Call our Washington DC office for information

202 529 2522

Here is a Link to the Flagler County FEMA Preparedness Library

FEMA Library Link

Tom Ridge's Homeland Security Dept. Ready Website

Privacy, Shipping, Return, Security Practices

Anthrax, SARS, Monkey Pox Protective Supplies

With the events of Sept. 11, 2001, and the following cases of Anthrax- borne illnesses still fresh in our nation’s mind, the awareness of chemical and biological warfare is at a heightened level. The following article provides some background information on the biological agent Anthrax and offers some practical suggestions for protecting yourself and your workforce.

What is Anthrax?

Anthrax is an acute infectious disease caused by the spore-forming bacterium Bacillus anthracis. “Bacillus anthracis derives from the Greek word for coal, anthrakis, because the disease causes black, coal-like skin lesions. Bacillus anthracis is an aerobic, gram positive, spore-forming, non-motile Bacillus species. The non-flagellated vegetative cell is large (1-8 micron in length, 1-1.5 microns in breadth). Spore size is approximately 1 micron.” (Journal of the American Medical Association, 5/12/1999.)

In the naturally occurring form of anthrax, the disease is passed on by contact with anthrax-infected or anthrax-contaminated animals and animal products. Anthrax is not spread from one person to another person.

Humans can host three forms of anthrax: inhalational, cutaneous and gastrointestinal.

Inhalational anthrax occurs when the anthrax spore is inhaled.

Cutaneous anthrax is the most common naturally occurring form. It is contracted by handling contaminated hair, wool, hides, flesh, blood or excreta of infected animals and from manufactured products such as bone meal. It is introduced through scratches or abrasions of the skin.

Gastrointestinal anthrax occurs when ingesting insufficiently cooked infected meat or from flies.

The spores are very stable and may remain viable for many years in soil and water. They will resist sunlight for varying periods.

Symptoms and Treatments

According to the Center for Disease Control and Prevention (CDC), symptoms of the disease vary depending on how the disease was contracted, but usually occur within 7 days after exposure. Initial symptoms of inhalation anthrax infection may resemble a common cold. After several days, the symptoms may progress to severe breathing problems and shock. Inhalation anthrax is often fatal.

Cutaneous anthrax occurs following the deposition of the organism into skin with previous cuts or abrasions especially susceptible to infection. After the spore germinates in skin tissues, toxin production results in local edema. An initially pruritic macule or papule enlarges into a round ulcer by the second day.

The gastrointestinal form of anthrax may follow the consumption of contaminated food 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.

Anthrax is diagnosed by isolating the bacteria from blood, other body fluids or skin lesions or by measuring specific antibodies late in the course of the disease.

The disease occurs when spores enter the lungs, migrate to the lymph nodes, change to the bacterial form, multiply and produce toxins. Bleeding and destruction of structures in the middle of the chest are a result of the toxins produced by the anthrax. The medical term for this condition is hemorrhagic necrotizing mediastinitis.

The CDC states that anthrax infection can be prevent-ed with antibiotic treatment. Early antibiotic treatment of anthrax is essential—delay lessens chances for survival. Anthrax usually is susceptible to penicillin, dioxycycline and fluoroquinolones. An anthrax vaccine also can prevent infection. Vaccination against anthrax is not recommended for or available to the general public to prevent disease.

Responding to Potential Exposures

Some facilities in communities around the country have received anthrax threat letters. Most were empty envelopes; but some have contained powdery substances. Anthrax organisms can cause infection in the skin, gastrointestinal system or the lungs. To do, so the organism must be rubbed into abraded skin, swallowed or inhaled as a fine, aerosolized mist. Disease can be prevented after exposure to the anthrax spores by early treatment with the appropriate antibiotics.

For anthrax to be effective as a covert agent, it must be aerosolized into very small particles. This is difficult to do and requires a great deal of technical skill and special equipment. If these small particles are inhaled, life-threatening lung infection can occur, but prompt recognition and treatment are effective.

Extra precautions are being taken in mailrooms across the country to guard against this hazard. The purpose of the guidelines listed below is to establish procedures for handling such potential exposure incidents.

