The document discusses anthrax, its transmission, symptoms, and prevention. It summarizes research on the effectiveness of an anthrax vaccine, finding it over 92% effective based on a study of workers exposed at contaminated mills. Public health experts recommend mass production and distribution of the vaccine in case of a bioterrorism attack involving anthrax. The best prevention strategies involve limiting exposure opportunities through the environment and host immunity.

1. 1Neeck
Anthrax Acts Atrociously
Dr. Meyer
Community Health Evaluation
Michelle Neeck
August 3, 2011

2. 2Neeck
As the world becomes more interconnected it makes many things such as commerce and
communication much more possible to travel great distances in decreasing amounts of time,
while this is a positive aspect for both financial and personal reasons there can be a down side to
being so connected to all parts of the world. One area of study where this connectedness may not
be the most positive is in the study of epidemiology. Epidemiology as covered in the course is
“The study of the distribution and determinants of health-related states or events (including
disease), and the application of this study to the control of diseases and other health problems.”1
Being in a much more connected world, the spread and the threat of disease is posing a much
greater threat to people since for instance, the polio outbreak that occurred in many parts of the
world during the early 20th century or most notably the bubonic plague which ravaged Europe
and Asia wiping out thousands of people and left towns virtually uninhabitable. The prevention
of disease and its ability to progress depends upon the knowledge of the disease and how best to
prevent it from spreading and what precautions major cities should take in order to prevent the
massive out breaks of the past. One of these diseases or shall we say biological agents that has
received increasing interest in the public eye is Anthrax. Anthrax is “an infectious disease
caused by bacteria called Bacillus anthracis. Infection in humans most often involves the skin,
the gastrointestinal tract, or the lungs.”2
Anthrax poses a very real threat to communities since there are several ways humans can
be infected. One way in which a person can affected with anthrax is through the skin. This is
often called cutaneous anthrax and occurs when the bacteria or the spores of anthrax come into
contact with the skin such as through infected animal hide or even handling the meat of the
1 ("World health organization,"2011)
2 (ww.ncbi.gov)

3. 3Neeck
animal may be the source of exposure.3 Once exposed a red bump like a mosquito bite appears,
but unlike many bug bites the skin becomes necrotic and a black lesion forms. This particular
type of anthrax is very responsive to antibiotics, however if not treated it will spread to the rest
of the body resulting in death.4 People who are most likely to come into contact with this kind of
anthrax are possibly farmers and those with direct contact with the hide such as tanners. The
second way of being infected with anthrax is through the respiratory tract. An infection of
anthrax can result when a person inhales the spores. After the spores are inhaled the bacteria then
begins to incubate in the lungs and from there spreads to the rest of the chest cavity and to the
lymph nodes. One of the problems that arise from inhalation of the anthrax virus is that once
inside the lungs the bacteria produces toxins and once it has reached the lymph nodes these
toxins can be devastating.5 The symptoms of anthrax inhalation can make themselves present a
week after exposure or can remain dormant and not make it known until a month later. Some of
the common symptoms associated with anthrax are listed as follows on National Institute of
Allergy and Infectious Disease website: fever, nausea, vomiting, aches, and fatigue. Some of the
symptoms that individuals may present when the disease has progressed are labored breathing,
shock, and death. Many patients with anthrax in the lungs are faced with a 75% mortality rate
even if they receive the treatment needed.6
The most recent outbreak occurred in 2001 when 11 people were infected through the
mail system. Out of the 11 that were infected 6 of those survived. Many people of the United
States feared more outbreaks, but before the incident in 2001 the last reported case was in 1976
when man received infected yarn from outside the country and as a result died from inhaling the
3 ( Anthrax 2010)
4 ( Anthrax 2010)
5 ( Anthrax 2010)
6 ( Anthrax 2010)

