Health News Now – Information on Bioterrorism

The Columbus Health Department protects and promotes the health of the public. This mission includes preparation for and response to local emergencies including bioterrorism. Current national events have increased the concerns of the public regarding exposure to anthrax and other chemical and biologic agents. Our department and the entire public health system are vigilant to possible threats and remain committed to assuring the highest level of protection to the public. For the past four years, we have been working locally with a range of organizations and systems to protect our community from an event of bio-terrorism. A strong plan is in place that involves all of the local health care organizations. We hope that Columbus residents will take some comfort in knowing that such efforts have taken place.

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FREQUENTLY ASKED QUESTIONS

• What is a bioterrorism incident?
• How likely is a bioterrorism attack?
• What is the local health department doing to protect the public and prepare for bioterrorism?
• What is anthrax? 
• What are the symptoms of anthrax?
• Are anthrax vaccines available and should I be vaccinated? 
• Is there an approved treatment for anthrax?
• Is anthrax contagious?
• What is Smallpox?
• Should I have a supply of antibiotics on hand for an incident of bioterrorism? 
• Should I buy a gas mask?
• Is it safe for me to drink water from the tap? 
• How can I best prepare for a bioterrorism threat?
• What should I do if I receive a suspicious letter? 
• What should I consider to be a suspicious package or letter?
• Where can I get additional information about bioterrorism?

What is a bioterrorism incident?
A bioterrorism incident is an event where an infectious agent or germ has been used to cause illness. Use or threatened use of any biologic agent as a weapon is a federal crime and will be thoroughly investigated and prosecuted by local law enforcement and the FBI.

How likely is a bioterrorism attack?
An attack with bacteria or virus spread in the air is extremely unlikely. It is difficult to make bacteria or virus that will survive being spread through the air. Of all the recently reported local suspected incidents involving a bioterrorism agent, all have turned out to be hoaxes. However unlikely local law enforcement and related agencies will take all necessary steps to evaluate the incident and secure the safety of the public.

What is the local health department doing to protect the public and prepare for bioterrorism?
The Columbus Health Department has been working for the past four years with many local organizations and systems on emergency preparedness to include bioterrorism. The effort is called the Metropolitan Medical Response System (MMRS). Participating organizations include: local law enforcement and fire departments, Franklin County Emergency Management Agency, local hospitals and health care providers, and many others who would play a key role in responding to any local emergency. Over the past four years, the MMRS has been instrumental in providing training to law enforcement and health care providers on recognizing and responding to a bioterrorism incident; purchasing and distributing decontamination equipment; purchasing a cache of pharmaceuticals; and establishing a two-pronged surveillance system to enable early detection of a bioterrorism event. In addition, the MMRS has established an emergency operations plan to be followed in a range of incidents. Elements of the plan have been tested through exercises and suspected events both serving to identify areas for improvement. The planning and preparatory activities of the MMRS and participating agencies continue with even greater intensity in light of current circumstances.

What is anthrax?
Anthrax is a disease caused by bacteria called Bacillus anthracis. Anthrax infection can occur in three forms: cutaneous (skin), inhalation, and gastrointestinal. It is most likely that the bacteria would be spread by air in a bioterrorism attack. As early as a day to two after and up to seven weeks after exposure, inhaled spores grow rapidly. This results in fever, difficulty breathing, and general discomfort. Death typically occurs within several days without medical treatment. Antibiotics can stop the disease if taken at the time the spores begin to grow or soon after. Anthrax is not contagious. It cannot be spread from person to person.

What are the symptoms of anthrax?
According to the Centers for Disease Control and Prevention (CDC), symptoms of disease vary depending on how the disease was contracted, but symptoms usually occur within 7 days.

Cutaneous: Most (about 95%) 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 characteristic black necrotic (dying) 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 is usually fatal.

Intestinal: The intestinal disease form of anthrax may follow the consumption of contaminated meat and is characterized by an acute inflammation of the intestinal tract. Initial signs of 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.

Are anthrax vaccines available and should I be vaccinated?
The anthrax vaccine is not commercially available in the United States and is not a recommended vaccine for the civilian population.

Is there an approved treatment for anthrax?
Doctors can prescribe antibiotics to treat anthrax. To be effective, treatment should be initiated early. If left untreated, the disease can be fatal. For people who have been exposed to anthrax, antibiotics are given to reduce the risk or progression of disease from inhaled anthrax.

Is anthrax contagious?
Anthrax cannot be spread from person to person.

What is Smallpox?
Smallpox is a disease caused by the Variola virus. One out of three people who get the disease have died in the past. Smallpox is spread from person to person, usually after the ill person develops a fever and a rash. The rash works itself from the face, arms and legs onto the trunk of the body. There is no treatment for smallpox, but the smallpox vaccine provides good protection and serves to stop the spread of the disease.

