CDC Anthrax update

Interview with Dr. Jeffrey P. Koplan
Director of the Centers of Disease Control and Prevention

10/18/01

1. What is CDC’s role in the anthrax investigation?

CDC plays a supportive role, both in our epidemiological investigations and environmental sampling, and monitoring and in laboratory work to state and local health departments so state and local health departments initiate these investigations and control measures and if they need further assistance we can provide that via phone consultation from a distance or come and work with them in the field.

CDC has over 50 years experience working on public health problems. We have a very talented staff with a wide range of skill sets including epidemiology and laboratory work and environmental health and occupational exposures. We brought them all to bear on this epidemic. We are considering this our major priority at the moment and people have been moved from other tasks and responsibilities to help work on this. We consider this is the most important thing we’re doing right now, and we’re doing it in partnership with state and local health authorities. We will do anything and everything we can to control these outbreaks as quickly as we can with a minimum of health un torrid effects and a minimum of disruption to people.

2. What is the average risk of contracting anthrax?

The risk of any individual in this country contracting anthrax is infinitesimal. The risk is for people who have been in a place of known exposure and we’ve seen that in a few instances in the last couple of weeks in this country. It’s been in one business place in Florida and it’s been in a couple of locations in New York City, a governmental office building in Washington. Persons who have not been in these circumstances are not at-risk.

3. What can the average person do to protect himself/herself?

Citizens in the country the best approach to take in dealing with anthrax, is to know a little bit more about anthrax. For one, it’s not contagious, it doesn’t spread from person-to-person. Two, it’s a disease that once exposed to is treatable and we have a number of different antibiotics that can be used to treat it. And, those antibiotics are very effective in preventing a person from ever getting the disease once exposed. And, if someone does develop cutaneous anthrax, for example, it’s readily treatable.

4. Should people buy and store antibiotics?

There’s no need to buy or store antibiotics, and indeed it can be detrimental to both the individual and to the community. For one, only people who are exposed to anthrax need to take antibiotics and that needs to be in consultation with heath authorities to make that determination. Two, the person may not stockpile or store the correct antibiotics; there are number of different ones that can be used for this condition. Three, we can get those antibiotics to you when you need them. We have the ability and we have the dosage to deliver over 2 million full courses of therapy. One of the antibiotics [is] Ciprofloxacin, or Cipro and we have other medications available as well. So, individuals do not need to stockpile or store antibiotics.

5. Should the public be vaccinated against anthrax?

For persons exposed to anthrax or for people with the disease there is no vaccine available for the general public. The antibiotics we use are very effective in preventing anthrax from occurring.

6. Can a person get screened or tested for 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 that it can be determined is through a public health investigation. And in those circumstances, for example, where people work in a given office or on a given floor have been exposed, the public health officials make great and aggressive efforts to inform people whether they have been exposed or not, and thus their need for antibiotics. But, the tests that you read about or hear about whether their blood tests or nasal swabs or other tests, are not tests to determine whether an individual should be treated. These nasal swabs and environmental tests are merely to determine the extent of exposure in a given building or workplace.

7. What are the symptoms of anthrax?

There are three clinical presentations of anthrax. And they are largely determined by the route of entry of the anthrax into the human body and some of the clinical manifestations, the symptoms. But the three are: cutaneuous anthrax, where your skin surface is exposed and you develop a skin lesion. Inhalation anthrax in which you breathe in the particles. And, gastrointestinal anthrax in which you ingest the particles, you eat the particles. And those have three different clinical manifestations, symptoms as well.

An important thing for people of the public in general, and certainly healthcare providers in particular to realize in this, “what does cutaneous anthrax look like?” Because that’s what we’ve seen in a couple of cases up in New York and that’s something worth being able to spot and identify quickly and report to your public health authorities.

Cutaneous anthrax looks like a brown recluse spider bite, those that have seen those. And what it really looks like is a swelling on the skin, it could be anywhere but often on the arms or hands and the swelling then develops a central area of ulceration of a depression, and then a scab or what we call a eschar, a very dark, blackish-brown scab forms over that central area. It can be painless and it can be accompanied by a fever or not. --- but this is something well worth noting. And, it doesn’t look like a lot of other things.

8. Is anthrax contagious?

Anthrax can not be spread from person-to-person. One person is not contagious to another person. We can only get it from the mechanisms of exposure to the skin, breathing it, or eating it.

9. What should an individual do about suspicious mail?

We’ve all learned a lot in the last few days about having an increased state of vigilance around life in general, and mail in particular. We’ve been told by colleagues in law enforcement, that what constitutes a suspicious envelope is one that you are not used to getting regularly such as your bills or letters from friends and family with a known return address. But letters that may have stains on them, may feel like they have contents including powder that you can feel inside; a different postmark address than the return address; any other kinds of items inside wires or protruding elements. So, I think all of us are used to the kind of mail we get regularly whether it’s the junk mail, our bills, or occasional cards and letters from friends, other things need to be looked at quite carefully.

If you find something suspicious in your mail be it a package or a letter, be calm. If you’ve picked it up, put it down. If you have a plastic bag or envelope handy, garbage bag, something for food small enough, just slip it in it and close it. If you don’t have such a plastic item available, cover it with a towel or some cloth or even a newspaper --- just cover it so that it is protected over its borders. Wash your hands with soap and water. Call local law enforcement and describe what you’ve got and can they come and help you.

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