How does anthrax get into my skin or lungs?
Anthrax bacteria can cause an infection in the skin, gastrointestinal system or the lungs. The bacteria enter the body through a cut or scrape on the skin, through contaminated food or through inhalation as a fine liquid mist. Symptoms of the infection usually occur about seven days after exposure. The infection can be stopped or prevented by early treatment with the appropriate antibiotics. Anthrax cannot be spread from person to person.

What are the symptoms of anthrax infection?
The first symptoms of inhalation anthrax are similar to those of the common cold. Several days after the cold symptoms appear, the person may develop breathing problems and shock. Symptoms of skin (cutaneous) anthrax infection include swelling and lesions on the skin. The intestinal form of anthrax also can occur after eating undercooked meat from infected animals — such animals are rare in the United States. This form of the disease is marked by acute inflammation of the intestinal tract, and symptoms include nausea, loss of appetite, vomiting and fever, followed by abdominal pain, vomiting of blood and severe diarrhea.

Can anthrax be sprayed through the air and affect me?
For anthrax to be used as a weapon and sprayed through the air, it would have to be broken down into very small particles. This is difficult to do, and requires a great deal of technical skill and special equipment. If enough of these small particles are inhaled, a life-threatening lung infection can occur, but early diagnosis and treatment are effective.

What should I look for when receiving mail?
The following information supplements CDC’s recommendations for recognizing and handling suspicious packages or envelopes that were published as a CDC Health Advisory on October 27, 2001, and replaces information about identifying suspicious packages that was published as a Health Advisory on October 12, 2001.

Letters containing Bacillus anthracis (anthrax) have been received by mail in several areas in the United States. In some instances, anthrax exposures have occurred, with several persons becoming infected. To prevent such exposures and subsequent infection, all persons should learn how to recognize a suspicious package or envelope and take appropriate steps to protect themselves and others.

Inappropriate or unusual labeling

• Excessive postage
• Handwritten or poorly typed addresses
• Misspellings of common words
• Strange return address or no return address
• Incorrect titles or title without a name
• Not addressed to a specific person
• Marked with restrictions, such as “Personal,” “Confidential,” or “Do not x-ray”
• Marked with any threatening language
• Postmarked from a city or state that does not match the return address

Appearance

• Powdery substance felt through or appearing on the package or envelope
• Oily stains, discolorations, or odor
• Lopsided or uneven envelope
• Excessive packaging material such as masking tape, string, etc.

Other suspicious signs

• Excessive weight
• Ticking sound
• Protruding wires or aluminum foil

The CDC says: If a package or envelope appears suspicious, DO NOT OPEN IT.

What should I do with such a letter?

• Do not shake or empty the contents of any suspicious package or envelope.
• Do not carry the package or envelope, show it to others or allow others to examine it.
• Put the package or envelope down on a stable surface; do not sniff, touch, taste, or look closely at it or at any contents which may have spilled.
• Alert others in the area about the suspicious package or envelope. Leave the area, close any doors, and take actions to prevent others from entering the area. If possible, shut off the ventilation system.
• WASH hands with soap and water to prevent spreading potentially infectious material to face or skin. Seek additional instructions for exposed or potentially exposed persons.
• If at work, notify a supervisor, a security officer, or a law enforcement official. If at home, contact the local law enforcement agency.
• If possible, create a list of persons who were in the room or area when this suspicious letter or package was recognized and a list of persons who also may have handled this package or letter. Give this list to both the local public health authorities and law enforcement officials.

Can I get vaccinated against anthrax?
Not at this time. Only one company makes an anthrax vaccine, and it is still waiting for FDA approval of its manufacturing facility. Even after the facility is approved, only military personnel will receive the vaccine. The CDC is not recommending the vaccine for the general public.

Is there an approved treatment for anthrax?
Yes. Three types of antibiotics are approved for anthrax: ciprofloxacin, tetracycline (including doxycycline) and penicillin. For people who have been exposed to anthrax but do not have symptoms, 60 days of one of these antibiotics is given to reduce the risk or potential progression of disease because of inhaled anthrax.

Does the government have a plan in place to make Cipro (ciprofloxacin) available if there were mass exposure to anthrax?
Yes. Under emergency plans, the federal government would ship appropriate antibiotics from its stockpile to wherever they are needed.

Should individual consumers ask their physicians to write a prescription for Cipro, so they have it on hand in case it is needed?
No. Antibiotics from the current stockpile will be made available if they are needed. In the meantime, Cipro should not be prescribed unless there is a clearly indicated reason, so that the drug will be available as the need arises for the standard infections for which it is used.

What is the Food and Drug Administration telling physicians and other health professionals about prescriptions for Cipro?
Although the FDA does not regulate the practice of medicine, the agency is strongly recommending that physicians not prescribe Cipro for individual patients to have on hand for possible use against inhaled anthrax. In addition to the potential influence on supply of the drug, indiscriminate prescribing and widespread use of Cipro could hasten the development of drug-resistant organisms.

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