What is anthrax?
Anthrax is an acute infectious disease caused by the spore-forming bacterium Bacillus anthracis. Anthrax most commonly occurs in wild and domestic livestock (such as cattle, sheep, and goats), but infections can occur in humans as well. In the fall of 2001, an outbreak of cutaneous and inhalation anthrax in New York City, New Jersey, the Washington, D.C. area, and Florida resulted from a still unsolved act of bioterrorism involving letters intentionally contaminated with anthrax spores. A New York City resident was diagnosed with inhalation (lungs) anthrax in February 2006. He was infected after using a contaminated African animal skin to make an African drum.
What are the different types of diseases of anthrax?Cutaneous (skin): Cutaneous anthrax first appears as a boil-like, itchy pimple that feels like an insect bite. Over the next week or so, it changes into a fluid-filled blister, then an ulcer which eventually may have a black center. Cutaneous anthrax can cause significant swelling and is painless. While cutaneous anthrax infections account for about 95% of all human anthrax cases, there are other, more serious forms of anthrax: inhalation, intestinal, meningeal and injectional.
Inhalation (lung): Initial symptoms of inhalation anthrax may resemble the common "flu" and include fever, muscle ache, mild cough, and chest pain. After several days, the symptoms may progress to severe breathing problems and shock. Without immediate treatment, inhalation anthrax is usually fatal.
Gastrointestinal (throat or abdomen): This is the rarest form of anthrax disease and can occur in the upper (throat) or lower (abdomen) intestinal tracts. It typically occurs after a person eats uncooked or undercooked food that is contaminated with anthrax spores or bacteria and causes severe inflammation of the intestinal tract. The first symptoms of gastrointestinal anthrax include nausea, loss of appetite, vomiting, and fever. These symptoms are followed by an extremely painful throat or abdominal pain, vomiting of blood, diarrhea, which can be bloody, or abdominal bloating. Unless antibiotic treatment is started shortly after symptoms begin, intestinal anthrax is usually a fatal disease.
Meningeal (brain): This can occur if anthrax bacteria enter the bloodstream following cutaneous, inhalation or intestinal anthrax infection, and from there spread to the brain. Symptoms include sudden headache, nausea, vomiting, muscle aches, chills and dizziness. This usually cannot be treated successfully.
Injectional (blood): This is a new form of anthrax that has been described recently. It is caused when contaminated heroin is injected (usually in the skin). Between 2009 and 2010, more than 30 cases of injectional anthrax were confirmed among heroin users in the United Kingdom, including 11 deaths. Severe infections of the skin and blood have been reported. Investigators think that the heroin was contaminated with anthrax spores at some point during transport of the drug by animal from Afghanistan (where anthrax occurs naturally) to Europe.
Who gets anthrax?
Human anthrax is most common in agricultural areas where anthrax in animals occurs, including: South and Central America, Southern and Eastern Europe, Asia and Africa. Anthrax occasionally occurs in animal herds in the United States as well, but until 2001, cases in humans were rare. Intestinal anthrax sometimes occurs in areas of the world where infected animals are slaughtered and then eaten. Typically, when anthrax affects humans, it is from an occupational exposure to infected animals or animal products, such as wool, hides and/or hair. However, those at-risk during the 2001 outbreak included persons who had come into contact with contaminated mail, such as postal, news media, and government employees.
Contaminated African animal hides have been involved in a number of recent anthrax infections. A NYC resident was diagnosed with inhalation (lungs) anthrax in February 2006. He was infected after using a contaminated African animal skin to make an African drum. In summer 2006, a Scottish citizen died from inhalation anthrax after taking part in a drumming class where contaminated African drums were used. Two Connecticut residents also were diagnosed with cutaneous anthrax in fall 2007 after at least one contaminated African animal hide was used to make a traditional African drum. A New Hampshire woman contracted gastrointestinal anthrax in 2009 after attending a drumming event where she presumably had contact with an African drum that was made with a contaminated hide. To reduce the potential risk from contaminated animal hides, it is recommended that drum makers purchase domestic hides that have been treated by a professional to reduce the number of spores.
In 2009 and 2010, intravenous drug users in Europe were infected when they injected heroin that had been contaminated with anthrax spores. This probably occurred during transport of the heroin from Afghanistan – where anthrax naturally infects animals – to Europe.
How is anthrax spread?
Anthrax is almost never spread from one person to another person. It also is not found in animal milk.
People get exposed to and then infected by the anthrax bacteria in four ways: (1) if anthrax spores enter through breaks in the skin (cutaneous), such as when carrying contaminated animal products, including hair, wool, or hides, or from intentionally contaminated letters as occurred in fall 2001; (2) if anthrax spores are breathed into the lungs (inhalation), such as in manufacturing processes that used contaminated animal hides, wool or hair; (3) by eating (gastrointestinal) uncooked or undercooked food that is contaminated with anthrax bacteria or spores; or (4) by shooting heroin (injectional) that is contaminated with anthrax spores.
How soon after anthrax infection do symptoms appear?Generally, the incubation period is seven days or less. Inhalation anthrax can occur within 48 hours of exposure. However, some people might not get symptoms for weeks.
Is anthrax contagious?
Anthrax is not spread from person to person by casual contact, sharing office space or by coughing or sneezing. Inhalation, gastrointestinal, meningeal and injectional anthrax cannot be spread from person to person. Even after the symptoms of inhalation anthrax begin, persons are not contagious to others. Very rarely, drainage from an open sore of cutaneous (skin) anthrax may lead to a skin infection in another person.
How is anthrax diagnosed?
Depending on where the infection is located, anthrax bacteria can be cultured from blood, skin, spinal fluid or from fluid that can collect in the abdominal cavity or around lungs (pleural fluid). Suspicious bacteria then can be tested and confirmed as the anthrax bacteria at governmental public health laboratories, such as the New York City Public Health Laboratory. Patients’ blood also can be tested for antibodies to the anthrax bacteria. These bacteria also can be seen and detected under a microscope, when looking at samples of infected human tissue. Lastly, there is a laboratory method called polymerase chain reaction (PCR) that can detect extremely small amounts of anthrax DNA.
What is the treatment for anthrax?
Doctors can prescribe antibiotics to treat anthrax. To be effective, treatment should be started as soon as possible after anthrax infection is suspected. Cutaneous anthrax can be treated easily with antibiotics. However, it may be fatal if not treated at all or if treatment is delayed. Inhalation (lung), gastrointestinal, meningeal (brain) and injection anthrax are much more severe infections. Successful treatment requires antibiotics, medical procedures and potentially long hospital stays.
Is there an anthrax vaccine, and how can I get it?
There is an effective anthrax vaccine. It is administered 3 times over one month. Periodic boosters might be recommended after that. It cannot be obtained from health care providers and currently is available only for military personnel thought to be at higher risk for potential exposure to anthrax in combat settings. The U.S. Centers for Disease Control and Prevention (CDC) maintains a supply of anthrax vaccine that would be available to state and local governments for emergency use.
What has New York City done to address the threat of anthrax?
Many federal, State, and City agencies-including the New York City Department of Health and Mental Hygiene (DOHMH)-have been working together for several years to prepare for the detection and response to a bioterrorist event in New York City. In cooperation with other emergency response agencies, DOHMH has set in place systems that improve our ability to detect and respond to public health emergencies caused by the intentional release of a biological agent.
For more information about anthrax, visit the CDC Web site.
Last Updated: December 2011