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Bioterrorism: Fear of the Unknown Turns to Search for Understanding

An NBC News employee in New York City has tested positive for anthrax. This comes on top of three cases in Florida, where one man died. The cases have led to questions and fears about anthrax. Dr. Bernadine Healy is in Cleveland with some answers.

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.

Can anthrax be spread from person to person?

Direct person-to-person spread of anthrax is extremely unlikely to occur. Communicability is not a concern in managing or visiting with patients with inhalation anthrax.

You say there are three types of anthrax. Tell us about the first one, called inhalation anthrax, which struck the three people in Florida, killing one of them.

A person gets inhalation anthrax by inhaling anthrax spores, which can live in the soil for many years. 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.

What about cutaneous anthrax, which the NBC employee in New York tested positive for?

This type of anthrax is the most common and the mildest form of the disease. There are about 2,000 cases worldwide and a handful of cases are seen every year in the United States. Most of those cases come from people who work with animals. The first sign of infection would be a small pimple or ulcer, which would continue to grow into a black, coal-like lesion. Anthrax got its name because an infection looks like anthracite, or coal.

There is also intestinal anthrax, which so far, no one has tested positive for.

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.

You say that there is an anthrax vaccine, but that it is not available to everyone?

Right now in the United States, the vaccine is only available to the military. But some in the armed forces are afraid to take it for fear of side effects. The only company that makes it, Bioport Corp. in Lansing, Michigan, has failed government inspections and has not received the green light from the Food and Drug Administration to release theisupply.

Several antibiotics, including Cipro, have been shown to treat anthrax. Should people be asking their doctors for prescriptions?

No, any needed antibiotics from the government's stockpile will be made available if they are needed. In the meantime, Cipro should not be prescribed unless there is a clearly indicated need, so that the drug will be available as the need arises for the standard infections for which it is used. It is important to note that Cipro becomes ineffective if not properly administered.

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