FAQ: Exposure to Anthrax
This document has been prepared for educational purposes by Dr.
Donald E. Low and Karen Green, RN, CIC. Should you have questions
regarding individual health concerns or health care practices,
please consult your physician or health care provider directly.
» What is Anthrax?
Anthrax is an infection that occurs when spores
from bacteria called Bacillus anthracis enter the body.
People can be infected through breaks in the skin ("cutaneous"
or skin anthrax), by breathing in the spores ("inhalation"
anthrax) or by eating contaminated, poorly cooked meat (gastrointestinal
anthrax). Anthrax mostly affects grazing animals such as sheep,
goats, cattle, horses, deer and bison, but humans can be infected
as well.
» How Could I Contract
Anthrax?
Anthrax is most common in agricultural regions where it occurs
in animals (eg South and Central America, Southern and Eastern
Europe, Asia, Africa, the Caribbean, and the Middle East). Anthrax
in animals is rare in North America. Humans can acquire anthrax
through contact with infected animals or animal products. Anthrax
is not commonly found in humans. More than 95 per cent of human
cases are cutaneous.
A patient with anthrax is not infectious to other persons, nor
are his/her body secretions or blood. There have been no known
cases of human-to-human transmission.
Anthrax has been put at the top of the list of "the most
likely agent to be used in a bioterrorist attack." For people
to contract inhalation anthrax, a very large number of spores
must be released. Not only that, it is difficult to create a form
of anthrax that could be made airborne because the spores have
a natural tendency to clump together and not remain in the air.
The environmental conditions (i.e., air movement and humidity)
must also be exact.
» How Long After
Being Exposed to Anthrax do People Get Sick?
It takes a few days after exposure to anthrax for the bacteria to
grow enough to make people sick. After breathing in spores, it takes
up to 10 days (most often four to five days) before people first
start to feel ill. It takes a bit longer for the skin form of the
disease to appear. If treatment is started early in illness, it
is effective. This means that you don't need to start antibiotics
immediately after exposure to be protected. It is safe for you to
wait until the substance you were exposed to is tested before starting
antibiotics.
» What are the Symptoms
of Anthrax?
Symptoms of disease vary depending on the type of exposure
to the bacterial spores.
Cutaneous anthrax: Most (about 95%)
of 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 close
to the area may become swollen and painful. This form of anthrax
represents about 95 per cent of the cases in humans. It is easily
treated with antibiotics.
Inhalation anthrax: If you contract anthrax by
breathing in anthrax spores, the initial symptoms may resemble
the "flu". After an incubation period of up to six days,
the initial stage of inhalation anthrax (the kind associated with
terrorists) begins with the onset of muscle aches, malaise, fatigue,
nonproductive cough, and fever. This phase lasts an average of
four days. The second stage, lasting 24 hours and often culminating
in death, develops suddenly with the onset of acute respiratory
distress. Up to 50 per cent of cases may develop meningitis. After
several days, the symptoms may progress to severe breathing problems
and shock. This type of anthrax also gets better with antibiotics
if it is treated early enough. However, it is a much more serious
type of infection if it is left untreated until a person has difficulty
breathing. This is one reason why we give antibiotics to people
who are exposed to anthrax before they get sick. If untreated,
inhalation anthrax is usually fatal.
Intestinal anthrax: The intestinal disease form
of anthrax may follow the ingestion 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 causes death in 25% to 60% of cases.
» What is the Treatment
for Anthrax?
If you are found to have been exposed to anthrax, it
is best to take antibiotics to prevent illness. The most common
form, cutaneous anthrax, is usually curable when treated with
antibiotics. Inhalation anthrax has a very high mortality rate,
with death usually occurring within a few days after the onset
of symptoms. However, therapy is successful if initiated during
the incubation period. The confirmation tests may take up to 48
hours to complete. If the substance is suspicious for anthrax,
you will be notified and given antibiotics Antibiotics are only
needed if it is confirmed that you were exposed to anthrax.
Indiscriminate use of antibiotics can lead to serious side effects
Anthrax is susceptible to several classes of antibiotics.
Recommended treatment options include penicillin, doxcycline and
ciprofloxacin. Visit the following webpages for detailed treatment
options for inhalational anthrax in controlled casualty situations
and treatment
options for identified anthrax infection in mass casualty situations.
» Is there an Anthrax
Vaccine?
There is a human vaccine against anthrax. Currently
there is limited availability for use for military personnel deployed
to areas with high risk of exposure to the organism (as when it
is used as a biological warfare weapon).
» What Should I do
if I Get Sick While Waiting for Results?
The Public Health Department should have final results
back to you within two to three days. This is a stressful time
and you may naturally worry about the way you are feeling. In
addition, this is a time of year when many people have coughs
and colds. Getting a runny nose, or a sore throat, or feeling
tired are symptoms you should NOT be worried about - anthrax will
not cause these symptoms. However, if you get a fever, or develop
severe muscle aches and pains, you should contact the Public Health
Department. They will check on the testing of the material you
were exposed to, and decide if you need antibiotics.
» Is Anthrax Contagious?
No. To catch it, a person must come directly into contact
with spores from bacterium. It cannot be spread from person to
person. When the bacteria is infecting a person, it does not form
spores, which are the only type of the bacteria that causes infection.
It is also important to know that you cannot take it home to your
family on your body or your clothes. You may be told to bag your
clothes (until results are available) and shower when you get
home. This is a precautionary measure only because we all want
everyone to be as safe as possible. No one has ever been infected
with anthrax from another person's clothes.
» What will Happen to
the Potentially Contaminated Envelope/Package or Powder that may
have Contained Anthrax?
Do not touch suspicious packages, report them
immediately to the appropriate authorities, and co-operate with
individuals whose responsibility it is to implement emergency
procedures if exposure has occurred.
Any material that may contain anthrax spores will be
sealed in plastic by the police hazardous materials team. They
transport the material to the Ontario Public Health Laboratory,
where technologists do a series of tests to determine whether
any spores are present, and, if so, whether these spores are anthrax.
Depending on the particular tests, final results can be available
from 24 to 72 hours. As soon as the laboratory finds anything
that is even suspicious for anthrax, they contact the Public Health
Department, who will then contact you. You will be informed immediately
if you need antibiotics.
» What is Mount Sinai
Hospital Doing to Ensure the Safety of Staff and Patients?
The hospital has increased its security measures to
protect staff and patients. In addition, Mount Sinai has a biohazard
response team that knows what to do and is prepared to respond
in the unlikely chance that the hospital receives an anthrax threat.
» Where can I get
More Information about Anthrax?
Please see the MSH Department of Microbiology Internet
Site at http://microbiology.mtsinai.on.ca
for a more in-depth background on anthrax, including issues such
as anthrax hoaxes and misinformation about protection.
This website has been made possible through an unrestricted educational grant from
Pfizer Canada Inc. |
