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Environmental Health - Information - Anthrax

 

Volusia County has a surveillance system in place for doctors and hospitals to report any suspicious infections including anthrax. Our first responders are very prepared to handle any potential threat and we have immediate access to State level experts and the Centers for Disease Control and Prevention (CDC) resources if needed. Please help our community by spreading the word to anyone you encounter who has concerns.

If someone has been in contact with powder that is feared to be anthrax, there is no indication for nasal swabs, blood tests or Cipro antibiotic prescriptions until the powder has been tested and found to be positive. Therefore, all powders and substances are being sent to Jacksonville, Florida for testing and if any turn out to be positive for anthrax, all contacts would then be notified to have tests and antibiotic prescriptions, but only after a positive test on powders or substances. Remember, most powders and substances being received in envelopes or packages are hoaxes and will test negative for anthrax.

If you receive a package or envelope that is suspicious or allegedly contains anthrax:

  1. Do not open, shake, throw, scatter or smell the package.
  2. Use gloves to Isolate the package.
  3. Call 911 and wait for the Hazmat Team who is trained to handle suspicious material.
  4. Follow Hazmat instructions.
  5. Notify Volusia County Health Department Administration at 386-274-0500.
  6. Administration or Hazmat will notify the local FBI and State Warning Point.
  7. The State will notify the CDC.

For many, it is difficult to remain calm, but take comfort in the fact that anthrax spores wash off easily and antibiotic prophylaxis does work to prevent anthrax infection.

Click on each question below for more information.

  1. What is anthrax?
  2. What is inhalation or pulmonary anthrax?
  3. How can I get pulmonary anthrax?
  4. How common is inhalation anthrax?
  5. Is inhalation anthrax always fatal?
  6. What are the symptoms?
  7. Can inhalation anthrax be treated?
  8. Can inhalation anthrax be prevented?
  9. Is there a vaccine?
  10. Is inhalation anthrax contagious?
  11. What's the difference between infectious and contagious?
  12. What if someone just dumped a pound of spores on the ground? Would they blow away in a fatal cloud?
  13. How can I get rid of spores in my house, my yard?
  14. Could an envelope carry anthrax germs?
  15. What if anthrax spores got washed into a storm drain? Or into our water supply?
  16. What about the old, the young, sick people. Are they more prone to getting anthrax?
  17. What can I do at home?
  18. So, you can't get inhalation anthrax from water. Can you get cutaneous or gastrointestinal anthrax from water?
  19. OK, so the biggest threat for inhalation anthrax comes from an airborne attack?
  20. Why would somebody modify the anthrax bacterium?
  21. Is it possible to make synthetic anthrax bacteria? I've heard newscasters say the Boca Raton strain was "man-made."
  22. How do you kill anthrax spores?

 

What is anthrax?

A disease caused by a bacterium: Bacillus anthracis. In its dormant state, the bacterium forms spores. When the spores enter the right nutritional environment, they germinate and multiply. Massive colonies of bacteria will then release toxins into the infected environment. The germs can enter through skin (cutaneous anthrax) or by ingestion or inhalation.

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What is inhalation or pulmonary anthrax?

It is a virulent infection of the lungs or brain lining, or both. The name derives from the same ancient Greek word root as anthracite: black. It refers to the skin lesions caused by cutaneous anthrax, which is not as lethal as pulmonary anthrax but is far more common.

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How can I get pulmonary anthrax?

By breathing large amounts of B. anthracis spores, which are found in the soil or on infected animals such as livestock, sheep or goats. The animals become infected from breathing the spores. Contact with them can result in one of the forms of anthrax.

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How common is inhalation anthrax?

So rare as to be almost nonexistent. But it has been chronicled since biblical times. Only 18 Americans contracted the disease in the 20th century. Thirteen of these worked in goat hair factories, where studies showed they breathed large amounts of the spores day in and day out. Yet thousands and thousands of fellow workers never got sick. Two of the other victims worked in laboratories, where bacterial concentrations were likely high. The last case, before Robert Stevens, was reported in 1978, according to The Journal of the American Medical Association.

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Is inhalation anthrax always fatal?

If not treated with antibiotics before symptoms appear, it is fatal more than 85 percent of the time. But that rate is based on cases chronicled before antibiotics were widely used and before microbiology diagnostic labs were as efficient as they are now.

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What are the symptoms?

Early symptoms can include sore throat, muscle aches, mild fever, cough, headache, and vomiting. Later symptoms can include stupor, delirium, shock and loss of breathing functions.

Can inhalation anthrax be treated?

It can be treated with antibiotics after exposure and before onset of symptoms, but once symptoms appear, treatment is not likely to succeed.

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Can inhalation anthrax be prevented?

It is hard to prevent because the anthrax bacterium is odorless and its distribution occurs silently and invisibly. But preventive antibiotics (Cipro is most common), taken before or immediately following exposure to the anthrax bacterium, will block or knock the disease down. The problem is, you shouldn't take these antibiotics unless public health officials determine a clear and present danger exists. One case does not create that condition. Even two cases may not, because rare diseases often happen in groups. Remember Legionnaires' disease of E. coli outbreaks.

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Is there a vaccine?

A vaccine was licensed in 1970 and almost 600,000 doses have been given to armed forces personnel. Its effectiveness diminishes with time, it is expensive and the government and scientists feel it is not, at this time, practical to manufacture and distribute enough for nationwide vaccination. Certain antibiotics rather than a vaccine would be the recommended course to follow if an outbreak was thought probable. But most experts agree that the anthrax bacterium used in a terrorist attack would be genetically altered to be resistant to penicillin, the workhorse of the antibiotic family. The bacterium can be altered, but not synthesized or man made.

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Is inhalation anthrax contagious?

