Anthrax: An Attack on the United States Anthrax is an acute disease that is caused by a bacteria known as bacillus anthracis. Anthrax most commonly occurs in lower-level vertebrates both wild and domestic, such as cows, goats, sheep, and camels. However, anthrax infection can also occur in humans when they are exposed to animals that are infected, or to tissue from these animals ("Anthrax," 2003). The anthrax infection in humans can take three forms: cutaneous, inhalation, or gastrointestinal. This paper examines the signs and symptoms of anthrax, as well as looks at the circumstances of the most current outbreak of anthrax in the United States.

Anthrax is not very common in the United States, at least not anymore. Anthrax is primarily a disease of agricultural countries where contact with and exposure to animals is a common, daily occurrence. When anthrax infects a human being, it is normally through contact with an infected animal or parts of an infected animal. This sort of contact does not happen in the United States very frequently anymore, as we have become an industrialized nation. In countries that still have an agricultural economy and way of life, however, anthrax infection in humans is much more common.

The cutaneous form of anthrax occurs as an infection of the skin. This type of anthrax is caused by touching animals or animal products with an anthrax infection. The cutaneous form of anthrax is the least serious form of anthrax. The inhaled version of anthrax occurs when a person inhales anthrax spores that are present in infected animal products or in soil that has been exposed to infected animals. The inhaled version of anthrax is the most serious form of the disease. The gastrointestinal version of anthrax occurs by eating undercooked meat from animals with anthrax. This is the rarest form of anthrax that people can contract.

Anthrax has a wide variety of symptoms, depending upon which type of the disease has been contracted. The main symptoms of the three types of anthrax are as follows:

Cutaneous: This is the most common type of anthrax infection seen in humans. About ninety-five percent of human-based anthrax infections are cutaneous infections. These infections occur when the anthrax bacteria enter a cut or abrasion on the skin of a person handling infected animal products or animals. This type of anthrax infection begins as an itchy red bump on the skin. This bump resembles an insect bite. In one to two days, however, this bump becomes a vesicle and then a painless ulcer on the skin. This ulcer is usually one to three centimeters in diameter and normally has a black area of dying tissue in the center of it. Lymph glands surrounding the area of the ulcer will often swell, as well. Without proper treatment, about twenty percent of cutaneous anthrax cases will result in death for the victim. However, with antibiotic treatment, almost all cutaneous anthrax cases can be cured.

Inhalation: A person may test positive for anthrax spores in their nasal passages, but this only indicates they have been exposed to anthrax, not that they will get the disease. By treating an exposed person with antibiotics, infection can actually be avoided entirely. In order for the infection to progress to a full-blown anthrax infection, the anthrax spores in the person's nasal passages must be allowed to germinate ("Medical Encyclopedia," 2003). This process of germination may take anywhere from a few days to up to sixty days to occur. The anthrax spores will move to the lymph nodes where they will release several toxic substances into the victim's system once they germinate. These substances lead to hemorrhaging, swelling, and tissue death.

Inhalation anthrax infection has two main stages. The first stage includes symptoms that resemble a simple cold. However, in a few days, theses symptoms will change to the second stage symptoms, which include severe breathing problems and shock. This form of anthrax is highly fatal, even with antibiotic treatment. Due to the build-up of toxins, this form of anthrax is about ninety percent fatal. However, inhalation anthrax is the most rare form of anthrax.

Gastrointestinal: In this form of anthrax, the lining of the intestines becomes inflamed. The first signs of this type of anthrax are nausea, vomiting, and loss of appetite. These symptoms will gradually increase to severe abdominal pain, vomiting of blood, and diarrhea. Without proper treatment, gastrointestinal anthrax can result in death in twenty to sixty percent of cases ("Anthrax," 2003).

The main treatment for all types of anthrax is antibiotic therapy....

This is because anthrax is caused by a bacteria. The earlier the treatment begins, the better the outlook for the patient. Penicillin, doxycycline, and ciprofloxacin are all effective against anthrax. Ciprofloxacin is normally the antibiotic of choice for anthrax, at least at first until it is determined if the anthrax strain present is resistant to any of the other antibiotics available. Since the germination process for anthrax can take up to sixty days, antibiotic treatment usually takes this long, too. Patients are usually given oral antibiotics for as long as they show no symptoms (meaning they were merely exposed to anthrax). If symptoms develop, intravenous antibiotics will be given for fourteen days, then oral antibiotics will be given for the remainder of the sixty day period. Though there is a vaccine against anthrax that is given in a six dose series, it is normally only given to U.S. military personnel, and is not recommended for use by the general public as it is a harsh vaccine with many unpleasant possibilities for side effects. However, there is no human to human spread of anthrax, so simply being around someone who has the disease will not cause infection to another person unless that person was exposed to the same source of anthrax.
In the wake of the recent anthrax bioterrorism attack in the United States, the question of physician preparedness to handle an anthrax outbreak is an important question. Since anthrax was (and still is) relatively uncommon in the United States, there has not been any real need for physicians to know about how to effectively treat the disease, and the availability of the anthrax vaccine is still reserved for only personnel of the U.S. military. This, of course, has raised concerns among the general public. If there were to be another or larger outbreak of bioterrorism using anthrax as the agent, how prepared would physicians in the United States be to treat the outbreak?

Currently, there is only one manufacturer of the anthrax vaccine in the United States. This manufacturer is the Bioport Corporation, based in Michigan. This company has been cited several times by the Food and Drug Administration for manufacturing violations. This is a concern, since the company is currently the only place in the United States from which the vaccine can be obtained. However, in light of the recent terrorist attacks, some say that the manufacturing standards should be relaxed anyway, in order to allow the vaccine to be produced more quickly.

The anthrax vaccine was developed using rhesus monkeys. The vaccine was completed for use in humans in the 1950s. Besides being used by the military, the anthrax vaccine has also been used to vaccinate those most likely to be exposed to the disease, such as lab workers, veterinarians, and people working in the livestock industry ("Anthrax Vaccine Availability Concerns USA," 2001). Severe reactions to the vaccine occur in less than one percent of cases. The anthrax vaccine works by aiding the immune system in preventing the anthrax bacteria from producing deadly toxins. The vaccine is made from dead bacteria from a strain of anthrax that is known to not cause the disease. Despite the low instance of severe side effects, there are some people who should not take the anthrax vaccine. These people are:

1) People with a history of severe reaction to the anthrax vaccine.

2) People with an acute anthrax infection or respiratory disease.

3) People with a depressed immune system.

4) People younger than 18 or older than 65.

5) Pregnant women.

The anthrax vaccine could prove important for the general population in the future, especially if there is a biological terrorism outbreak in the United States. This is because the vaccine is useful in those who have already been exposed or infected, especially in conjunction with antibiotics. The current vaccine must be administered in six doses over an eighteen month period. However, a new version of the vaccine is in development that would only require two or three doses, which would make the vaccine much easier to administer on a wide scale. While some people believe that the anthrax vaccine may need to begin being administered to the general population soon, there are many others who believe that this would be a hasty decision. Critics of the mass vaccination plan believe that the anthrax vaccine is still not proven safe enough for use in the general public. These critics say that while the anthrax vaccine should be held in reserve and available should the need arise, vaccinating now without a clear threat present to warrant…