DHSS BIOTERRORISM FACT SHEET

Anthrax is an acute infectious disease caused by the spore-forming bacterium Bacillus anthracis. Anthrax most commonly occurs in warm blooded animals, but can also infect humans. Anthrax is most common in agricultural regions where it occurs in animals. These include South and Central America, Southern and Eastern Europe, Asia, Africa, the Caribbean, and the Middle East.

Who gets Anthrax?

When anthrax affects humans, it is usually due to an occupational exposure to infected animals or their products. Workers who are exposed to dead animals and animal products (industrial anthrax) from other countries where anthrax is more common may become infected with Bacillus anthracis. Anthrax in animals rarely occurs in the United States. Most reports of animal infection are received from Texas, Louisiana, Mississippi, Oklahoma and South Dakota.

How is Anthrax spread?

Anthrax infection can occur in three forms: cutaneous (skin), inhalation, and gastrointestinal. Bacillus anthracis spores can live in the soil for many years and humans can become infected with anthrax by handling animal products from infected animals or by inhaling anthrax spores from contaminated animal products. Anthrax can also be spread by eating undercooked meat from infected animals. It is rare to find infected animals in the United States.

What are the symptoms of Anthrax?

Symptoms of disease vary depending on how the disease was contracted, but symptoms usually occur within seven days. Cutaneous: Most anthrax infections occur when the bacterium enters a cut or abrasion on the skin, such as when handling contaminated wool, hides, leather or hair products (especially goat hair) of infected animals. Skin infection begins as a raised itchy bump that resembles an insectbite but within 1-2 days develops into a vesicle and then a painless ulcer, usually 1-3 cm in diameter, with a characteristic black necrotic (dying) area in the center. Lymph glands in the adjacent area may swell. About 20% of untreated cases of cutaneous anthrax will result in death. Deaths are rare with appropriate antimicrobial therapy. Inhalation: Initial symptoms may resemble a common cold. After several days, the symptoms may progress to severe breathing problems and shock. Inhalation anthrax usually results in death in 1-2 days after onset of the acute symptoms. Intestinal: The intestinal disease form of anthrax may follow the consumption of contaminated meat and is characterized by an acute inflammation of the intestinal tract. Initial signs of nausea, loss of appetite, vomiting, fever are followed by abdominal pain, vomiting of blood, and severe diarrhea. Intestinal anthrax results in death in 25% to 60% of cases.

How soon do symptoms occur?

Symptoms of anthrax usually appear within 7 days after coming into contact with Bacillus anthracis bacteria.

How is Anthrax diagnosed?

Anthrax is diagnosed by isolating Bacillus anthracis from the blood, skin lesions, or respiratory secretions or by measuring specific antibodies to Bacillus anthracis in the blood of suspected cases.

What is the treatment for Anthrax?

Doctors can prescribe effective antibiotics. Usually penicillin is preferred, but erythromycin, tetracycline, or chloramphenicol can also be used. To be effective, treatment should be initiated early. If left untreated, the disease can be fatal.

How long is an infected person infectious to others?

Direct person-to-person spread of anthrax most likely does not occur.

Should an infected person be excluded from work or school?

Since direct person-to-person spread of anthrax most likely does not occur, an infected person need not be excluded from work or school.

How can Anthrax be prevented?

An anthrax vaccine for use in humans is available in the United States. It is indicated for individuals who come in contact in the workplace with imported animal hides, furs, bonemeal, wool, animal hair (especially goat hair), and bristles; and for individuals engaged in diagnostic or investigational activities which may bring them into contact with anthrax spores.

Terrorism is the unlawful use of force against people or property in an effort to intimidate or coerce a government and its population in the furtherance of political or social objectives.

What is bioterrorism?

Bioterrorism is a terrorist activity that involves the intentional release of a microbiological agent, either a bacteria or a virus, into the environment.

How was New Jersey preparing for a potential biological terrorist attack before September 11, 2001?