4. 4Neeck
spores on the yarn.7 The third known way a person can become infected with anthrax is through
the gastrointestinal tract. People may become infected with anthrax in the digestive system by
eating contaminated meat.8 Symptoms of this type of anthrax exposure are stomach pain,
diarrhea, and loss of appetite.9 If the individual is able to receive the proper antibiotic treatment
they are usually cured. If a person does not receive treatment there is a 50% chance the
individual will die. Most occurrences of this type of anthrax are found in Africa, the Middle East,
and Asia.10
Although generally speaking anthrax before the 21st century was not considered a threat,
but after the incident in September 2001 anthrax once again became of concern to public health
officials as a possible use for bioterrisiom. In 2005 a journal article was published entitled
Evaluation of public health interventions for Anthrax: a report to the secretary's council on
Public Health Preparedness.11 Written by authors Wein and Craft the journal article delves into
how officials should respond in the event of a bioterriost attack involving the bacteria anthrax.12
The authors used several different types of models to come to a conclusion. Some of the models
Wein and Craft used in their analysis include the progression of the disease, how long
individuals would wait in line to receive the antibiotic and what the best method of distribution
would be for such an event.13 The authors used several different types of public health policies to
determine what kind of intervention would be the best in the event of a bioterrorist attack. After
comparing several different models the authors found that the best method would be to create a
rapid response team to distribute the antibiotics necessary. Wein and Carter also found that in
7 ( Anthrax)
8 ( Anthrax 2010)
9 (Anthrax 2010)
10 ( Anthrax 2010)
11 (Wein, & Craft, 2005)
12 (Wein, & Craft, 2005)
13 (Wein, & Craft, 2005)

5. 5Neeck
order to handle the surge of individuals after the attack was to make sure there was enough to
provide vaccines and antibiotics for an extra 100 million people.14 The vaccine would be able to
spare many lives in the event that a person may become infected with the spores or bacteria. The
journal does not specify if the vaccine would help in the prevention of the bacteria in all manners
that it enters the body or if it works for only the cutaneous and gastrointestinal manner of
infection since inhaling the spores has been shown to be the most lethal. This kind of
preparedness that was analyzed by Wein and Craft could possibly be something that might be a
very real future if there is not some kind of peace agreement between terrorists and nonterrorist
in the near future.
Preventing the spread of disease was also a part of the coursework for this class. Chapter
7 entitled Epidemiology and Control of Infectious Diseases. Within the chapter the author
Valains discusses the three factors that can make an infectious disease such as anthrax topics for
research and prevention as carried out by Craft and Wein. The three factors are as follows:
environment, agent, and host. An agent is the actual infectious disease which in this case is
anthrax. Valains describes that an infectious agent such as anthrax elicits one of the following
mechanisms as they are referred to: production of a toxin, invasion and infection, and production
of an immune response in the host that produces the disease.15 As mentioned earlier anthrax can
produce a toxin when it is inhaled and the buildup of toxins can result in death. In the invasion
and infection scenario this could possibly fall under the description of cutaneous anthrax
exposure when before the skin becomes necrotic appears as an inflamed mosquito bite. The third
is not like anthrax because the disease can take an effect on its own without an immune response
14 (Wein, & Craft, 2005)
15 (Valanis,1999)

