More
questions and answers about anthrax: |
Anthrax
& the Mail
Cross-contamination,
handling your mail... |
Anthrax
& Influenza
Differences, symptoms,
quick tests... |
Diagnosis
Detecting anthrax, tests,
nasal swabs... |
Exposure
Being exposed vs. being
sick, suspicious mail, powders, protecting
your family... |
Laboratory
Safety
Keeping lab workers safe... |
Laboratory
Testing
Effectiveness, home test
kits, getting screened, Mayo Clinic/Roche
Rapid Anthrax test... |
Pregnancy
Pregnancy and medications... |
Preventive
Therapy
Cipro, storing antibiotics... |
Reporting
Letting authorities know... |
Risk
Chances of getting sick,
pregnancy... |
Signs
& Symptoms
What you should look
for... |
Sources
Genetic sources of anthrax,
importance of knowing sources... |
Treatment
Side effects, antibiotics... |
Vaccination
Availability, getting
vaccinated... |
Worker
Safety
Guidelines, protective
equipment... |
Additional
Questions & Answers
Provided by the Division
of Bacterial and Mycotic Diseases, NCID, CDC |
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Frequently
Asked Questions (FAQ)
What is anthrax?
Anthrax is an acute infectious disease caused by the spore-forming bacterium
Bacillus anthracis. Anthrax most commonly occurs in wild and domestic lower vertebrates
(cattle, sheep, goats, camels, antelopes, and other herbivores), but it can also
occur in humans when they are exposed to infected animals or to tissue from infected
animals or when anthrax spores are used as a bioterrorist weapon.
Transmission
How is anthrax transmitted?
Anthrax is not contagious; the illness cannot be transmitted from person to
person. B. anthracis spores can live in the soil for many years, and humans
can become infected with anthrax by handling products from infected animals
or by inhaling anthrax spores from contaminated animal products. Anthrax
can also be spread by eating undercooked meat from infected animals. It is
rare to find infected animals in the United States. Anthrax spores can be
used as a bioterrorist weapon, as was the case in 2001, when Bacillus
anthracis spores had been intentionally distributed through the postal system, causing
22 cases of anthrax, including 5 deaths.
What are the types of anthrax infection?
Anthrax infection can occur in three forms: cutaneous (skin), inhalation, and
gastrointestinal.
- Cutaneous: Most (about 95%) anthrax infections
occur when the bacterium enters a cut or abrasion on the skin, such as when
handling contaminated wool, hides,
leather or hair products (especially goat hair) of infected animals. Skin
infection begins as a raised itchy bump that resembles an insect bite but
within 1-2
days 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 with appropriate antimicrobial
therapy.
- Inhalation: Initial
symptoms may resemble a common cold – sore throat,
mild fever, muscle aches and malaise. After several days, the symptoms may
progress to severe breathing problems and shock. Inhalation anthrax is usually
fatal.
- Gastrointestinal: The
intestinal disease form of anthrax may follow the consumption
of contaminated meat and is characterized
by
an acute inflammation of the intestinal
tract. Initial signs of nausea, loss of appetite, vomiting, fever
are followed by abdominal pain, vomiting of blood, and severe
diarrhea. Intestinal anthrax
results in death in 25% to 60% of cases.
What
are the case fatality rates for the various forms of anthrax?
Early treatment of cutaneous anthrax is usually curative,
and early treatment of all forms is important for recovery.
Patients with cutaneous
anthrax
have reported case fatality rates of 20% without antibiotic
treatment and less than
1% with it. Although case-fatality estimates for inhalational
anthrax are based on incomplete information, the rate is
extremely high,
approximately
75%, even
with all possible supportive care including appropriate antibiotics.
Estimates of the impact of the delay in postexposure prophylaxis
or treatment on
survival are not known. For gastrointestinal anthrax, the case-fatality
rate is estimated
to be 25%-60% and the effect of early antibiotic treatment
on that case-fatality rate is not defined.
For
more information, see the Signs
and Symptoms Q & A.
Symptoms
What are the
symptoms for anthrax?
These symptoms can occur within 7 days of infection:
- Fever (temperature
greater than 100 degrees F). The fever may be accompanied by chills
or night sweats.
- Flu-like symptoms.
- Cough,
usually a non-productive cough, chest discomfort, shortness of breath,
fatigue, muscle aches
- Sore throat,
followed by difficulty swallowing, enlarged lymph nodes, headache, nausea,
loss of appetite, abdominal distress,
vomiting, or diarrhea
- A sore, especially
on your face, arms or hands, that starts as a raised bump and develops
into a painless ulcer with a
black area in
the center.
See also Notice
to Readers: Considerations
for Distinguishing Influenza-Like Illness from Inhalational Anthrax.
How
can I know my cold or flu is not anthrax?
Many human illnesses begin with what are commonly referred
to as “flu-like” symptoms,
such as fever and muscle aches. However, in most cases
anthrax can be distinguished from the flu because the
flu has additional symptoms. In
previous reports
of anthrax cases, early symptoms usually did not include
a runny nose, which is
typical of the flu and common cold.
For
more information, see the Signs
and Symptoms Q & A.
Preventive/Vaccine UPDATED Sep 9, 2004
Which antibiotics does CDC recommend for prevention of inhalational anthrax?
In selecting an antibiotic, we will be guided by the organism's culture and sensitivity results, history of allergic reactions, age and health status factors and antibiotic availability. When no information is available about the antimicrobial susceptibility of the implicated strain of B. anthracis, initial therapy with ciprofloxacin or doxycycline is recommended for adults and children.
If an anthrax event occurs, should people buy and store antibiotics?
There is no need to buy or store antibiotics, and indeed, it can be detrimental to both the individual and to the community. First, only people who are exposed to anthrax should take antibiotics, and health authorities must make that determination. Second, individuals may not stockpile or store the correct antibiotics. Third, under emergency plans, the federal government can ship appropriate antibiotics from its stockpile to wherever they are needed.
What drugs are FDA-approved for postexposure prophylaxis (PEP)?
Ciprofloxacin and doxycycline are FDA-approved for PEP.
Is there
a vaccination for anthrax?
A protective vaccine has been developed for anthrax; however, it
is primarily given to military personnel. Vaccination is recommended
only for those at high
risk, such as workers in research laboratories that handle anthrax
bacteria routinely. The antibiotics used in post exposure prophylaxis
are very effective
in preventing anthrax disease from occurring after an exposure.
Is
the anthrax vaccine available to the public?
A vaccine has been developed for anthrax that is protective against
invasive disease, but it is currently only recommended for high-risk
populations. CDC
and academic partners are continuing to support the development
of the next generation of anthrax vaccines. Who should
be vaccinated against anthrax?
The Advisory Committee on Immunization Practices (ACIP) has recommended
anthrax vaccination for the following groups:
- Persons
who work directly with the organism in the laboratory.
- Persons
who work with imported animal hides or furs in areas where standards
are insufficient to prevent exposure to anthrax spores.
- Persons
who handle potentially infected animal products in high-incidence
areas; while incidence is low in the United States, veterinarians
who travel to work
in other countries where incidence is higher should
consider being vaccinated.
- Military
personnel deployed to areas with high risk for exposure to the
organism.
For
more information, see the Preventive
Therapy Q & A and the Vaccination
Q & A.
Testing
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. 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.
What
is a nasal swab test?
A nasal swab involves placing a swab inside the nostrils and taking
a culture. The CDC and the U.S. Department of Health and Human
Services do not recommend
the use of nasal swab testing by clinicians to determine whether
a person has been exposed to Bacillus anthracis, the bacteria
responsible for anthrax, or
as a means of diagnosing anthrax. At best, a positive result may
be interpreted only to indicate exposure; a negative result does
not exclude the possibility
of exposure. Also, the presence of spores in the nose does not
mean that the person has inhalational anthrax. The nose naturally
filters out many things
that a person breathes, including bacterial spores. To have inhalational
anthrax, a person must have the bacteria deep in the lungs, and
also have symptoms of
the disease.