NO. It is an infectious disease, but not contagious.

What's the difference between infectious and contagious?

An infectious illness spreads and grows within your body: For example, from lungs to blood to spinal fluid. A contagious illness spreads from person to person. Some bacterial and viral illnesses are both contagious and infectious: AIDS, the common cold, certain staph infections that can be transferred through person-to-person contact. But pulmonary anthrax, though an infectious disease, is NOT contagious.

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What if someone just dumped a pound of spores on the ground? Would they blow away in a fatal cloud?

Highly doubtful. The Journal of the American Medical Association cited Army tests conducted with soldiers exercising heavily, noses to the ground, on dirt infected by 2 million spores per square meter. The tests concluded that the soldiers might breathe a lethal dose. The simulation was meant to determine how safe runways and roads might be after an anthrax attack. But soldiers under those attack conditions would have been immunized and would be wearing gas masks. Again, the conclusion is: Those concentrations of spores would not exist naturally. You need aerosol delivery to infect large numbers of people.

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How can I get rid of spores in my house, my yard?

First of all, chances are extremely low that you'd ever get spores in your house. If you did, the spores would be very difficult to kill. But that's OK. The spores exist naturally throughout the United States. They're out there, along with many benign bacteria and other, virulent bacteria. If you follow the same cleaning procedures as hospitals and scrub surfaces as hospitals scrub surfaces with detergent solutions and wash hands frequently - you'll protect yourself against all sorts of bacteria that pose a more immediate and predictable health threat than anthrax spores. And you could wash away some anthrax spores in the bargain. If you feel you must scrub everything down, good luck. The British successfully used a strong solution of formaldehyde and tons of sea water to decontaminate a former anthrax research site. It took 30 years.

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Could an envelope carry anthrax germs?

Theoretically. Someone could put a large quantity of the spores into any container. But you'd have to snort the contents to have devastating results. It's not the way to make large numbers of people sick.

What if anthrax spores got washed into a storm drain? Or into our water supply?

Inhalation anthrax is not a water-borne disease. Even if millions of spores washed into drains and sewers, they'd be in solution with billions and billions of gallons of water and pose no measurable risk. For that matter, spores washed down your kitchen drain pose no measurable threat. Water might not kill the spores, but it spreads them out, and when they're spread out in water, they're not going to make you sick.

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What about the old, the young, sick people. Are they more prone to getting anthrax?

As with just about everything about this bacterium, and this outbreak, it's a mixed bag. Based on the limited statistics available for anthrax, as well as what is known about most common bacterial infections, the very old, the very young, the sick, smokers or those with weakened lung function may be more at risk. But that's all academic: Experts think the massive concentrations of anthrax spores likely in an actual attack would put everybody downwind at risk.

What can I do at home?

"Homeowners should carry on normal hygienic precautions," says Dr. Istvan Krisko, an infectious disease specialist in Palm Beach County. "Wash surfaces, clean the house, wash hands."

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So, you can't get inhalation anthrax from water. Can you get cutaneous or gastrointestinal anthrax from water?

Cutaneous: no. That usually comes from contact with infected animals. It could come from direct contact with anthrax spores; if skin has a cut or abrasion, entry would be easier. Gastrointestinal anthrax comes from eating undercooked meat contaminated with anthrax, from game usually. Gastrointestinal anthrax is very rare. A few small outbreaks have been reported in Asia and Africa since 1980.

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OK, so the biggest threat for inhalation anthrax comes from an airborne attack?

Yes. Clearly, Stevens breathed a fatal dose, source unknown, which appears to be limited in scope. A large-scale attack would be much harder to pull off. Large-scale anthrax contamination takes large-scale production, experts say. It's very high-tech. Not low-tech. Same with transportation of spores and equipment into the United States. A crop-dusting plane would have to be specially rigged to spray a lethal cloud of anthrax spores. But here's an even more comforting fact from a counter-terrorism expert: Planes flying near population centers appear on FAA air traffic control radar screens. The FAA has a stringent system of air traffic control. It is much easier to commandeer and crash a plane than it is to fly an unannounced pattern over a big city for prolonged periods. Anthrax spores cannot be effectively delivered by crashing a plane. Any plane that varies from a flight plan or doesn't file a flight plan and then veers into heavily used air corridors will appear - literally - on everybody's radar screen.

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Why would somebody modify the anthrax bacterium?

Two broad reasons: military research and infectious disease research. Military researchers might alter the germ to make it a more potent weapon, or they might alter the germs to gain a step on enemies who are altering the germs. Infectious disease scientists might alter the bacteria during research to find more potent antibiotics or during research to determine why certain medicines are losing their effectiveness. In general, bacteria lose their battle against antibiotics in two ways: They can't reproduce or their cell walls collapse. When doctors find an antibiotic-resistant strain, they want to learn about its new genetic code. U.S. researchers would register the new strain with the Centers for Disease Control and Prevention. The strains might then be shipped to other labs for research.

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Is it possible to make synthetic anthrax bacteria? I've heard newscasters say the Boca Raton strain was "man-made."

No. It's incorrect to say man-made. Anthrax spores can be modified, altered, re-engineered. A new strain might be the result, but a new strain cannot be synthesized. You have to start with a live germ that already exists.

How do you kill anthrax spores?

It's difficult, but the good news is, you need not worry about contamination from surfaces. That's a good thing. The British cleaned up a highly contaminated former bioresearch site using formaldehyde mixed with sea water. It took almost 30 years. Use the same safeguards hospitals use: Wash hands, clean surfaces, utensils, glassware. But remember: Anthrax spores virtually never enter the lungs from the ground or surfaces. Scientists think it's highly unlikely the spores can be stirred or kicked up from a surface and cause pulmonary infection.

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Page last updated: 07/9/13