Frequently asked questions about anthrax
December 1, 2001 5 minutes read
Frequently asked questions about anthrax
What are the signs and symptoms of anthrax?
Symptoms of disease vary depending on how the disease was contracted, but symptoms usually occur within seven days.
Cutaneous anthrax is the most common naturally occurring type of infection (>95%) and usually occurs after skin contact with contaminated meat, wool, hides, or leather from infected animals. The incubation period ranges from 1-12 days. The skin infection begins as a small papule, progresses to a vesicle in 1-2 days, followed by a necrotic ulcer. The lesion is usually painless, but patients also may have fever, malaise, headache, and regional lymphadenopathy. Most (about 95%) anthrax infections occur when the bacterium enters a cut of abrasion on the skin. Skin infection begins as a raised bump that resembles a spider bite, but (within 1-2 days) it develops into a vesicle and then a painless ulcer, usually 1-3 cm in diameter, with a characteristic black necrotic (dying) area in the center. Lymph glands in the adjacent area may swell. About 20% of untreated cases of cutaneous anthrax will result in death. Deaths are rare if patients are given appropriate antimicrobial therapy.
Inhalational anthrax is the most lethal form of anthrax. Anthrax spores must be aerosolized in order to cause inhalational anthrax. Studies show that 4,0005,000 spores must be present to cause an infection. The incubation period of inhalational anthrax among humans is unclear, but it is reported to range from 1-7 days, possibly ranging up to 60 days. It resembles a viral respiratory illness and initial symptoms include sore throat, mild fever, muscle aches, and malaise. These symptoms may progress to respiratory failure and shock, with meningitis frequently developing.
Gastrointestinal anthrax usually follows the consumption of raw or undercooked contaminated meat and has an incubation period of 1-7 days. It is associated with severe abdominal distress followed by fever and signs of septicemia. The disease can take an oropharyngeal or abdominal form. Involvement of the pharynx is usually characterized by lesions at the base of the tongue, sore throat, dysphagia, fever, and regional lymphadenopathy. Lower bowel inflammation usually causes nausea, loss of appetite, vomiting and fever, followed by abdominal pain, vomiting blood, and bloody diarrhea.
What specific symptoms should I watch for?
Persons should watch for the following symptoms:
- fever (temperature greater than 100° F);
- flu-like symptoms (cough, fatigue, muscle aches), nausea, vomiting, or diarrhea;
- a sore, especially on your face, arms, or hands.
Is anthrax contagious?
No. Anthrax is not contagious; the illness cannot be transmitted from person to person.
What is the difference between exposure to anthrax and disease caused by anthrax?
A person can be exposed to anthrax when that person comes in contact with the anthrax bacteria and a culture taken from that person is positive for anthrax. A person can be exposed without having disease. A person who might have come in contact with anthrax, but without a positive culture might be potentially exposed. Disease caused by anthrax occurs when there is some sign of illness, such as the skin lesion that occurs with cutaneous anthrax.
A person who is exposed to anthrax but is given appropriate antibiotics can avoid developing disease.
Can I be exposed to anthrax via mail?
Letters containing Bacillus anthracis (anthrax) have been received by mail in several areas in the United States. In some instances, anthrax exposures have occurred, with several persons becoming infected. To prevent such exposures and subsequent infection, all persons should learn how to recognize a suspicious package or envelope and take appropriate steps to protect themselves and others.
What kind of mail should be considered suspicious?
Identifying Suspicious Packages and Envelopes
Some characteristics of suspicious packages and envelopes include the following:
— Inappropriate or unusual labeling:
- excessive postage;
- handwritten or poorly typed addresses;
- misspellings of common words;
- strange return address or no return address;
- incorrect titles or title without a name;
- not addressed to a specific person;
- marked with restrictions, such as "Personal," "Confidential," or "Do not X-ray"
- marked with any threatening language;
- postmarked from a city or state that does not match the return address.
— Appearance:
- powdery substance felt through or appearing on the package or envelope;
- oily stains, discolorations, or odor;
- lopsided or uneven envelope;
- excessive packaging material such as masking tape, string, etc.
— Other suspicious signs:
- excessive weight;
- ticking sound;
- protruding wires or aluminum foil.
If a package or envelope appears suspicious, DO NOT OPEN IT.
What should people do who get a letter of package with powder?
Tips for handling suspicious packages or envelopes:**
- Do not shake or empty the contents of any suspicious package or envelope.
- Do not carry the package or envelope, show it to others, or allow others to examine it.
- Put the package or envelope down on a stable surface; do not sniff, touch, taste, or look closely at it or at any contents that may have spilled.
- Alert others in the area about the suspicious package or envelope. Leave the area, close any doors, and take actions to prevent others from entering the area. If possible, shut off the ventilation system.
- WASH hands with soap and water to prevent spreading potentially infectious material to face or skin. Seek additional instructions for exposed or potentially exposed persons.
- If at work, notify a supervisor, a security officer, or a law enforcement official. If at home, contact the local law enforcement agency.
- If possible, create a list of persons who were in the room or area when this suspicious letter or package was recognized and a list of persons who also may have handled this package or letter. Give this list to both the public health authorities and law enforcement officials.
** These recommendations were published on Oct. 26, 2001 in: Update: Investigation of bioterrorism-related anthrax and interim guidelines for exposure management and antimicrobial therapy. MMWR 2001; 50:909-919.
Can anthrax spores be killed on letters in the mail by microwave, ultraviolet light, or ironing?
While some of these methods may kill some spores, it is not known what procedures to use (e.g., length of time, temperature, etc.). Furthermore, because of insufficient data on the efficacy of these methods in inactivating anthrax spores, the Centers for Disease Control and Prevention does not recommend these techniques for reliable decontamination.
Can I get screened or tested to find out whether I have been exposed to anthrax?
There is no screening test for anthrax; there is no test that a doctor can do for you that says you’ve been exposed to or carry it. The only way exposure can be determined is through a public health investigation. The tests that you hear or read about, such as nasal swabs and environmental tests, are not tests to determine whether an individual should be treated. These kinds of tests are used only to determine the extent of exposure in a given building or workplace.
Source: Centers for Disease Control and Prevention, Atlanta.
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