Anthrax: An Update

Anthrax

Over the past days, many Maryland residents have come to fear that they have been exposed to anthrax.  Many have also requested that they be tested for anthrax exposure.  While we understand your concern, the Maryland Department of Health and Mental Hygiene has asked Hopkins and other Maryland hospitals NOT to perform such tests unless the proper law enforcement or public health officials have determined that there is a strong possibility that an individual was actually exposed to anthrax.  The recommendation not to conduct routine tests for anthrax exposure was made to ensure that all Maryland residents receive the appropriate health care when they need it.

What is anthrax?

Anthrax is an infectious disease caused by the bacterium Bacillus anthracis, which is capable of forming spores that can travel through air.

Anthrax infection can occur in three forms depending on the way a person is exposed: cutaneous (skin), inhalation (lung), and gastrointestinal (stomach and intestines).

If people have intentionally been exposed, as in a bioterrorist release, breathing in the spores is the most likely route of exposure that might lead to a serious lung infection (inhalation anthrax).  However, the infectious dose for inhalation (lung) anthrax is quite high.

Although less likely, a cutaneous (skin) infection due to anthrax can occur if the spores are in contact with an area of skin that is broken, such as a cut or sore.  Cutaneous (skin) anthrax is marked by a boil-like sore that eventually forms an ulcer with a black center.  The cutaneous form responds well to antibiotics if treatment is started soon after symptoms appear.

What are the symptoms of anthrax infection?

The symptoms of anthrax depend on where the infection is occurring, but usually develop within 7 days of exposure.  Initial symptoms of inhalation (lung) anthrax may resemble the common cold.  After several days, the symptoms may progress to severe breathing difficulties.  Cutaneous (skin) anthrax is typically a boil-like lesion that eventually forms an ulcer with a black center.

Is anthrax contagious from person to person?

Inhalation (lung) anthrax is not spread from person to person.  Even if someone develops symptoms of inhalation anthrax, they are not contagious to other persons.  If someone develops 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.

Why am I not being given antibiotics to prevent anthrax infection?

You do not need antibiotics if you have not been exposed to anthrax.  The decision of who to treat with antibiotics to prevent anthrax infection will be based on the results of investigations by law enforcement and public health officials

I'm concerned about getting anthrax.  Why shouldn't I be treated?

If you do not need antibiotics you should not take them.  Taking antibiotics unnecessarily can be dangerous.  The course of antibiotic treatment to prevent anthrax infection is long (60 days) and many people experience side effects.  Although most side effects are mild, severe side effects may occur (such as diarrhea, abdominal symptoms, rash, and allergic reactions) and the use of antibiotics may dangerously interfere with medications you are currently taking.  In addition, the inappropriate use of antibiotics may cause the development of antibiotic-resistant strains of common bacteria.

Should I keep a supply of antibiotics on hand, just in case?

No.  Storing a supply of antibiotics "just in case" can be dangerous.  Antibiotics should only be taken under the supervision of a physician who has done an evaluation to minimize the potential for side effects or interaction with other medications.

After the anthrax infections in Florida, many people received antibiotics.  Why aren't we doing the same thing here?

Because in Florida, law enforcement and public health officials determined that a credible exposure to anthrax for many people had occurred.

Who can I call if I have questions or concerns?

Call your primary care physician or local health department.

For  further information and questions please call the Local Health Department at (410) 383-2683