Last time, we looked at a "virtual" infection. This time we will examine "real life" infection.

The current frenzy among media is the threat of bio-terrorism as an offshoot of the activities of terrorists allied with Osama bin Laden.

But what is the real score? Are we really targets of biological warfare?

Biological or germ warfare is banned by international convention but some deadly "agents" have been identified. Of these, some six or seven have high lethality (i.e. it can kill most of those infected). Among these are (not in any order) anthrax, cholera, pneumonic plague, smallpox, hemorrhagic fever, botulism, and ricin. The focus of the BioWar threat right now (at least from media point of view) is Anthrax. Here is some information about Anthrax culled from various sources.

Anthrax is a naturally occurring infectious disease caused by the spore-forming bacterium, Bacillus anthracis, which infects livestock including sheep, cattle, horses, goats and pigs. Bacillus anthracis derives from the Greek word for coal, anthrakis, because the disease causes black, coal-like skin lesions. It is an aerobic, gram-positive, spore-forming, nonmotile Bacillus species. The vegetative cell (active phase) is large (1-8 µm long, 1-1.5 µm wide). Its spore (dormant phase) is approximately 1 µm. (note: 1 µm = one-millionth of a meter)

Spores grow readily on all laboratory culture media at 37°C (normal human body temperature), with cells that look like a "jointed bamboo-rod" and colonies that have a unique "curled-hair" appearance. This cellular and colonial appearance should make its identification by an experienced microbiologist straightforward, but only a few microbiologists outside the veterinary community have seen anthrax colonies other than in textbooks.

Anthrax spores germinate when they enter an environment rich in amino acids, nucleosides, and glucose, such as that found in the blood or tissues of an animal or human host. Active anthrax bacilli will only form spores after local nutrients are exhausted, such as when anthrax-infected body fluids are exposed to ambient air. Anthrax bacteria cannot survive outside of an animal or human host; colony counts decline to almost nil within 24 hours following inoculation into water. In contrast, the B anthracis spore can survive for 2-3 decades on the ground, where they are easily picked up by browsing animals.

The disease has been known since ancient times (e.g. the plagues in Exodus and other similar records in ancient manuscripts), its causative agent was identified in 1876 and a vaccine against it was developed 5 years later. (note: Anthrax in animals has been recorded in the Ilocos region of northern Philippines)

Anthrax may be transferred to humans through skin exposure, spore inhalation or ingestion, but it is not contagious. No cases of human-to-human infection have been reported.

Anthrax spores are harmful to humans only if inhaled, ingested, or when introduced into an open cut or the eyes. A person can become infected with anthrax:

• Through cuts in the skin or through contact with infected animal wool, hide or tissue (cutaneous anthrax). This is the most common form of infection.
• By eating infected meat (gastro-intestinal anthrax), rare in countries where livestock are routinely immunized.
• By breathing anthrax spores (inhalation anthrax). The resultant pneumonia rapidly causes respiratory distress followed by death. Meningitis can also develop. Pulmonary and meningeal anthrax are 90 percent fatal despite therapy. The incidence of inhalation anthrax is very rare.

There are three main types of infection:

Cutaneous anthrax comes from direct contact of the skin (cuts and abrasions) with infected animals. After 1-5 days incubation, lesions or ulcers form on the skin which display a black eschar, hence the name, accompanied by fever and pain in the lymph nodes. It can be fatal if untreated (20% mortality) but, with prompt treatment, rarely so. In recent times, there have been few reported outbreaks of cutaneous anthrax (1979, Zimbabwe, ~ 6000 infected).

Gastro-intestinal anthrax comes from eating improperly cooked meat of animals infected with anthrax. After 1-5 days incubation, lesions form in the intestines or esophagus accompanied by stomach pain, fever and bloody stool. It is fatal in 25-60% of infected persons. In recent times, a few outbreaks have been reported (1982-1987, Thailand, ~ 50 infected).

Inhalation anthrax (also called woolworker's disease because it formerly infected mostly those working in wool factories) comes from inhaling spores of anthrax which lodge in the lungs and air passages. After 1-5 days incubation, the disease manifests itself by high fever, hemorrhage and edema. It is fatal in more than 85% of persons infected, despite treatment. In recent times, an accident at a research facility released anthrax spores into the air and caused an outbreak in a nearby city (1979, Sverdlovsk, 79 infected, 68 dead).

Even in the unlikely event that a letter or package contains actual anthrax spores, contamination would be localized to the immediate area. The chance of the letter or package containing infectious anthrax spores is very remote.

If the envelope or package remains sealed, first responders should not take any action except to notify the authorities. Quarantine, evacuation, decontamination and chemo-prophylaxis efforts are not needed as long as the envelope or package remains unopened.

If the package is opened and you handled the item, wash your hands with soap and water. Have medical personnel assess your potential exposure. Isolate the area and treat as a crime scene. Note that veterinarians and farmers routinely handle animals infected with anthrax yet do not contract the disease as long as they carefully follow sanitary precautions.

An anthrax vaccine, an inactivated cell-free product, licensed in 1970, is used in the US for military personnel as well as those at risk such as medical professionals and workers in wool, goat-hair, and skin tannery mills. It is administered in a 6-dose regimen with the first 3 doses given 2 weeks apart and the remainder 6 months apart. A live attenuated anthrax vaccine is used in countries of the former Soviet Union.

Data on Anthrax Vaccine from US Army Medical Command

• National Stock Number (NSN): 6505-01-399-6828
• Unit of Issue: Ten 0.5ml doses per 5.2ml multidose vial
• Shelf Life: 36 months after packaging in multidose vial
• National Drug Code (NDC): 64678-0211-05

Human infections of Anthrax are usually treated with penicillin G, ciprofloxacin and doxycycline. Alternative antibiotics include chloramphenicol, erythromycin and amoxicillin.

You may visit the following web sites for more information:

• Bacteriology Dept – University of Wisconsin, USA
• Center for Disease Control – US Dept of Health, USA
• Center for Nonproliferation Studies – Monterey Institute for International Studies, USA
• Veterinary Dept – University of Arizona, USA
• A biologist’s (often skeptical) homepage

1. Anthrax does not spread from person-to-person. The only way to get the inhalation form of the disease is to be exposed to large numbers of spores of the microbe.

2. Not much will kill these spores. They are resistant to microwaves, heat and many disinfectants. If you burn your mail, that will work, but then you can't read that letter from Aunt Marge.

3. As far as getting dangerous mail, Use your head! First, you are not that important, why would terrorists send a package to you? Second, think about the logistics of sending out a large number of envelopes containing spores. Finally, getting spores in an envelope is not a grave threat. Anthrax spores need to be dispersed in the air with very advanced equipment to become the dangerous form, pulmonary anthrax, that is lethal.

4. If you are still worried about it, think, don't give into blind fear.

1. Check the address, is it someone you know? If it is someone you know, no problem.
2. Check the post mark, where is it mailed from?
3. Is it a catalog? It is not likely that any retailer is going to send you something dangerous. (Note, glossy magazines will often put baby powder in between the pages to prevent them from sticking together. Keep that in mind.) If you are still worried and receive a suspicious package that does have a powder in it, report it to your local authorities and consult your physician. However, it will be very unlikely that you will receive one of these letters. Think about how many pieces of mail go out and how many people there are. Your chances are very low.

5. Things you can do to protect yourself from bioterrorism

a. Stop worrying

b. Stop smoking

c. Don't drink too much

d. Eat right

e. Exercise

f. Stop worrying

What? What does that have to do with bioterrorism? All of the above will build up your immune system. And besides, if you have to be scared into taking care of yourself, so be it.

6. Cutaneous anthrax only occurs when the spores encounter broken skin creating an easily recognized boil. Even then, the illness is rarely fatal, if treated.

7. Anthrax is easily treated with antibiotics if it is caught early enough. The only time one should be worried about this is if everyone around you is coming down with the flu at the same time. The government should be all over something like that and should have a stock pile of antibiotics for such an occasion.

8. You should not try to get vaccinated nor buy antibiotics just in case. First, your chances of contracting the disease are less than getting hit by lightning or winning the lottery, so you would be wasting your money. Second, you are depleting the stores of antibiotics that are available to treat people who may end up having the illness or, much more likely, some other illness where they need that antibiotic. Finally, they will go bad over time and not be effective anyway. No responsible physician should be filling prescriptions to people who have not been exposed to anthrax, "just in case".

9. The disease is caused by a bacterium, Bacillus anthracis, not a virus as reported by some news agencies. (By the way, some journalists are woefully ignorant of medicine and microbiology - be careful what you believe.) It is disappointing that certain news agencies are frankly feeding this frenzy in the name of ratings.

10. Is a biological attack possible? Sure anything is possible, but it is very, very unlikely. Could it happen. Yep. Is it worth worrying about? Nope.

Disclaimer: the above opinions are those of the author or authors of the articles from which this was "assembled" and do not necessarily reflect those of the owner, management and staff of this website. J