The first step is to be on the lookout for suspicious parcels. According to the United States Postal Service (USPS) and the FBI, some typical characteristics of suspicious parcels are:

Parcels that are unexpected or from someone unfamiliar to you
Parcels with handwritten or poorly typed addresses
Parcels with excessive postage
Parcels with misspelled common words
Parcels with excessive security material, such as masking tape or string
Parcels that are addressed to someone no longer with your organization or have incorrect titles or have a title, but no name
Parcels that have no return address, or have one that can't be verified as legitimate
Parcels that are of unusual or excessive weight given their size, or are lopsided or oddly shaped or have an uneven envelope
Parcels that are marked with restrictive endorsements, such as “Personal” or “Confidential”
Parcels with protruding wires or aluminum foil, strange odors, oily stains or discolorations
Parcels that show a city or state in the postmark that doesn't match the return address
Parcels with a ticking sound

Additionally, the USPS has a downloadable poster “Suspicious Mail Alert” on their website to help educate employees on suspicious packages:
http://www.usps.com/news/2001/press/serviceupdates.htm.

If you or your employees do encounter a suspicious mail piece or package:

Do not try to open the mail piece. Do not shake or empty the contents of any suspicious envelope or package. If an envelope has powder and the powder spills out, DO NOT try to clean up the powder. Cover the spilled contents immediately with anything (e.g., clothing, paper, trash can, etc.) and do not remove this cover.
Isolate the mail piece. Place the envelope or package in a plastic bag or some other type of container to prevent leakage of contents. If you do not have any container, then cover the envelope or package with anything (e.g., clothing, paper, trash can, etc.) and do not remove this cover.
Evacuate the immediate area. Leave the room and close the door, or section off the area to prevent others from entering.
Wash your hands with soap and water to prevent spreading any powder to your face.
Contact your local law enforcement agency. If you are at work, then report the incident to local police, and notify your building security official or an available supervisor.
List all people who were in the room or area when this suspicious letter or package was recognized. Give this list to both the local public health authorities and law enforcement officials for follow-up investigations and advice.

The FBI has prepared a useful downloadable .pdf file offering instructions on responding to a suspicious package. This is accessible at their web site, http://www.fbi.gov/.

If you may have had contact with an unknown powdery substance:

Remove heavily contaminated clothing as soon as possible and place in a plastic bag, or some other container that can be sealed. This clothing bag should be given to the emergency responders for proper handling.
Shower with soap and water as soon as possible. Do not use bleach or other disinfectant on your skin.
List all people who were in the room or area, especially those who had actual contact with the powder, if possible. Give this list to both the local public health authorities so that proper instructions can be given for medical follow-up and to law enforcement officials for further investigation.

Personal Protective Equipment

Respiratory Protection

Since Bacillus anthracis is a biological particulate, an air-purifying respirator (APR) equipped with a mechanical filtering element would be the minimum level of respiratory protection required.

A joint study by the Department of Defense (DOD), the National Institute for Occupational Safety and Health (NIOSH), and the Occupational Safety and Health Administration (OSHA), came out with a report titled “Chemical and Biological Respiratory Protection Workshop Report,” http://www.cdc.gov/niosh/2000-122.html.

This report states, “Currently, NIOSH approved particulate filters, (N, R, and P 100 filters) have the capability to filter out biological agents. Although respirators can filter out biological agents, face-seal leakage— which facial structure and face piece models and sizes affect—is a significant problem. Factors such as beard growth, scars and perspiration also affect fit and leakage.”

While N100, R100, or P100 mechanical filtering elements are effective against biological agents such as anthrax, they’re only effective if the face piece fits properly. OSHA has established specific guidelines for respirator fit testing.

In general, there is the potential that biological agents may be absorbed into the body through mucous membranes (i.e. eyes, nose). Due to these concerns, respiratory protection that incorporates protection for the face such as a full-face respirator with N100, R100, or P100 filters, or full-face powered air-purifying respirator (PAPR) with High Efficiency Particulate Absolute (HEPA) filters should be used.

A self-contained breathing apparatus (SCBA) or a pressure demand airline respirator incorporating an egress (escape) bottle of breathing air is the highest level of respiratory protection. Again, it’s vital that the face piece be properly fitted to achieve the maximum level of protection from any tight fitting respirator.

