anthrax-130514015632-phpapp02

8/12/2019 anthrax-130514015632-phpapp02

1/68

Anthrax

Malignant Pustule, MalignantEdema, Woolsorters Disease,

Ragpickers Disease, MaladiCharbon, Splenic Fever

8/12/2019 anthrax-130514015632-phpapp02

2/68

Center for Food Security and Public Health, Iowa State University, 2008

Overview

Organism History

Epidemiology Transmission Disease in Humans

Disease in Animals Prevention and Control

8/12/2019 anthrax-130514015632-phpapp02

3/68

The Organism

8/12/2019 anthrax-130514015632-phpapp02

4/68


The Organism

Bacillus anthracis Large, Gram positive,

non-motile rod Vegetative form

and spores

Nearly worldwidedistribution Over 1,200 strains

8/12/2019 anthrax-130514015632-phpapp02

5/68


The Spore

Sporulation requires Poor nutrient conditions Presence of oxygen

Spores Very resistant to extremes Survive for decades Taken up by host and germinate

Lethal dose 2,500 to 55,000 spores

8/12/2019 anthrax-130514015632-phpapp02

6/68

History

8/12/2019 anthrax-130514015632-phpapp02

7/68


Sverdlovsk, Russia, 1979

94 people sick 64 died Soviets blamed contaminated meat Denied link to biological weapons 1992

Soviet President Yeltsin admits outbreakrelated to military facility

Western scientists find victim clustersdownwind from facility

Caused by faulty exhaust filter

8/12/2019 anthrax-130514015632-phpapp02

8/68


South Africa, 1978-1980

Anthrax used by Rhodesian andSouth African apartheid forces Thousands of cattle died 10,738 human cases 182 known deaths Black Tribal lands only White populations untouched

8/12/2019 anthrax-130514015632-phpapp02

9/68


Aum Shinrikyo

Japanese religious cult Supreme truth

1993

Unsuccessful attemptsat biological terrorism Released anthrax from office building

Vaccine strain used not toxic No human injuries

Successful attempt in 1995 Sarin gas release in Tokyo subway 1,000 injured 12 deaths

8/12/2019 anthrax-130514015632-phpapp02

10/68


2001 Anthrax Letters

8/12/2019 anthrax-130514015632-phpapp02

11/68


8/12/2019 anthrax-130514015632-phpapp02

12/68


Anthrax Cases, 2001

22 cases 11 cutaneous 11 inhalational

5 deaths (all inhalational) Index case in Florida 2 postal workers in Maryland Hospital supply worker in NYC Elderly farm woman in Connecticut

8/12/2019 anthrax-130514015632-phpapp02

13/68


Anthrax Cases, 2001

7 month old boy Visited ABC

Newsroom Cutaneous lesion Initial diagnosis:

Spider bite Punch biopsies confirmed anthrax

8/12/2019 anthrax-130514015632-phpapp02

14/68

8/12/2019 anthrax-130514015632-phpapp02

15/68


Anthrax Cases, 2001

Antimicrobial prophylaxis Ciprofloxacin

5,342 prescribed60 day regime

44% compliance 57% suffered side effects

8/12/2019 anthrax-130514015632-phpapp02

16/68

Transmission

8/12/2019 anthrax-130514015632-phpapp02

17/68


Human Transmission

Industry Tanneries Textile mills Wool sorters Bone processors Slaughterhouses

8/12/2019 anthrax-130514015632-phpapp02

18/68


Human Transmission

Cutaneous Contact with infected

tissues, wool, hide, soil

Biting flies Inhalational

Tanning hides,processing wool or bone

Gastrointestinal Undercooked meat

8/12/2019 anthrax-130514015632-phpapp02

19/68


Animal Transmission

Most commonly infected byingestion from contaminated soil orcontaminated feed or bone meal

8/12/2019 anthrax-130514015632-phpapp02

20/68

Epidemiology

8/12/2019 anthrax-130514015632-phpapp02

21/68


20,000-100,000 cases estimated globally/yearhttp://www.vetmed.lsu.edu/whocc/mp_world.htm

8/12/2019 anthrax-130514015632-phpapp02

22/68


Anthrax in U.S.

Cutaneous anthrax Early 1900s: 200 cases annually Late 1900s: 6 cases annually

Inhalational anthrax 20 th century: 18 cases/16 fatal

8/12/2019 anthrax-130514015632-phpapp02

23/68


Anthrax in the U.S.

