Biological Terrorism: Anthrax

On September 18, 2001, one week following the
destruction of the twin towers by terrorists,
another terrorist used the U.S. Postal Service to
deliver mail containing anthrax spores that
ultimately killed five people, infected
seventeen people, and exposed thousands of
others to this deadly bacteria. While only a few
people were killed compared to the destruction
of the twin towers, the anthrax scare reached
across America affecting every citizen.

The contamination spread throughout the postal
system to office buildings and residences of
intended targets. The potential existed for cross
contamination from a few pieces of contaminated
mail to anyone, anywhere in the United
States. Most of us knew little about anthrax then,
and most of us know little about anthrax now. Do
you know how anthrax is spread? Do you understand
the seriousness of anthrax infection, that it has a high
death rate? Would you recognize possible anthrax
spores? Would you know how to report suspected
anthrax?

Do you know how anthrax is spread?
Do you understand the seriousness of anthrax
infection, that it has a high death rate?
Would you recognize possible anthrax spores?
Do you know how to report suspected anthrax?

 Throughout our history,
anthrax has been
described as a plague that
has killed our livestock
and diminished our
population.
 While descriptions are
sometimes vague, fitting
anthrax, bubonic plague,
and other diseases,
anthrax fits the
description of the Biblical
5th and 6th plagues.
Picture Source: Microsoft ClipartCNN. (2001). Timeline: Anthrax through the ages. Retrieved October 2, 2010, from:
http://edition.cnn.com/2001/HEALTH/conditions/10/16/anthrax.timeline/

 Exodus 9:1-7 describes the
fifth Egyptian plague
which occurred
approximately 1500 B.C.
 This plague affected
livestock, camels, horses,
donkeys, sheep, and goats
and was most likely
anthrax (1.1).
 The sixth plague, known
as the plague of boils, also
describes anthrax.
Picture Source Microsoft Clipart.CNN. (2001). Timeline: Anthrax through the ages. Retrieved October 2, 2010, from:

 If you believe that 2001 was the first attempt at
using anthrax as a biological weapon against
the United States, you would be wrong.
 In 1915, during World War I, German agents
injected horses, mules, and cattle with anthrax
on their return to Europe (1.2).
CNN. (2001). Timeline: Anthrax through the ages. Retrieved October 2, 2010, from:

 In 1937, the Japanese began biological
weapons testing in Manchuria that
included the use of anthrax (1.3).
 The United States acquired a lot of
biological weapons information from the
Japanese at the end of World War II.
However, Japan was not the only nation
experimenting with anthrax as a
biological weapon.
 Great Britain experimented with anthrax
on Gruinard Island off the coast of
Scotland in 1942 (1.4). (Gruinard Island
was only recently decontaminated.)
 In 1945 Iraq, approximately one million
sheep were killed by anthrax (1.4).
Gruinard Island
Picture Source: http://en.wikipedia.org/wiki/File:Gruinard_Island.jpgCNN. (2001). Timeline: Anthrax through the ages. Retrieved October 2, 2010, from:

 With information
gathered from the
Japanese and our allies,
the United States worked
on our own biological
warfare program at Fort
Detrick, Maryland during
the 1950s and 1960s (1.5) .
 However, in 1969
President Richard Nixon
put an end to our
offensive biological
weapons program
allowing only defensive
work to continue (1.6).
Picture Source:
http://en.wikipedia.org/wiki/File:Leonid_Brezhnev_and_Richard_Nixon_talks_in_1973.png

 In 1970, the Food and Drug administration approved a
vaccine for anthrax that was primarily in tended for those
working with livestock that might be at risk (1.7).
 In 1972, an international convention outlawed stockpiling of
biological weapons (1.7).
 From 1978-1980, an anthrax epidemic occurred in Zimbabwe
that infected over 6,000 people, killing well over 100 (1.7).
 In 1979, the Soviet Union accidentally released aerosolized
anthrax that spread from a military facility into a
neighboring community killing 68 people (1.7).

 While the 1980s were quiet regarding anthrax, it re-
emerged during the 1990s. In 1991, our troops were
vaccinated against anthrax in preparation for the Gulf
War (1.8).
 In 1993, the terrorist group, Aum Shinrikyo, released
anthrax in Tokyo, but no one was reportedly infected
(1.8).
 In 1995, Iraq admitted to producing 8,500 liters of
anthrax as part of its biological weapons program. In
1998, the Secretary of Defense approved a plan for all
military service members to be immunized against
anthrax (1.8).

