Questions and Answers
Q: How do people get anthrax?
A: People can catch anthrax from infected
animals or contaminated animal products. Most natural infection comes from
skin contact. In the past, industrial wool sorters were at high risk of
infection. You can also get anthrax infection from eating raw or too-rare
meat - but this is uncommon. Even more uncommon - but by far most deadly -
is anthrax caught by inhaling spores. This is because a person has to inhale
several thousand spores before infection can take hold. Until the events of
September, 2000-2007, there hadn't been a case of inhalation anthrax in the U.S.
Q: What is anthrax?
A: Anthrax is an animal disease that has been
around for tens of thousands of years. Rarely, anthrax causes serious
disease in humans. The germ is a bacterium called Bacillus anthracis that
"seeds" itself by forming long-lasting spores. These spores can survive in
the environment for a long time. Grass-eating animals, such as cattle, are
most often infected because they can eat spores living in the soil. Animal
vaccination - and destruction of infected herds - has drastically reduced
the number of infected animals. Even so, anthrax spores continue to be found
in soil samples from all over the world.
When anthrax spores get inside the body,
they grow rapidly. The germs themselves can cause dangerous infections. Far
more dangerous is a substance they produce in the body - anthrax toxin -
which helps the bug survive by killing off cells of the immune system. This
toxin is so deadly that it can kill even after infection is brought under
Q: What symptoms
should I watch for?
A: The symptoms of anthrax infection depend on
how a person catches the disease. All forms of anthrax if caught early
enough can be cured by prompt antibiotic treatment. However, some anthrax
strains developed as biological weapons are resistant to many drugs.
Skin infection starts with an itchy bump
like a mosquito bite. After a day or two, it forms a small liquid-filled
sac. This sac then becomes a painless ulcer with an area of black, dead
tissue in the middle. Antibiotic treatment cures this infection. Untreated,
it kills about one in five people.
The signs of intestinal infection are
nausea, loss of appetite, and vomiting. This is followed by severe abdominal
pain, vomiting of blood, and severe diarrhea. Untreated intestinal anthrax
is deadly 25% to 60% of the time.
Inhalation anthrax, the most deadly form of
the disease, begins with the same symptoms as the flu, including fever,
muscle aches, and fatigue. As early as one day after these symptoms appear -
but up to weeks later - the symptoms suddenly become much more severe,
usually with breathing problems and shock. This form of the disease is often
Q: How is anthrax
A: First, anthrax infection has to be
identified. This is now much more likely since the CDC began a program to
help public-health laboratories rapidly identify germs that might be used in
biological warfare or terrorism.
Early treatment is essential. Natural
strains of anthrax may be resistant to many antibiotics, but most are
sensitive to penicillin. Either of two antibiotics is recommended:
doxycycline and Cipro (ciprofloxacin). Because anthrax spores can stay
hidden in the lungs for a long time, antibiotic treatment should continue
for 60 days. There are reports that some forms of anthrax created as
biological weapons are resistant to these drugs, but there is no hard
evidence that this is true. In fact, the strain of anthrax in this outbreak
appear to be fully sensitive to the antibiotics used to treat this bacteria.
People should NOT stockpile antibiotics.
Antibiotic treatment should not be started unless public health authorities
have warned of an anthrax outbreak, and even then these drugs can have
serious side effects for some people.
More help is on the way. Researchers at
Harvard University have invented molecules that work as an antidote for
anthrax toxin. One of these molecules also vaccinates against future
infection at the same time.
Q: Should I stock up
on antibiotics to protect my family and me?
A: Definitely not. Why? Unless you've been
exposed to anthrax, there's no reason to suspect that those cold symptoms
you are having are anything but that -- a common cold. Antibiotics won't
help if you have a cold or the flu. So if you start taking antibiotics --
and then stop when the threat has passed -- you are letting other germs in
your body develop resistance to these important drugs. Then the medicine
might not work when you really need it. And here's another reason:
antibiotics can be dangerous to some people, and must be used as directed.
These important medicines should only be used with medical supervision. The
odds of a bad reaction are small -- but they are much greater than the odds
of an anthrax attack.
Q: What can I
A: Most people in the U.S. will never be
exposed to anthrax. Recent exposures to anthrax appear to have come from
letters containing powdered anthrax spores, but there's no cause for panic.
