Emergency Preparedness

Kern Medical Bioterrorism Response Guide Section 2-A-1 – Anthrax ( Bacillus anthracis )

ANTHRAX (BACILLUS ANTHRACIS) OVERVIEW

Any suspected case of anthrax ( Bacillus anthracis ) MUST BE TREATED AS A PUBLIC HEALTH EMERGENCY and reported to the infection control practitioner [ insert telephone number ] and the local health department [ insert telephone number ] immediately.

Naturally Occurring Anthrax Anthrax, a gram-positive spore-forming rod, is a zoonotic disease rarely seen in the United States. In humans, anthrax has three somewhat clinically distinct syndromes: cutaneous, inhalation and gastrointestinal. The cutaneous form occurs most frequently on the hands, forearms, neck and face of persons working with infected livestock (cattle, sheep, goats and horses). Gastrointestinal anthrax is transmitted to humans by ingesting insufficiently cooked meat from infected animals. Inhalation anthrax, also known as Woolsorter’s disease, results from the inhalation of spores and occurs primarily in persons who handle contaminated hides, wool, and furs. Bioterrorism Epidemiology Anthrax bacteria are easy to cultivate and spore formation is readily induced. The spores are highly resistant to sunlight heat and disinfectants. As a bioterrorism agent, anthrax can be delivered as a bioaerosol. Anthrax is not transmitted from person to person. If anthrax spores are released intentionally as a bioaerosol, there will be a sudden influx of many persons with severe flu-like symptoms seeking treatment in the hospital’s emergency rooms. Most likely, these persons will require assisted ventilation and immediate antibiotic support. The mortality rate will be high even in the setting of modern medical technology. Until October 4, 2001 inhalation anthrax had not been reported in the U.S. since 1976. Between October 4 and November 2, 2001, 10 confirmed cases of inhalation anthrax caused by the intentional release of Bacillus anthracis in major mail sorting facilities on the East coast were identified. These 10 cases provided a wealth of knowledge about diagnosing and treating the disease. (Jernigan JA, Stephens DS, et al. Bioterrorism- Related Inhalation Anthrax: The First 10 cases Reported in the United States. Emerging Infectious Diseases. 2001;7:933-944.) Cutaneous anthrax also occurred in the 2001 mail-related incidents. Most of these cases occurred in mail handlers, presumably as the result of direct cutaneous contact with mail or environmental surfaces contaminated with anthrax spores. Detailed information on the diagnosis and treatment of anthrax is available at the CDC bioterrorism web site ( www.bt.cdc.gov )

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