PHLS Communicable Disease Surveillance Centre Questions Commonly asked by Health Care Providers about Anthrax
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Disease Facts:

Frequently Asked Questions About the Perceived Threat of Anthrax:
Section A: Anthrax Disease Facts:
 
1. What is Anthrax?
Anthrax is a bacterial infection caused by the organism Bacillus anthracis. This bacterium is carried by wild and domestic grass eating animals such as cows in Asia, Africa, South America and parts of Europe. The bacterium can exist in a form known as a spore, which allows it to survive in the environment (for example, in the soil).
 
2. What are the Symptoms?
There are three different types of Anthrax. The most common type is the skin (cutaneous) type. Very rarely it can cause gut or lung (inhalational) disease.
 
Cutaneous Anthrax

In cutaneous anthrax, itching occurs first. This is followed by appearance of a lesion commonly on the head, forearms or hands. At first, the lesion is a small bump. It then ulcerates and in 2-6 days develops a black centre. It is rarely painful but can have associated swelling. If untreated the infection can spread and cause blood poisoning. If untreated, it used to be fatal in 5-20% of cases but with effective antibiotic therapy very few deaths occur.
 
Inhalational Anthrax
Initial symptoms of Inhalational Anthrax are mild and non-specific. They characteristically include fever, tiredness, mild cough or chest pain. This is followed by the second phase characterised by acute respiratory distress, sepsis and acute haemorrhagic mediastinitis causing mediastinal widening.
 
Intestinal Anthrax
Intestinal Anthrax is a very rare form of food poisoning and results in severe gut disease, fever and blood poisoning. It is very difficult to recognise and consequently is often fatal
 
3. How is Anthrax caught?
Anthrax is primarily a disease of animals not humans. It is an occupational hazard of workers who process hides, hair, bone and bone products, vets and agricultural workers and people inn specialist laboratories working with anthrax. Its reservoir is in herbivores. When their blood is spilt however accidentally or intentionally, the bacteria is in contact with air whereupon it converts to a tough coated spore which can last in the soil for years. Cutaneous Anthrax is by contact with tissues of animals dying with the disease or by contact with contaminated products. Inhalational Anthrax results from inhalation of spores in industrial processes e.g. From hides of animals. It is very rare, the last case in England and Wales was in 1974.. Intestinal Anthrax is even more rare but occurs from swallowing spores in contaminated meat. It is extremely unusual for anthrax to be transmitted from person to person
 
4. How long can you have the infection before developing symptoms?
From 1 –7 days, although incubation period can be up to 60 days.
 
5. How can anthrax be prevented?
There is a vaccine against anthrax, but this is recommended only for those in highest risk (for example laboratory staff who may be handling the organism or those working in tanneries). Vaccination is not recommended for the general public. Correct treatment of hides and wool (washing, or disinfecting them) as well as adequate ventilation of work areas in hazardous industries are also recommended.
 
6. How do you treat Anthrax?
Anthrax can be treated effectively with a variety of antibiotics, but early recognition of the disease is essential if the treatment to be successful. In case of cutaneous anthrax, antibiotic therapy sterilises a skin lesion within 24 hours but the ulcer goes on through its natural cycle. The antibiotics of choice are penicillin for cutaneous anthrax, giver for 5-7 day. Tetracyclines, erythromycin and chloramphenicol are also effective. Intravenous ciprofloxacin is the drug of choice for inhalational anthrax. If exposure to aerosolised anthrax is credible or confirmed, person at risk should begin post exposure prophylaxis with both antibiotics (fluorquinolones are the drug of choice or doxycycline) and vaccine. Immunisation is recommended because of the uncertainty of when or if the inhaled spores may germinate. It consists of 5 injections, first one is as soon as possible followed by 3 weeks, 6 weeks, 6months and 1 year after the exposure
 
7. Do patients need to be Quarantined?
No there is no need for quarantine
 
Section B: Frequently Asked Questions by Health Professionals About the Perceived Threat of Anthrax:
 
1. I have a patient who has come back form Florida, does he or she need to be tested or to be given antibiotics or vaccine for anthrax?
No, they do not need any of these. The general population in Florida is not at risk. Only people who worked in the American Media Inc. (AMI) publishing house in, Florida or visited the building for more than an hour between August 1st and October 4th 2001 need to be tested for anthrax spores and be put on antibiotics.
 
2. One of my patients is very concerned about ANTHRAX and believes that he / she should be vaccinated. Where can I get the vaccine from?
Anthrax Vaccination is not recommended for the general public. It is recommended for a very few people at risk from their work. This is those working with animal hides (especially imported hides), in abattoirs or laboratories. Details are in the recommendations of the UK Joint Committee for Vaccination and Immunisation (JCVI) in the current Green Book (Immunisation Against Infectious Disease pp 61-3). The vaccine is not produced commercially and cannot be purchased.
 
3. My patient works in a tannery / abattoir does he need to be vaccinated against Anthrax?
Yes, he is in the population group that is at higher risk and can be vaccinated. The Green book page 61 gives details of the vaccine. Your GP or Occupational Health Specialist need to contact immunisation department at CDSC to arrange vaccine issuance.
 
4. One of my patients is going to work abroad where I hear anthrax is common. Should he be vaccinated?
No, you only need anthrax vaccine if it is recommended as a vaccine in the Green Book (see question 2) or in the yellow book on “Health Information for Overseas Travel”
 
5. I am a GP, Can I buy anthrax / smallpox vaccines privately for my patients?
No. Both vaccines are produced by the government and are not for sale to private individuals or companies. They are not produced commercially in the UK.
 
6. My patient has received a letter from AMI. Is it dangerous?
Treat it like any other letter. There is no risk from mail from AMI.
 
7. My patient has received a package from the USA. He is anxious about whether it could contain anthrax. What shall I advise?
He should treat it like any other package. However, if you feel that the package is suspect, then put it in a plastic bag and call the local police. Do not take it to the local police station.
 
8. I / my patient has received what he feels is a suspect letter / package. What shall I do?
You should not open the suspect package, letter but should call the local police station.
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