Anthrax (Bacillus anthracis) is an acute infectious disease caused by the
spore-forming bacterium. The most common victims of anthrax are warm-blooded
animals, but it can also infect humans. Anthrax spores can be produced in a
powdery form for biological warfare. When inhaled by humans, these particles
cause respiratory failure and death within a week. Because anthrax is
considered to be a potential agent for use in biological warfare, the
Department of Defense (DOD), in 1998, announced it would begin a systematic
vaccination of all U.S. military personnel. (DOD, 1998) Anthrax infection
occurs in three forms: cutaneous (skin), inhalation, and gastrointestinal. B.
anthracis spores can survive in the soil for many years and handling animal
products from infected animals or inhaling anthrax spores from contaminated
animal products can cause humans to become infected. Anthrax can also be spread
by eating undercooked meat from infected animals. Anthrax is diagnosed by
isolating B. anthracis from the blood, skin lesions, or respiratory secretions
or by measuring specific antibodies in the blood of suspected cases. (Dire,
2001)
Demographics
Anthrax is most common in the agricultural regions where it occurs in animals,
such as South and Central America, Southern and Eastern Europe, Asia, Africa,
the Caribbean, and the Middle East. When anthrax affects humans, it is usually
because of occupational exposure to infected animals or their products. Workers
who are exposed to dead animals and animal products from other countries where
anthrax is more common may become infected with B. anthracis. Anthrax in
animals rarely occurs in the United States. Most reports of animal infection
are received from Texas, Louisiana, Mississippi, Oklahoma and South Dakota.
Symptoms of disease vary depending on how the disease was contracted, but
symptoms usually occur within seven days. (Dire, 2001)
Types of Anthrax
Cutaneous: Most 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 black necrotic area in the center. Lymph glands in the adjacent area may
swell. About 20% of untreated cases of cutaneous anthrax will result in death.
Deaths are rare with appropriate antimicrobial therapy.
Inhalation: Initial symptoms may resemble a common cold. After several days,
the symptoms may progress to severe breathing problems and shock. Inhalation
anthrax usually results in death in 1-2 days after onset of the acute symptoms.
Intestinal: The intestinal disease form of anthrax may follow ingestion of
contaminated meat and is characterized by an acute inflammation of the
intestinal tract. Nausea, loss of appetite, vomiting and fever are followed by
abdominal pain, vomiting of blood, and severe diarrhea. Intestinal anthrax
results in death in 25% to 60% of cases. The incubation period is usually
within seven days. There are no reports of the disease spreading from human to
human. Direct person-to-person spread of anthrax most likely does not occur.
Once a person has been infected with anthrax and survived, a second bout with
this disease is unlikely.
To treat anthrax, doctors can prescribe antibiotics. Usually penicillin based
antibiotics such as Cipro are preferred, but erythromycin, tetracycline, or
chloramphenicol can also be used. To be effective, treatment should be
initiated early. The disease could be fatal if left untreated. (Sofaer, et al,
1999)
Anthrax Vaccine
Anthrax vaccine is available for people in high-risk occupations. To prevent
anthrax, carefully handle dead animals suspected of having anthrax; provide
good ventilation when processing hides, fur, hair or wool; and vaccinate
animals. In countries where anthrax is common and vaccination levels of animal
herds is low, humans should avoid contact with livestock and animal products,
and avoid eating meat that has not been properly slaughtered and cooked. For
high risk occupations, such as those exposed to potentially contaminated animal
hair, wool or hides, vaccination is recommended. An anthrax vaccine has been
licensed for use in humans. The vaccine is reported to be 93% effective in
protecting against cutaneous anthrax. (Sofaer, et al, 1999)
The anthrax vaccine uses dead bacteria as opposed to live bacteria, and is indicated
for individuals who come in contact in the workplace with imported animal
hides, furs, bonemeat, wool, animal hair and bristles. It is also indicated for
individuals engaged in diagnostic or investigational activities which may bring
them into contact with anthrax spores. Now, the terroristic use of anthrax in
this country has caused us to vaccinate our armed service and certain
governmental personnel.
BioPort Corporation is the sole manufacturer of the anthrax vaccine. The
vaccine is US Food and Drug Administration (FDA)-licensed and has been
routinely given in the US since 1970. The immunization consists of three
subcutaneous injections given two weeks apart followed by three additional
subcutaneous injections given at 6, 12, and 18 months. Annual booster
injections of the vaccine are required to maintain immunity. Like all vaccines,
anthrax vaccine may cause soreness, redness, itching, swelling, and lumps at
the injection site. About 30% of men and 60% of women report these local
reactions, but they usually last only a short while. Lumps can persist a few
weeks, but eventually disappear. Injection-site problems occur about twice as
often among women. For both genders, between 1% and 5% report reactions at the
injection site of 1 to 5 inches in diameter. Larger reactions at the injection
site occur in about one in a hundred vaccine recipients. Beyond the injection
site, from 5% up to 35% will notice muscle aches, joint aches, headaches, rash,
chills, fever, nausea, loss of appetite, malaise, or related symptoms. Again,
these symptoms usually go away after a few days. Serious events, such as those
requiring hospitalization, are rare. They happen about once per 50,000 doses.
