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Anthrax advice

From the Department of Health

Since September 11th we have reviewed all our plans for protecting the public and dealing with public health emergencies, including how to deal with a deliberate anthrax release. We will go on reviewing and renewing those plans. There remains no specific credible risk in the UK, but we have an obligation to be vigilant and well prepared.

Our contingency planning for an anthrax release is built on guidance produced in March 2000, "Deliberate Release of Biological and Chemical Agents". Since the terrorist attacks in September the Department has been actively discussing its anthrax contingency plans with emergency planning managers and directors of public health at regional and local level.

In the light of the US cases, we contacted all GPs this week to remind them how to access latest advice on diagnosing anthrax, and yesterday the Public Health Laboratory Service produced its new guidelines for doctors dealing with any anthrax case. These guidelines cover clinical and laboratory procedures, plus general public health coordination.

Our ongoing planning activity includes a review of all relevant stocks and supplies. This includes maintaining a strategic supply of treatments for chemical and biological incidents.

What is anthrax?

Anthrax is a bacterial infection caused by the organism Bacillus anthracis. The bacterium is carried by wild and domestic animals in Asia, Africa and parts of Europe. The bacterium can exist in a form known as a spore which allows the bacterium to survive in the environment (for example, in the soil).

What are the symptoms?

There are two main forms of anthrax infection.

In cutaneous (skin) anthrax, a lesion appears on the skin, often on the head, forearms or hands. This lesion starts as a small bump and develops into a characteristic ulcer with a black centre. It is rarely painful, but if untreated the infection can spread to cause blood poisoning. If untreated, the disease can be fatal in 5% of cases, but with antibiotic treatment recovery occurs.

Inhalation anthrax is normally much less common. Symptoms begin with a flu like illness followed by respiratory difficulties and shock after 2-6 days.

Intestinal anthrax is a very rare form of food poisoning, and results in severe gut disease, fever and blood poisoning.

Inhalation and intestinal anthrax are serious and can often be fatal. They can be treated effectively with antibiotics if identified early enough, but early identification can be difficult as the initial symptoms are similar to other illnesses.

How do you catch anthrax?

Cutaneous anthrax is caught through direct contact with the skins or tissues of infected animals, and tends to occur in those whose occupation brings them into contact with cattle in countries where the animal form of the disease is prevalent. In the UK this mostly occurs among people working with animal products (eg hides from abroad).

Inhalation anthrax is caused by breathing in anthrax spores, again usually in industrial processes such as the tanning of animal skins, and processing of wool or bones from abroad.

Intestinal anthrax is very rare, but occurs from swallowing spores in contaminated meats.

It is extremely unusual for anthrax to be spread from person-to-person. Airborne transmission from one person to another does not occur; direct contact with anthrax lesions in a case of cutaneous anthrax can lead to subsequent cutaneous infection, but this is uncommon.

How long can you have the infection before developing symptoms?

With inhalation anthrax, symptoms usually develop within 48 hours of exposure, but some cases of skin anthrax may not appear for days or weeks.

How can anthrax be prevented or treated?

There is a vaccine against anthrax, and this is recommended only for those at highest risk, for example, those handling dead animals (eg abattoir workers, tanners) and laboratory staff who may be handling the organism. Vaccination is not normally recommended for the general public.

Anthrax can be treated effectively with a variety of antibiotics, but successful treatement depends on early recognition of the disease.

Post exposure prophylaxis with antibiotics can be very effective in preventing disease if given early enough.

How common is anthrax?

Anthrax is uncommon in the UK - only a handful of cases have been notified over the last decade. Infections are more common in countries where the disease is common in animals, including countries in South and Central America, southern and eastern Europe, Asia and Africa.

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