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AnthraxAnthrax is a naturally-occurring bacterium that rarely infects humans. But with the recent attacks involving anthrax in the United States, we’ve consulted the experts – at the Public Health Laboratory Service in the UK, and the Centres for Disease Control and Prevention in America – to develop some essential public information and advice. What is anthrax? Anthrax is an infectious disease caused by a bacterium called Bacillus anthracis. If exposed to air it can change into a form known as a spore and that can last for a long time (many generations) in the environment e.g. the soil before ‘germinating’. It is carried by wild and domestic animals in Asia, Africa and parts of Europe. What are the symptoms? There are two main types of anthrax. The cutaneous type starts as a skin bump that ulcerates, which is not generally a serious illness. The second type, inhalational anthrax, is normally less common and symptoms begin as a flu-like illness which progresses to pneumonia, respiratory failure and sometimes septicaemia, which can lead to shock and death. There is a third type, intestinal anthrax, but this is a very rare form of food poisoning and results in fever and severe gut disease. How is it spread and what is the incubation period? Cutaneous anthrax tends to occur through direct contact with the skin or tissues of infected animals. The early stages of the lesion are noticed about three days from exposure, although the incubation period can be 60 days. Usually it is an occupational disease of farmers, hide workers and people working in the leather-making industry. Inhalational anthrax usually occurs about 2-3 days after exposure and the outcome can be fatal within a futher 2-3 days. The spores can be inhaled directly into the lungs. Spores on food will contaminate it and cause the intestinal form of the disease. In times of famine people may eat infected meat and this causes the illness. How contagious is anthrax? Normally 95 percent of anthrax cases are cutaneous and are caused by direct contact with abrasions on the skin. Person to person infection is rare. Despite the potential seriousness of the inhalational type of anthrax, sufferers do not produce a lot of large numbers of infectious material to pass onto other people (unlike for example, the flu which is very contagious). This is because the main lesions caused by anthrax are not in the lung tissues, where they produce material that could be transmitted by coughing. Instead, the rapid decline in health is caused by toxins that are the by-product of the activity of the bacterium. There have been no known cases of person-to-person spread of anthrax pneumonia and it is not thought to be a significant health risk. Therefore there is no need to strictly quarantine patients with anthrax and people who have simply had contact with them do not need treatment. Is there a treatment? The antibiotics ciprofloxacin, doxycycline and penicillin can be given in high doses to treat the condition. Ciprofloxacin and doxycyline are also used as prophylaxis (prevention) for people who have been exposed. Early treatment is needed if inhalational anthrax is suspected. Is there a vaccine? There is an immunisation against anthrax but it takes five doses of vaccine over the course of a year to get immunity. This makes immunisation too slow to deal with accidental or deliberate exposure. It is normally offered to those who handle infected animals, and laboratory staff who work with the bacteria. It would be recommended for a person who had been exposed, in conjunction with antibiotics, because of uncertainty about when the spores may germinate. The armed forces in the USA are currently being given immunisation, but concerns have been expressed about how safe, and effective, it is for the general public. In the UK, the Public Health Laboratory Service controls supply of the vaccine. Their advice, as of 15 October 2001, is that immunisation is not recommended pre-exposure to anyone except people who are in the relevant occupational groups mentioned above. PHLS is monitoring the situation and will act according to any outbreaks or events. Is there a test? Swabs and smears can be taken from infected exposed people and blood can be analysed for the presence of the bacteria. What should ordinary people do? There is no need to take any specific action. Increased understanding and awareness are probably the best defence. People who develop severe unexplained fever with or without vomiting, severe respiratory symptoms and sudden flu-like symptoms such as headaches and muscle pains should contact their doctor.
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