Violence... The story so far

June 2002; Dec 2003

Anthrax Symptoms and a rundown on the bug is available here.

INHALATION Systemic symptoms accompany inhalation infections. These include fever, sick-all-over feeling, nausea, fatigue, and diarrhea. Stuffy nose, wet hacking cough, and upper respiratory symptoms are much more likely to indicate influenza. Immediate treatment by medical personnel is required to avoid death.

INGESTION Stomach and/or intestinal distress accompany oral infection. Seek medical attention.

SKIN A large itchy but painless skin lesion with black scab clearly indicates an Anthrax infection has begun. Seek medical attention.

Diagnostic Tests

A series of tests is required to eliminate all other possibilities. These take time, typically a day or more, so treatment should not await positive confirmation. Identification of the specific strain takes longer. Research is underway to shorten and simplify these procedures.

Progression of disease

Anthrax bacteria produce toxins that seek out and, in a complex process, punch their way through cell membranes, weakening cell walls, so that cells eventually burst. When the bacteria multiply and produce toxins faster than the immune system can develop antibodies, the infected animal or person dies.

After infection, spores mature into bacteria in lymph nodes and spread from there to the blood stream. After infection, the immune system responds by either killing the bacteria or carrying them to the lymph nodes where they thrive and multiply. Wherever they reside, anthrax bacteria produce toxins. If the body load of toxins becomes too high, the body begins to shut down and death results. The entire system is poisoned. Untreated, Anthrax from skin entry is fatal in about 20% of cases; lung ingestion carries a much higher fatality rate. Recovery can be as long as 6-7 weeks.

Once a fatal load of toxins has accumulated, killing bacteria will not save the infected person. This is why immediate medical treatment is necessary.

Neither animals nor humans ill with the disease are contagious.

Treatment

Anthrax is treated by antibiotics with success depending on how soon medication begins, how deadly the strain is, and the route of entry into the infected person. The longer medication is delayed, the more likely the result will be fatal. Lung infections must be treated immediately.

Immunization is possible and is now done for military units that might be endangered in the course of their duties. Research is proceeding in several directions with several possibilities in the offing. One involves immuno globulin, a protective protein, extracted from people who have already been vaccinated. It would not confer immunity, but might prove useful at the onset of disease.

Implications

Psychological stress could be a significant issue until the populace is inoculated. Immunization seems to be the best available preventive measure.

Given the many findings of anthrax that do not correlate with letters it is likely that terrorists are experimenting with means of delivery.

We can feel reassured on some important points.

1 It is difficult to infect large numbers of people at once with Anthrax.
2 Prompt treatment greatly reduces fatalities, so educating the populace in symptom recognition would reduce any toll; so, also, would national stocks of vaccine in every major city.
3 Anthrax has so far been less deadly than previously thought.
4 Several effective antibiotics are available.

Additional proactive defenses can be implemented.

1 Vaccination of all members of the populace likely to be in the areas of targeted individuals, groups, or buildings, as well as key government, communication, medical, public-safety, and military personnel.

2 Facilities with recirculating air can install ultraviolet lights in the ductwork to kill airborne bacteria. This can be done on private and commercial airplanes as well.

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Public Information Available

Ed Lake and Associates are a group of private citizens following developments in the anthrax-by-letter case that closely followed the World Trade Center bombing. Their web site is the most complete and authoritative single source of information on this case.

Anthrax (scientific name Bacillus anthracis) is a gram-positive bacterial disease of grazing animals (domesticated and wild) that can spread to humans in nature through contact with animal meat, dung, hides, bones, hair, or wool. Most natural infections occur in countries that do not maintain strict public health procedures. There are several strains of varying lethality. Anthrax bacteria divide and multiply by doubling their number with each generation. In the inhaled form, they can quickly overwhelm their host.

Anthrax is not naturally contagious (airborne infections from person to person) among either animals or humans, but it can be naturally infectious (passed directly among animals or people). When animals die of the disease, the bacteria continue reproducing until their food is gone. At that point they go dormant as spores and enter the surrounding environment and ground. Spores can lie dormant in water or the ground for years. When grazing, healthy animals can ingest spores from carcasses or grass and foliage nearby which give birth to new generations of bacteria, often with lethal results. In nature, the survival of anthrax bacteria depends on their ability to kill their host.

Anthrax was the first microorganism identified as the cause of a specific disease by Robert Koch in 1876. Later that year Dr. Koch was growing Anthrax bacillus in his laboratory. Within the decade, Louis Pasteur developed a viable anthrax vaccine for use in livestock.

Public information on anthrax has expanded explosively since the WTC bombing. Older public references are now largely outdated.

Weapons Grade Anthrax

The most virulent grade of spores would be selected and highly purified. Spores tend to clump together but can be milled so small that individual spores can be suspended in air and easily find homes in human or animal lungs where they spread though the body, multiplying as they go. Lung infections typically spread too quickly for the immune response to counter.

Milling spores fine enough to be suspended in air requires sophistication and effective controls. The spores must be made nonconductive to electricity so they will not agglomerate and clump. Airborne spores are destroyed by direct sunlight.

Three nations are known to have weapons grade anthrax, the USA, Russia, and Iraq. The average farmer could not produce such materials. Only an expert could put together a facility to manufacture Anthrax for terror use.

Anthrax Delivery

Because of their speed and lethalness, airborne infections are the preferred terrorist route. In the hands of terrorists, anthrax can become as widespread as they wishgiven sufficient supplies of spores and means of dispersal.

Terrorist targets would be groups of people, or lone individuals. Closed buildings, commercial airplanes, buses, and any large congregation of people would be natural targets. Areas with unfiltered recirculating air are particularly vulnerable. Air filters do not guarantee spore removal unless made for that specific purpose.

One convenient and specific route is the postal system. Package deliveries are equally effective. One reason for this is the anonymity of the sender. Another is that spores do not survive long in direct sunlight.

More deadly and harder to fight is the situation where spores are spread from autos and other vehicles roaming through large cities at night. Many infections would be immediate, but many could, in theory, occur over some period of time later.

Public Health Measures

Immunization is the best counter to the most serious inhaled form that can kill in a day or two without treatment. Immunization is effective against all types of anthrax, but immunization carries risks that might limit its general use.

Stores of antibiotics in strategic locations should be maintained. An aside here is that most of the antibiotics manufactured go to fatten animals. Policy makers need to revisit this use as ever more drug resistant mutations could arise escalating the potential danger from anthrax terror.

Vaccines against the toxins must be developedthis is in progress and should be accelerated as the first line of defense.

Routes of infection

Humans contract the disease in one or more of three ways: inhaling, eating (ingesting) , or through skin (cutaneous). Spores, finding food plentiful again, convert back into bacteria. The incubation period depends on the route of entry and is typically 1-5 days.

Inhalation is the most rare form in natureand the most dangerous since death can occur in as little as 24 hours if not treated. More commonly, symptoms arise in 2-10 days.

Infection by ingestion leads to ulcers in the stomach and intestines as the bacteria multiply and spread toxins to levels that can lead to death if not caught in time.

Contaminated meat is a common natural route of infection.

Infection through the skin leads first to painless vesicles filled with clear liquid. These spread from the site of infection, then join to form a single large lesion that is not likely to be painful. This lesion then ulcerates and forms a deep crater crusted by a blue-black dry scab.