Occupational Health and Safety magazine presents Q & A on Anthrax threat

Anthrax: Questions and Answers
A web feature presented by OHS Canada Magazine

Why does OHS Canada have a feature on anthrax?

This information is posted because anthrax is very much in the news in the last few days, and because readers and members of the public may have questions about the bacterium, the disease it causes and measures required to deal with any possible exposure. OHS Canada does not believe, based on current information, that anthrax is a serious threat to Canadians. We believe that exposure is extremely unlikely; we know that treatment is both widely available and highly effective.

So why all the fuss over anthrax?

Because it’s very frightening. The possibility that news organizations in the United States have been targeted by terrorist groups (or others) gives us pause for thought. One employee of a tabloid-newspaper in Florida has died. Other workers at the company, employees of NBC News, the New York Times and a Microsoft branch plant in Nevada, as well as staff members in the offices of several U.S. politicians appear to have been exposed to anthrax through letters mailed to them. However, public health officials in the United States report that none of the currently affected people are at risk and all are expected to recover or never develop symptoms. (There was one fatality, the tabloid photo-editor in Florida, but that case occurred before the current state of heightened awareness. He did not immediately seek treatment.)

Is this a terrorist attack?

No one knows at this point, but if it was a terrorist attack, perhaps linked to the events of September 11, it was a spectacularly unsuccessful one. The effects so far have been to increase public awareness and vigilance; to cause emergency responders across the continent to be ready to deal with the threat; and to harden public and political willingness to deal seriously with any and all possible threats.

Is the anthrax that has so far been detected the so-called “weaponized” bacterial warfare agent we’ve heard about over the years?

Apparently not. Public health authorities in the United States report that DNA testing on the anthrax recovered from letters to news organizations appears to be a natural, unaltered strain similar to one first identified in the wild in the western U.S. many years ago. Unlike “weaponized” versions developed primarily in the former Soviet Union, this strain does not have an enhanced immunity to antibiotics. It is also less virulent than the biological warfare agents developed by some countries.

What is anthrax?

Anthrax is an infectious disease caused by a bacterium called Bacillus anthracis. The bacterium occurs naturally throughout most temperate regions of the world. It is a disease that affects mainly grazing animals, and human exposures have occurred in the past when people — primarily livestock handlers such as farmers, ranchers, veterinarians and slaughterhouse workers — have been exposed to infected animals.

How common is anthrax?

Anthrax can be classified as a rare disease. The last known case in Canada occurred in 1990, and that case was a “cutaneous infection” that was cured by antibiotics. The number of known human deaths from anthrax in North America since 1800 is less than two dozen (most of them over 60 years ago).

How common is the animal disease?

It is also rare, but not unheard of. By coincidence, the most recent natural outbreak took place in July and August in Wood Buffalo National Park in northern Alberta and the Northwest Territories, when as many as 92 bison were killed by the disease. Although park officials were involved in monitoring the disease, no human transmissions occurred. Such outbreaks in wild populations of grazing animals are considered normal, and occur from time to time.

How is anthrax spread?

Anthrax is a bacterium which, like many other types of bacteria, produces spores. The bacteria themselves can be transmitted from a source (such as an infected animal) to humans, but the bacteria are relatively fragile and do not survive long outside a host. However, the spores are extremely hardly and can survive in a dormant state for long periods of time in soil and other places.

How does an anthrax infection occur?

Anthrax can enter the body in three ways: through contact with broken skin, through ingestion (eating) of infected animal products, and through the inhalation of spores.

What are the symptoms?

Cutaneous: Anthrax can enter the body through broken skin and cause a “cutaneous infection”. About 95 per cent of known cases are of this type (the most easily treated). Health Canada reports that symptoms begin with a red, itchy bump that may resemble an insect bite. It grows over several days into an open sore up to three centimetres in diameter, usually with a dark core. Swelling of the area will increase as lymph glands are affected. While about 80 per cent of cutaneous cases recover without treatment, reports Health Canada, the disease could be fatal for some if left untreated. However, the skin lesion is impossible to ignore after several days, and patients who seek treatment can be cured with antibiotics.
Inhalation: People who inhale a substantial number of anthrax spores may develop severe, flu-like symptoms that lead to breathing problems. Without early treatment, this form of the disease can be fatal. (This is the form contracted by the tabloid-newspaper employee in Florida who recently died of the disease.)
Intestinal: Consumption of animal products contaminated with anthrax can lead to an intestinal form of the disease. It leads to inflammation of the intestinal tract, nausea, fever, vomiting and bloody diarrhea. It, too, can be fatal if left untreated.

Is there a treatment for anthrax?

Yes. Anthrax infections can be treated with widely available antibiotics. If the exposure is detected before symptoms develop, or early in the progress of the disease, treatment is extremely effective.

Can anthrax be spread from person to person?

Essentially, no. It is not spread by coughing or skin contact, for example.

Is there a vaccine for anthrax?

Yes. Effective vaccines are widely used by animal handlers, laboratory workers — and members of the military forces potentially exposed to biological warfare agents during the Gulf War in 1991, for example.

Should you get vaccinated for anthrax?

No. Only people at risk, such as veterinarians, people working with grazing animals in affected areas, laboratory workers and members of the armed forces potentially exposed overseas need to consider vaccination.

How was anthrax sent to the news organizations in the United States?

It was sent in the mail. Recipients of the letters opened them and typically discovered a white powder inside the envelope. The amount of active anthrax in the powder appears to have been very small — to the point where early tests were unable to identify any anthrax spores. (Reports indicate that a normal person would have to inhale at least 5,000 spores to be at risk of developing disease.)

What should organizations look out for?

Authorities in Canada and the United States have advised that everyone watch out for “suspicious” letters and parcels arriving by mail or other means. Factors to consider include the following:
o Any letter or parcel that does not come from a usual correspondent
o Any letter or parcel in which the return address is missing, or which does not match the postmark or courier label
o Hand addressed mail
o Incorrectly or inappropriately addressed mail
o Mail with excess postage
o Letters that appear to have something other than folded paper inside them (such as powder, which may be felt inside the envelope).
o Letters sent to members of the U.S. government were said to be “excessively wrapped” and to have been “extensively taped” perhaps to avoid detection by electronic sniffers in the postal system. Excessive wrapping may be seen as “suspicious”.
It is important to note that these factors (as well as “anything unusual or suspicious”) do not mean that a letter or parcel should trigger an emergency response. They are merely indicators that should cause more careful consideration.
Mailroom staff (and others receiving mail or parcels) should be instructed to watch out for “suspicious” letters and parcels — as well as anything unusual — and to call a supervisor, building security or other designated person to examine the situation and decide whether further action is appropriate.
One way to eliminate many (if not most) cases of doubt is to set aside the suspect envelope in a secure location (wrapped in a plastic bag, for example) and to contact the sender on the return address to locate the sending person and verify the contents of the envelope.

What should you do with “suspicious mail”?

