TERRORISM READINESS

GUIDELINES FOR HANDLING MAIL

ANTHRAX CONTAMINATION

What You Should Do
What You Should Not Do

WHAT YOU CAN EXPECT FROM A RESPONSE BY
PUBLIC SAFETY AND HEALTH

COMMONLY ASKED QUESTIONS

What is Anthrax?
How common is anthrax and who can get it?
How is anthrax transmitted?
What are the symptoms of anthrax?
Where is anthrax usually found?
Can anthrax be spread from person-to-person?
Is there a way to prevent infection?
What is the anthrax vaccine?
Who should get vaccinated against anthrax?
What is the protocol for anthrax vaccination?
Are there adverse reactions to the anthrax vaccine?
How is anthrax diagnosed?
Is there a treatment for anthrax?

Additional information regarding anthrax can be obtained by visiting the Center for Disease Control, CDC, or by calling the OES (California Governor's Office of Emergency Services) emergency preparedness hotline at (800) 550-5234.  A wide range of terrorism-related subject matter can be located at the FBI's, Counterterrorism page, Council on Foreign Relations, Terrorism: Questions & Answers page, and the FEMA page entitled, Are You Ready?

The United States Government has stated that in light of recent military actions in Afganistan that there is an increased likelihood that retaliatory terrorist strikes could occur in the United States.

Experts believe that if such an attack does occur it would most probably be through the use of a conventional rather than a biological or chemical weapon.

If another terrorist incident does occur, there is no better-prepared place to be than in the State of California. For more than 25 years state and local government agencies have been preparing for terrorist acts to ensure the safety and security of the general public.

What you can do?

• Remain calm. Stay informed. Identify credible and reliable sources of information such as local law enforcement agencies or county Office of Emergency Services. Avoid extremes such as canceling trips or withdrawing.

• All Californians should already have emergency preparedness kits, such as for earthquakes. Keep emergency preparedness kits up-to-date and stocked for at least 72 hours of self-sufficiency.  Disaster Supply Kit

• Keep emergency phone lists updated.

• Choose an out-of-state friend or relative who you and your family members can call after an emergency to report your whereabouts and conditions.

• Avoid spreading unsubstantiated stories.

What has the State done?

• The state has been actively aware of, and planned for, terrorism incidents for more than 25 years.

• The Governor's Office of Emergency Services coordinates state level terrorism preparedness, response, and recovery. Many State agencies are involved in these actions.

• California's Terrorism Response Plan was activated immediately after notification of the East Coast Terrorist Attack on September 11, and remains in force. This high level of readiness ensures that if there should be an incident, the response will be as swift as is possible.

• For the past five years terrorism has been OES' top priority in terms of hazard-specific planning.

  • The OES chairs the State Terrorism Threat Advisory Committee. This group of representatives from the FBI, Secret Service, FEMA, ATF, the California Highway Patrol, the State Department of Justice, Department of Health Services, and the Emergency Medical Services Authority. The S-TAC meets by secure conference call to discuss current situations and develop recommendations and advice for top-level decision makers.

• OES has provided local governments with terrorism planning guidance for many years, and published a stand-alone guide for local governments in 1998.

  • The California Department of Health Services (CDHS) has been for five years and will continue to be, actively engaged in bioterrorism preparedness activities with local, state, and federal agencies.

  • CDHS staff work with local health departments and the FBI to monitor for cases of disease outbreaks or reports of unusual illnesses.

  • Local health departments have been placed on a heightened level of alert for reports of unusual diseases.

  • All water systems have been directed to review their emergency plans and to increase surveillance of their facilities.

  • Security at all water conveyance systems has been increased.

  • California's State Water Project (SWP) is continuing routine water deliveries and operations at a heightened level of security.

  • SWP has taken appropriate measures to safeguard the water project infrastructure, and to protect key Department of Water Resources (DWR) facilities and the water supply.

What if an attack occurs?

If an attack were to occur in California, there are a significant numbers of emergency management resources statewide that would be brought to bear to respond.

