What is anthrax?

Anthrax is an infection caused by bacteria (a type of germ) calledBacillus anthracis (say:

buh-SIL-us an-THRAY-sus). These bacteria make spores, a form of the germ covered by a
protective shell. The spores can live for years in the soil, and they cause anthrax when they
enter the body. Although the disease is most common in farm animals like sheep, cows,
and goats there's a small chance that people can get it as well, usually from some type of
contact with an animal or part of an animal that had anthrax.
Anthrax disease is a severe illness caused by bacteria named Bacillus anthracis. Anthrax disease
can result in pneumonia, blood infection, and death.
Most of the time anthrax bacteria live in an inactive form called spores. Inactive anthrax spores
live naturally in soil and can be carried in the wool or on the skin of animals-usually cows,
sheep, or goats. A hard coating helps the spores survive heat, drying, and radiation for long
periods of time.
People can touch, eat, or breathe in anthrax spores. When this happens, the anthrax spores enter
the human body and can turn into active bacteria. This is called exposure to anthrax. Not
everybody who is exposed to anthrax will get sick. But many will, and as anthrax bacteria
multiply inside the body, they can cause very serious illness.
For example, 1 person in New York in 2006 and 2 people in Connecticut in 2007 were exposed
to anthrax while making drums from imported animal skins. The skins contained anthrax spores.
These people became extremely sick with anthrax disease. Getting anthrax this way is very
unusual. In California, there has been no anthrax disease in humans since 1983, but there are
cases of anthrax in farm animals (usually cattle) every few years.
Terrorists could use anthrax to hurt people on purpose by releasing anthrax spores in public
places. In 2001, letters containing powdered anthrax spores were sent through the U.S. mail,
causing skin and lung anthrax in 22 people. Five people died, all due to lung anthrax.
What if there is an Anthrax Emergency in San Francisco?
The San Francisco Department of Public Health (SFDPH) has a plan to respond quickly to an
anthrax emergency. SFDPH will evaluate the anthrax situation and may recommend ways for
people to keep themselves and their family safe. Recommendations may include antibiotics for
people who are at risk of illness. SFDPH will also participate in efforts to provide needed
medical support and treatment, and to reduce any ongoing sources of anthrax spores.
How can I keep from getting Anthrax?
To lower your risk of getting anthrax from a natural source:

Do not eat meat that has not been properly slaughtered and cooked.

Do not work with raw animal hides, fur or skin, especially those of goats, sheep, or cows.
To lower your risk of getting anthrax if terrorists release spores on purpose:

If you were exposed to a suspicious substance or if you were in an area thought to contain
anthrax spores, it may help to wash your skin and hair thoroughly with soap and water. It may also
help to change and wash your clothing, or if you cannot wash your clothes immediately, put them in
a plastic bag to keep them separate from your other things. In such an emergency, SFDPH will
provide specific instructions.
Is there a Medicine to Prevent Anthrax Disease?
Yes. If you have been exposed to anthrax, there are certain antibiotics you can take before you
get sick as a way to prevent illness. These antibiotics can prevent anthrax disease, even if the
anthrax spores have already gotten into your body. They work best when you start taking them as
soon as possible after anthrax exposure. In an emergency involving anthrax, SFDPH will
announce which antibiotics to take, who should take them, how and where you can get them, and
how to take them after exposure to anthrax.

Is there a Vaccine (shot) to Prevent Anthrax?

Yes there is a vaccine but it is in short supply and is available only for the military.
Can I Catch Anthrax from Someone?
No. Anthrax is spread by contact with spores, not by contact with sick people. No one has ever
been known to catch anthrax directly from another person who is sick with anthrax.
What are the Signs of Anthrax Disease?

Lung Anthrax or Pneumonia is the most likely form of disease after an intentional
release of anthrax and occurs by breathing in anthrax spores. After exposure, it usually takes 2-7
days (but sometimes up to 2 months) until illness starts. First there are a few days of symptoms like
headache, cough, and muscle aches. But there is usually no runny nose. Then after a few days, there
can be trouble breathing, chest pain, large lymph glands, worse headache, stomach pain, and
vomiting or diarrhea. With lung anthrax, bacteria almost always enters the bloodstream, leading to
severe illness or death.

Skin Anthrax occurs when spores enter the body through a break in the skin. Within 7
days, a painless skin blister appears at the point of entry. This blister becomes a painless open sore
and then a black scab.

Intestine Anthrax occurs after eating undercooked meat from an animal that has anthrax
infection. An upset stomach develops 2-5 days afterward. Later there can be bloody diarrhea, fever,
and severe stomach pain.

