Anthrax and you: in Maine
Dear Dr. Jeff: "Like all of us, we're very worried about the
threat of anthrax. What is the situation up here Maine? How is the Health
Center handling this bioterrorist threat?" -A Concerned Parent
Dear Concerned Parent: The threat of anthrax is of course frightening
to us all. There are so many unknowns, so many imponderables, and the
situation seems to change hourly.
There are also many things we do know and many reasons to feel reassured
and protected, particularly here in Maine.
The numbers involved so far are very small. Nationally, there have been
about 35 exposures, which have resulted in 16 infections. Ten people have
developed inhalation anthrax, and four of those ten have died. Six people
have developed the far less dangerous cutaneous disease, and four others
are thought to have unconfirmed cutaneous infections.
In Maine, there have been no known exposures to anthrax and no known
cases of anthrax infection. To date, about 105 packages have been tested
for anthrax by the State lab, and all 105 were negative.
Without meaning to seem insensitive to the plight of any of the unfortunate
victims of anthrax poisoning, allow me to point out that we can expect
a full 20,000 people to die of the flu this winter. This is expected the
timing and nature of the annual flu epidemic fully characterized, risk
factors for developing complications of the illness well described, the
clinical course of the disease well known, an effective preventive vaccine,
diagnostic tests for influenza readily available, and antiviral medication
readily available. At issue here is much more our health care and public
health systems than extremely limited and unlikely exposures to aerosolized
The microbiology of anthrax was described in depth by Dr. McBride last
week in The Orient.
The Maine Bureau of Health would like us all to understand four key clinical
facts about anthrax. First, anthrax is not contagious. It cannot be spread
through personal contact. Second, anthrax infection is treatable, especially
if the infection is caught early, or is cutaneous. Third, anthrax spores
are very difficult to aerosolize effectively via an envelope or package.
And finally, cutaneous anthrax is very difficult to contract through intact
skin, especially after hand-washing.
Maine has a coordinated system of health, emergency management, and law
enforcement agencies, which are monitoring and ready to address any potential
threat from biological, chemical or nuclear terrorism. It is important
to note that much of this system existed prior to September 11. Antibiotic
and vaccine stockpiles, for instance, were created over two years ago
as a component of emergency response plans that were elaborated more than
three years ago.
We have all heard a lot about what to do and what not to do with suspicious mail and unknown powders. We may also need to understand a little more about nasal swab testing for anthrax. These are not clinical tests that detect incubating anthrax infections. These tests only measure possible exposure, within the previous 24 hours, to anthrax spores. They are epidemiologic tools, often criminal investigative tools, and not diagnostic tools. Federal and State health officials recommend nasal swab testing only for those who may have been exposed to a substance that has been proven to contain anthrax spores.
So far, thank goodness, no one in Maine has met the criterion for testing.
What else can we do, should we do? We should all get flu shots. As our
Surgeon General has pointed out, most of us can avoid flu-like symptoms,
the kind which might make us worry about early, prodromal anthrax, by
simply getting a flu shot and preventing influenza infection. Production
of flu vaccine may have gotten off to a late start this year, but there
will be more vaccine available by late December than ever before. At the
Health Center, we hope to start our flu vaccine clinics towards the end
of this month. Flu shots will be available free of charge to students
and for $5.00 to faculty, staff and community members.
We should also do our best to stay well informed. There are many web-based
sources for up-to-date information about anthrax and bioterrorism. Many
of the most helpful Centers for Disease Control and World Health Organization
websites can be accessed via the Bureau of Health (www.state.me.us/dhs
and click on "bioterrorism") or the University of Albany (www.albany.edu/sph/bt/index.html).
To all of our healths!
Jeff Benson, M.D.