• California's nearly 80,000 sworn peace officers, more than 60,000 firefighters, and thousands of emergency management personnel, combined with the State's multi-disciplinary approach to emergency response, give California a robust and formidable capability to deal with any disaster or emergency. Federal resources multiply this capability.

• California has more than 1,500 FBI agents available to investigate threats, physical evidence and to control federal assets.

• Local Emergency Medical Services agencies work with Regional Disaster Medical Health Coordinators to ensure that appropriate resources are available during an incident. If all of the regions' resources are being utilized, OES and the Emergency Medical Services Authority would deploy Disaster Medical Assistance Teams to assist the impacted areas.

Although a biological or chemical attack is not seen as a likely threat, if such an attack were to occur, the following assets are available:

• The Department of Health Services laboratories are part of a network of laboratories that can test for biological agents. The network consists of multiple state and local labs.

• Labs in both southern and northern California are "level C" labs, capable of testing for anthrax, botulism, plague, tularemia, brucellosis, smallpox, and mycotoxins. There is only one higher-level laboratory, Level D. The CDC and the Army have level D labs that can be used if necessary.

• Emergency Medical Services (EMS) trained personnel are the first responders to any emergency. EMS personnel are trained to work in emergency situations, and their training provides for initial treatment of hazardous material and biohazard exposure. Local EMS agencies can provide additional training to personnel in their areas at their discretion.

• Public health personnel would be contacted immediately in the event of any biological hazard.

• Responding personnel would have necessary medicines for short-term treatments. Medicines for longer-term treatments or mass dosages of medicines would be made available from the National Pharmaceutical Stockpile.

• The Centers for Disease Control could dispatch its stockpile of medicines to shield against biological weapons and treat people already exposed.

Again, biological and chemical attacks are not considered to be a likely threat.

The above information is courtesy of the California Governor's Office of Emergency Services,  OES.

• Wear protective gloves, especially if you have open cuts or skin lesions on your hands

• When opening mail, do NOT touch your eyes, nose, mouth, or any open wound

• Do not eat, drink or smoke around mail

• Wash your hands with warm water and soap before and after handling mail

IF YOU RECEIVE A LETTER OR NOTE THREATENING ANTHRAX CONTAMINATION

RELAX AND REMAIN CALM - Although any threatened use of biological agent must be treated as though it is real, experience has demonstrated that these are likely to be a HOAX. If the suspected biological agent is reported as anthrax, be assured that it is NOT contagious, and that treatment is readily available if administered before the onset of symptoms.

What You Should Do

• If it is a letter that you have opened, set it down gently at the location where you first read it. Then move to an area that will minimize your exposure to others. Avoid contact with others when possible, and remain in the area. Public Safety and Health responders will come to you.

• If it is a note that you happen to find, LEAVE IT ALONE.

• Advise a coworker in the immediate area what has happened and ask them to call 911.

• If possible, have the buildings ventilation system shut down and turn off any fans in the area.

• Do not allow others into the area. If anyone enters, they should stay until instructed to leave by Public Safety or Health responder.

• Remain calm. Exposure does not mean that you will become sick. Public Health responders will provide specific information and instructions about the symptoms and effective treatment to prevent illness.

• Do not pass the letter or note to others to look at.

• Do not disturb any contents in the letter or note. Handling the letter may only spread the substance inside and increase the chances of it getting into the air.

• Do not ignore the threat. It must be treated as real until properly evaluated.

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WHAT YOU CAN EXPECT FROM A RESPONSE BY PUBLIC SAFETY AND HEALTH

The initial response when you call 9-1-1 will include Galt Police, Fire and EMS. People will be asked to cooperate by waiting in the area until an appropriate evaluation of the incident is made. You will be given information as soon as it is available. There may be a decontamination (washing/rinsing) process performed on the persons exposed and/or the area. There are several ways to accomplish decontamination and the method used will be based upon the conditions present at the scene. The scene will be photographed and the letter and any product taken into custody as evidence to determine the nature of any product. Statements will be taken from those involved.

