So! A couple of pearls:

◦ Micro-organisms have been here for about 3 billion years. We only showed up 100 million years ago so they’ve been here 30 times longer than we have been around.

◦ When truth, science, fear, threats, and common sense

collide, fear and threats often win – at least for a time!

2 – 3 μM

Two principal virulence factors are responsible for the lethality of anthrax: ◦ poly-D-glutamic acid capsule protects the

bacterium from phagocytosis by host neutrophils◦ anthrax toxin a tripartite protein toxin that is a

mixture of three protein components: (i) protective antigen (PA) (ii) edema factor (EF) (iii) lethal factorr (LF).

PA plus LF produces lethal toxin, and PA plus EF produces edema toxin. These toxins cause death and tissue swelling (edema), respectively.

Non-industrial: - incidental exposure to infected carcasses or ingestion of infected meat.◦ E.g.farmers, veterinarians, hunters.

Industrial - direct exposure to t issue, wool, hides, bone and animal products.◦ E.g. tanners, woollen workers, abattoir workers

Inhalation of spores by “accidental release” from a Russian mil i tary microbiological establishment.

Spores spread by wind at the t ime of the accident

Over 50 human deaths directly attr ibutable to inhalation of spores; many animals in the zone also died.

04/04/79: - faintness, dizzinees trouble breathing 08/04/79: - complete collapse on. Five hours to bring up her blood pressure, then transported to a local hospital (No. 20). 09/04/79: - Deceased- Family given tetracycline pills- Buried in a special cemetery (Sector 13). - Son received vaccine in late April01/05/79. Buildings hosed down and asphalt road built in the area.

Dr. Nikolay Babich: - “people died in streetcars and in the lobbies of buildings. There was no time for an ambulance”.

Dr. D.N. Ponomaryev: - “a man and woman had died as if by lightning”.

Dr. Faina Abramova (pathologist): - “massive thoracic and gastrointestinal

bleeding – there was a distinctive pattern of bleeding in the brain - (a ‘Cardinal’s cap’ of red

haemorrhagic tissue”).

Pathology observations (1994) on 42 necropsies:◦ hemorrhagic necrosis of thoracic lymph nodes◦ hemorrhagic mediastinit is◦ primary focal hemorrhagic necrotizing

pneumonia (11 cases)◦ mesenteric lymphadenitis (9 cases)◦ edema adjacent to sites of extensive

infection/pleural effusion◦ hemorrhagic meningit is (21 cases)◦ gastrointestinal submucosal hemorrhage (39

cases)

63 yr. male in Florida - newspaper photo-editor Sept 27 - malaise, fever, fatigue, chills, anorexia,

sweats. Oct 2 - nausea, vomiting, confusion. T;39.2C◦ -normal WBC, low platelets, mild hyponatremia, elevated

total bilirubin.◦ Chest Xray- Prominent superior mediastinum, left pleural

effusion

CSF ◦ WBC (4750 - 80% PMNs), RBC(1375), glucose (3.2),

protein (6.6)◦ Gram smear - many Gram-positive bacilli

Bacillus anthracis ◦ CSF (after 7 hr)◦ Blood cultures (after 24 hr)

October 2:◦ Antibiotics - ceftazidime, gentamicin, metronidazole,

doxycycline, ampicllin, TMP-SMX. October 4: penicillin G, levofloxacin,

clindamycin October 5: Deceased Autopsy: hemorrhagic mediastinal

lymphadenitis, disseminated B.anthracis in many organs

Fever, chills Sweats Fatigue, malaise, lethargy, myalgia Cough, mimimal Nausea, vomiting Dyspnea, pleuritic pain Headache, confusion Abdominal pain Sore throat, rhinorrhea

The Mirage Man (David Willman): Bruce Ivins, the anthrax attacks and America’s rush to war. (Bantam Books).◦ The powdered letters – five deaths, 17 additional infections.

Senators Daschle and Leahy, Tom Brokaw.◦ Bruce Ivins- eccentric microbiologist at Fort Detrick, MD, with

unlimited access to B. anthracis. Eventually commits suicide?◦ Enormous discussion on what is required to create a lethal

spore (a lot of fiction and not much fact!)◦ FBI, faulty investigation, op-ed witch hunts.◦ Struggles for control, overzealous press, disregard for

scientific data to justify the means to an end – war in the Gulf and the war on terrorism.

Since 1931 there have been 30 recorded cases of anthrax in humans in Canada

Last reported cases: 1991 and 2006◦ Central Alberta: Farmer handling infected

carcasses◦ Saskatchewan: Person assisting a farmer fr iend

with calving All cases primary cutaneous infection No deaths direct ly attr ibutable to infection

“The animals, head lowered, gaunt and drawn,feeding voraciously at t imes were depressedand inordinately indifferent ---. Most walked with diff iculty, staggering at t imes and exhibited a stiff- legged gait when running. A swell ing of the preputial and umbil ical regions was noted in many animals”

Anthrax – the Natural Aftermath

According to my former graduate student – the vaccine “hurts like hell!”◦ It is given to all military personnel and those personnel

working in higher threat areas. ◦ Is it safe? Most likely except for reactions – fever,

selling at injection sites, sometimes serum sickness, flu-like illness. ◦ Does it protect? Primate data suggests that two

immunizations given over 2 weeks is effective for at least a year. In one study 1/8 monkeys died when aerosol challenged 2 years later.

Stockpiling antibiotics is like building a bomb shelter – a human response to a perceived threat!

When the powder scares occurred in the United States – the immediate response was to stockpile ciprofloxacin

The problem – a sudden realization that no one knew how susceptible strains of B. anthracis were to this agent.

So the federal government requested USAMRID and the antibiotic subcommittee of CLSI to conduct a study. Three labs in the U.S. (CDC, USAMRID, and Mayo Clinic). Our lab could not participate directly because of the “Select Agent Rule”. We used the same protocol and tested about 50 strains isolated from animals isolated since 1962 – a larger collection than those tested in the U.S.

Results were the same as those in the U.S. – there was good susceptibility (at least in vitro) to ciprofloxacin and several other agents.

The outcome (from scientists):◦“We can’t combine the Canadian data since their strains are not ‘HUMANIZED’

Then someone reminded them that the vaccine strain and the strain they were using as a quality control isolate all arose from animals!!

The strain used in the letter powders also was derived from a naturally occurring animal isolate.

The perception of a threat is often in the eye of the beholder.

◦ Anthrax is not a great pathogen on it’s own. Conditions and circumstances have to be right for dissemination.

◦ In the natural environment the spore has to be in the right condition – at the surface, wet in the spring to float and concentrate at the surface, dry in the late summer to be ingested or inhaled.

◦ In the “action” environment, the spore itself has to be the right size. It must therefore be “weaponized”.

Humans may actually support the

democratization of evil by poor science,

ignorance and panic, or other motives.