# Presentation: 665205

## How to Respond to an Anthrax Threat 

**How to Respond to an Anthrax Threat **
**Basic Briefing**

**Notes:**
Recent events have brought to light the importance of learning some basic information about anthrax, what it is, how to identify suspicious letters or packages and the steps to take if an anthrax threat has been made. This briefing will help you with information on this and dispel some the unknown factors about anthrax.  We will also give you instructions on who to call and answer your question at the end.

## Objectives

- Define
- What is anthrax and what do I need to know
- Why is this happening now
- Identify
- What to look for in a suspicious letter or package
- Steps you should take if anthrax is suspected
- Know
- Who to call
- Roles of CDC, FBI, FPS, ATF, Local Law Enforcement
- Update
- Fact or Fiction

## What is Anthrax

**Anthrax is a bacterial, disease caused by Bacillus Anthracis.  Anthrax occurs in domesticated and wild animals, including goats, sheep, cattle, horses and deer****, but other animals may be infected. Anthrax is an invisible bacteria that can live in soil, water, and dead animals****.**

**Picture of an Anthrax Spore**

**Notes:**
Those of us in public service never really anticipated that we would be called on in this role to help our customers deal with their fears and concerns.  Information on and discussion will help us to do this.

The spores are very stable and may remain viable for many years in soil and water. They will resist sunlight for varying periods. 

##   Skin or cutaneous form may be contracted by            exposure to spores on an open area.
 First appears as a rash or blister that may resemble a bite, progressing to a painless ulcer with a black area in the center.
 Can be treated effectively with antibiotics.
 Represents 95% of cases of human anthrax.
 With treatment mortality rate is 1%.

** ****First appears as a rash or blister that may resemble a bite, progressing to a painless ulcer with a black area in the center.**
** ****Can be treated effectively with antibiotics.**
** ****Represents 95% of cases of human anthrax.**
** ****With treatment mortality rate is 1%.**

**There are three forms:**

**Notes:**
It is initially characterized by a papule which progresses to a fluid filled blister with swelling at the site of infection. The scab that typically forms over the lesion can be black as coal, hence the name anthrax, which is  Greek for coal.
most frequently on the hands and forearms of persons working with infected livestock or contaminated animal products
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. 
The inhalation form is contracted by inhalation of the spores, occurs mainly among workers handling infected animal hides, wool, and furs. Under natural conditions, inhalation anthrax is exceedingly rare, with only 18 cases having been reported in the United States in the 20th century. 

##  Inhalational may be contracted by breathing in spores or dispensing within a closed space, e.g. the air conditioning system.
 First appears as flu like symptoms (1 – 7 days)
 Fever
 Malaise
 Fatigue
 Cough
 Mild chest discomfort followed by severe
  respiratory distress
 Can be treated with antibiotics if prompt treatment is initiated.

** ****First appears as flu like symptoms (1 – 7 days)**
** ****Fever**
** ****Malaise**
** ****Fatigue**
** ****Cough**
** ****Mild chest discomfort followed by severe**
**  ****respiratory distress**
** ****Can be treated with antibiotics if prompt treatment is initiated.**

##  Gastrointestinal tract must be ingested most commonly through improperly cooked or contaminated meat.

 First appears as intense stomach pains, 
   vomiting and diarrhea.	
 Most cases appear within 48 hours.
 Is extremely rare in the US as animals are
   vaccinated in high risk areas.
 Can be treated with antibiotics if prompt treatment is initiated.

** ****First appears as intense stomach pains, **
**   ****vomiting and diarrhea.****	**
** ****Most cases appear within 48 hours.**
** ****Is extremely rare in the US as animals are**
**   ****vaccinated in high risk areas.**
** ****Can be treated with antibiotics if prompt treatment is initiated.**

## What Is the Treatment for Anthrax?

**Treatment with antibiotics beginning immediately after exposure has proven to be effective:****	**
**  ****Penicillin **
**  ****Doxycycline**
**  ****Ciproflaxin (Cipro) **

**Notes:**
The element of time is critical to full recovery

If untreated, inhalation 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. 

## Why is this happening now?

**A little known fact for most people is that chemical and biological warfare (CBW) is the number 1 choice of terrorists today.  **
**Biological arms are:**
** ****Easy to produce and difficult to detect once**
**  ****created.**
** ****They are cheap and likely to cause human**
**   ****fatalities and economic damage**
** ****They are likely to cause panic and fear**

**Notes:**
A little known fact for most people is that chemical and biological warfare (CBW) is the number 1 choice of terrorists today.
Some forms of BW can be mailed!   Even if the threat is a hoax, it can disrupt the operations of an agency.
A delivery system for a BW agent can consist of just about anything that can produce an aerosol, including a wide variety of commercially available objects.
The most likely form for dissemination of anthrax as a biological terrorist agent is aerosolization of spores.
Unlike nuclear and chemical agents, biological agents are not detectable with the five human senses. You would never realize you may have been exposed to a biological agent until you started becoming sick with certain symptoms.

