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© 2006

With the currently active warfare existing between Israel and the Hezbollah in Lebanon, I am reminded that one of the inevitable outcomes of this struggle will be more hatred for both Israel and the United States. More and more under-educated or brainwashed religious fanatics may pour across our borders intent on doing us harm. It's also possible these terrorist groups are already in place and only waiting for a "go" signal from an unidentified leader.

Our borders are getting tighter and tighter and it is getting more difficult to smuggle in arms and weapons – except for biological warfare (germ warfare) weapons. These can be made relatively easily inside our country with only a minimum of cash outlay. Just as the drug culture still builds "meth labs", the enemies of our country can set up bio-terror labs. All it takes is someone trained in handling the proper equipment, and a few helpers who run errands – including the dissemination of the biological agents.

Anthrax was the first bio-terrorist weapon of choice and, unfortunately, it was successful. It wasn't the horrendous disaster of 9-1-1, but for all intents and purposes it shut down Washington D.C., for several weeks in 2001. Had these terrorists selected a lesser "high profile" location, it probably would not have been detected as quickly as it was found, nor would the response have been as rapid or as large as it was.

Senator Bill Frist, the only medical doctor in Congress, wrote a book about this subject titled: When Every Moment Counts. In it, he describes what happened, how the government responded, and pointed out the existing weaknesses that the incident pointed out. It's a book worth reading. I'll paraphrase some of his major points later on.

Anthrax isn't new. Some historians believe anthrax was one of the Egyptian plagues at the time of Moses. Now, terrorists have re-discovered this disease and have demonstrated an ability to manufacturer the bugs, the willingness to use the bugs as a weapon, and the ability to deliver it. There is no reason they won't re-use it again whenever it suits their purpose. While America was learning its' lessons in bio-terrorism, the terrorists were learning more about what does, and does not work.

From the Centers for Disease Control:

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 lower vertebrates (cattle, sheep, goats, camels, antelopes, and other herbivores), but it can also occur in humans when they are exposed to infected animals or tissue from infected animals.

How common is anthrax and who can get it?

Anthrax is most common in agricultural regions where it occurs in animals. These include South and Central America, Southern and Eastern Europe, Asia, Africa, the Caribbean, and the Middle East. When anthrax affects humans, it is usually due to an occupational exposure to infected animals or their products. Workers who are exposed to dead animals and animal products from other countries where anthrax is more common may become infected with B. anthracis (industrial anthrax). Anthrax in wild livestock has occurred in the United States.

How is anthrax transmitted?

Anthrax infection can occur in three forms: cutaneous (skin), inhalation, and gastrointestinal. B. anthracis spores can live in the soil for many years, and humans can become infected with anthrax by handling products from infected animals or by inhaling anthrax spores from contaminated animal products. Anthrax can also be spread by eating undercooked meat from infected animals. It is rare to find infected animals in the United States.

What are the symptoms of anthrax?

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.

Where is anthrax usually found?

Anthrax can be found globally. It is more common in developing countries or countries without veterinary public health programs. Certain regions of the world (South and Central America, Southern and Eastern Europe, Asia, Africa, the Caribbean, and the Middle East) report more anthrax in animals than others.

Can anthrax be spread from person-to-person?

Anthrax is not known to spread from one person to another person. Communicability is not a concern in managing or visiting with patients with inhalation anthrax.

Is there a way to prevent infection?

In countries where anthrax is common and vaccination levels of animal herds are low, humans should avoid contact with livestock and animal products and avoid eating meat that has not been properly slaughtered and cooked. Also, an anthrax vaccine has been licensed for use in humans. The vaccine is reported to be 93% effective in protecting against anthrax.

What is the anthrax vaccine?

The anthrax vaccine is manufactured and distributed by BioPort Corporation, Lansing, Michigan. The vaccine is a cell-free filtrate vaccine, which means it contains no dead or live bacteria in the preparation. The final product contains no more than 2.4 mg of aluminum hydroxide as adjuvant. Anthrax vaccines intended for animals should not be used in humans.

Who should get vaccinated against anthrax?

The Advisory Committee on Immunization Practices has recommended anthrax vaccination for the following groups:

  • Persons who work directly with the organism in the laboratory

  • Persons who work with imported animal hides or furs in areas where standards are insufficient to prevent exposure to anthrax spores.

  • Persons who handle potentially infected animal products in high-incidence areas. (Incidence is low in the United States, but veterinarians who travel to work in other countries where incidence is higher should consider being vaccinated.)

  • Military personnel deployed to areas with high risk for exposure to the organism (as when it is used as a biological warfare weapon).

The anthrax Vaccine Immunization Program in the U.S. Army Surgeon General's Office can be reached at 1-877-GETVACC (1-877-438-8222).

Pregnant women should be vaccinated only if absolutely necessary.

What is the protocol for anthrax vaccination?

The immunization consists of three subcutaneous injections given 2 weeks apart followed by three additional subcutaneous injections given at 6, 12, and 18 months. Annual booster injections of the vaccine are recommended thereafter.

Are there adverse reactions to the anthrax vaccine?