Outbreaks - soil of endemic areas Alkaline soil

Anthrax weather Wet spring that leads to grass killfollowed by hot, dry period in summeror fall

Grass or vegetation damaged byflood-drought sequence

8/12/2019 anthrax-130514015632-phpapp02

24/68

Disease in Humans

8/12/2019 anthrax-130514015632-phpapp02

25/68


Human Disease

Three forms Cutaneous Inhalational Gastrointestinal

8/12/2019 anthrax-130514015632-phpapp02

26/68


Cutaneous Anthrax

95% of all cases globally Incubation: 2-3 days (up to 12 days)

Spores enter skin through openwound or abrasion Papule progresses to black eschar

Severe edema Fever and malaise

8/12/2019 anthrax-130514015632-phpapp02

27/68


Day 2

Day 6

Day 4

8/12/2019 anthrax-130514015632-phpapp02

28/68


Day 4

Day 6

8/12/2019 anthrax-130514015632-phpapp02

29/68


Cutaneous Anthrax

Case fatality rate 5-20% Untreated septicemia and death

Edema can lead to death fromasphyxiation

Day 10

8/12/2019 anthrax-130514015632-phpapp02

30/68


Cutaneous Anthrax

2000 32 farms quarantined 157 animals died

67 year old man in North Dakota Helped in disposal of 5 cows

that died of anthrax Developed cutaneous anthrax Recovered with treatment

8/12/2019 anthrax-130514015632-phpapp02

31/68


Gastrointestinal Anthrax

Severe gastroenteritis Incubation: 2-5 days after consumption

of undercooked, contaminated meat

Case fatality rate: 25-75% GI anthrax never documented in U.S.

Suspected cases in 2000

8/12/2019 anthrax-130514015632-phpapp02

32/68


Minnesota, 2000

Downer cow approvedfor slaughter by local vet

5 family members ate meat 2 developed GI signs

Diarrhea, abdominal pain, fever

4 more cattle die B. anthracis isolated from farm but

not from humans

8/12/2019 anthrax-130514015632-phpapp02

33/68

8/12/2019 anthrax-130514015632-phpapp02

34/68


8/12/2019 anthrax-130514015632-phpapp02

35/68

8/12/2019 anthrax-130514015632-phpapp02

36/68


Diagnosis in Humans

Anthrax quick ELISA test New test approved by FDA on June 7 th ,

2004. Detects antibodies produced during

infection with Bacillus anthracis Quicker and easier to interpret than

previous antibody testing methodsResults in less than ONE hour

8/12/2019 anthrax-130514015632-phpapp02

37/68


Treatment

Penicillin Has been the drug of choice Some strains resistant to penicillin and

doxycycline Ciprofloxacin

Chosen as treatment of choice in 2001 No strains known to be resistant

Doxycycline may be preferable

8/12/2019 anthrax-130514015632-phpapp02

38/68


8/12/2019 anthrax-130514015632-phpapp02

39/68


Prevention and Control

Humans protected by preventingdisease in animals Veterinary supervision Trade restrictions

Improved industry standards Safety practices in laboratories Post-exposure antibiotic prophylaxis

8/12/2019 anthrax-130514015632-phpapp02

40/68


Vaccination

Cell-free filtrate Licensed in 1970

At risk Wool mill workers Veterinarians Lab workers Livestock handlers Military personnel

8/12/2019 anthrax-130514015632-phpapp02

41/68


Vaccine Side Effects

Injection site reactions Mild: 30% men, 60% women Moderate:1-5% Large local:1%

5-35% experience systemic effects Muscle or joint aches, headache, rash,

chills, fever, nausea, loss of appetite,malaise

No long-term side effects noted

8/12/2019 anthrax-130514015632-phpapp02

42/68


Vaccine Schedule

3 injections at two-week intervals 3 injections 6 months apart

Annual booster

8/12/2019 anthrax-130514015632-phpapp02

43/68


Protection AgainstInhalational Anthrax

No human

postexposure

trials havebeen

documented

21 monkeys vaccinated at 0 and 2weeks.

o Challenged by anthrax spores at 8week and 38 week later: Allsurvived o Challenged at 100 weeks: 88%survived

The two doses of vaccine (0 and 2weeks) provided protection for mostanimals for almost two years

8/12/2019 anthrax-130514015632-phpapp02

44/68


Vaccination

8/12/2019 anthrax-130514015632-phpapp02

45/68

Animals and

Anthrax

8/12/2019 anthrax-130514015632-phpapp02

46/68


Clinical Signs in Animals

Signs differ by species Ruminants at greatest risk

Three forms of illness Peracute

Ruminants (cattle, sheep, goats, antelope)

AcuteRuminants and equine

Subacute-chronicSwine, dogs, cats

Copyright WHO

8/12/2019 anthrax-130514015632-phpapp02

47/68


Ruminants

Peracute infection Rapid onset Sudden death Bloody discharge

from body orifices Incomplete rigor mortis

Rapidly bloat

8/12/2019 anthrax-130514015632-phpapp02

48/68


Ruminants

Acute infection: 1-3 days Fever, anorexia Decreased rumination Muscle tremors Dyspnea Abortions Disorientation Bleeding from orifices Hemorrhages on internal organs

8/12/2019 anthrax-130514015632-phpapp02

49/68


Ruminants

Chronic infection Pharyngeal and lingual edema Ventral edema Death from asphyxiation

Treatment successful if started early

8/12/2019 anthrax-130514015632-phpapp02

50/68

8/12/2019 anthrax-130514015632-phpapp02

51/68


Equine

Ingestion Enteritis, severe colic,

high fever, weakness,

death within 48-96 hours Insect bite/vector

Hot, painful swelling

Spreads to throat, sternum,abdomen, external genitalia

Death

Copyright WHO

8/12/2019 anthrax-130514015632-phpapp02

52/68


Swine

Sudden death without symptoms Localized swelling of throat Death by asphyxiation Ingestion of spores