In September 2001,
letters containing
anthrax spores were
mailed several news
media offices and two
Senators. The FBI
case investigating this
incident became
known as Amerithrax
(1.9).
Picture Source: Microsoft ClipartCNN. (2001). Timeline: Anthrax through the ages. Retrieved October 2, 2010, from:

Anthrax occurs worldwide
primarily in herbivores
such as sheep, goats,
horses, and cattle.
Humans who come in
contact with infected
animals may become
infected.
The most common entry
route for anthrax is
through the skin with
gastrointestinal and
inhalation anthrax being
much less common.
Reference: Friedlander, A.M. (1997). Medical aspects of chemical and biological warfare. U.S. Army.
Retrieved October 2, 2010 from
http://www.bordeninstitute.army.mil/published_volumes/chemBio/Ch22.pdf
Picture Source: Microsoft Clipart

 However, inhalation anthrax
occurred for the first time from
people working with wool and
goat hair who caused aerosols
of the spores that were
subsequently inhaled.
 This occurred during the later
part of the 19th century which
probably makes anthrax the first
occupational respiratory illness.
 The infectiousness of anthrax
spores combined with its high
mortality rate, especially when
inhaled, makes it ideal for use
as a biological weapon.
Picture Source: Microsoft ClipartReference: Friedlander, A.M. (1997). Medical aspects of chemical and biological warfare. U.S. Army.

 Bacteria, fungi, algae, and
viruses are micro-
organisms that most of us
are familiar with. Bacteria
are usually round, spiral,
or rod shaped single-
celled micro-organisms
that may be gram positive
or gram negative.
 Bacteria typically live in
soil, water, organic matter,
plants, and animals (2.1).
Reference: Meriam-Webster.com. (2010). Bacterium. Retrieved November 2, 2010, from
http://www.merriam-webster.com/dictionary/bacterium

 Anthrax is a bacteria that is a
non-motile, spore forming rod
(2.2) (CDC, Slide 3, 2001.)
 Spores are reproductive
structures. They are similar to
seeds, but lack the stored food
of seeds (2.3). Spores can
survive very harsh conditions.
(Stephens, slide 22, 2001.)
 When conditions are favorable,
spores develop into new
organisms. These spores can be
spread from animals to humans.
Physical contact, ingestion, and
inhalation of spores results in
infection (Stephens, slide 22, 2001.)
Picture Source: Stephens, D.S. (2001). Clinical Anthrax. CDC. Retrieved October 2, 2010,
from http://www.bt.cdc.gov/documentsapp/Anthrax/Clinical/ClinicalAnthrax.pdf
References: CDC. (2001). Bacillus anthracis. CDC. Retrieved October 2, 2010, from
http://www.bt.cdc.gov/agent/anthrax/SlideSetAnthrax.pdf
Stephens, D.S. (2001). Clinical Anthrax. CDC. Retrieved October 2, 2010, from
http://www.bt.cdc.gov/documentsapp/Anthrax/Clinical/ClinicalAnthrax.pdf

Anthrax is spread by contact with spores, not
person to person. There are three clinical forms
or manifestations of anthrax. They are:
 cutaneous,
 intestinal,
 and inhalation.

Cutaneous anthrax is the most common,
naturally occurring form of anthrax.
 Cutaneous anthrax begins with
spores entering the skin through an
opening such as a scrape or cut.
 It first appears as a papule that
progresses through a vesicular stage
before becoming a depressed black
necrotic ulcer called an eschar.
 Cutaneous anthrax is the most
common naturally occurring form of
the disease.
 The incubation period for cutaneous
anthrax is 1-5 days (3.1)
Eschar, Day 10.

Intestinal anthrax begins with spores entering the digestive system
when grazing animals ingest spores on contaminated land or
when eating contaminated feed.
 Likewise, humans acquire intestinal anthrax by ingesting
contaminated food.
 Gastrointestinal anthrax begins with nausea, vomiting, and fever.
 Severe abdominal follows along with the possibility of vomiting
with blood and a buildup of fluid in the abdominal cavity.
 The incubation period for gastrointestinal anthrax is 2-5 days (3.2).