Mild local reactions occur in 30% of recipients and consist of slight tenderness and redness at the injection site. Severe local reactions are infrequent and consist of extensive swelling of the forearm in addition to the local reaction. Systemic reactions occur in fewer than 0.2% of recipients.

How is anthrax diagnosed?

Anthrax is diagnosed by isolating B. anthracis from the blood, skin lesions, or respiratory secretions or by measuring specific antibodies in the blood of persons with suspected cases.

Is there a treatment for anthrax?

Doctors can prescribe effective antibiotics. To be effective, treatment should be initiated early. If left untreated, the disease can be fatal.

Anthrax as a biological weapon

Before 2001, numerous nations are believed to have experimented with anthrax as a biological weapon, including the United States. The worst documented outbreak of inhalation anthrax in humans occurred in Russia in 1979, when anthrax spores were accidentally released from a military biological weapons facility near the town of Sverdlovsk, killing at least 66 people.

But the average person wasn't aware of this weapon until the fall of 2001, when 22 cases of anthrax infection resulted from letters containing anthrax spores sent via the U.S. Postal Service. Eleven people were infected with cutaneous anthrax. Eleven others were infected with inhalation anthrax, resulting in five deaths.

These cases have heightened concern about the possibility of a large-scale anthrax attack by independent well-funded terrorist groups. The Centers for Disease Control and Prevention has classified anthrax as a Category A bioterrorism agent — which is considered the biggest threat to national security. Anthrax raises concerns as a biological weapon because:

  • It's not difficult to obtain. Anthrax is a naturally occurring bacterium, so it's relatively easy to grow or acquire. Samples of anthrax already exist at some research laboratories worldwide. Theoretically, anthrax could also be isolated and grown from the remains of an animal that died of anthrax or from nearby soil.

  • It's highly lethal. Experts calculate that 100 kilograms (220 pounds) of anthrax aerosolized over a city on a clear, calm night could kill 130,000 to 3 million people — making such an attack as lethal as a hydrogen bomb. The small size of anthrax spores means they would be likely to infect people indoors as well as those outdoors.

  • It's hardy. Anthrax spores are resistant to environmental damage. During World War II, the British government experimented with anthrax on an island off the coast of Scotland. Nearly 40 years later, abundant numbers of spores survived on the island. Cleaning up the island required tons of formaldehyde and seawater.

Risk factors

Anthrax is not contagious. People who get inhalation anthrax don't exhale spores. There are no reports of the disease spreading from one person to another.

To contract anthrax, you must come in direct contact with anthrax spores. However, you can be exposed to anthrax spores and not become infected. Your risk depends on the amount of exposure and the virulence of the strain of anthrax to which you're exposed.


In addition to treating anthrax, antibiotics can prevent infection in anyone exposed to anthrax. Ciprofloxacin and doxycycline are FDA-approved for post-exposure prevention of anthrax.

The government is working to increase the nation's supply of antibiotics, in the event of a large-scale anthrax attack. Since Sept. 11, 2001, the CDC has expanded the National Pharmaceutical Stockpile (NPS) to include more antibiotics and medical supplies, additional pediatric supplies and antibiotics, as well as antidotes for chemical agents. These supplies are strategically placed so medical supplies can be delivered throughout the United States quickly.

The NPS program is also responsible for storing and transporting the anthrax vaccine, to ensure rapid distribution of vaccines in an emergency.

Should you buy a gas mask?

It's unclear whether over-the-counter (OTC) masks would do any good in an anthrax attack. Unlike gas masks worn by hazardous-material teams, most OTC gas masks can't filter out anthrax spores. In addition, anthrax can't be seen or smelled. If it were released, you wouldn't see a cloud of anthrax coming toward you, so you wouldn't know when to put on a gas mask. Even if you were to wear a gas mask, you wouldn't necessarily know when it's safe to remove the mask. Government authorities don't recommend buying gas masks. However, Senator Bill Frist says that the HEPA-type filters labeled N95 may be effective in reducing exposure. The MAJOR PROBLEM is that you have to be wearing it at the exact time the anthrax spores are released. If you put it on after-the-fact, it is too late.

How Anthrax Enters the Body Through the Lungs

Copyright © 2005 Nucleus Communications, Inc. All rights reserved.


Untreated anthrax is often fatal, but death is far less likely with appropriate care. Ten to twenty percent of patients will die from anthrax of the skin (cutaneous anthrax) if it is not properly treated. All patients with inhalation (pulmonary) anthrax will die if untreated. Intestinal anthrax is fatal 25-75% of the time.

One of the scariest revelations I found is that (while researching facts for this article) I found several web sites that teach you the fundamentals of how to grow and/or manufacture the Bacillus anthracis - anthrax.


Following the anthrax attacks of 2001, substantial efforts were undertaken to decontaminate environmental surfaces exposed to B anthracis spores. Sections of the Hart Senate office building in Washington, DC, contaminated from opening a letter laden with B anthracis, were reopened only after months of decontamination procedures at an estimated cost of $23 million. Decontamination efforts at many other buildings affected by the anthrax attacks of 2001 have not yet been completed (as of 2002).