6. 6Neeck
from the body. Second the right environment is key to the spreading of a disease which is can
what make an infectious disease so dangerous. The environment can also help aid in the
transmission of the agent to its host. In the case of anthrax there are several kinds of
environments such as inside the animals themselves and their hides.16 The spores however, can
be found in all kinds of environments that allow the spores to be carried, such as the mail system
as was the case in the September attacks. The ability for anthrax or anthrax spores rather to make
its home in many different kinds of environments is one the many reasons many fear it could be
used as weapon during a bioterriost attack. The third and final way to prevent an infectious
disease outbreak it by making sure the infectious disease, anthrax, has no susceptible host ,
meaning that if an individuals were to come into contact with the disease that the human body
would not react to it either because of immunity or inherent resistance.17 Because it is very hard
to establish with persons would indeed have an inherent resistance, the best method would be to
provide immunity for all persons risk by way of inoculations. The vaccine given may give the
person like long immunity because a vaccine is made up of parts of the infectious agent. For the
anthrax vaccine people would be inoculated with a part of the anthrax pathogen in order for the
population to build immunity.18 The preventative measures mentioned above are the best
methods for providing the best method for the preventing the spread of any kind of infectious
disease such as the spread of anthrax and how would preventative measures should be
undertaken.
Following multiple responses from public health officials that in order to prevent the
spread of anthrax in case of attack the best line of defense would be an anthrax vaccine, in the
16 (Valanis,1999)
17 (Valanis,1999)
18 (Valanis,1999)

7. 7Neeck
1950s several medical doctors began doing research to create an effective vaccine. There were
four mills in which researches found traces of contaminated materials and used the workers of
those mills to be subjects of a study to determine the effectiveness of the anthrax vaccine that
showed to have positive results in animals, in that the animals did not contract anthrax,
specifically they did not contract subcutaneous anthrax.19 The vaccine created contained
aluminum potassium sulfate given in .05 ml booster doses over a period of time and was given to
random sample population while the other received a placebo.20 After an initial period of giving
participants in the study vaccines containing either a placebo or the anthrax vaccine results show
that those who received the vaccine did not present symptoms of anthrax when exposed to the
agent in the mills, but those who received the placebo did display a reaction to the anthrax
bacteria.21 It was also noted in the study that some of the participants receiving the actual anthrax
virus and did not complete the full round of booster inoculations in some cases did display
subcutaneous anthrax symptoms in the form of legions on the skin.22 Overall though, the vaccine
was found to be statically effective. After receiving the data and analyzing all the information
that collected during the study, it was found that the vaccine was over 92 percent effective and
could therefore be used as a suitable vaccine for the prevention of anthrax.23
Anthrax is a deadly bacterium that can enter the body in variety of ways and if not treated
quickly with the proper medication death will surely be the result. Anthrax was not a major
threat before September 2001 although studies had been conducted on the bacteria because of its
known potency and ease of transmission, it was after the terrorist attacks with the deadly bacteria
19 (Brachman,Gold, Plotkin,Fekety, & Werrin,1962)
20 (Brachman,Gold, Plotkin,Fekety, & Werrin,1962)
21 (Brachman,Gold, Plotkin,Fekety, & Werrin,1962)
22 (Brachman,Gold, Plotkin,Fekety, & Werrin,1962)
23 (Brachman,Gold, Plotkin,Fekety, & Werrin,1962)

8. 8Neeck
that epidemiologist once again placed a high degree importance on properly containing and
providing adequate protection in the form of mass production of the anthrax vaccine to be given
out to the population in a time of need. Much research has been done this according to
epidemiologist has been found to be the best method and further research and understanding of
such a deadly bacteria continues with the increasing and ongoing threat of terrorism and
continual expansion of knowledge in the medical field.

9. 9Neeck
Bibliography:
Anthrax.(2010, August4).Retrievedfrom
http://www.niaid.nih.gov/TOPICS/ANTHRAX/Pages/research.aspx
Brachman,P, Gold,H, Plotkin,S,Fekety,R, &Werrin,M. (1962). Fieldevaluationof ahumananthrax
vaccine.Retrievedfromhttp://ajph.aphapublications.org/cgi/reprint/52/4/632.pdf
Valanis,B.(1999). Epidemiology in health care. Stamford,CT: Appleton&Lange.
Wein,L, & Craft,D. (2005). Evaluationof publichealthinterventionsforanthrax:areportto the
secretary'scouncil onpublichealthpreparedness. BiosecurBioterror,3. Retrievedfrom
http://ucdper.org/node/8573
World healthorganization.(2011).Retrievedfromhttp://www.who.int/en/