1 85 25(29) 24(28) 5 10 4(40) 2(20) 10 9 5(56) 1(11) Total 166 62(37) 38(23)

8. Bacteria Isolated from Coins and Paper Money Worldwide l Bacillus spp. l Enterobacteria: Shigella, EPEC, etc.. l Staphylococci: Toxigenic S. aureus and MRSA. l Streptococci l Pseudomonas spp. l Etc...

9. Currencies that are candidates for use as vehicles for spreading B. anthracis

10. How to Tackle the Problem l The threat of using money and other possible methods by terrorists to spread B. anthracis (and other agents) should be taken seriously (see next slide). l Incorporating antimicrobial agents into currency? l Finding alternatives to coins and paper money? electronic money. l Others

11. When evaluating a threatened release of anthrax, the lack of volatility of the disease, as well as its inability to penetrate intact skin, should be taken into account. These factors make it unlikely, in most cases, that persons coming in contact with letters, packages, and other devices purported to contain anthrax will be at risk for aerosol exposure. Moreover, because energy is required to aerosolize anthrax spores, opening a letter, even if it contained anthrax, would be unlikely to place a person at substantial risk. Source: Cieslak TJ. and Eitzen, Jr EM.1999. Clinical and epidemiologic principles of anthrax. EID, vol 5.