## Now that we know

- What it is.
- How it is contacted.
- What treatment is available.
-   How can we reduce the
- threat of exposure?

## What constitutes a suspicious letter or parcel?

**Some typical characteristics which ought to trigger suspicion include letters or parcels that:**
**     ****Excessive Postage, no postage, or non-canceled postage.**
**     ****No return address or fictitious return address.**
**     ****Improper spelling of addressee names, titles, or locations. **
**     ****Unexpected envelopes from foreign countries. **

## What constitutes a suspicious letter or parcel?(cont) 

**      ****Suspicious or threatening messages written on packages. **
**     ****Postmark showing different location than return address **
**     ****Distorted handwriting or cut and paste lettering. **
**     ****Unprofessionally wrapped packages or excessive use of tape,**
**       ****strings, etc. **
**     ****Packages marked as ****“Fragile - - Handle with Care”, “Rush - -       **
**       ****Do Not Delay”,  “Personal” or  “Confidential”****.**** **

## What constitutes a suspicious letter or parcel?(cont)

**  ****Rigid, uneven, irregular, or lopsided packages. **
**  ****Packages that are discolored, oily, or have an unusual odor**
**   ****or ticking sound. **
**  ****Packages with soft spots, bulges, or excessive weight **
**  ****Protruding wires or aluminum foil. **
**  ****Visual distractions.**

## Courtesy of ATF http://www.atf.treas.gov/explarson/information/indic.htm

- No return address.  Mailed from foreign country. Excessive or no postage.  Rigid or bulky envelope.  Address: badly typed or written, misspelled, title with no name, wrong title with name.  Restrictive markings (I.e., personal or confidential).  Strange odor.  Lopsided packages. No return address. Protruding wires. Oily stains on wrapper.  Precautions:  1) Never accept mail, especially while in a foreign country. 2) Make sure family members and clerical staff no to refuse all unexpected mail at home or office. 3) Remember, it may be a bomb, treat it as suspect.  For more information on bomb security or bomb threats, contact your local ATF office.

- Suspect letter and package indicators.
- No return address.  Mailed from foreign country. Excessive or no postage.  Rigid or bulky envelope.  Address: badly typed or written, misspelled, title with no name, wrong title with name.  Restrictive markings (I.e., personal or confidential).  Strange odor.  Lopsided packages. No return address. Protruding wires. Oily stains on wrapper.  Precautions:  1) Never accept mail, especially while in a foreign country. 2) Make sure family members and clerical staff no to refuse all unexpected mail at home or office. 3) Remember, it may be a bomb, treat it as suspect.  For more information on bomb security or bomb threats, contact your local ATF office.

**Courtesy of ATF **_[http://www.](http://www.atf.treas.gov/explarson/information/indic.htm)__[atf](http://www.atf.treas.gov/explarson/information/indic.htm)__[.treas.](http://www.atf.treas.gov/explarson/information/indic.htm)__[gov](http://www.atf.treas.gov/explarson/information/indic.htm)__[/](http://www.atf.treas.gov/explarson/information/indic.htm)__[explarson](http://www.atf.treas.gov/explarson/information/indic.htm)__[/information/](http://www.atf.treas.gov/explarson/information/indic.htm)__[indic](http://www.atf.treas.gov/explarson/information/indic.htm)__[.](http://www.atf.treas.gov/explarson/information/indic.htm)__[htm](http://www.atf.treas.gov/explarson/information/indic.htm)_

**Picture of package with suspect and package indicators**

## What Should You Do If You Receive an Anthrax Threat?

**Do not shake or empty the contents of any suspicious envelope or package;**
**Double bag the letter or package in zipper-type or zip-lock type plastic bags using latex gloves, or some other type of container to prevent leakage of contents; If you do not have any container, then COVER the envelope or package with anything (e.g., clothing, paper, trash can, etc.). DO NOT REMOVE THIS COVER;**
**Then LEAVE the room and CLOSE the door, or section off the area to prevent others from entering (i.e., keep others away);**

**Notes:**
If you opened a letter that claims to have contaminated you with anthrax and there is a substance in the letter or envelope the Centers for Disease Control and Prevention (CDC) in Atlanta recommends the following steps.
These threats require prompt action by health, law enforcement and laboratory personnel. Coordination and communication across agencies are necessary to protect the public and first responders from agents such as anthrax. 

## What Should You Do If You Receive an Anthrax Threat (cont)

**4.      Notify your immediate supervisor and both local police and the FBI, who will arrange to collect the letter/package and assess the threat situation;**
**5.     WASH your hands with soap and water to prevent spreading any powder to your face;**
**WASH your hands with soap and water to prevent spreading any powder to your face;**
**7.****	****Ensure that all persons who have touched the letter wash their hands with soap and water;**

## 8.	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;
9.	Place all items worn at the time in plastic bags and keep them available for law enforcement;  If possible change clothing in the workplace and DO NOT let anyone else touch the clothing.
10.	Shower with soap and water;
Notify Center for Disease Control (CDC) Emergency Response at 770-488-7100 for any questions of if you require further information.  Also you can  access their web site at: http://www.cdc.gov. 

**9.****	****Place all items worn at the time in plastic bags and keep them available for law enforcement;  If possible change clothing in the workplace and DO NOT let anyone else touch the clothing.**
**10.****	****Shower with soap and water;**
**Notify Center for Disease Control (CDC) Emergency Response at 770-488-7100 for any questions of if you require further information.  Also you can  access their web site at: **_[http://www.](http://www.cdc.gov/ncidod/dbmd/diseaseinfo/anthrax_g.htm)__[cdc](http://www.cdc.gov/ncidod/dbmd/diseaseinfo/anthrax_g.htm)__[.](http://www.cdc.gov/ncidod/dbmd/diseaseinfo/anthrax_g.htm)__[gov](http://www.cdc.gov/ncidod/dbmd/diseaseinfo/anthrax_g.htm)_**. **

_**What Should You Do If You Receive an **__**Anthrax Threat**_** (cont)**

## Fact or Fiction

**Q:  *****Is anthrax contagious?***
**A:  No.  Anthrax does not spread from person to person.  It is a one-time agent; to catch it, a person must come directly in con tact with the bacterium.**
**Q:  *****Should I take antibiotics to prevent infection?***
**A:  No.  Taking unnecessary antibiotics can result in the development of antibiotic-resistant strains of common bacteria.  The course of treatment is long (60 days), and many people experience unpleasant side effects.**

## Fact or Fiction(cont)

**Q:  *****Should I keep a supply of antibiotics on hand, just in case?***
**A:  No.  Antibiotics should only be taken under the supervision of a physician, who has done an evaluation to minimize the potential for side effects or interaction with other medication.  There is also the “shelf life” of the medication to consider.**
**Q:  *****Haven’t there been a lot of hoax letters in the past?***
**A:  Yes, but given the recent national and international events, and the confirmed exposures to anthrax, ANY incident will be responded to with the highest level of urgency.**

## What Sources are Available to Help Me?

**There are a variety of resources available to help federal Mail Managers cope with these threats and develop better means of responding: **
**For additional information:**
- _[http://www.firstgov.gov](http://www.firstgov.gov/)_** **** -  use the search feature to locate your topic or organization.**
- _[http://www.gsa.gov/](http://www.gsa.gov/mailpolicy)__[mailpolicy](http://www.gsa.gov/mailpolicy)_** - training, policy and the latest information for federal mail managers.**
- _[ http://www.](http://www.atf.treas.gov/)__[atf](http://www.atf.treas.gov/)__[.treas.](http://www.atf.treas.gov/)__[gov ](http://www.atf.treas.gov/)_**- ATF Bomb Threats and Physical Security Planning. **

## What Sources are Available to Help Me? (cont)

- _[http://www.bd.cdc.](http://www.bd.cdc.gov/)__[gov](http://www.bd.cdc.gov/)_** - ****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. **

## What Sources are Available to Help Me? (cont)

- _[http://www.fbi.gov/contact/fo/info.](http://www.fbi.gov/contact/fo/info.htm)__[htm](http://www.fbi.gov/contact/fo/info.htm)_** ****-To report suspected illegal intelligence or terrorism activity against the interest of the United States, telephone the ANSIR Coordinator at the FBI Field Office nearest you.**
- _[http://www.framed.](http://www.framed.usps.com/postal%20inspectors)__[usps](http://www.framed.usps.com/postal%20inspectors)__[.com/postal inspectors ](http://www.framed.usps.com/postal%20inspectors)_**-**** ****The U. S. Postal Inspection Service**** is the law enforcement branch of the U.S. Postal Service. The Postal Inspection Service extends full cooperation to all federal, state and local authorities in law enforcement matters to ensure greater protection to the public.**** **