Clothing

When it comes to clothing, standard Tyvek ® will hold out 99.9 percent of all dry particles down to 0.5 microns. According to an information sheet from DuPont, the manufacturer of Tyvek ® , “Garments made of Tyvek ® can be used against dry chemical, biological and radioactive particle hazards and against liquid hazards when the amount of liquid is small and the pressure is low. For liquid chemical, biological or radioactive hazards, the appropriate style garment made of Tychem ® can be used. For gas and vapor hazards, vapor protective suits made of Tychem ® fabrics are appropriate when worn with the proper respiratory equipment.”

The Tychem ® garments incorporate layers of laminates to provide the liquid protection. Both Tyvek ® and Tychem ® garments are considered disposable and should be disposed of after an exposure or potential exposure to anthrax causing spores or other biological and chemical agents.

In terms of hand protection, the goal is to establish a barrier between the Bacillus anthracis and any potential cut or abrasion on the hands. Either vinyl, natural rubber (latex) or synthetic rubber (nitrile, neoprene) gloves will provide this protection. Individuals with latex sensitivities should consider either a nitrile or vinyl material as an alternative to latex.

Government Recommendations

CDC’s Interim Recommendations for Mail Handlers The Oct. 31, 2001, CDC advisory states, “These interim recommendations are based on the limited information available on ways to avoid infection and the effectiveness of various prevention strategies and will be updated as new information becomes available. These recommendations do not address instances where a known or suspected exposure has occurred. Workers should be trained in how to recognize and handle a suspicious piece of mail (www.bt.cdc.gov). In addition, each work site should develop an emergency plan describing appropriate actions to be taken when known or suspected exposure to B. anthracis occurs.”

The recommendation lists a hierarchy of measures to be used to prevent potential exposures to B. anthracis spores. In hierarchical order the measures are:

Engineering controls
Administrative controls
Housekeeping controls
Personal protective equipment (PPE) for workers

Under PPE, the recommendation states, “Personal protective equipment for workers in mail-handling/ processing work sites must be selected on the basis of potential for cutaneous or inhalational exposure to B. anthracis spores.”

It advises the use of gloves and long sleeves for workers who handle mail. The recommendation provides nine bullet points to assist in the selection of proper gloves.

In terms of respiratory protection the CDC states, “Persons working with or near machinery capable of generating aerosolized particles (e.g. electronic mail sorters) or at other work sites where such particles may be generated should be fitted with NIOSH-approved respirators that are at least as protective as an N95 respirator. Persons working in areas where oil mist from machinery is present should be fitted with respirators equipped with P-type filters.”

The recommendation states that employees with facial hair interfering with the fit of the respirator face piece and employees that cannot pass a fit test with a tight-fitting air purifying respirator (APR) may require the use of PAPR with HEPA filters. Aprons and goggles are also suggested for those working near machinery capable of generating aerosolized particles.

The previous recommendation from the CDC for mail handlers (http:// www.bt.cdc.gov/DocumentsApp/45.pdf), advised those working near automated mail sorting equipment should use an N, R or P100 respirator and those sorting mail by hand should use an N95 respirator as the minimum level of respiratory protection.

CDC’s PPE Recommendations for Investigators and Responders

In the CDC’s Oct. 25, 2001 interim recommendations for firefighters and other first responders, the levels of protection are tiered and “based upon the anticipated level of exposure risk associated with different response situations.” Recommendations range SCBAs and Level A protective suits, for incidents where the contaminant is unknown or the event is “uncontrolled,” down to full face respirators with P100 filters or PAPRs with HEPA filters for more controlled incidents. Please refer to the CDC’s recommendations for details at: http://www.bt.cdc.gov/DocumentsApp/ Anthrax/Protective/10242001Protect.asp.

Decontamination

To decontaminate materials exposed to Bacillus anthracis, a document from the U.S. Navy Manual on Operational Medicine and Fleet Support entitled “Biological Warfare Defense Information Sheet” states, “Disinfection of contaminated articles may be accomplished using a 0.05 percent hypochlorite solution (1 Tbsp. bleach per gallon of water). Spore destruction requires steam sterilization.”

Contact Information: