In the fall of 2001, the United States experienced its first illnesses caused by the intentional release of anthrax. In all cases for which the cause was determined, illness followed contact with anthrax spores delivered in powder sent through the mail.
These events led to widespread concern about what to do in cases of exposure to suspicious powders or other substances. These concerns are addressed by the following questions and answers. Additional information is available from the federal Centers for Disease Control and Prevention.
- What is anthrax?
- What happens when a suspicious, unknown substance such as a powder is found?
- How is the risk of a substance being anthrax determined?
If there has been an exposure
- How likely is it that I have actually been exposed to anthrax?
- Do I need to decontaminate myself, or throw away my clothes and belongings?
- Do I need any treatment immediately, such as antibiotics or vaccines?
- How long will it be until I know what the test results are?
- Should I be tested for anthrax?
- Would a nasal swab test be helpful?
- Am I a risk to my family or to others?
- Should I see a doctor?
- If I start to feel sick in the next couple days, what should I do?
- Who can my doctor or I call if we have questions?
Anthrax is a disease caused by the spore-forming bacterium Bacillus anthracis.
- Cutaneous anthrax, the most common form, occurs when the anthrax spore gets through a break in the skin and causes infection. It begins as a raised, often itchy bump that might look like an insect bite, but within a day or two it develops into a blister, then a painless ulcer that develops a black center. This is the least serious form of anthrax and responds well to antibiotic treatment.
- Inhalational anthrax, caused by inhaling microscopic anthrax spores, begins with influenza-like symptoms such as fever or chills and cough, and may be accompanied by vomiting or shortness of breath. After a few days the illness worsens, leading to severe breathing problems and shock. This is a severe form of anthrax; in the Fall of 2001, five of the 11 people infected in the United States died.
- Gastrointestinal anthrax is caused by eating meat contaminated with anthrax spores. It causes severe symptoms such as vomiting, abdominal pain and diarrhea. This form has never been detected in the United States.
Individuals or businesses that find a substance that they consider suspicious should do the following:
- Leave it: Put it down, cover it up, leave it alone until it can be assessed. Do not try to clean it up. Do not shake or empty the contents of a suspicious envelope or package; do not sniff, touch or look closely at any substance that may have spilled. Have individuals leave the room or general area where the substance is located until an assessment of risk can be made.
- Report it: If you are at work, tell your supervisor or building security. Call 911 and report what you have found.
- Wash it off: While you are waiting for a threat assessment to be done, thoroughly wash your hands and any skin area that has touched the substance with soap and water.
If the spilled substance is visible on your clothing, don’t spread the substance around by walking through your building. Take off the affected clothing and put it into a plastic bag. This helps to avoid spreading the substance and decreases the risk that you will get more on your skin.
If you had direct contact with the substance, shower with soap and water as soon as this can be reasonably arranged.
Whenever a suspicious substance is reported, state or local police must make an assessment as to whether there may be a threat involved. They will investigate to see if there is any natural explanation for the substance that might not have been apparent at first.
White powder near an area in which sheet rock is being stored or installed, for example, probably would seem normal, whereas the envelopes and letters delivered to the television networks in 2001 were clearly threatening.
In many situations, of course, police determine that there is no threat and thus no reason to believe that the substance constitutes a risk.
If no risk is determined, the substance will not be tested. It can be cleaned the way you would clean anything unknown but not dangerous. There is no reason to do anything further.
If the police believe that there may be a threat, someone with the proper equipment and training for hazardous materials response will collect a sample, which will then be taken to the Vermont Health Department’s laboratory for testing.
In thousands of cases of suspicious substances investigated since the fall of 2001, anthrax has been found in only a few, all of which appeared to be focused on national political and media targets.
While we expect the chance of having a real anthrax event in Vermont remains extremely low, we continue to work with police and other officials to take all necessary steps to evaluate each incident and to assure your safety.
If you touched the suspicious substance, you should follow the hand-washing instructions given above. Any clothing you have packaged in plastic bags should be left undisturbed until test results are available. You do not need to perform other decontamination procedures or discard your belongings.
No. You do not need medication immediately after exposure to a suspicious substance. If preliminary laboratory test results and other risk assessment findings indicate that there is a possibility that the substance is anthrax, we will be contacting you and everyone else involved and advising you to start antibiotics while waiting for final test results.
If the final laboratory results then show there was no anthrax present, you will be advised to stop taking the antibiotics. If the final results confirm anthrax, you should continue taking the antibiotics for 60 days.
Preliminary results by PCR (polymerase chain reaction) test are usually available within a few hours after testing is started. Final confirmatory results take about 72 hours, although some tests may take a day or two longer.
Confirmatory tests involve growing cultures, and because these cultures may grow at different speeds, not all tests take the same amount of time.
You do not need to be tested for anthrax just because you have been near a suspicious substance.
Anyone who has been exposed to a suspicious substance that preliminary tests and associated risk assessment indicate may be anthrax will immediately be urged to begin taking antibiotics as a precautionary measure.
No. Nasal swab tests are not used to diagnosis anthrax disease. Someone could be infected with anthrax without testing positive to a swab test, and, conversely, a swab could discover anthrax spores in a person who is not infected.
These tests do have some value in helping public health officials better understand exposure risks and they are appropriate for situations in which anthrax has been confirmed.
No. After emergency personnel have completed their response, you may continue your usual activities at work or home. Removing clothing contaminated with the substance and washing skin and hair exposed to the substance is considered adequate protection.
Even when a person is actually ill with anthrax, it is not transmitted from person to person. You do not pose any risk to others.
Unless you become sick, it is not necessary for you to visit a hospital or doctor’s office. If you wish to contact your private physician to discuss your possible exposure, you should give your physician the Vermont Health Department number listed below.
If you should become ill, or develop a fever greater than 100.0 degrees, contact your doctor immediately. While you are probably ill with something that has nothing to do with this exposure, it would be important for you to have a thorough evaluation.
You and/or your doctor should also contact staff at the Vermont Department of Health. We will make recommendations to you and your health care provider about how best to evaluate and treat your symptoms, based on the circumstances of this possible exposure incident.
If you or your physician has questions, please call the Health Department at 1-800-640-4374 or 863-7240. If it is a weekend or evening, an epidemiologist will be on call and able to return your call promptly.