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Anthrax

Anthrax is caused by the Bacillus anthracis. Anthrax, in the minds of most military and counterterrorism planners, represents the single greatest biological warfare threat. A World Health Organization report estimated that 3 days after the release of 50 kg of anthrax spores along a 2-km line upwind of a city of 500,000 population, 125,000 infections would occur, producing 95,000 deaths

Transmission:
• direct skin contact with spores; in nature, contact with infected animals or animal products (usually related to occupational exposure)
• inhalation of aerosolised spores
• consumption of undercooked or raw meat products or dairy products from infected animals
• NO person-to-person transmission of inhalation or GI anthrax

Manifestation:
• Local skin involvement after direct contact with spores or bacilli
o Localised itching followed by
o Popular lesion that turns vesicular
o Black ulcer within 7–10 days of initial lesion
• After inhalation of spores or bacilli
o Fever
o Non-productive cough
o Malaise
o Fatigue
o Muscle pain
o Profound sweats
o Chest discomfort (upper respiratory tract symptoms are rare)
o After 1–5 days after onset of initial symptoms
o Abrupt onset of high fever
o Severe respiratory distress (dyspnea, stridor, cyanosis)
o Shock, death within 24–36 hours
• After consumption of spores or bacilli:
o Nausea
o Anorexia
o Vomiting
o Fever
o Severe abdominal pain
o Haematemesis
Diarrhoea that is almost always bloody
o Shock, death within 2–5 days of onset

Diagnosis and treatment: Bacilli are demonstrated in blood. Treatment is available and has to be started rapidly.
Handling of Suspicious Packages or Envelopes:
• Do not shake or empty the contents of a suspicious package or envelope.
• Do not carry the package or envelope, show it to others, or allow others to examine it.
• Put the package or envelope on a stable surface; do not sniff, touch, taste, or look closely at it or any contents that may have spilled.
• Alert others in the area about the suspicious package or envelope. Leave the area, close any doors, and take actions to prevent others from entering the area. If possible, shut off the ventilation system.
• Wash hands with soap and water to prevent spreading potentially infectious material to face or skin. Seek additional instructions for exposed or potentially exposed persons.
• If at work, notify a supervisor, a security officer, or law enforcement official. If at home, contact the local law enforcement agency.
• If possible, create a list of persons who were in the room or area when this suspicious letter or package was recognised and a list of persons who also may have handled this package or letter. Give the list to both the local public health authorities and law enforcement officials.