Bulletin Board

• Double bag the letter or package in zipper-type or zip-lock type plastic bags using latex gloves, if possible, and a particulate mask
• Wash your hands with soap and water
• Notify your immediate supervisor and local police, postal inspectors and the FBI, who will arrange to collect the letter or the threat and assess the threat situation
• Notify the local, county, and state health departments
• Notify the state emergency manager
• Ensure that all persons who have touched the letter wash their hands with soap and water
• List all persons who have touched the letter and/or envelope with locating and contact information and provide the list to appropriate people
• Place all items worn at the time in plastic bags and keep them wherever you change your clothes and have them available for law enforcement, should they request them
• Shower with soap and water
• Take medication until otherwise instructed or it runs out
• Notify Center for Disease Control (CDC) Emergency Response at (770) 448-7100 for any questions, or if you require further information

Anthrax is a bacterial, zoonotic disease caused by Bacillus anthracis, a rod-shaped, gram positive, sporulating organism with the spores constituting the usual infective form. Anthrax occurs in domesticated and wild animals, primarily herbivores, including goats, sheep, cattle, horses, and deer, but other animals may be infected.

The skin form of the human disease may be contracted by handling contaminated hair, wool, hides, flesh, blood or excreta of infected animals and from manufactured products such as bone meal. Infection is introduced through scratches or abrasions of the skin, wounds, inhalation of spores, eating insufficiently cooked infected meat or flies. The spores are very stable and may remain viable for many years in soil and water. They will resist sunlight for varying periods.

After an incubation period of 1-7 days, the onset of inhalation anthrax is gradual. Possible symptoms include:

• fever
• malaise
• fatigue
• cough
• mild chest discomfort followed by severe respiratory distress

This mild illness can progress rapidly to respiratory distress and shock in 2-4 days followed by a range of more severe symptoms including difficulty breathing, exhaustion, tachycardia, cyanosis and terminal shock can occur. Death usually occurs within 24 hours of respiratory distress onset.

Anthrax is an acute bacterial infection of the skin, lungs, or gastrointestinal tract. Infection occurs most commonly via the skin route and only very rarely via the others.

The cutaneous or skin form occurs most frequently on the hands and forearms of persons working with infected livestock or contaminated animal products and represents 95% of cases of human anthrax. It is initially characterized by a papule which progresses to a fluid filled blister with swelling at the site of the infection. The scab that typically forms over the lesion can be black as coal, hence the name anthrax--Greek for coal. With treatment, the case fatality rate should be less than 1% among cutaneous cases. The fatality rate for untreated inhalational or intestinal anthrax is over 90%.

The inhalational form is contracted by inhalation of the spores, occurs mainly among workers handling infected animal hides, wool, and furs. Under natural conditions, inhalational anthrax is exceedingly rare, with only 18 cases having been reported in the United States in the 20th century.

Treatment with antibiotics beginning one day after exposure to a lethal aerosol challenge with anthrax spores (8,000 - 22,000 spores) has been shown to provide significant protection against death in monkeys, especially when combined with active immunization. Penicillin, doxycycline, and ciproflaxin are all effective against most strains of B anthracis. Penicillin is the drug of choice for naturally occurring anthrax. If untreated, inhalational anthrax is fatal. For post-exposure prophylaxis the administration of antibiotics should be continued for at least 4 weeks in those exposed and if available, those exposed should receive 3 doses of vaccine before antibiotics are discontinued.

A vaccine is available and consists of a series of 6 doses over 18 months with yearly boosters. The first vaccine of the series must be given at least 6 weeks before exposure to the disease. This vaccine, while known to protect against anthrax acquired through the skin, is also believed to be effective against inhaled spores. While a vaccine does exist for anthrax, its availability to the general public is not widespread.

Effective decontamination can be accomplished by boiling contaminated articles in water for 30 minutes or longer and using some of the common disinfectants. Chlorine is effective in destroying spores and vegetative cells. Remember, anthrax spores are stable, able to resist sunlight for several hours and able to remain alive in soil and water for years.

Some typical characteristics Postal Inspectors have detected over the years, which ought to trigger suspicion, include parcels that may:

• Be unexpected or from someone unfamiliar to you
• Be addressed to someone no longer with your organization or otherwise outdated (e.g., improper title)
• Bear no return address, or one that can't be verified as legitimate
• Be of unusual weight, given its size, or be lopsided
• Be marked with restrictive endorsements, such as "Personal" or "Confidential"
• Exhibit protruding wires, strange odors or stains
• Exhibit a city or state in the postmark that doesn't match the return address

• Do not try to open the parcel as they are usually designed to withstand handling while in the mail and to explode when opened or when an item is removed
• Isolate the parcel
• Evacuate the immediate area
• Call a Postal Inspector to report that you've received a parcel in the mail that may be a bomb

Additional Resources:

The Federal Bureau of Investigation (FBI) is the lead Federal agency for crisis management for all acts of terrorism and in all threats or incidents of WMD. The FBI will coordinate the Federal Government's efforts to prepare the nation's response community for threats involving weapons of mass destruction (WMD). The National Domestic Preparedness Office (NDPO) works in conjunction with other Federal, State and Local crisis managers specific to WMD and will perform an Interagency Threat Assessment and deploy a Domestic Emergency Support Team (DEST) if a threat is received. To contact them call: 202-324-0259, FBI Special Information Operations Center, SIOC.

The Defense Threat Reduction Agency (DTRA) is a new agency that is charged with reducing the present threat to the U.S. and its allies from WMD and preventing future threats. DTRA focuses Department of Defense efforts to prepare for and respond to chemical or biological attacks. The CB Hotline is 1-800-424-8802. The web site is https://www.dtra.mil/.

The Centers for Disease Control and Prevention (CDC) is responsible for coordinating all public health and would be contacted at the Emergency Preparedness and Response Branch, National Center for Environmental Health to report an incident at 770-488-7100. Their web site is https://cdc.gov.