Treatment and prevention
ANTHRAX CANNOT spread directly from person to person but a patient’s clothing and body may be contaminated with anthrax spores. Effective decontamination of people can be accomplished by a thorough wash down with antimicrobial effective soap and water. Waste water should be treated with bleach or other anti-microbial agent. Effective decontamination of articles can be accomplished by boiling contaminated articles in water for 30 minutes or longer.
Chlorine bleach is ineffective in destroying spores and vegetative cells on surfaces, though formaldehyde is effective. Burning clothing is very effective in destroying spores. After decontamination, there is no need to immunise, treat or isolate contacts of persons ill with anthrax unless they were also exposed to the same source of infection. Early antibiotic treatment of anthrax is essential—delay significantly lessens chances for survival. Treatment for anthrax infection and other bacterial infections includes large doses of intravenous and oral antibiotics, such as fluoroquinolones, like ciprofloxacin (cipro), doxycycline, erythromycin, vancomycin or penicillin.
In possible cases of inhalation of anthrax, early antibiotic prophylaxis treatment is crucial to prevent possible death. In May 2009, Human Genome Sciences submitted a Biologics License Application (BLA, permission to market) for its new drug, raxibacumab (brand name ABthrax) intended for emergency treatment of inhaled anthrax. If death occurs from anthrax, the body should be isolated to prevent possible spread of anthrax germs. Burial does not kill anthrax spores.
If a person is suspected to have died from anthrax, every precaution should be taken to avoid skin contact with the potentially contaminated body and fluids exuded through natural body openings. The body should be put in strict quarantine. A blood sample taken in a sealed container and analysed in an approved lab should be used to ascertain if anthrax is the cause of death. Microscopic visualisation of the encapsulated bacilli, usually in very large numbers, in a blood smear stained with polychrome methylene blue (McFadyean stain) is fully diagnostic, though culture of the organism is still the gold standard for diagnosis.
Full isolation of the body is important to prevent possible contamination of others. Protective, impermeable clothing and equipment such as rubber gloves, rubber apron and rubber boots with no perforations should be used when handling the body. No skin, especially if it has any wounds or scratches, should be exposed. Disposable personal protective equipment is preferable but if not available, decontamination can be achieved by autoclaving. Disposable personal protective equipment and filters should be autoclaved and/or burned and buried.
Bacillus anthracis bacillii range from 0.5-5.0 μm in size. Anyone working with anthrax in a suspected or confirmed victim should wear respiratory equipment capable of filtering this size of particle or smaller. The US National Institute for Occupational Safety and Health (NIOSH) and Mine Safety and Health Administration (MSHA) approved high efficiency-respirator, such as a half-face disposable respirator with a high-efficiency particulate air (HEPA) filter, is recommended. All possibly contaminated bedding or clothing should be isolated in double plastic bags and treated as possible bio-hazard waste.
The victim should be sealed in an airtight body bag. Dead victims that are opened and not burned provide an ideal source of anthrax spores. Cremating victims is the preferred way of handling body disposal. No embalming or autopsy should be attempted without a fully equipped biohazard lab and trained and knowledgeable personnel. Delays of only a few days may make the disease untreatable and treatment should be started even without symptoms, if possible, contamination or exposure is suspected. Animals with anthrax often just die without any apparent symptoms. Initial symptoms may resemble a common cold— sore throat, mild fever, muscle aches and malaise.
After a few days, the symptoms may progress to severe breathing problems and shock and ultimately death. Death can occur from about two days to a month after exposure. Antibiotic-resistant strains of anthrax are known. In recent years, there have been many attempts to develop new drugs against anthrax, but existing drugs are effective if treatment is started soon enough.
Early detection of sources of anthrax infection can allow preventive measures to be taken. In response to the anthrax attacks of October 2001, the United States Postal Service (USPS) installed Bio Detection Systems (BDS) in their large scale mail cancellation facilities. BDS response plans were formulated by the USPS in conjunction with local responders including fire, police, hospitals and public health.
Employees of these facilities have been educated about anthrax, response actions and prophylactic medication. Because of the time delay, inherent in getting final verification that anthrax has been used, prophylactic antibiotic treatment of possibly exposed personnel must be started as soon as possible. The most effective form of prevention is vaccination against infection but this must be done well in advance of exposure to the bacillus and does not protect indefinitely.
Anthrax vaccines
An FDA-licensed vaccine, produced from one non-virulent strain of the anthrax bacterium, is manufactured by BioPort Corporation, subsidiary of Emergent BioSolutions. The trade name is BioThrax, although it is commonly called Anthrax Vaccine Adsorbed (AVA).
It is administered in a six-dose primary series at 0,2,4 weeks and 6,12,18 months; annual booster injections are required thereafter to maintain immunity. Unlike western countries, the Soviets developed and used a live spore anthrax vaccine, known as the STI vaccine, produced in Tbilisi, Georgia. Its serious side effects restrict use to healthy adults.