Should I have a supply of antibiotics on hand for an incident of bioterrorism?
It is not recommended that persons have personal supplies of antibiotics. There are a number of different germs that may be used in an act of bioterrorism. While many antibiotics are effective for a variety of diseases, there is no antibiotic that is effective against all diseases. Therefore no one pill can offer blanket protection. Additionally, because of the limited “shelf life” of antibiotics, they may lose their strength and not be effective when needed. In addition, there are side effects and medical contraindications that accompany any prescription of antibiotics

Should I buy a gas mask?
No. A mask will only protect you if you are wearing it at the exact moment an attack occurs. A biologic attack is most likely to be “covert” or without anyone knowing it. That would mean that you need to have your mask on 24 hours a day seven days a week. Gas masks must be carefully fitted to work effectively. During Desert Storm, people in Israel suffocated when they didn't put the mask on properly.

Is it safe for me to drink water from the tap?
It would be extremely difficult for a bioterrorist to contaminate our drinking water supplies to cause widespread illness. Because of the large volume of water in reservoirs anything deliberately put into the water supply would be greatly diluted. In addition, water treatment facilities routinely add chlorine in order to kill harmful germs. Information about the safety of our local water supply is available from the Columbus Division of Water. You can reach their website at www.ci.columbus.oh.us

How can I best prepare for a bioterrorism threat?
At present, there is little that individuals can do in advance to protect themselves from a bioterrorist attack. However, there is much that government agencies, health care facilities and public health departments are doing to improve our state and city's capacity to protect the public following an attack. While specific bioterrorism-related precautions for the public are not recommended, it is important that families and individuals do have a disaster plan in place for any event that includes these emergency supplies:

• Three-day supply of water
• Clothing, blankets, and sleeping bags
• First ai d kit including current prescription medications (e.g. for blood pressure)
• Battery powered radio and flashlight with extra batteries
• Sanitation supplies
• Special needs items for infants, older adults, or disabled family members

What should I do if I receive a suspicious letter?
Local law enforcement agencies are in the process of issuing guidelines to be followed for a suspicious package or letter. In the meantime, the following guidelines from the Centers for Disease Control are recommended:

HOW TO HANDLE ANTHRAX AND OTHER BIOLOGICAL AGENT THREATS
Many facilities in communities around the country have received anthrax threat letters. Most were empty envelopes; some have contained powdery substances. The purpose of these guidelines is to recommend procedures for handling such incidents.

1. Anthrax organisms can cause infection in the skin, gastrointestinal system, or the lungs. To do, so the organism must be rubbed into abraded skin, swallowed, or inhaled as a fine, aerosolized mist. Disease can be prevented after exposure to the anthrax spores by early treatment with the appropriate antibiotics. Anthrax is not spread from one person to another person.
   
   
2. For anthrax to be effective as a covert agent, it must be aerosolized into very small particles. This is difficult to do, and requires a great deal of technical skill and special equipment. If these small particles are inhaled, life-threatening lung infection can occur, but prompt recognition and treatment are effective.

1. Do not shake or empty the contents of any suspicious envelope or package.
2. PLACE the envelope or package in a plastic bag or some other type of container to prevent leakage of contents.
3. If you do not have any container, then COVER the envelope or package with anything (e.g., clothing, paper, trash can, etc.) and do not remove this cover.
4. Then LEAVE the room and CLOSE the door, or section off the area to prevent others from entering (i.e., keep others away).
5. WASH your hands with soap and water to prevent spreading any powder to your face.
6. What to do next?
   • If you are at HOME, then report the incident to local police.
   • If you are at WORK, then report the incident to local police, and notify your building security official or an available supervisor.
7. LIST all people who were in the room or area when this suspicious letter or package was recognized. Give this list to both the local public health authorities and law enforcement officials for follow-up investigations and advice.

• Excessive Postage Excessive weight
• Handwritten or poorly typed addresses Lopsided/uneven envelope
• Incorrect titles
• Protruding wires or foil
• Title but no name
• Visual Distractions
• Misspellings of common words
• Ticking Sound
• Oily stains, discolorations or odors
• No return address
• Excessive security material (masking tape, string, etc.)
• Marked with restrictive endorsements such as "Personal" or "Confidential"
• Shows a city or state in the postmark that doesn't match return address

Where can I get additional information about bioterrorism?
Centers For Disease Control and Prevention: www.cdc.gov
Federal Bureau of Investigation: www.fbi.gov
Ohio Department of Health: www.odh.state.oh.us
State of Ohio Information Hotline: 1-866-936-4636
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