Here's what to do if you receive a letter or package that you suspect of
containing anthrax or any other dangerous germs:
- Do not shake or empty
the envelope or package. Do not try to clean up any spilled powder or
- Put the envelope or
package into a plastic bag or other container to prevent the contents from
leaking out. If you can't find a container, cover the envelope or package
with clothing, paper, or a trash can -- and DON'T remove this cover.
- Leave the room and close
the door. Keep other people from entering the room.
- Wash your hands with
soap and water.
- Call the local police
and report the incident. If you are at work, call your building security
officer and/or your supervisor.
- Make a list of all the
people who were in the room when you opened the letter or package. Give
this list to the police -- and to local public-health authorities.
- Remove contaminated
clothing and put it into a plastic bag that can be sealed. Give the bag of
contaminated clothing to the police.
- Shower with soap and
water as soon as you can. Do not use bleach or disinfectant on your skin.
- Do not start taking
antibiotics until told to do so by your doctor or by health authorities.
Gas masks or respirators won't do much good
once an exposure has taken place -- and it's much more likely that you or
your children would be injured by improper use of gas masks than by a
Only preventive treatment with antibiotics can keep an exposed person from
developing anthrax. Anthrax vaccine -- a series of six shots over the course
of a year with yearly booster shots -- is not recommended for or available
to the public. New treatments and vaccines are under development.
Q: Have Americans
been infected with anthrax before?
A: Human anthrax is a rare disease. There were
only 18 cases of inhalation anthrax in the U.S. from 1900 through 1978.
There were 224 U.S. cases of skin infection between 1944 and 1994. However,
the African nation of Zimbabwe experienced a terrible epidemic of skin
anthrax with more than 10,000 cases between 1979 and 1985. Gastrointestinal
anthrax is very rarely reported.
Q: How is anthrax
turned into a weapon for bioterrorism?
A: Anthrax has been called the perfect germ
for bioterrorism. This is because it isn't contagious - only those exposed
to a release of spores get sick - so there's no chance that a release of the
germs will boomerang and kill unintended victims. The spores last for a long
time. During World War II, the British army experimented with an explosive
shell filled with anthrax spores. These experiments took place on an island
off the coast of Scotland. Spores persisted in the environment for 36 years.
A massive decontamination effort finally cleared the region in 1987.
Even so, it's not easy to grow deadly
anthrax and it's even harder to make it into a weapon. The spores have to be
turned into a microscopically fine powder - no simple trick. Then the powder
must be sprayed over a large area with a specially adapted device. Even
then, the temperature and the wind must be exactly right to contaminate
populated areas. One expert told WebMD that a terrorist would have to be
very lucky to successfully deploy anthrax as a weapon of mass destruction.
Q: Where is this
anthrax coming from?
A: An intensive federal investigation is
underway, but few details have been released. There is no doubt that these
anthrax exposures are the result of a criminal act. So far, all of the
anthrax discovered remains fully sensitive to antibiotic treatments.
Sophisticated bioweapons programs generally use anthrax that can resist most
antibiotics. However, there are signs that the anthrax has been "weaponized"
to a degree. Some of the samples from contaminated mail appear to have been
treated in order to make them disperse in the air, making them easier to
inhale. Other samples appear to contain a skin irritant that makes it easier
for the anthrax to attack the skin.
Researchers are looking at the problem in two ways. First, they will grow
the anthrax to see how it behaves. Next, they will examine its DNA for
unique patterns. Using this data, the various anthrax strains will be
compared to similar information from anthrax strains studied in laboratories
around the world. Of course, there's no guarantee that this will lead
investigators to the bugs' ultimate source.
Q: How can I tell the
difference between an anthrax infection and the flu?
A: The early symptoms of inhalation anthrax
are the same as those of a mild case of flu. Treatment to prevent anthrax
begins only after a person has had a suspected exposure. There is no quick
test that can show whether a person has been exposed to anthrax. If a cold
or flu suddenly gets much worse -- especially with a severe headache -- seek
immediate medical attention.
Q: Can I catch
anthrax from someone else?
A: No. Anthrax can't be spread from person to
Q: Who should I
contact in my local area if I'm worried?
A: Contact your local police department,
and contact your local health department or your doctor for more information
if you think you've been exposed to anthrax. Don't start taking antibiotics
unless advised to do so by your doctor or by health authorities.