See a doctor right away if you are having the symptoms listed above AND you think you may
have been exposed to anthrax. It is important to start medical treatment as soon as possible.
Is there Treatment for Anthrax Disease?
Yes. All three forms of anthrax disease (lung, skin, and intestine) can be treated with the proper
antibiotics. However, the chance of cure depends on how soon treatment gets started and on
whether the disease is in lung, skin, or intestine. Nearly everyone who has skin anthrax can be
cured with proper antibiotics.
Lung anthrax is the most dangerous. In 2001, only half of those with lung anthrax survived, even
with antibiotics and hospital treatment. This is why it is so imporant for people with anthrax
exposure to start taking antibiotics before they get sick.
What is anthrax?
Anthrax is a rare infectious disease caused by the bacterium Bacillus anthracis. Anthrax occurs
naturally around the world in wild and domestic hoofed animals, especially cattle, sheep, goats,
camels and antelopes. It can also occur in humans when they are exposed to the bacterium,
usually through handling animals or animal hides. There are three forms of anthrax infection:
cutaneous (skin), inhalation (lungs) and gastrointestinal (stomach and intestine). If people have
been intentionally exposed, as in a bioterrorist release, contact with skin would be the most likely
route of exposure. Breathing in the spores that have been spread through the air could cause
inhalation anthrax.
How common is anthrax and who can get it?
Anthrax can be found around the world. It is most common in agricultural regions where it
occurs in animals. It is more common in developing countries or countries without veterinary
public health programs. Anthrax is reported more often in some regions of the world (South and
Central America, Southern and Eastern Europe, Asia, Africa, the Caribbean and the Middle East)
than in others. It has been extremely rare in the United States in recent decades, and until cases in
Florida and New York City in 2001, has been limited to the cutaneous (skin) form. When anthrax
affects humans, it is usually due to an occupational exposure to infected animals or their
products. However, anthrax is considered to be one of a number of potential agents for use in
biological terrorism.

How is anthrax spread?

Anthrax is usually spread in the form of a spore. (A spore is a dormant form that certain bacteria
take when they have no food supply. Spores can grow and cause disease when better conditions
are present, as in the human body.) Anthrax is generally spread in one of three ways. Most
persons who are exposed to anthrax become ill within one week but can take as long as 42 days
for inhalation anthrax:

Skin (cutaneous) - Most anthrax infections occur when people touch contaminated animal
products like wool, bone, hair and hide. The infection occurs when the bacteria enters a
cut or scratch in the skin.

Inhalation (lung) - Some anthrax infections occur when people breathe in the spores of
the bacteria.

Gastrointestinal - Some people may get anthrax by eating infected meat that has not been
properly cooked.

What are the symptoms of anthrax?

Skin (cutaneous) - This is the most common form of anthrax. Infection requires a break in
the skin. The first symptoms include itching where the skin has been exposed. Then, a
large boil or sore appears. The sore becomes covered by a black scab. If not treated, the
infection can spread to the lymph nodes and bloodstream.

Inhalation - Inhalation anthrax has been very rare in the U.S. First symptoms include
fever, fatigue, malaise and a cough or chest pain. High fever, rapid pulse and severe
difficulty breathing follow in two to five days. Inhalation anthrax is often fatal.

Gastrointestinal - This form occurs only after eating infected, undercooked meat. First
symptoms include fever, severe abdominal pain, loose, watery bowel movements, bloody
diarrhea and vomiting with blood.

How soon after exposure do symptoms develop?

Symptoms usually develop between one and seven days after exposure but prolonged periods up
to 42 days for cutaneous (skin) anthrax and 60 days for inhalation anthrax are possible, though
rare.
Can anthrax be spread person to person?
Inhalation (lung) anthrax is not spread from person to person. Even if you develop symptoms of
inhalation anthrax, you are not contagious to other persons. If you develop cutaneous (skin)
anthrax, the drainage from an open sore presents a low risk of infection to others. The only way
cutaneous (skin) anthrax can be transmitted is by direct contact with the drainage from an open
sore. Anthrax is not spread from person to person by casual contact, sharing office space or by
coughing and sneezing.
How is it diagnosed?
Anthrax is diagnosed when the Bacillus anthracis bacterium is found in the blood, skin lesions or
respiratory secretions by a laboratory culture. It can also be diagnosed by measuring specific
antibodies in the blood of infected persons. Nasal swabs are not a good way to diagnose anthrax
because a swab cannot definitively determine if someone has not been exposed to anthrax.
What is the treatment for illness caused by anthrax?
There are several antibiotics that are used successfully to treat anthrax. Treatment is highly
effective in cases of cutaneous (skin) anthrax and is effective in inhalation and gastrointestinal
anthrax if begun early in the course of infection. The United States has a large supply of these
antibiotics and can quickly manufacture more if needed.