Anorexia, vomiting,enteritis

8/12/2019 anthrax-130514015632-phpapp02

53/68


Dogs & Cats

Relatively resistant Ingestion of contaminated raw meat

Clinical signs Fever, anorexia, weakness Necrosis and edema of upper GI tract Lymphadenopathy and edema

of head and neck Death

Due to asphyxiation, toxemia, septicemia

8/12/2019 anthrax-130514015632-phpapp02

54/68


Diagnosis and Treatment

Necropsy not advised! Do not open carcass! Samples of peripheral blood needed

Cover collection site with disinfectantsoaked bandage to prevent leakage

Treatment Penicillin, tetracyclines

Reportable disease

D /Pi

8/12/2019 anthrax-130514015632-phpapp02

55/68


Dogs/PigsInhalational Anthrax

Experimental studies - 1968 14 dogs and 14 pigs infected 8/14 pigs had transient fevers 3/14 dogs significant temp elevations

B. anthracis Isolated from lungs and pulmonary

lymph nodes of dogs Never isolated from blood

C R

8/12/2019 anthrax-130514015632-phpapp02

56/68


Case-ReportMississippi, 1991

Golden retriever, 6 yrs old 2 days ptyalism and swelling of RF leg Temperature 106F, elevated WBC Died same day

Necropsy Splenomegaly, friable liver, blood in

stomach 2x2 cm raised hemorrhagic leg wound Some pulmonary congestion

C R t

8/12/2019 anthrax-130514015632-phpapp02

57/68


Case-ReportMississippi, 1991

Source of exposure in question Residential area 1 mile from livestock No livestock deaths in area Dove hunt on freshly plowed field

6 days prior to onset

Signs consistent with ingestion butcutaneous exposure not ruled out

8/12/2019 anthrax-130514015632-phpapp02

58/68


Animal Anthrax Vaccine

Recommended for livestockin endemic areas

Sterne strain

Live encapsulated spore vaccine Immunity in 7-10 days Other countries use in pets and exotics

No safety or efficacy data Adjuvant may cause reactions

Working dogs may be at risk

8/12/2019 anthrax-130514015632-phpapp02

59/68


Animal Disease Summary

Anthrax should always be high ondifferential list when High mortality rate in group of

herbivores Sudden death with unclotted blood

from orifices

Localized edemaEspecially neck of pigs or dogs

8/12/2019 anthrax-130514015632-phpapp02

60/68

Prevention and

Control

8/12/2019 anthrax-130514015632-phpapp02

61/68



Report to authorities Quarantine the area Do not open carcass Minimize contact Wear protective clothing

Latex gloves, face mask

8/12/2019 anthrax-130514015632-phpapp02

62/68



Burn or bury carcasses,bedding, other materials

Decontaminate soil Remove organic

material anddisinfect structures

8/12/2019 anthrax-130514015632-phpapp02

63/68



Sick animals should be isolated Scavengers should be discouraged Insect control or repellants to

prevent fly dispersal Prophylactic antibiotics

Vaccination In endemic areas Endangered animals

8/12/2019 anthrax-130514015632-phpapp02

64/68


Disinfection

Effective disinfection can be difficult Prevention of sporulation best High pressure cleaners discouraged Soil

5% lye or quicklime Hydrogen peroxide, peracetic acid, or

gluteraldehyde Bleach 1:10 dilution

May be corrosive

8/12/2019 anthrax-130514015632-phpapp02

65/68

Biological Terrorism:

8/12/2019 anthrax-130514015632-phpapp02

66/68


Biological Terrorism:Estimated Effects

50 kg of spores Urban area of 5 million 250,000 cases of anthrax

100,000 deaths

100 kg of spores Upwind of Wash D.C. 130,000 to 3 million deaths

8/12/2019 anthrax-130514015632-phpapp02

67/68


Additional Resources

Centers for Disease Control and Prevention http://emergency.cdc.gov/agent/anthrax/

World Organization for Animal Health (OIE) www.oie.int

U.S. Department of Agriculture (USDA) www.aphis.usda.gov

Center for Food Security and Public Health www.cfsph.iastate.edu

USAHA Foreign Animal Diseases(The Gray Book)

www.vet.uga.edu/vpp/gray_book02/index.php

8/12/2019 anthrax-130514015632-phpapp02

68/68

Acknowledgments

Development of this presentationwas funded by grants from

the Centers for Disease Control and Prevention, the Iowa Homeland Security and Emergency

Management Division, and the Iowa Departmentof Agriculture and Land Stewardship

to the Center for Food Security and PublicHealth at Iowa State University.

Authors: Radford Davis, DVM, MPH, DACVPM; Jamie Snow, DVM; Katie Steneroden, DVM;Anna Rovid Spickler, DVM, PhD; Reviewers: Dipa Brahmbhatt, VMD; Katie Spaulding, BS;Glenda Dvorak, DVM, MPH, DACVPM

anthrax-130514015632-phpapp02

Documents