Inhalational anthrax begins with spores entering the
lungs from breathing in anthrax spores.
 At first inhalation anthrax develops non-specific
symptoms that include malaise, fatigue, muscle
aches, and fever.
 There might also be a nonproductive cough with
chest discomfort. These symptoms last 2-3 days.
 A slight period of improvement may follow.
This is followed by a sudden onset of respiratory
distress with labored breathing, stridor (a shrill
noise), bluing of the skin, increased chest pain,
and severe sweating.
 The chest and neck area may also become
swollen.
 The incubation period for inhalation anthrax is
1-6 days (3.3).
Anthrax Chest X-ray.

Each of these forms of anthrax has a different mortality rate.
 The mortality rate for cutaneous anthrax is 20% when
untreated and 1% when treated with antibiotics (3.4).
 The mortality rate for gastrointestinal anthrax is 25-60%
with an unknown role for antibiotics (3.5).
 The mortality rate for inhalation anthrax is about 97% when
untreated and about 75% when treated with antibiotics (3.6).
Antibiotic treatment immediately after exposure, before any
symptoms appear, greatly improves chances of survival!
Reference: CDC. (2001). Bacillus anthracis. CDC. Retrieved October 2, 2010, from
http://www.bt.cdc.gov/agent/anthrax/SlideSetAnthrax.pdf

Modern research for developing anthrax as a
biological weapon began over 80 years ago.
This research seeks to genetically enhance anthrax
and to weaponize it.
Genetic enhancements to anthrax make it more
resistant to antibiotics and vaccines, easier to
handle, and deadlier (4.1).
Reference: Inglesby, T.V. (2002.) Anthrax as a Biological Weapon, 2002. JAMA. 2002;287:2236-2252.
Retrieved November 12, 2010 from http://jama.ama-assn.org/cgi/content/full/287/17/2236

Weaponization of anthrax
makes it easier to
deliver through the air.
 This process starts with
drying the spores, then
proceeds to milling the
spores, then
neutralizing the spores
so they will float in the
air.
 Unaltered weaponized
anthrax appears as a
grayish-white powder
(4.2)
Picture Source: Microsoft Clipart.Reference: Park, A.(2001.) How anthrax is weaponized. Time. Retrieved November 12, 2010
from http://www.time.com/time/magazine/article/0,9171,1001161,00.html#ixzz1578Sp0ZK

 Once anthrax has
been weaponized, it
can be delivered by a
variety of means.
 Aerosolized delivery
of anthrax could be
made by a bomb, crop
duster, fire
extinguisher, or
heating and
ventilation system of
a building (4.3)

 Other methods of
delivery systems
include mail and
consumable goods (4.4).
 Anthrax spores can
even be implanted in
cigarettes and given to
unsuspecting Sailors in
foreign ports as an
apparent gesture of
goodwill (4.4)

If you suspect anthrax, CALL 9-1-1 immediately.
 Key elements for reporting suspected anthrax
includes:
 identifying yourself,
 your location,
 where the suspected anthrax is located,
 a description of the suspected anthrax, and if you
and others have been exposed (5.1)
Reference: http://en.wikipedia.org/wiki/IPad

The first responder on the scene (law enforcement officer,
fireman, or emergency medical technician) will take charge
of the scene as the Incident Command until relieved by
other competent authority. You and others may require
decontamination prior to receiving treatment or being
transported to a hospital. Decisions like this will be the
responsibility of the Incident Commander.
As additional resources arrive, the first responder might be
relieved by others as the Incident Command System
expands to accommodate the size of the emergency. The
Incident Command System is a flexible tool for command,
control, and coordination of emergency services (5.2).

If the substance is
identified as anthrax,
the Homeland
Security Advisory
System will likely
change. Each level
requires specific
actions by the
government. The five
color-coded levels are
identified by the chart
on the right (5.3).
Picture Source: Wikipedia. Downloaded on October 23, 2010 from:
http://en.wikipedia.org/wiki/File:Hsas-chart_with_header.svg
Reference: Wikipedia. Downloaded on October 23, 2010 from:
http://en.wikipedia.org/wiki/Homeland_Security_Advisory_System

Follow the instructions of the Incident
Commander at the scene, and watch for
additional instructions by our government
after any incident or change in the Homeland
Security Advisory System.

Biological Terrorism: Anthrax

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