For the last several years, state agencies have been planning for the possibility of a biological terrorism attack and improving their collective response capabilities. We are more prepared today than we were two years ago, and we'll be better prepared in the coming months.

In September 1999, the New Jersey Department of Health and Senior Services (DHSS) received a major grant from the federal Centers for Disease Control and Prevention (CDC) as part of a national effort to respond to the threat of bioterrorism. The $1 million, one-year grant, has been renewed annually and can be renewed each year for up to five years. In addition, the DHSS received state funds to support enhanced surveillance, communications and laboratory testing services.

What is the $1 million in CDC funding for bioterrorism being used for?

These funds are being used to strengthen the state's overall public health system so it can better respond to man-made threats, such as the deliberate release of disease-causing organisms, as well as to naturally occurring infectious diseases or newly emerging infectious diseases, such as antibiotic-resistant organisms, West Nile virus and a potential influenza pandemic.

The funds are being used in three areas: expanding surveillance programs to more actively search for diseases and spot unusual disease occurrences and/or trends; creating a 24-hour-a-day rapid communication system linking all levels of government, the health care community and emergency response personnel; and expanding laboratory capacity to test for biological agents likely to be used in a terrorist attack.

Has New Jersey implemented any stronger measures to fight potential biological terrorism since September 11th?

Acting Governor Donald T. DiFrancesco signed into law four bills on October 4, 2001 to increase anti-terrorism efforts and aid disaster victims and their families, including one piece of legislation - the New Jersey Domestic Security Preparedness Act that will create the New Jersey Preparedness Task Force. Reporting directly to the Governor, the Act commits nearly $9 million for improving response planning and crisis management capabilities, fighting biological and chemical terrorism, and providing statewide disease surveillance. Included is $1.8 million to establish a program of laboratory services in the DHSS to provide for the prompt and accurate detection and analysis of biological and chemical agents that may be used in terrorist acts. The DHSS will also receive $1.45 million to fund a program of disease surveillance and investigation.

How do other grants or programs at the DHSS currently support its bioterrorism preparedness?

The department has established an electronic communications system linking it via e-mail to 22 public health agencies in the community who in turn can quickly relay information to all local health officers, health care facilities and other health care professionals and first responders in their area. The DHSS has also received funding for the detection and tracking of West Nile virus that has improved its ability to find and respond to public health threats.

Does the DHSS currently have the laboratory capacity to safely identify bioterrorism agents submitted for testing?

The state's Public Health and Environmental Laboratories (PHEL) were expanded and upgraded over the past two years to make possible rapid and accurate diagnostic testing for disease organisms such as those causing anthrax and plague. This included the renovation and conversion of 1,500 square feet of laboratory space for specialized bio-containment testing. Through both work experience and attendance at workshops presented at the CDC, qualified DHSS staff is capable of performing tests for identifying a number of potential bioterrorism agents.

In response to the September 11th attacks, acting Governor DiFrancesco and the New Jersey Legislature have committed new state funding to the DHSS to hire more lab staff and purchase the equipment and supplies necessary to perform rapid toxicity screening tests for unknown agents in human blood and urine specimens.

Has surveillance expanded for bioterrorism?

Active disease surveillance is conducted statewide. Until now, particular focus has been in three geographic areas: the City of Newark, and Bergen and Middlesex Counties. Federal legislation designated Newark as one of the 120 cities in the United States vulnerable to a bioterrorist attack, and Bergen and Middlesex Counties were chosen because of their strong public health systems, industrial base and critical locations. In the very near future, additional public health agencies will be funded to implement enhanced surveillance activities.

How does expanded surveillance in the three pilot sites work?

In these three sites, public health specialists in local health departments work more intensively with area hospitals, physicians and emergency response workers to perform surveillance and epidemiological investigations. For example, the public health specialists are frequent visitors to area hospitals, and have developed close working relationships with staff dealing with infectious diseases.

How has DHSS improved surveillance statewide?

On the state level, the DHSS has conducted, and will continue to provide, training for the many organizations that could play a role in identifying an unusual public health event, such as a bioterrorist attack. These include local health departments, hospital workers, clinical laboratories doing diagnostic testing, state agencies, medical examiners and the New Jersey Poison Information and Education System.

Another important aspect is the training of physicians in recognizing diseases caused by acts of bioterrorism, and to train the medical and public health communities in all aspects of bioterrorism detection and response. Some of the training is being conducted through the state's Distance Learning Network, which has been developed in partnership with Rutgers University's Cook College. Learning sites have been designated in each county - 60 sites in all - that can receive training programs via satellite.

What impact has the focus on bioterrorism had on our more routine disease surveillance activities?

Through the expanded surveillance and communication system, public health officials can receive more timely information and determine if an outbreak of food borne illness, or the emergence of an antibiotic-resistant organism in a hospital, is a local or more widespread problem. In the case of chemical spills, the system could also be used to transmit information the DHSS maintains on hazardous chemicals in the workplace, or information on how to best treat those exposed to hazardous chemicals.

What is the Health Alert Network?

New Jersey, like other states, has created an internet-based communications system called the Local Information Network Communications System-Health Alert Network (LINCS-HAN), which connects the DHSS and 115 local health departments in an around-the-clock system to transmit health alerts and timely updates in an emergency. Local health departments, in turn, are linked to health care providers, and community health and emergency response agencies through e-mail and a rapid telefax system that is used to communicate information and coordinate an emergency response.

Is there a statewide bioterrorism response plan?

With input from DHSS staff and many state and federal partners, an appendix on bioterrorism has been drafted as part of the state's Emergency Operation Plan. This plan defines the roles, responsibilities and relationships among federal agencies, departments of state government, and numerous volunteer agencies, drawing into its scope the capabilities and resources of a multiplicity of responders. All efforts will be coordinated with the newly established New Jersey Domestic Security Preparedness Task Force, established in response to the events of September 11th.

In the event of a bioterrorism attack, what is the DHSS' role?

Through the enhanced statewide disease surveillance system, the DHSS will play a key role in identifying that an attack has occurred and notifying state and federal authorities. The DHSS will then communicate with the healthcare community directly through the Health Alert Network on steps to be taken to address public health issues, while playing a major role with direct caregivers in the surveillance and epidemiological response, and actively support the law enforcement community.

How was New Jersey's bioterrorism response plan activated during the World Trade Center attack and did it work?

In cooperation with the CDC, the DHSS on September 11th contacted local health officers and hospital emergency departments and infection control professionals and instructed them to heighten surveillance for any unusual disease occurrence or increased numbers of illnesses that might be associated with the events in New York City. This was done strictly as a precaution and not in response to any specific threat. So far, we have not had any reports of unusual or increased illnesses. There has been no evidence to suggest that any chemical or biological agents were used in the attack on the World Trade Center.

Is smallpox vaccine available now or in the event smallpox is used in a terrorist attack?

Naturally occurring smallpox was eradicated in 1977. The only known remaining samples of smallpox are under the control of the CDC and Russia. There is no evidence that any rogue nation with biological weapons capability has smallpox, therefore, the probability of a bioterrorist using smallpox is extremely low.

The only supply of smallpox vaccine in the United States is controlled by the U.S. Public Health Service as an emergency 15 million-dose stockpile. Smallpox vaccine is tightly controlled and only supplied to a limited number of laboratory workers at risk of infection from smallpox-like viruses as a result of their occupation. Government agencies will not permit the release of smallpox vaccine to any other person for any reason. The CDC has contracted with a major pharmaceutical company to produce more smallpox vaccine.

Is anthrax vaccine available now or in the event anthrax is used in a terrorist attack?

