Biowar 2002: 

Anthrax:

At this writing reports indicate a low, but not zero risk of this deadly ancient bacterial disease. Most patients have had the less dangerous skin infection, and have been exposed to spores sent in the mail. But anthrax lung disease in a NY Eye & Ear worker and in a 94 year old Connecticut woman is unexplained at this time, and preparation for additional patients is prudent.

What is Anthrax? It is a bacterial illness caused by exposure to the naturally occurring spores – either a skin pustule that turns black, or a respiratory illness that mimics influenza. There is also an intestinal form, which hasn’t been seen at this writing.

Who is at Risk? The highest risk appears to be in postal workers near government or major media offices. Next highest risk is in those who work in such offices, particularly those who open the mail.

What are the Symptoms? Cough, fever, chills and muscle aches start 3 days to 6 weeks after exposure to the spores. Patients are sick for about 2-3 days, then appear to be getting better for 1-2 days. Then they "crash" with severe damage to the lungs, "air hunger" and a death rate of 80%+.

What is the Treatment? Ciprofloxin (Cipro) is the only currently licensed antibiotic. Penicillin, doxycycline (Doryx, etc), Avelox and Tequin also work on the strains seen so far. Speed is of the essence in starting treatment!

What Can be Done?

First, get your flu shot! The best way to decide on anthrax vs. flu is to avoid all such symptoms, and since flu is so frequent, and the vaccine so effective, get it!

For serious respiratory illness, we’ll see you right away and assess your risk. We have the ability to test for anthrax and for flu. But the most important test is how you do! We’ll ask you to call us the following days, and we’ll carefully track your progress. We are convinced that the problems seen so far would largely have been avoided with follow-up. IF antibiotics are needed, it’ll be for 60 days.

Is Anthrax Contagious? NO!! It cannot be spread person to person.

Is There a Vaccine? Yes, but it’s not available for civilian use. And none has been made since 1998.

This would be a whole different level of problem. For one thing, it is highly contagious person to person. The attack rate is about 90% just by being in the same room! The disease was last seen in 1977. One of the final patients was in a German hospital; he was promptly isolated, but still infected 11 other people on 3 floors! There’s no known effective treatment - only an untested antiviral medicine, cidofovir (Vistide). Those who were vaccinated over 20 years ago may have immunity, but may NOT. There are some 12-15 million doses of vaccine in the country. They won’t be used unless definite cases are seen, and then they will go to military and public safety people first. If smallpox starts and you have a rash, DO NOT come in! We’ll send someone to you!

Botulism: the toxin of this spore forming germ can cause muscle paralysis, including breathing failure. But the germ is treatable with antibiotics, and there is an antitoxin.

Plague: is another treatable germ; but it CAN be spread from person to person. In the most serious form a pneumonia develops after 2-4 days. A vaccine is being developed.

Tularemia: is another treatable germ that causes a flu-like illness, then pneumonia. It can NOT be carried person to person. Untreated, 35% die, but treatment is generally effective.