White Powder in the Mail

Is it anthrax?

How can you tell?

What do you do?

What is Anthrax?

• Bacillus Anthracis– Spores– Bacteria

Knight Ridder/Tribune News/UCLA School of Public Health Dept. of Epidemiology

What Diseases are Caused by Anthrax?

• Cutaneous– Most common naturally occurring form– Low mortality

• Gastrointestinal– Results from eating contaminated, undercooked meat– Up to 50% mortality if untreated

• Inhalational– Most likely in bioterrorism– High mortality without prompt treatment

Inhalation Anthrax

• Onset of symptoms 2 days up to 60 days post-exposure

• Antibiotics most effective before onset of symptoms

• LD50 about 8000 spores– Infective dose probably less than 10 spores in susceptible persons

History of Anthrax

• Biblical plagues– Fifth and Sixth Plagues in Exodus Believed to

be Anthrax

• Animal disease– Endemic to horses, cows, goats, sheep– Economically important agricultural disease

Natural Incidence of Anthrax

• Most common in temperate agricultural regions– Rare in US– More common in India and southern Africa

• Human infection unusual– 95% is cutaneous– Result of contact with infected animals

Naturally Occurring Human Anthrax

• Endemic in south/central Asia, central America, southern Africa

• Several thousand human cases each year – Always associated with livestock– Often associated with war

• Largest human outbreak

Zimbabwe 1978-1980

Development of Anthrax as a Biological Weapon

• Historical use

• US and UK Development

• Soviet Development

Sverdlovsk Outbreak, 1979

• Spores accidentally released from army microbiology lab

• 96 Infected, 66 Dead

• All victims lived or worked in a narrow band downwind from lab– Human casualties within 4 km– Animal deaths extended to 50 km downwind

Late 1990s: Rising incidence of Mailed Anthrax Hoaxes

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1997 1998 1999 2000 2001 pre-9/11

US Hoaxes

...the hundreds of anthrax hoaxes involving envelopes filled with harmless powders lack a plausible delivery system and hence are more of a nuisance than a serious danger.

Jonathan Tucker

Toxic Terror: Assessing Terrorist Use of Chemical and Biological Weapons, 2000

The Anthrax Letters

• Five Known Letters to Media and Political Targets– Four letters recovered, mailed on two dates

from Trenton, NJ

• Letters Contained ~1g anthrax– Fine particle size– Treated to Enhance Dispersion

Anthrax Letters: Effects

• Anthrax in Second Mailing– <5 micron size– Escaped through pores in envelopes– Contamination throughout US postal service– Cross-contamination to many other letters

• Most illnesses and all but one death resulted from spores leaking through envelopes

Anthrax Letters: Casualties

• 5 dead from inhalational anthrax

• 17 ill– 11 cutaneous– 6 inhalational

• 10000 people taking antibiotics

• All but few survivors still suffering effects

Anthrax Letters: Effect on Business

• >500 reports of anthrax per day– Investigations– Facility Closures

• Side Effects from Cipro– 57% reported serious side effects– 26% missed work

Anthrax Letters: Cleanup Costs

• AMI Building in Boca Raton remains shuttered

• Clean-up of Hart Senate Office Building cost $41.7 million– Building was closed for three months

• 23 US Postal Service Facilities Contaminated– Clean-up costs estimated at $800 million

Hoaxes and Suspicious Packages Post 9/11

• 2001 before 9/11, 368 incidents, including one simultaneous mailing of 350 letters

• 2001 after 9/11, 7089 hoaxes and other reports of suspicious substances

Hoaxes and Suspicious Packages Post 9/11

• 2001 before 9/11, 368 incidents, including one simultaneous mailing of 350 letters

• 2001 after 9/11, 7089 hoaxes and other reports of suspicious substances 0

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After the Anthrax Mailings, Everything is Taken Seriously

• Any suspicious powder received full response

• FBI director reported that agents responded to over 29,000 reports in the year following the attack

• Practical jokes and powdered sugar merited hazmat crews

• Attacks inspired other hoaxers

Suspicious Powder: Response

• First Responders including hazmat teams and FBI arrive

• Area is evacuated and possibly closed

• Field tests are done– If positive, those exposed are decontaminated

• Suspicious package is sent to CDC-certified lab for testing

Hoaxes Continue Today

• FBI's National Capital Response Squad responds to 5-10 reports per week of suspicious substances in Washington area

• U.S. Capitol Police respond to 3-10 reports per day on Capitol Hill

Washington Post, 13 April 2004

Sometimes the Threat is Real

• Ricin in ‘Fallen Angel’ Letters– Intercepted at mail handling facility Greenville

SC 10/03– Intercepted at White House mail handling

facility Washington DC 11/03

• Ricin in Senator Frist’s Office 2/04– No source letter found

USPS Guidelines for Suspicious Mail

What to do if you see Suspicious Powder

• If parcel is closed, don’t open or shake it

• Isolate area of package or powder

• Turn off fans or ventilation units and shut down the air handling system in the building

• Keep track of who has had contact with the powder

• Call 911

Would USPS Guidelines Have Helped to Recognize Anthrax Letters?

USPS Protective Measures

• Procedures– Off-site handling for potential targets– Irradiation of Government Mail

• Hazardous material detection– BDS in distribution centers– Detects anthrax only– Can potentially be modified to detect other hazards

What Your Company Can Do to Protect Itself

• Establish mail handling procedures• Establish policies in case of discovery of powder

– Include in emergency action plan

• Evaluate risk level• Establish plan for keeping business operating in case of

facility closure– Clean-up plan– Back-ups of important documents

Selected References

• Office of the Surgeon General, US Army Medical Aspects of Chemical and Biological Warfare. Washington 1997

• Centers for Disease Control and Prevention, Emergency Preparedness Website http://www.bt.cdc.gov/agent/anthrax/index.asp

• Cole, Leonard A. The Anthrax Letters: A Medical Detective Story. Washington: Joseph Henry Press 2003

• Meselson, Matthew et al. “The Sverdlovsk Anthrax Outbreak of 1979” Science, November 18,1994

• Tucker, Jonathan Toxic Terror: Assessing Terrorist Use of Chemical and Biological Weapons Cambridge: Belfer Center 2000