Biological Emergencies: Anthrax - NYC Health

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What We Do

At-Risk Populations

Threats

Individuals and Families

Mental Health

Emergency Medication Distribution

Communities and Businesses

Health Care Providers

Emergency Departments


Anthrax

Anthrax is an 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 also can occur in humans.

Anthrax does not typically occur in New York City. 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. In February 2006, a New York City resident was diagnosed with inhalation (lungs) anthrax. He was infected after using a contaminated animal skin to make an African drum. Intentional contamination of food with anthrax spores could cause gastrointestinal anthrax after a person eats uncooked or undercooked food that is contaminated with anthrax spores or bacteria. Gastrointestinal anthrax causes severe inflammation of the intestinal tract and is usually fatal.

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What are the different types of anthrax disease?

Cutaneous (skin) 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 but 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, gastrointestinal, meningeal and injectional.

Inhalation (lung) anthrax has initial symptoms that may resemble the common "flu,' including 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) is the rarest form of anthrax. It can occur in the upper (throat) or lower (abdominal) intestinal tracts, typically after a person eats uncooked or undercooked food that is contaminated with anthrax spores or bacteria. Gastrointestinal anthrax causes severe inflammation of the intestinal tract. The first symptoms of 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, gastrointestinal anthrax is usually fatal.

Meningeal (brain) can occur if anthrax bacteria enter the bloodstream following cutaneous, inhalation, gastrointestinal or injectional anthrax infection. It then spreads to the brain. Symptoms include sudden headache, nausea, vomiting, muscle aches, chills and dizziness. Meningeal or brain anthrax disease usually cannot be treated successfully.

Injectional (blood) anthrax is a new type of anthrax 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 believe the heroin was contaminated with anthrax spores during transport of the drug by animals from Afghanistan, where anthrax occurs naturally, to Europe.

How common is gastrointestinal anthrax and how is it usually caused?

In the United States, gastrointestinal anthrax is extremely rare. It has never been reported in New York City. In 2009, a New Hampshire woman contracted gastrointestinal anthrax after attending a drumming event where she presumably had contact with an African drum that was made with a contaminated hide. Gastrointestinal anthrax cannot be spread from person to person.

What is bioterrorism?

Bioterrorism is the intentional use of biological agents, or germs, to cause illness. Bioterrorism has occurred in New York only in 2001, when media outlets received letters that were intentionally contaminated with anthrax bacteria.

How soon after anthrax infection do symptoms appear?

Generally, the incubation period is seven days or less. However, it is possible for inhalation anthrax to develop up to 2 months after exposure to anthrax spores.

I am concerned that I have or someone who I know has anthrax symptoms. What should I do?

Anyone with the symptoms of anthrax should contact their medical provider immediately. If you are having difficulty breathing, severe abdominal pain or other serious illness, call 911. If you do not have a medical provider, call 911 so that you can be directed to an emergency department.

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 U.S. as well, but until 2001, cases in humans were rare. When inhalation or cutaneous anthrax affects humans, it typically is due to 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.

Gastrointestinal anthrax sometimes occurs in areas of the world where infected animals are slaughtered and then eaten.

How is anthrax spread?

Anthrax is almost never spread from one person to another person. It also is not found in animal milk. People are exposed to and infected by anthrax bacteria in four ways:

through breaks in the skin, such as when carrying contaminated animal products, including hair, wool, or hides, or from intentionally contaminated letters as occurred in fall 2001

by breathing spores into the lungs, such as in manufacturing processes that used contaminated animal hides, wool or hair

by eating uncooked or undercooked food that is contaminated with anthrax bacteria or spores

by injecting heroin contaminated with anthrax spores

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, people are not contagious. Very rarely, drainage from an open sore of cutaneous (skin) anthrax may lead to a skin infection in another person.

How is anthrax diagnosed?

Anthrax bacteria can be cultured from blood, skin, and spinal fluid or from fluid that collects in the abdominal cavity or around lungs (pleural fluid). Suspicious bacteria can be tested and confirmed as the anthrax bacteria at government public health laboratories, such as the NYC Public Health Laboratory. Patients' blood also can be tested for antibodies to the anthrax bacteria. These bacteria can be detected under a microscope when looking at samples of infected human tissue. The laboratory method polymerase chain reaction (PCR) can detect extremely small amounts of anthrax DNA.	In a gastrointestinal anthrax outbreak, some persons with anthrax symptoms might not have the disease diagnosed in a laboratory. If they have an illness that appears to be anthrax and they had exposure to the food or beverage that has been linked to the outbreak, they may still be diagnosed and treated for anthrax.

What is the treatment for anthrax?

Doctors 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, gastrointestinal, meningeal and injection anthrax are much more severe infections. Successful treatment requires antibiotics, medical procedures and potentially long hospital stays.

What happens if gastrointestinal anthrax is not treated?

Untreated gastrointestinal anthrax almost always results in death.

How can I prevent myself or others from getting anthrax during this outbreak?

If you have the food item that has been linked to the outbreak, follow Health Department recommendations.

How will I cope?

An anthrax outbreak in NYC can be very stressful, especially if it is large scale event. It can disrupt your everyday life and make you and those around you feel less safe. You may experience fear and uncertainty. Learning about stress and strategies to manage it can help you cope.

Prepare Today, Cope Better Tomorrow - Stress During Disasters provides basic information and practical advice on dealing with the stress and anxiety caused by disasters. It is available in seven languages.

If there is anthrax in the city and you feel overwhelmed and unable to cope, or if you are concerned about someone else, you can find help by calling 988. 988 is a free, confidential helpline for New York City residents, available 24/7, with trained staff ready to take your calls and offer advice.

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For more information about anthrax, visit: Centers for Disease Control and Prevention (CDC)