1. Basic Information About Anthrax All Employee Briefing 05 November 2001

2. Anthrax – The Disease An acute, infectious disease Can infect animals – herbivores –Cattle –Sheep Can infect humans – usually via occupation Infects herbivores Infect humans

3. Causative Agent - Anthrax B. anthracis (Gk: anthrakis – “coal”) –Large, spore-forming bacterium Gram-stain positive Rod-shaped bacillus Non-motile –Two states Vegetative - causes infection via toxin production Spores –Protective in adverse environments –May subsist for years

4. Historical Aspects of Anthrax Disease of antiquity –Biblical days Fifth Plague – Anthrax in cattle? Sixth Plague – Anthrax in humans? –“Black Bane” (Europe – 1600) – Anthrax? Important disease in Public Health History –Robert Koch – 1 st disease to satisfy postulates –Firmly established microbial etiology (1876) –First immunization for bacterial disease (1881)

5. Historical Aspects of Anthrax (continued) Outbreaks –Zimbabwe Outbreak (October 1979 – March 1980) 6,000 cases –Paraquay – 1987 25 cases of cutaneous anthrax Associated with slaughter of a single, infected cow –Russia (Sverdlovsk) 77 cases 66 deaths (primarily inhalational) Note: few cases have occurred in the US in last century

6. Forms of Anthrax-Routes of Entry

7. Inhalational Anthrax - Symptoms Initial symptoms –Mild, non-specific (e.g., “flu-like”) –Fever –Malaise –Mild cough, chest pain Acute symptoms –Respiratory distress –Shock –Mediastinal widening on chest X-ray Fatalities can occur (80-90%)

8. Cutaneous Anthrax - Symptoms Itching of skin Lesion - progression –spider bite-like pustule –Vesicle (blisters) –black lesion - eschar Lesion – location –Head –Arms –Hands Moderate to severe swelling around lesion –Lymph nodes –Secondary infection Fatalities can occur

9. G.I. Anthrax - Symptoms May resemble food-borne disease –Abdominal distress –Fever Septicemia (toxins in blood) Fatalities can occur

10. Public Health – Geographic Dist n B. anthracis found globally –Central and South America –Southern and Eastern Europe –Asia –Africa –Middle East Countries with poor veterinary medicine & public health programs Occurs in animals in United States

11. Public Health – Pop n at Risk No person-to-person transmission Historically associated with occupational exposures –Animal handling –Rendering plants –Preparing animal hides – Woolsorter’s Disease Accidental exposures have occurred –Russian experience (Sverdlovsk) –Biological weapons production –Laboratory exposures Bioterrorism – recent events

12. Public Health - General Incubation period –2-60 days –Mean incubation – 7 days Susceptibility and Resistance –Uncertain –Some inapparent infections –Second attacks can occur (rare)

13. Factors That Influence Natural History of Disease Occupation Amount of organisms –Infectious Dose: 8,000-10,000 spores (est.) Spore size –2-6 um diameter –May bind to larger particles (static charge?) Host Factors –General health –Age –Pre-existing conditions –Immunization status –Hygienic practices Treatment –Prompt –Appropriate

14. Tests For Anthrax Nasal swabs – epidemiological tool –Not diagnostic for disease –Determines “Zone(s) of Exposure” Cultures –Blood –Exudates Antibody tests – antibodies to anthrax Polymerase Chain Reaction (PCR) –DNA amplification Environmental tests –Swabs –Wipes

15. Tests for Anthrax Antibody tests –Quick antibody test strips –ELISA test (lab) –Blood test Microscopic analysis Bacterial culture DNA test – PCR Environmental samples –Swabs –Wipes

16. Medical Prevention and Treatment All forms of anthrax –Floroquinolones-oral (Ciprofloxacin)* –Doxycycline-oral** 100 mg BID for adults 1mg/pound BID for children (less than 100 pounds) –Penicillin –Others available Antibiotics effective for exposed persons Antibiotics effective early * Drug of choice ** Approved by FDA for Anthrax on 18 October 2001

17. Anthrax Vaccine Adsorbed (AVA) Licensed by FDA in 1970 Vaccine consists of: –Noninfectious sterile filtrate from B. anthracis culture –Adsorbed to aluminum hydroxide adjuvant –Formaldehyde stabilizer (<0.02% conc.) –Benzethonium chloride preservative –Impossible to contract disease from vaccine Dosage schedule: –Six (6) doses 0, 2, 4 weeks 6, 12, 18 months –Annual booster required Administered to: –Healthy people –18-65 years of age

18. Who Should Be Vaccinated? Work directly with B. anthracis in the laboratory Persons who work with imported animal hides or furs in areas where standards are insufficient to prevent exposure to anthrax spores. Veterinarians Handle potentially infected animal products in high-incidence areas. Military personnel Source: The Advisory Committee on Immunization Practices (ACIP)

19. Medical Prevention and Treatment Vaccine (AVA) information –Produced by Bioport Inc., Lansing, MI –Military/mission-essential civilians vaccinated –Not available to general public –Not used for contacts of index case Adverse Events –No unexpected local adverse reactions –No unexpected systemic adverse reactions

20. Anthrax: Current Issues Employee Briefing-Part II 05 November 2001

21. Issue of Cross Contamination Some letters were intentionally contaminated Current evidence points to the likelihood of cross contamination What does that mean?

22. Cross Contamination Number of spores should decline farther from the source Inhalation vs Cutaneous Makes risk low … but not zero

23. So… What to Do ? Don’t panic but take simple steps to protect yourself: –Watch for suspicious mail –Know the symptoms and act on them if you feel you need to –Wash your hands at appropriate times

24. We Will Stay Current As new information is known, we will make every attempt to get it to you ! * PS: We Will Win !