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White Powder in the Mail. Is it anthrax? How can you tell? What do you do ?. What is Anthrax?. Bacillus Anthracis Spores Bacteria. Knight Ridder/Tribune News/UCLA School of Public Health Dept. of Epidemiology. What Diseases are Caused by Anthrax?. Cutaneous

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white powder in the mail

White Powder in the Mail

Is it anthrax?

How can you tell?

What do you do?

what is anthrax
What is Anthrax?
  • Bacillus Anthracis
    • Spores
    • Bacteria
what diseases are caused by anthrax
What Diseases are Caused by Anthrax?
  • Cutaneous
    • Most common naturally occurring form
    • Low mortality
  • Gastrointestinal
    • Results from eating contaminated, undercooked meat
    • Up to 50% mortality if untreated
  • Inhalational
    • Most likely in bioterrorism
    • High mortality without prompt treatment
inhalation anthrax
Inhalation Anthrax
  • Onset of symptoms 2 days up to 60 days post-exposure
  • Antibiotics most effective before onset of symptoms
  • LD50 about 8000 spores
    • Infective dose probably less than 10 spores in susceptible persons
history of anthrax
History of Anthrax
  • Biblical plagues
    • Fifth and Sixth Plagues in Exodus Believed to be Anthrax
  • Animal disease
    • Endemic to horses, cows, goats, sheep
    • Economically important agricultural disease
natural incidence of anthrax
Natural Incidence of Anthrax
  • Most common in temperate agricultural regions
    • Rare in US
    • More common in India and southern Africa
      • Human infection unusual
        • 95% is cutaneous
        • Result of contact with infected animals
naturally occurring human anthrax
Naturally Occurring Human Anthrax
  • Endemic in south/central Asia, central America, southern Africa
  • Several thousand human cases each year
    • Always associated with livestock
    • Often associated with war
  • Largest human outbreak

Zimbabwe 1978-1980

development of anthrax as a biological weapon
Development of Anthrax as a Biological Weapon
  • Historical use
  • US and UK Development
  • Soviet Development
sverdlovsk outbreak 1979
Sverdlovsk Outbreak, 1979
  • Spores accidentally released from army microbiology lab
  • 96 Infected, 66 Dead
  • All victims lived or worked in a narrow band downwind from lab
    • Human casualties within 4 km
    • Animal deaths extended to 50 km downwind
...the hundreds of anthrax hoaxes involving envelopes filled with harmless powders lack a plausible delivery system and hence are more of a nuisance than a serious danger.

Jonathan Tucker

Toxic Terror: Assessing Terrorist Use of Chemical and Biological Weapons, 2000

the anthrax letters
The Anthrax Letters
  • Five Known Letters to Media and Political Targets
    • Four letters recovered, mailed on two dates from Trenton, NJ
  • Letters Contained ~1g anthrax
    • Fine particle size
    • Treated to Enhance Dispersion
anthrax letters effects
Anthrax Letters: Effects
  • Anthrax in Second Mailing
    • <5 micron size
    • Escaped through pores in envelopes
    • Contamination throughout US postal service
    • Cross-contamination to many other letters
  • Most illnesses and all but one death resulted from spores leaking through envelopes
anthrax letters casualties
Anthrax Letters: Casualties
  • 5 dead from inhalational anthrax
  • 17 ill
    • 11 cutaneous
    • 6 inhalational
  • 10000 people taking antibiotics
  • All but few survivors still suffering effects
anthrax letters effect on business
Anthrax Letters: Effect on Business
  • >500 reports of anthrax per day
    • Investigations
    • Facility Closures
  • Side Effects from Cipro
    • 57% reported serious side effects
    • 26% missed work
anthrax letters cleanup costs
Anthrax Letters: Cleanup Costs
  • AMI Building in Boca Raton remains shuttered
  • Clean-up of Hart Senate Office Building cost $41.7 million
    • Building was closed for three months
  • 23 US Postal Service Facilities Contaminated
    • Clean-up costs estimated at $800 million
hoaxes and suspicious packages post 9 11
Hoaxes and Suspicious Packages Post 9/11
  • 2001 before 9/11, 368 incidents, including one simultaneous mailing of 350 letters
  • 2001 after 9/11, 7089 hoaxes and other reports of suspicious substances
hoaxes and suspicious packages post 9 1121
Hoaxes and Suspicious Packages Post 9/11
  • 2001 before 9/11, 368 incidents, including one simultaneous mailing of 350 letters
  • 2001 after 9/11, 7089 hoaxes and other reports of suspicious substances
after the anthrax mailings everything is taken seriously
After the Anthrax Mailings, Everything is Taken Seriously
  • Any suspicious powder received full response
  • FBI director reported that agents responded to over 29,000 reports in the year following the attack
      • Practical jokes and powdered sugar merited hazmat crews
  • Attacks inspired other hoaxers
suspicious powder response
Suspicious Powder: Response
  • First Responders including hazmat teams and FBI arrive
  • Area is evacuated and possibly closed
  • Field tests are done
    • If positive, those exposed are decontaminated
  • Suspicious package is sent to CDC-certified lab for testing
hoaxes continue today
Hoaxes Continue Today
  • FBI's National Capital Response Squad responds to 5-10 reports per week of suspicious substances in Washington area
  • U.S. Capitol Police respond to 3-10 reports per day on Capitol Hill

Washington Post, 13 April 2004

sometimes the threat is real
Sometimes the Threat is Real
  • Ricin in ‘Fallen Angel’ Letters
    • Intercepted at mail handling facility Greenville SC 10/03
    • Intercepted at White House mail handling facility Washington DC 11/03
  • Ricin in Senator Frist’s Office 2/04
    • No source letter found
what to do if you see suspicious powder
What to do if you see Suspicious Powder
  • If parcel is closed, don’t open or shake it
  • Isolate area of package or powder
  • Turn off fans or ventilation units and shut down the air handling system in the building
  • Keep track of who has had contact with the powder
  • Call 911
usps protective measures
USPS Protective Measures
  • Procedures
    • Off-site handling for potential targets
    • Irradiation of Government Mail
  • Hazardous material detection
    • BDS in distribution centers
    • Detects anthrax only
    • Can potentially be modified to detect other hazards
what your company can do to protect itself
What Your Company Can Do to Protect Itself
  • Establish mail handling procedures
  • Establish policies in case of discovery of powder
    • Include in emergency action plan
  • Evaluate risk level
  • Establish plan for keeping business operating in case of facility closure
    • Clean-up plan
    • Back-ups of important documents
selected references
Selected References
  • Office of the Surgeon General, US Army Medical Aspects of Chemical and Biological Warfare. Washington 1997
  • Centers for Disease Control and Prevention, Emergency Preparedness Website http://www.bt.cdc.gov/agent/anthrax/index.asp
  • Cole, Leonard A. The Anthrax Letters: A Medical Detective Story. Washington: Joseph Henry Press 2003
  • Meselson, Matthew et al. “The Sverdlovsk Anthrax Outbreak of 1979” Science, November 18,1994
  • Tucker, Jonathan Toxic Terror: Assessing Terrorist Use of Chemical and Biological Weapons Cambridge: Belfer Center 2000