Severe allergic reactions can occur after any vaccination, less than once per
100,000 doses. A moderate local reaction can occur if the vaccine is given to
anyone with a past history of anthrax infection. Acute symptoms have varied.
Depending on the vaccine lot used. The most common side effects reported are:
mild discomfort (localized swelling and redness at the site of injection),
joint aches, and in a few cases, nausea, loss of appetite, and headaches. There
have been no long term side effects from the vaccine. Sofaer, et al, 1999)
Small quantities of anthrax vaccine are made available as needed to civilians
who are exposed to anthrax hazards in their work environment such as
veterinarians, lab workers and others. Anthrax vaccine is produced exclusively
by the Michigan Biologic Products Institute under contract to the Defense Department.
Virtually all vaccine produced is earmarked for military use in recognition of
the documented threat to military personnel. (Cordesman, 2001)
Biological Warfare
The use of bacteriological agents in an armed conflict can be dated back to
1346, at Kaffa (now Feodossia) where the bodies of Tartar soldiers who died
from the plague were thrown over the walls of the besieged city. It is
hypothesized by some medical historians that the action resulted in the
infamous pandemic that spread over the entire continent of Europe from Genoa,
via the Mediterranean ports. USAMARIID (2001) Since that time, various forms of
biological warfare have been used in many countries. Boris Yeltsin acknowledged
in a press conference, prior to meeting with President Bush in the summer of
1992, Washington, D.C., that an incident in Sverdlovsk where civilians came
down with a "mysterious illness," resulting in many fatalities was in
fact a massive biological warfare accident involving an aerosol of anthrax
spores. Presumptive evidence acquired by United Nations Biological Warfare
Inspection Team in 1992 indicated that Iraq could have been in the early stages
of developing an offensive BW capability. On-site inspections revealed several
laboratories with state-of-the-art equipment that could have been used for
agent production. No evidence, to date, has been established for munitions
development and/or agent weapons. The experience of the U.N. team emphasizes
the difficulty of locating a Smoking Gun relative to BW programs. This type of
program is much easier to hide from inspection than either chemical or nuclear
programs. USAMARIID (2001)
U.S. Offensive Program
The United States initiated a review of the potential of BW in 1941-1942,
implemented a program in 1943 and had established its feasibility by 1969. In
1969, President Nixon disestablished offensive studies including the
destruction of all stock piles of agents and munitions. As important events of
this program are to be described, the political climate in which the program
was implemented must be considered. The policy of the United States was first
and foremost to deter its use against U.S. forces, and secondarily to retaliate
if deterrence failed. When the biological warfare program was established, the
United States was fighting World War II on two fronts, Europe and Asia. When
World War II ended, a cold war developed in which the security of the country
was still threatened. The tempo of world attitudes and times have changed
significantly in the 23 years following the elimination of U.S. biological
warfare programs. Because a potential BW threat still exists, the U.S.
maintains a defensive biological program. USAMARIID (2001)
According to the Centers for Disease Control and Prevention (CDC), biological
agents pose a risk to national security because they are easily disseminated;
cause high mortality, which would have a major impact on public health systems;
cause panic and social disruptions; and require special action and funding to
increase public preparedness. 5 As the following facts and figures show, the
challenges facing the Bush Administration, the new Office of Homeland Security,
and Congress in responding to the growing threat of bioterrorism are immense.
(Heritage Foundation, 2001)
The following map shows the countries known and suspected to have biological
weapons programs:
According to a recent U.S. General Accounting Office (GAO) report, coordination
of federal terrorism research, preparedness, and the responsible programs thus
far has been fragmented. Several agencies are responsible for coordinating
functions, and this both limits accountability and hinders unity of effort.
Moreover, several agencies have not been included in bioterrorism-related
policy and response planning meetings, and different agencies have developed
lists of biological agents as well as disaster response assistance programs for
state and local governments. The Federal Emergency Management Agency (FEMA),
the Department of Justice, the CDC, and the Office of Emergency Preparedness (OEP),
for example, offer separate assistance to state and local governments in
planning for emergencies that include bioterrorism. (USGAO, 2001)
Bioterrorism Agents
As many as 17 nations, including several the U.S. State Department considers
"state sponsors of terrorism," have developed lethal biological
agents as weapons of war. The list of bacteria, viruses, and toxins explored by
these weapons programs is vast -- running in the dozens. We focus on eight
agents that may pose the greatest threats. Most of these deadly pathogens are
difficult to obtain, process, and most critically, deploy to cause mass
casualties. Yet we must understand these agents -- how they would be used and
the diseases they trigger -- to prepare for even the most unlikely bioterrorist
attack. (Nova, 2001) Some of these agents include anthrax, cholera, botulism,
the plague and smallpox. Of these, the popularity of anthrax could be explained
by the fact that there is a vaccine for it, so that it can be safely handled by
someone who has been vaccinated. Also, it has a relatively short incubation
period, and, while all types can be treated with antibiotics, the inhaled
version is often confused with the flue and by the time it is diagnosed, it
usually proves fatal. (Nova, 2001)
Production of biological warfare agents such as anthrax does not require
specialized equipment or advanced technology. When comparing equivalent amounts
of biological and chemical warfare agents, the biological agent is farmore
potent. Small amounts can produce large numbers of casualties. Delivery
vehicles include: aerial bombs, artillery shells, long-range missiles,
agricultural sprayers, and spray tanks carried by aircraft. Many of the
materials and equipment that are used to produce biological warfare agents are
available from legitimate sources and intended for other uses. It is difficult
to limit spread of biological warfare agents because of the dual-use nature of
the equipment and technologies. There is a legitimate market for legal products
which can be produced with this equipment, i.e., pharmaceuticals,
biopesticides, etc. (DOD, 1998)
Conclusion
After reviewing the research, it is apparent that the threat bioterrorism with
the use of anthrax and other agents is of worldwide proportions. It is
difficult to find laboratory sites, because of the ease of acquisition of the
minimal equipment used and the agent itself, in some countries. Another factor
is the different modes of relaying the biological agent, which range from
massive amounts to small amounts, as distributed through the post office via
mail. Even the ongoing infections through the mail are forms of terrorism,
since they make a large number of people fearful of being contaminated,
although the numbers actually infected are minimal. This is because the mail is
something that is usually taken for granted and trusted.
As far as the governments capabilities for handling these threats, on a
small-scale, the government does have large numbers of antibiotics on hand to
treat people once they have become infected. However, there is certainly not
enough vaccine available to pre-inoculate people so that they do not have to
worry about becoming infected. Even if they did have enough vaccine for
anthrax, there are many other diseases that could be used in biological
warfare, and vaccines, if available, would have to be given for all of these.
Should we be attacked on a large scale, i.e. through a missile containing a
large number of spores, the devastation would be of pandemic proportions if
there were not enough antibiotics available to treat everyone. The United
States government is taking the threat of bioterrorism seriously, however there
is a long way to go before it can be said that we are fully prepared.
It is difficulty in a country where freedom is a top priority to efficiently
fight these and other methods of terrorism. People should not have to give up
their freedom, however they also need to be protected. It is possible, for
instance, that it may become necessary for people to receive mandatory vaccinations.
Right now, to provide more intense screening of packages shipped through the
mail, people are required to provide identification when shipping packages from
their local post office. Mail is delayed because of the anthrax scares. This is
an inconvenience few would complain about. Hopefully, a plan will be devised
for maximum safety at minimum loss of freedom.
References
Abraham D. Sofaer, George D. Wilson, and Sidney D. Dell, The New Terror: Facing
the Threat of Biological and Chemical Weapons (Stanford, Cal.: Hoover
Institution, 1999), pp. 79-81.
Anthony H. Cordesman, Asymmetric and Terrorist Attacks with Biological Weapons
(Washington, D.C.: Center for Strategic and International Studies, 2001), pp.
74-76
Daniel J. Dire, "CBRNE-Biological Warfare Agents," eMedicine Journal,
Vol. 2, No. 7 (July 3, 2001), Section 2.
U.S. Department of Defense. News Release. Defense Link. "Accelerated
Anthrax Vaccination Program to Enhance Force Protection Announced," March,
1998.
U.S. Department of Defense. Defense Link. " Information Paper; DOD
Biological Warfare Threat Analysis," 1998.
USAMARIID. (2001) "History of Biological Warfare,"
http://www.gulfwarvets.com/biowar.htm.
Nova (2001) "Bioterror,"
http://www.pbs.org/wgbh/nova/bioterror/agents.html
U.S. General Accounting Office, Bioterrorism: Federal Research and Preparedness
Activities, GAO-01-915, September 2001, pp. 15-16.