Another
reason not to use nasal swabs is that most hospital laboratories
cannot fully identify anthrax spores from
nasal swabs. They are
able to tell only
that bacteria that resemble anthrax bacteria are present.
If
patients are suspected of being exposed to anthrax, should
they be quarantined
or should other family members be tested?
Direct person-to-person spread of anthrax is extremely unlikely
and anthrax is not contagious. Therefore, there is no need
to quarantine individuals suspected
of being exposed to anthrax or to immunize or treat contacts
of persons ill with anthrax, such as household contacts, friends,
or coworkers, unless they
also were also exposed to the same source of infection.
For
more information, see the Laboratory
Testing Q & A.
Treatment UPDATED Sep 9, 2004
What is the treatment for patients with inhalational and cutaneous anthrax?
Treatment protocols for cases of inhalational and cutaneous anthrax associated with this bioterrorist attack are found in the MMWR, 10/26/2001; 50(42), 909-919.
What drugs are FDA-approved for treatment of anthrax?
Ciprofloxacin, doxycycline, and amoxicillin are FDA-approved for treatment.
For
more information, see the Treatment
Q & A.
Safety
Issues/Mail
How
can mail get cross-contaminated with anthrax?
CDC does not have specific studies to address this, however, cross-contamination
of the mail could occur during the processing, sorting, and delivery of mail
when an envelope comes in contact with an envelope, piece of equipment (e.g.,
an electronic sorting machine), or other surface that is contaminated with
Bacillus anthracis spores. In addition, airborne spores in contaminated postal
facilities before they were cleaned might play a role.
When there is a known incident, how can I prevent anthrax exposure from cross-contaminated
mail?
There are no scientifically proven recommendations for preventing
exposure. However, there are some common-sense steps people can
take:
- Do
not open suspicious mail
- Keep
mail away from your face when you open it
- Do
not blow or sniff mail or mail contents
- Avoid
vigorous handling of mail, such as tearing or shredding
- Wash
your hands after handling the mail
- Discard
envelopes after opening mail.
What should people do when they get a letter or package with powder?
Handling of 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 which
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 local
public
health authorities and law enforcement officials.
*These recommendations were published on October 26, 2001,
in “Update:
Investigation of bioterrorism-related anthrax and interim guidelines
for exposure management and antimicrobial therapy” MMWR 2001; 50(42):909-919. (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5042a1.htm)
What is the risk for getting anthrax from handling my own mail?
If there is a risk for inhalational anthrax associated with exposure to cross-contaminated
mail, it is very low. For example, about 85 million pieces of mail were processed
on the few days in 2001 after envelopes containing Bacillus
anthracis (addressed
to two U.S. senators) passed through the New Jersey and District of Columbia
sorting facilities until they were closed. Despite the fact that both of
these facilities had evidence of widespread environmental contamination with
B. anthracis spores and the fact that public health officials had been aggressively
looking for anthrax cases, no new cases of anthrax were identified during
that time.
When the possibility of cross-contamination of the mail exists, should I take
antibiotics?
Preventive antibiotics are not recommended for persons who routinely open or
handle mail, either at home or at the workplace. Antimicrobial prophylaxis
is recommended only in certain specific situations such as for persons exposed
to an air space known to be contaminated with aerosolized Bacillus anthracis or for persons in a postal sorting facility in which an envelope containing
B. anthracis spores was processed. CDC's complete recommendations on antimicrobial
prophylaxis are contained in the November
9, 2001 MMWR. (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5044a1.htm)
What
kinds of anthrax worker safety guidelines have been issued?
The recommendations are divided into four categories. They are engineering
controls, administrative controls, housekeeping controls, and personal protective
equipment for workers. The guidelines describe measures that should be implemented
in mail-handling/processing sites to prevent potential exposures to B.
anthracis spores.
For
more information, see the Anthrax
and the Mail Q & A and
the Worker Safety
Q & A. |