Even in the event of a substance being real anthrax, infection is unlikely and treatment is extremely effective. Stay calm and proceed slowly with the above instructions.

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COMMONLY ASKED QUESTIONS

Anthrax is an acute infectious disease caused by the spore-forming bacterium Bacillus anthracis. Anthrax most commonly occurs in wild and domestic lower vertebrates (cattle, sheep, goats, camels, antelopes, and other herbivores), but it can also occur in humans when they are exposed to infected animals or tissue from infected animals.

Because anthrax is considered to be a potential agent for use in biological warfare, the Department of Defense (DOD) has begun mandatory vaccination of all active duty military personnel who might be involved in conflict.

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.

Anthrax infection can occur in three forms: cutaneous (skin), inhalation, and gastrointestinal. B. anthracis spores can live in the soil for many years, and humans can become infected with anthrax by handling products from infected animals or by inhaling anthrax spores from contaminated animal products. Anthrax can also be spread by eating undercooked meat from infected animals. It is rare to find infected animals in the United States.

Symptoms of disease vary depending on how the disease was contracted, but symptoms usually occur within 7 days.

Cutaneous: Most (about 95%) anthrax infections occur when the bacterium enters a cut or abrasion on the skin, such as when handling contaminated wool, hides, leather or hair products (especially goat hair) of infected animals. Skin infection begins as a raised itchy bump that resembles an insect bite but within 1-2 days develops into a vesicle and then a painless ulcer, usually 1-3 cm in diameter, with a characteristic black necrotic (dying) area in the center. Lymph glands in the adjacent area may swell. About 20% of untreated cases of cutaneous anthrax will result in death. Deaths are rare with appropriate antimicrobial therapy.

Inhalation: 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.

Intestinal: 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, fever are followed by abdominal pain, vomiting of blood, and severe diarrhea. Intestinal anthrax results in death in 25% to 60% of cases.

Anthrax can be found globally. It is more common in developing countries or countries without veterinary public health programs. Certain regions of the world (South and Central America, Southern and Eastern Europe, Asia, Africa, the Caribbean, and the Middle East) report more anthrax in animals than others.

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.

In countries where anthrax is common and vaccination levels of animal herds are low, humans should avoid contact with livestock and animal products and avoid eating meat that has not been properly slaughtered and cooked. Also, an anthrax vaccine has been licensed for use in humans. The vaccine is reported to be 93% effective in protecting against anthrax.

The anthrax vaccine is manufactured and distributed by BioPort, Corporation, Lansing, Michigan. The vaccine is a cell-free filtrate vaccine, which means it contains no dead or live bacteria in the preparation. The final product contains no more than 2.4 mg of aluminum hydroxide as adjuvant. Anthrax vaccines intended for animals should not be used in humans.

Who should get vaccinated against anthrax?

The Advisory Committee on Immunization Practices has recommend anthrax vaccination for the following groups:

• Persons who work directly with the organism in the laboratory

• Persons who work with imported animal hides or furs in areas where standards are insufficient to prevent exposure to anthrax spores.

• Persons who handle potentially infected animal products in high-incidence areas. (Incidence is low in the United States, but veterinarians who travel to work in other countries where incidence is higher should consider being vaccinated.)

• Military personnel deployed to areas with high risk for exposure to the organism (as when it is used as a biological warfare weapon).

Pregnant women should be vaccinated only if absolutely necessary.

The immunization consists of three subcutaneous injections given 2 weeks apart followed by three additional subcutaneous injections given at 6, 12, and 18 months. Annual booster injections of the vaccine are recommended thereafter.

Mild local reactions occur in 30% of recipients and consist of slight tenderness and redness at the injection site. Severe local reactions are infrequent and consist of extensive swelling of the forearm in addition to the local reaction. Systemic reactions occur in fewer than 0.2% of recipients.

Anthrax is diagnosed by isolating B. anthracis from the blood, skin lesions, or respiratory secretions or by measuring specific antibodies in the blood of persons with suspected cases.

Doctors can prescribe effective antibiotics. To be effective, treatment should be initiated early. If left untreated, the disease can be fatal.