(A) The last case before the set of October 2001 cases occurred in August
2001 (Aug. 17, 2001, MMWR). The August 2001 cases was a 67-year-old resident of
(B) Before 2000, there hadn't been a human case of anthrax since 1992 (see Editor's note in the Aug 17 MMWR article).
(C) Yes, the current cases are alarming in several respects. First, the proximity to the September 11th event make it highly suspicious. Second, seven cases is more than expected, under any circumstance. Third, this may represent the tip of the iceberg. This is clearly an epidemiologic emergency.
(D) The agent is a gram-positive encapsulating bacteria (non-motile rod) called Bacillus anthracis.
(E) The normal reservoir for anthrax is animals, mostly herbivores.
(F) The [unnatural] reservoir of bioterrorism-related anthrax [where the agent is multiplied and is stored] is a laboratory.
(G) Environmental cleanup is difficult. Hypochlorite is sporicidal when organic matter is not overwhelming and the item is not corrodible. Spores require steam sterilization, autoclaving or burning to assure complete destruction. Fumigation and chemical disinfection may be effective.
(H) The Communicable Disease Manual says "transmission from person-to-person is very rare." Any such risk is trivial compared with direct exposure to the mail.
(I) Precautions when handling potentially contaminated materials:
(J) In this atypical mode of bioterrorism with of exposure, the fly would be acting as a mechanical vector.
(K) The incubation period is a few hours to several days (usually less than 48 hours).
(L) Untreated cutaneous anthrax has a fatality rate of between 5 and 20 percent. With effective treatment, few deaths occur.
(M) No figure is given for the fatality rate associated with respiratory anthrax. However, the Communicable Disease Manual notes that fever and shock follow acute symptoms in 3 - 5 days with death shortly thereafter. This implies that death is common, if not universal.
(N) The risks probably outweigh the benefits. (This could change in the event of a generalize anthrax attack.)
(O) Strategies for prevention may be directed against any of the following infectious disease process: