----- Original Message -----
From: Dr Bing Wibisono [ victorino@diffy.com ] - Non Alumni
Sent: Thursday, October 25, 2001 9:01 AM
Subject: Info about ANTHRAX

    WORLD HEALTH ORGANIZATION

    REGIONAL OFFICE FOR SOUTH-EAST ASIA

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ORGANISATION MONDIALE DE LA SANTE

BUREAU REGIONAL DE L’ASIE DU SUD-EST

Tel: (0091) 11 337-0804     Fax: 337-9507


 

    ANTHRAX 

Recent happenings in the United States have focused attention on Anthrax and its potential as an instrument of war. Considerable interest has been generated and many questions are coming up. People are concerned about personal protection and Governments are worried about public safety in their countries. To attempt to answer common concerns the following document summarises information about Anthrax. It must be kept in mind that in the SEA Region anthrax does occur naturally in a small number of cases. These few cases need attention but should not cause panic, as the potential for sudden massive outbreaks from natural infection is virtually non-existent. 

The enclosed fact sheet has been compiled from various sources on the web as an immediate measure. WHO/HQ is in the process of preparing informational guidance material, which will be circulated as soon as it is available.  


FACT SHEET 

Anthrax is an acute infectious disease caused by the spore-forming bacterium Bacillus anthracis. Anthrax most commonly occurs in hoofed mammals and also occasionally infects humans who come into contact with affected animals or animal products. Wool, hide/leather and infected meat are the usual vehicles. 

Symptoms of disease vary depending on how the disease was contracted, but usually occur within 7 days after exposure. The common forms of human anthrax are inhalation anthrax, cutaneous anthrax, and intestinal anthrax. Anthrax is often fatal unless treatment is initiated early. 

Initial symptoms of inhalation anthrax infection may resemble a common cold. After several days, the symptoms may progress to severe breathing problems and shock.  

In cutaneous anthrax itching of an exposed skin surface occurs first, followed by a lesion that becomes papular, then vesicular and in 2-6 days develops into a depressed black eschar (depressed lesion with a black center). The eschar is usually surrounded by moderate to severe and very extensive oedema, sometimes with small secondary vesicles. Lymph glands in the adjacent area may swell.  

The intestinal disease form of anthrax may follow the consumption of contaminated food and is characterised by an acute inflammation of the intestinal tract. Initial signs of nausea, loss of appetite, vomiting, and fever are followed by abdominal pain, vomiting of blood, and severe diarrhoea. 

Direct person-to-person spread of anthrax is extremely unlikely, if it occurs at all. Therefore, there is no need to immunise or treat contacts of persons ill with anthrax, such as household contacts, friends, or co-workers, unless they also were also exposed to the same source of infection. 

 

In persons exposed to anthrax, infection can be prevented with antibiotic treatment.  

Early antibiotic treatment of anthrax is essential–delay lessens chances for survival. Anthrax usually is susceptible to penicillin, doxycycline, and fluoroquinolones. Ciprofloxacillin is the drug of choice at present.  

An anthrax vaccine also can prevent infection. Vaccination against anthrax is not recommended for the general public to prevent disease. It is currently recommended only for laboratory staff handling anthrax and military personnel under certain circumstances.  

 

HOW TO HANDLE ANTHRAX AND OTHER BIOLOGICAL AGENT THREATS 

many facilities in communities around the affected 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.
 

  1. 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.
 

 

suspicious Unopened letter or PACKAGE MARKED WITH THREATENING MESSAGE SUCH AS “ANTHRAX”: 

 

    1. Do not shake or empty the contents of any suspicious envelope or package.

    2. PLACE the envelope or package in a plastic bag or some other type of container to prevent leakage of contents.

    3. If 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.

    4. Then LEAVE the room and CLOSE the door, or section off the area to prevent others from entering (i.e., keep others away).

    5. WASH your hands with soap and water to prevent spreading any powder to your face.

    6. What to do next…

    • If you are at HOME, then consult your doctor.
    • If you are at WORK, then report the incident to the management.

7. LIST all people who were in the room or area when this suspicious letter or package was recognized. Give this list to both the local public health authorities and law enforcement officials for follow-up investigations and advice.  

 

Envelope with powder and powder spills out onto surface: 

    1. DO NOT try to CLEAN UP the powder. COVER the spilled contents immediately with anything (e.g., clothing, paper, trash can, etc.) and do not remove this cover!

    2. Then LEAVE the room and CLOSE the door, or section off the area to prevent others from entering (i.e., keep others away).

    3. WASH your hands with soap and water to prevent spreading any powder to your face.

    4. What to do next…

    • If you are at HOME, then consult your doctor.
    • If you are at WORK, then report the incident to the management.
    5. REMOVE heavily contaminated clothing as soon as possible and place in a plastic bag, or some other container that can be sealed. This clothing bag should be given to the emergency responders for proper handling.  

    6. SHOWER with soap and water as soon as possible. Do Not Use Bleach Or Other Disinfectant On Your Skin.  

    7. If possible, list all people who were in the room or area, especially those who had actual contact with the powder. Give this list to both the local public health authorities so that proper instructions can be given for medical follow-up, and to law enforcement officials for further investigation.  

     

     

    QUESTION OF ROOM CONTAMINATION BY AEROSOLIZATION:  

     

    For example: small device triggered, warning that air handling system is contaminated, or warning that a biological agent released in a public space.  

     

    1. Turn off local fans or ventilation units in the area.  

    2. LEAVE area immediately.  

    3. CLOSE the door, or section off the area to prevent others from entering (i.e., keep others away).  

    4. What to do next…
      - If you are at HOME, then consult your doctor.  

      - If you are at WORK, then report the incident to the management.
    5. SHUT down air handling system in the building, if possible.
  1. If possible, list all people who were in the room or area. Give this list to both the local public health authorities so that proper instructions can be given for medical follow-up, and to law enforcement officials for further investigation.
  2. Precautions should be taken to protect central air conditioning systems from contamination.
 

     

    HOW TO IDENTIFY SUSPICIOUS PACKAGES AND LETTERS  

     

    Some characteristics of suspicious packages and letters include the following…  

    • Excessive postage
    • Hand-written or poorly typed addresses
    • Incorrect titles
    • Title, but no name
    • Misspellings of common words
    • Oily stains, discoloration’s or odour
    • No return address
    • Excessive weight
    • Lopsided or uneven envelope
    • Protruding wires or aluminium foil
    • Excessive security material such as masking tape, string, etc.
    • Visual distractions
    • Ticking sound
    • Marked with restrictive endorsements, such as “Personal” or “Confidential”
    • Shows a city or state in the postmark that does not match the return address

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