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ASHP Offers Members Guidance on Talking to Public About Anthrax Threat

Donna Young

In the wake of the Sept. 11 tragedies, ASHP members may find themselves answering media and public questions about the risk of bioterrorism in the United States. First, some facts from the Centers for Disease Control and Prevention (CDC):
  • Anthrax, according to most military and counterterrorism authorities, represents the single greatest potential biological warfare threat today.      
  • Anthrax is caused by infection with Bacillus anthracis, a gram-positive spore-forming bacterium. The spore form of this organism, which can survive in the environment for many decades, is not virulent, doesn’t aerosolize well, and, in natural concentrations, is very hard to transmit through touch.      
  • Anthrax acquired by inhalation generally occurs after an incubation period of one to six days. After incubation, a nonspecific flu-like illness ensues, characterized by fever, myalgia, headache, a nonproductive cough, and mild chest discomfort. The second phase is marked by high fever, dyspnea, stridor, cyanosis, and shock.      
  • Ciprofloxacin, doxycycline, and penicillin are effective for prophylaxis and treatment after exposure to B. anthracis spores. For specific information about the use of these drugs, go to CDC's Web site.

Important points for the public to keep in mind:

  • Inhalational anthrax has little potential for person-to-person transmission. It also is very difficult to disperse effectively across large populations.      
  • The U.S. health care system has effective treatment protocols for individuals who have contracted anthrax. However, early diagnosis and treatment of inhalational anthrax is critical. If therapy is begun more than 48 hours after the onset of symptoms, the probability of death is high.      
  • Vaccines for anthrax are currently only available for military personnel, are for pre-exposure prophylaxis, and require multiple injections and yearly boosters.      
  • CDC does not recommend that influenza vaccination be considered as a way to avoid confusing influenza disease with suspected anthrax illness.      
  • Consumer stockpiling of medications such as ciprofloxacin (Cipro, Bayer Corp.) can lead to national shortages when a real need arises. Self-diagnosis and self-treatment with prescription medicines is never a good idea. Medicines, in general, also have a limited shelf life, can have significant side effects and drug interactions, and may not be the right therapeutic agent for the condition you have.      
  • Moreover, health care providers must ensure they have a clear diagnosis or strong indication of anthrax infection in immature pediatric patients, because ciprofloxacin (Cipro) can stunt cartilage growth in this patient population.

For more information, go to CDC's Web site about bioterrorism and ASHP's Counterterrorism Resource Center.