How to Handle Anthrax and Other Biological Agent Threats

Many facilities in communities around the country have received anthrax threat letters. Most were empty
envelopes; some have contained powdery substances. The purpose of these guidelines is to recommend
procedures for handling such incidents.

DO NOT PANIC

1. Anthrax organisms can cause infection in the skin, gastrointestinal system, or the lungs. To do, so the organism must be rubbed into abraded skin, swallowed, or inhaled as a fine, aerosolized mist. Disease can be prevented after exposure to the anthrax spores by early treatment with the appropriate antibiotics. Anthrax is not spread from one person to another person.
   
2. For anthrax to be effective as a covert agent, it must be aerosolized into very small particles. This is difficult to do, and requires a great deal of technical skill and special equipment. If these small particles are inhaled, life-threatening lung infection can occur, but prompt recognition and treatment are effective.
   

What Is Anthrax?

Anthrax is a bacterial, zoonotic disease caused by Bacillus Anthracis. Anthrax occurs in domesticated and
wild animals, including goats, sheep, cattle, horses and deer.

The skin form of the disease may be contracted by handling contaminated hair, wool, hides, flesh, blood
or excreta of infected animals and from manufactured products such as bone meal. Infection is introduced
through scratches or abrasions of the skin, wounds, inhalation of spores, eating insufficiently cooked
infected meat or from flies. The spores are very stable and may remain viable for many years in soil and
water. They will resist sunlight for varying periods.

What Are the Symptoms and Effects of Anthrax?

After an incubation period of 1-7 days, the onset of inhalation anthrax is gradual. Possible symptoms
include:

• fever
• malaise
• fatigue
• cough
• mild chest discomfort followed by severe respiratory distress

This mild illness can progress rapidly to respiratory distress and shock in 2-4 days followed by a range of
more severe symptoms, including breathing difficulty and exhaustion. Death usually occurs within 24
hours of respiratory distress.

What Are the Clinical Features of Anthrax?

Anthrax is an acute bacterial infection of the skin, lungs or gastrointestinal tract. Infection occurs most
commonly via the skin.

The cutaneous or skin form of the infection occurs most frequently on the hands and forearms of persons
working with infected livestock or contaminated animal products and represents 95% of cases of human
anthrax. It is initially characterized by a small solid elevation of the skin, which progresses to a fluid-filled
blister with swelling at the site of infection.

The scab that typically forms over the lesion can be black as coal, hence the name anthrax - Greek for coal.
With treatment, the case fatality rate is less than 1% among people who get the skin form of the disease.
The fatality rate for untreated inhaled or intestinal anthrax is over 90%.

The inhaled form of anthrax-is contracted by inhalation of the spores, occurs mainly among workers
handling infected animal hides, wool and furs. Under natural conditions, inhaled anthrax is exceedingly
rare, with only 18 cases reported in the United States in the 20th century.

What Is the Treatment for Anthrax?

Treatment with antibiotics beginning one day after exposure has been shown to provide significant
protection against death in tests with monkeys, especially when combined with active immunization.
Penicillin, doxycycline, ciproflaxin, are all effective against most strains of the disease. Penicillin is the
drug of choice for naturally occurring anthrax. If untreated, inhaled anthrax is fatal.

A vaccine is available and consists of a series of 6 doses over 18 months with yearly boosters. This
vaccine, while known to protect against anthrax acquired through the skin, is also believed to be effective
against inhaled spores.

Effective decontamination can be accomplished by boiling contaminated articles in water for 30 minutes
or longer and using common disinfectants. Chlorine is effective in destroying spores and vegetative cells.
Remember, anthrax spores are stable, able to resist sunlight for several hours and able to remain alive in
soil and water for years.

How likely is it that someone would receive a harmful biological or chemical substance in the mail?

The Postal Service delivers approximately 208 billion pieces of mail per year, and as of September 11,
2001, they had not seen any real incidents - including Anthrax - only threats or hoaxes.

How often do these threats and hoaxes occur?

During FY 1999 and FY 2000, there were approximately 178 anthrax threats received at courthouses,
reproductive health service providers (clinics offering abortion services or counseling), churches, schools,
and post offices. During FY 2001 the U.S. Postal Service have had only approximately 60 threats or
hoaxes, which included anthrax, hoof and mouth disease, the KJingerman virus hoax and others.

Chemical and biological weapons are sometimes referred to as the "poor man's nuclear weapons" and pose
a significant threat in the post-Cold War environment. Their relative low cost and simplicity of design and
technology make them weapons of choice for a variety of rogue states and terrorist and non-state
organizations. Although acts of chemical and biological terrorism have not been prevalent in the U.S. up
to now, use of these weapons or the threat of their use are disruptive forces.

What Should I do if I Receive an Anthrax Threat or Suspicious Package by Mail?

• Do not handle the mail piece or package suspected of contamination if at all possible.
• If you are holding the suspected envelope or package, PLACE the envelope or package in a plastic bag or some other type of container to prevent leakage of contents.
• If no one is holding the package or you do not have any container, then COVER the envelope or package with anything (e.g., clothing, paper, trash can, etc.) and do not remove this cover.
• Make sure that damaged or suspicious packages are isolated and the immediate area cordoned off.
• Then LEAVE the room and CLOSE the door, or section off the area to prevent others from entering
  (i.e., KEEP OTHERS AWAY). WASH your hands with soap and water to prevent spreading any powder to your face.
• If you are at HOME, then report the incident to the local law enforcement and fire agencies.
• If you are at WORK, then notify your supervisor and/or manager, and immediately contact Police and Fire (9-1-1).
• Ensure that all persons who have touched the mail piece wash their hands with soap and water.
• The Police or Fire Department Investigators will collect the mail, assess the threat situation and coordinate with the FBI and the U.S. Postal Inspection Service.
• Designated officials will notify local, county, and state health departments.
• Designated officials will notify the state emergency manager.
• List all persons who have touched the letter and/or envelope. Include contact information.
• Provide the list to the Police and Fire Department Investigators who will coordinate with the FBI and the U.S. Postal Inspection Service.
• Place all items worn when in contact with the suspected mail piece in plastic bags and keep them wherever you change your clothes and have them available for law enforcement.
• As soon as practical, shower with soap and water.
• If prescribed medication by medical personnel, take'it until otherwise instructed or it runs out.
• Call the Police and Fire Departments (9-1 -1) to report that you've received a parcel in the mail that may contain biological or chemical substances. Stay on the line and assist in directing emergency public safety personnel to the suspicious parcel.
  

What constitutes a "suspicious parcel?"

Some typical characteristics Postal Inspectors have detected over the years, which ought to trigger
suspicion, include parcels that:

• are unexpected or from someone unfamiliar to you.
• are addressed to someone no longer with your organization or are otherwise outdated.
• have no return address, or have one that can't be verified as legitimate.
• are of unusual weight, given their size, or are lopsided or oddly shaped.
• are marked with restrictive endorsements, such as "Personal" or "Confidential."
• have protruding wires, strange odors or stains.
• show a city or state in the postmark that doesn't match the return address.

Contact the Center for Disease Control Emergency Response at 770-488-7100 for answers to any other questions.