Q&A: About Anthrax

Q. What is anthrax?

A. Anthrax is a potentially fatal hemorrhagic disease, which means it can result in internal bleeding. It is caused by Bacillus anthracis, a hardy rod-shaped bacterium. It gets its name from the Greek word for coal because of the black scab it causes in the skin form of the disease.

Q. What are the anthrax spores we keep reading about?

A. To survive during harsh conditions, the bacterium forms a hardy spore which contains the ingredients to make a new bacterium. The spores can remain viable in a dormant phase in soil or infected animal products such as hides and bone meal for decades. When conditions improve, the spore germinates to form a new bacterium. If animals or humans become infected with spores, allowing them to germinate, that sets off a chain of events that leads to the release of toxins. It is these toxins that cause illness or death.

Q. How do you get anthrax?

A. Anthrax infection can be acquired after contact with infected animals -- generally sheep, goats, horses or cows -- contaminated animal products or after the intentional release of anthrax spores into the air or placement in powders. There are three ways to get anthrax: through cuts or scrapes in the skin, called "cutaneously,” by inhaling it or by ingesting it. Ingested anthrax is rare in humans and is contracted by eating insufficiently cooked meat from infected animals. Inhaled anthrax occurs when someone inhales the spores. The death rate from untreated inhaled anthrax is 90 to 100 percent; with treatment by antibiotics the fatality rate is 75 percent, according to the Centers for Disease Control and Prevention. Death from untreated skin anthrax occurs in about 20 percent of cases and in 1 percent of cases treated with antibiotics. Untreated gastrointestinal anthrax causes death in 25 to 60 percent of cases; the percentage of deaths after treatment is unknown, according to the CDC.

Q. How long after exposure do you show signs of the disease?

A. Incubation is generally one to six days, although it can be up to 60 days, depending on the dose and strain of the bacteria.

Q. What are the symptoms of inhalational anthrax?

A. They are gradual and nonspecific. The person may have a fever, feel tired and may have a dry cough. That is usually followed by a period -- which can last hours or up to two to three days -- in which the person feels better. That abruptly changes and the person develops severe trouble breathing as the lungs begin bleeding. Death can follow 24 to 36 hours later.

Q. What does the skin type of anthrax look like?

A. Cutaneous anthrax occurs most frequently on the hands and forearms, causing a red spot that develops fluid and then dries to a coal-black scab.

Q. Is anthrax contagious?

A. No. It is contracted by direct exposure to active spores. It is not passed person to person.

Q. If somebody comes in contact with anthrax through a ventilation system or contaminated mail, couldn't that person pass on the spores to someone else?

A. Theoretically you could carry spores on your clothes, said Dr. Joseph Waeckerle, editor in chief of the Annals of Emergency Medicine and an expert in bioterrorism. However, you would have to be heavily contaminated and then shake your clothes hard to get the spores into the air so they could be breathed in, he said. To get pulmonary anthrax, someone has to inhale at least 8,000 to 40,000 spores, according to the CDC.

It takes fewer spores to cause cutaneous anthrax. But Dr. Roy Steigbigel, chief of the division of infectious diseases at Stony Brook University Hospital, pointed out they have to enter through a cut or scratch.

Q. Where would can anthrax be obtained?

A. The bacterium that causes anthrax, Bacillus anthracis, exists naturally in soil throughout the world, especially in Africa, Asia, and the Middle East. In the United States, anthrax spores are common in rural Texas, Oklahoma and the Mississippi Valley and can contaminate goat and other animal hides.Genetic changes made in the laboratory can also create new strains of Bacillus anthracis. Some of these changes occur naturally through mutation, but most are engineered by scientists by adding or deleting DNA. More than 1,200 strains of Bacillus anthracis have been catalogued by Paul Jackson at the Los Alamos National Laboratory, who has been identifying an average of two new strains every week. Many of the strains exist in universities, commercial laboratories, government laboratories, and at least 46 germ banks worldwide.

Q. Are there regulations on who can obtain anthrax?

A. In 1997, the Centers for Disease Control and Prevention implemented tough new regulations on anthrax and other hazardous agents stored and shipped in the United States. Most other countries have far less rigid controls over their own supplies, however.

Q. What is the treatment?

A. The preferred antibiotic, ciprofloxacin hydrochloride -- brand name Cipro -- is prescribed for 60 days. Doxycycline, also called tetracycline, can also be prescribed for 60 days. Penicillin can also be used.

Q. What is "weaponized” anthrax?

A. For anthrax to be effective as a biological weapon on a large scale, it has to be aerosolized into very small particles, a process that experts say requires technical skill and special equipment. "It's very hard to weaponize,” said Waeckerle. "You have to mix them up in a certain manner and make sure you have the right-sized particle and that they don't clump together.”

Q. If you come into contact with a suspicious letter or package, what should you do?

A. This is what the CDC recommends: Don't shake or empty the contents; don't try to clean up powders or fluids. Place the envelope in a plastic bag or container. If you don't have a bag, cover it and don't remove the cover. Leave the room and close the door or section off the area to prevent others from entering. Wash your hands with soap and water for five to 10 minutes. Report the incident to local police; notify your building security officer. List all the people who were in the room. Remove contaminated clothing and place them in a plastic bag that can be sealed and give to law enforcement personnel. Shower with soap and water as soon as possible. Do not use bleach or disinfectant on your skin.

Q. What about the vaccine?

A. The United States has a vaccine. However, it is available only for use by military personnel and is controversial. The one company that makes it has not been able to pass inspection by the Food and Drug Administration and it's not known how effective it is against inhaled anthrax.