It depends how suspicious you believe it to be. The FBI in the U.S. advises the following:
o Handle with care
o Don’t shake or bump the letter or parcel
o Isolate it and look for indicators (as above)
o Don’t open, smell or taste the contents
o If you believe it to be suspect, call local authorities (911 in cases where an exposure is suspected, the local police non-emergency line in cases where no exposure is thought to have occurred, such as if the letter or parcel has not been opened).
What if you open a letter or parcel and you discover that the contents are suspicious?
If a letter or parcel that you have opened appears to contain suspicious material (such as a white powder, although other factors could raise legitimate concerns) authorities recommend that you do several things:
o Immediately limit your contact with the suspicious material. Avoid touching or inhaling the contents. Put it down gently and leave it alone. If you have a garbage bag available at your desk, place the suspicious material in the bag and tie it shut. Avoid any action that will disturb the contents. Do not move potentially contaminated materials around.
o Stay where you are, although you should back away from the suspicious material so that you are not, for example, leaning over it on your desk.
o Call 911 emergency responders immediately and describe the situation to the operator. He or she will give you further advice on what to do.
o Call your own building security (or the person in overall charge)
o Avoid spreading the contents of the suspicious letter or parcel (i.e., by moving them or showing them to other people).
o Keep other people away from your immediate area until emergency responders arrive. (Tell people, “Don’t come in here, we may have spilled some nasty stuff. The police are on the way.”)
o Remember, that your own risk is very small once emergency responders take charge and that the early medical treatment you will receive is effective.
In addition to these measures, advise the security people in your building (or such other people in charge) to do the following:
o Meet the emergency responders at the building entrance to escort them to your location
o Shut down all activity in the mailroom and ask employees the wait for further instructions
o Post staff around your area to direct people not to enter
o Instruct other staff in the building to avoid opening any mail or parcels until cleared to do so by emergency responders
o Reassure other staff in the building as soon as possible (via public address or e-mail alert or other means) that no immediate threat exists. One approach is to inform staff “A suspicious letter has arrived in our building. We believe it is almost certainly a false alarm or a hoax, but we have to follow emergency procedures in the meantime. Please remain where you. We will give you further information soon.”
o Keep track of people who may have been in close contact with the people or area where the suspected exposure took place. Health authorities may want to contact them for testing, should the exposure turn out to have involved anthrax. This applies especially to visitors to the site (non-employees) who could otherwise be missed.
Should you go and wash your hands and take a shower?
In most circumstances, no. Doing so will have the potential to spread any possible contaminant throughout the building. Wait for emergency responders, who will advise you on how best to decontaminate yourself and the area.
In cases where access to emergency assistance is not available or is hours away (although it’s hard to think of circumstances in which this would be the case) consider the following:
o If possible, isolate the suspected materials (such as by placing all possibly contaminated items in plastic garbage bags and tying them shut) and remove yourself from the immediate area
o Take steps to ensure that others will not come into that area or be exposed to the material (such as cordoning off the area)
o Wash you hands
o Remove your clothing and place outer garments that may have been exposed (such as if they have spilled powder on them) in a sealed container
o Shower thoroughly
o Seek help from emergency responders at first opportunity

Isn’t washing your hands better than nothing?

It may not be “better than nothing”. The simple fact of the matter is that if there is no suspected exposure, you don’t have to do anything. But if the is any suspected exposure, you have to do everything. Washing and/or showering are only one part of a proper decontamination. Merely washing your hands will neither decontaminate the area where the exposure took place (if there was an exposure) nor prevent others from being exposed.
In order to properly handle a suspected exposure (such as after opening a letter and finding suspicious material) you will have to follow the entire emergency procedure as outlined above — starting with notification of authorities and then following through on the entire process under their direction. If hand-washing or other measures are taken in place of other, more effective measures, they can give a false sense of security.

What should you do if you believe you have symptoms of anthrax disease from an earlier, undetected exposure?

There have been no cases reported in Canada. However, if you believe that you were exposed, or if you have symptoms consistent with anthrax, you should do the following:
o Alert the authorities (police) to the circumstances of your suspected exposure (such as if you opened a suspicious letter at work and observed a powder).
o Seek medical assistance immediately.

Links
Health Canada: http://www.hc-sc.gc.ca/

A message about anthrax from the Canadian Medical Association:
http://www.cma.ca/cmhsn/anthrax.htm

The following article appeared in the September, 200o issue of OHS Canada Magazine:
DISASTER PLANS: FAILING TO PLAN IS PLANNING TO FAIL
By Rem Gaade

How do you plan for the unthinkable? The first step is to understand that nothing is “unthinkable”.

The following articles appeared in Hazardous Materials Management magazine, a sister publication to OHS Canada:

“Toxic Terrorism: Are industry and governments prepared for nuclear, biological, chemical and other threats?”
http://www.hazmatmag.com/library/articles/0299.html

“Anthrax: The use of anthrax as a bacterial warfare agent and the human health effects on humans.”

http://www.hazmatmag.com/library/chemical/0800.html

“The Tools of Terrorism: Killer germs and chemical attacks.”
http://www.hazmatmag.com/library/articles/0299s1.html