THE THREAT

We do not know if or when another anthrax attack might occur. However, federal agencies
have worked for years with health departments across the country to plan and prepare for an
anthrax attack. If such an emergency were to occur in the United States, CDC and other federal
agencies would work closely with local and state partners to coordinate a response.
Anthrax is an infection caused by the bacterium Bacillus anthracis. It can occur in four
forms: skin, inhalation, intestinal, and injection. Symptoms begin between one day and two
months after contracting the infection. The skin form presents with a small blister with
surrounding swelling that often turns into a painless ulcer with a black center. The inhalation
form presents with fever, chest pain, and shortness of breath. The intestinal form presents with
nausea, vomiting, diarrhea, or abdominal pain. The injection form presents with fever and
an abscess at the site of drug injection.
Anthrax is spread by contact with the spores of the bacteria, which are often from
infectious animal products. Contact is by breathing, eating, or through an area of broken skin. It
does not typically spread directly between people. Risk factors include people who work with
animals or animal products, travelers, postal workers, and military personnel. Diagnosis can be
confirmed based on finding antibodies or the toxin in the blood or by culture of a sample from
the infected site.
The anthrax vaccine is recommended for people who are at high risk. Immunizing animals
against anthrax is recommended in areas where previous infections have occurred. Two months
of antibiotics, such as doxycycline or ciprofloxacin, after exposure can also prevent infection. If
infection occurs treatment is with antibiotics and possibly antitoxin. The type and number of
antibiotics used depends on the type of infection. Antitoxin is recommended for those with
widespread infection.
Anthrax among people is most common in Africa and central and southern Asia. [9] It also
occurs fairly regularly in southern Europe, but is uncommon in northern Europe and North
America. Globally, at least 2,000 cases occur a year, with about two cases a year in the United
States. Skin infections represent more than 95% of cases. Without treatment the risk of death
from skin anthrax is 24%.[7] For intestinal infection the risk of death is 25% to 75% while in
inhaled anthrax despite treatment it is around 50% to 80%. Until the 20th century, anthrax
infections killed hundreds of thousands of people and other animals each year. Anthrax has been
developed as a weapon by a number of countries. In plant eating animals infection occurs when
they eat or breathe in the spores while grazing. Carnivores may become infected by eating
infected animals.
If a bioterrorist attack were to happen, Bacillus anthracis, the bacteria that causes anthrax,
would be one of the biological agents most likely to be used. Biological agents are germs that

can sicken or kill people, livestock, or crops. Anthrax is one of the most likely agents to be used
because: Anthrax spores are easily found in nature, can be produced in a lab, and can last for a
long time in the environment.Anthrax makes a good weapon because it can be released quietly
and without anyone knowing. The microscopic spores could be put into powders, sprays, food,
and water. Because they are so small, you may not be able to see, smell, or taste them.Anthrax
has been used as a weapon before.
Anthrax has been used as a weapon around the world for nearly a century. In 2001,
powdered anthrax spores were deliberately put into letters that were mailed through the U.S.
postal system. Twenty-two people, including 12 mail handlers, got anthrax, and five of these 22
people died.
A subset of select agents and toxins have been designated as Tier 1 because these
biological agents and toxins present the greatest risk of deliberate misuse with significant
potential for mass casualties or devastating effect to the economy, critical infrastructure, or
public confidence, and pose a severe threat to public health and safety. Bacillus anthracis is a
Tier 1 agent.
B. anthracis is a select agent. The possession, use, or transfer of B. anthracis is regulated
by the Division of Select Agents and Toxins (DSAT), located in CDC's Office of Public Health
Preparedness and Response.
An anthrax attack could take many forms. For example, it could be placed in letters and

mailed, as was done in 2001, or it could be put into food or water. Anthrax also could be released
into the air from a truck, building, or plane. This type of attack would mean the anthrax spores
could easily be blown around by the wind or carried on peoples clothes, shoes, and other
objects. It only takes a small amount of anthrax to infect a large number of people.
If anthrax spores were released into the air, people could breathe them in and get sick with
anthrax. Inhalation anthrax is the most serious form and can kill quickly if not treated
immediately. If the attack were not detected by one of the monitoring systems in place in the
United States, it might go unnoticed until doctors begin to see unusual patterns of illness among
sick people showing up at emergency rooms.

Muh Ady Prabowo

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