The greatest risk to humans exposed to an aerosol of B anthracis spores occurs when spores first are made airborne, the period called primary aerosolization.

Decontamination of buildings or parts of buildings following an anthrax attack is technically difficult. If vaccines were available, postexposure vaccination might be a useful intervention for those working in highly contaminated areas, because it could further lower the risk of anthrax infection. Any person coming in direct physical contact with a substance alleged to be containing B anthracis should thoroughly wash the exposed skin and articles of clothing with soap and water.

The risk that B anthracis spores might pose by a process of secondary aerosolization (resuspension of spores into the air) is uncertain and is likely dependent on many variables, including the quantity of spores on a surface; the physical characteristics of the powder used in the attack; the type of surface; the nature of the human or mechanical activity that occurs in the affected area and host factors.

This appears to be the JAMA/AMA method of handling "decontamination". By saying there are too many variables to give an accurate answer to the problem of decontamination, they avoid any possibility of future lawsuits based on their recommendation. While the JAMA/AMA may be a very educated bunch, they don't like to stick their neck out. (JAMA: Journal of the American Medical Association)

At the very least, hose off the house, yard, kids, dogs & cats, and wash everything with soap and bleach-water. Don't let the water used for cleaning puddle up. There are studies about the exact number of spores you can inhale and still avoid the infection. I don't care how many, do you? I don't want ANY spores around my family and will wash everything I own if I think its been even remotely exposed to anthrax. I have very limited laboratory equipment (meaning none) in my house, and I sent my microscope out to be re-chromed. If I think anthrax is in the area, I will wash parts of my home and family that haven't seen water and soap in years. Can you wash an attic? I'll try.

Fortunately, Senator Bill Frist, in his book When Every Moment Counts, DOES have a recommendation about decontamination – but with conditions: He recommends that you check with local health officials to make sure you won't put yourself at risk by cleaning up without following proper protective procedures. You don't want to contract anthrax while cleaning it up. He also goes on to say you may be removing important "legal" evidence...but, who cares? My family comes first. Collect the evidence from the dead people next door.

The cleaning solution recommended by Dr. Frist consists of normal household bleach and water.

Use one part Clorox (0.5% sodium hypochlorite solution) to 10 parts water. You will need a LOT of bleach to clean even a small area. Do not get the bleach solution in your eyes. Let the bleach stand 15 minutes before rinsing.

For personal decontamination, get in the shower with a friend to help wash your back, and scrub gently. Don't open any skin wounds that could allow the bacteria into your skin. Then, when you are done – do it again. Don't forget all those sensitive "nooks and crannies"!

Historical Irony

Much has been written about the technical difficulty of decontaminating an environment contaminated with B anthracis spores. A classic case is the experience at Gruinard Island, Scotland. During World War II, British military undertook explosives testing with B anthracis spores. Spores persisted and remained viable for 36 years following the conclusion of testing. Decontamination of the island occurred in stages, beginning in 1979 and ending in 1987 when the island was finally declared fully decontaminated. The total cost is unpublished, but materials required included 280 tons of formaldehyde and 2000 tons of seawater.

OK...I guess the British weren't in a hurry. WW II ended in 1946 and cleanup started in 1979, 33 years later. Makes you wonder, doesn't it?


If you are on the road and inadvertently drive into an anthrax-contaminated area, immediately turn off your car air conditioning/heater system, roll up the windows and get out of there quickly. If possible, find a car wash and wash all the dirt and dust off your car. If you can't wash the car, try not to touch it as you get out of the vehicle. Then hose it off at home.

If you are walking around at the time of an anthrax release, cover your mouth and nose and try to cover as much exposed skin as possible. Exit the area as quickly as possible and get out of there. Since your clothing may have spores trapped in the fabric, keep your mouth and nose covered. When you get to a safe area (probably your home), decontaminate yourself as best as you can. I personally would (at the least) hose myself off, remove all outer layers of clothing, and then go directly to the shower and decontaminate as described earlier. Before you use your car again, remember to wash out the inside as well as the outside of the vehicle. Seek medical treatment at the first signs of any infection.

Final Words

To RogueTurtle, the scariest thing about the anthrax attacks in 2001 was the fact that there were people in this world cruel enough to do this sort of thing in the name of religion. There really are people out there who hate America enough to use weapons so completely diabolical that it defies imagination. But the fact is, those people are now a part of our lives. We, as Americans, can either bury our heads in the sand, or continue on as if it never happened.

I didn't say ignore it, I said carry on "as if" it didn't happen. Be alert. Avoid crowded areas if at all possible. The RogueTurtle hates crowds. A panicked crowd can kill you even without bio-chemical attacks. People get trampled at sports events and movie theater fires. I can only imagine the panic when someone yells "It's raining anthrax".

I prefer to let my enemy know that he has had no effect on my life. I want him to know that I do not fear him and will never bow to his cruel wishes and ignorant demands. I continue to monitor what is going on around me, but I will continue to do what I want, when I want to do it. This is MY American way of life.

So sayeth RogueTurtle...