Anthrax is a naturally occurring yet very rare disease that is not transmitted person-to-person. The vaccine against anthrax is not commercially available to the general public except for United States military personnel who might encounter anthrax in the course of armed conflict. As reported in the news media, there has been some controversy over its mandatory administration among some members of the U.S. military.

Should citizens buy gas masks?

If there were to be a bioterrorism attack, it would most likely be a covert event. The initial indication of its presence will almost certainly be the occurrence of illness in large numbers of individuals over a brief time interval. By the time the attack has been recognized, exposure will already have occurred some days to weeks previously. Therefore, there is no utility in wearing a protective mask, and the restriction of airflow with use might well exacerbate mild or emerging symptoms. Also, the effectiveness of protective masks depends upon proper use and proper maintenance; improper wearing of the mask with a poor seal over the face may result in greater exposure to potential aerosols than wearing no mask at all. Failure to keep the filters current results in no effective filtration of infectious aerosol particles. Therefore, there is no general indication for the public to purchase or consider wearing protective masks to prevent exposure to biological aerosols delivered as weapons.

Where can I get more information on bioterrorism?

For more information on this subject, visit the CDC's bioterrorism preparedness website at www.bt.cdc.gov.

Plague

Plague is an infectious disease of animals and humans caused by a bacterium named Yersinia pestis.

Who gets Plague?

People usually get plague from being bitten by a rodent flea that is carrying the plague bacterium or by handling an infected animal. Millions of people in Europe died from plague in the Middle Ages when human homes and work places were inhabited by flea-infected rats. Wild rodents in certain areas around the world are still infected with plague and outbreaks in people still occur. In the United States, the last urban plague epidemic occurred in Los Angeles in 1924-25. Since then, human plague in the United States has occurred as mostly scattered cases in rural areas. Most recent human cases in the United States occur in two regions: northern New Mexico, northern Arizona and southern Colorado; and California, southern Oregon and far western Nevada.

How is Plague spread?

People usually get plague from being bitten by a rodent flea that is carrying the plague bacterium or by handling an infected animal or tissues from an infected animal. Plague can also be spread from person to person, but only if the illness in the infected person has spread to the lungs (pneumonic plague).

What are the symptoms of Plague?

The initial symptoms usually include fever, chills, headache, muscle aches, and a tired feeling. This is followed by a painful and reddened swelling of the lymph nodes in the region of the body which suffered the flea bite (bubonic plague). A draining abscess of one or more lymph nodes may develop. If the disease spreads to the lungs, pneumonia with cough and some difficulty breathing may develop (pneumonic plague).

How soon do symptoms occur?

Symptoms usually appear within 2 to 6 days after a bite from an infected flea, or within 2 to 4 days after exposure to an individual with pneumonic plague.

How is Plague diagnosed?

Plague is usually diagnosed based upon the characteristic symptoms (painful and reddened swollen lymph nodes with fever) and a history of possible exposure to rodents (such as camping in areas inhabited by potentially infected rodents). The diagnosis is usually laboratory confirmed by examination of sputum (in pneumonic plague) or material aspirated with a needle from a swollen lymph node (in bubonic plague).

What is the treatment for Plague?

Untreated bubonic plague can be fatal in over half of the cases. Specific antibiotics are needed to prevent death, and early diagnosis and treatment offers better success at preventing death and other medical complications. However, despite modern antibiotic therapy, many deaths still occur.

How long is an infected person infectious to others?

Only patients with the pneumonic form of plague can be a source of infection to others. A patient becomes non-infectious to others after 48 hours on an appropriate antibiotic.

Should an infected person be excluded from work or school?

An individual with pneumonic plague should be excluded from work or school until he/she has completed 48 hours on an appropriate antibiotic.

How can Plague be prevented?

Eliminate food and shelter for rodents around homes, work places and recreational areas.

Pets (dogs and cats) should be treated for flea control.

Persons working in high risk areas or high risk occupations can be vaccinated with the plague vaccine.