Recommendations for Handling
Suspicious Letters or Packages

Anthrax organisms can cause infection in the skin, gastrointestinal system, or the lungs. To do so, the organism must be rubbed into abraded skin, swallowed, or inhaled as a fine, aerosolized mist. It is important to note that the attached guidance emphasizes minimum disruption of suspect packages and their contents.

General Mail Handling

• Be observant for suspicious envelopes or packages.
• Be observant for suspicious envelopes or packages.
• Open all mail with a letter opener or method that is least likely to disturb contents. Do not use hands.
• Open packages/envelopes with a minimum amount of movement.
• Do not blow into envelopes.
• Do not shake, pour out contents.
• Keep hands away from nose and mouth while opening mail.
• Wash hands after handling mail.

Some items that can trigger suspicion

• Discoloration, crystallization, strange odors or oily stains
• Envelope with powder or powder-like residue
• Protruding wires or aluminum foil
• Excessive tape or string
• Unusual size or weight given size
• Lopsided or oddly shaped envelope
• Postmark that does not match return address
• Restrictive endorsements such as "Personal" or "Confidential"
• Excessive postage
• Handwritten, block-printed or poorly typed addresses
• Incorrect titles
• Title but no name
• Misspellings of common words
• No return address
• Addressed to individual no longer with organization

How to handle a suspect package or letter

• Stay calm.
• Do not shake or empty the contents of any suspicious package or letter.
• Keep hands away from mouth, nose and eyes.
• Isolate the package or letter.
• Gently cover the envelope or package with anything available nearby (e.g. clothing, paper, inverted trash can, etc.) and do not remove cover.
• If an unknown substance spills from the package/envelope, do not try to clean up substance.
• Avoid creating air currents.
• Do not handle package/envelope any further.
• If material spills on floor avoid stepping near it. Avoid tracking any spilled materials to other locations.
• Wash hands with soap and water.
• Do not remove any potentially contaminated items from area.
• If contaminated, keep movements within the building to a minimum. This will keep contamination of building to a minimum. Remove heavily contaminated clothing as soon as possible and gently to minimize dispersal.
• If shower facilities are available, remove clothing in shower under water stream. Place clothing into a plastic bag or other container that can be sealed. This bag should be given to responders for proper handling.
• Contact supervisor/designated responder.
• Supervisors/ designated responders will determine if further action is necessary such as:
• Notify others in the room, turn off any fans/portable heaters, evacuate the room and close the door.
• Ensure no one enters the room until proper authorities arrive.
• Report incident to security and to the Federal Protective Service so they may notify appropriate authorities.
• Report incident to facility management so they can shut down the room's ventilation system.
• List all people who were in the room or area when the package or letter was recognized. Give this list to the health and law enforcement officials.

Disease can be prevented after exposure to the anthrax spores by early treatment with the appropriate antibiotics. Anthrax is not spread from one person to another person.

Source: http://www.osha.gov/bioterrorism/pkghandling.html

Frequently Asked Questions

• What is anthrax?
• Why has anthrax become a current issue?
• How common is anthrax and who can get it?
• How is anthrax transmitted?
• What are the symptoms of anthrax?
• Where is anthrax usually found?
• Can anthrax be spread from person-to-person?
• Is there a way to prevent infection?
• What is the anthrax vaccine?
• Who should get vaccinated against anthrax?
• What is the protocol for anthrax vaccination?
• Are there adverse reactions to the anthrax vaccine?
• How is anthrax diagnosed?
• Is there a treatment for anthrax?
• Where can I get more information about a recent Department of Defense decision to require men and women in the Armed Services to be vaccinated against anthrax?

What is anthrax?

Anthrax is an acute infectious disease caused by the spore-forming bacterium Bacillus anthracis. Anthrax most commonly occurs in wild and domestic lower vertebrates (cattle, sheep, goats, camels, antelopes, and other herbivores), but it can also occur in humans when they are exposed to infected animals or tissue from infected animals.

Why has anthrax become a current issue?

Because anthrax is considered to be a potential agent for use in biological warfare, the Department of Defense (DoD) has begun mandatory vaccination of all active duty military personnel who might be involved in conflict.

How common is anthrax and who can get it?

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. 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 from other countries where anthrax is more common may become infected with B. anthracis (industrial anthrax). Anthrax in wild livestock has occurred in the United States.

How is anthrax transmitted?

Anthrax infection can occur in three forms: cutaneous (skin), inhalation, and gastrointestinal. B. anthracis spores can live in the soil for many years, and humans can become infected with anthrax by handling 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 7 days.

Cutaneous: Most (about 95%) 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 insect bite 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 is usually fatal.

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.

Where is anthrax usually found?

Anthrax can be found globally. It is more common in developing countries or countries without veterinary public health programs. Certain regions of the world (South and Central America, Southern and Eastern Europe, Asia, Africa, the Caribbean, and the Middle East) report more anthrax in animals than others.

Can anthrax be spread from person-to-person?

Direct person-to-person spread of anthrax is extremely unlikely to occur. Communicability is not a concern in managing or visiting with patients with inhalational anthrax.

Is there a way to prevent infection?

In countries where anthrax is common and vaccination levels of animal herds are low, humans should avoid contact with livestock and animal products and avoid eating meat that has not been properly slaughtered and cooked. Also, an anthrax vaccine has been licensed for use in humans. The vaccine is reported to be 93% effective in protecting against anthrax.

What is the anthrax vaccine?

The anthrax vaccine is manufactured and distributed by BioPort, Corporation, Lansing, Michigan. The vaccine is a cell-free filtrate vaccine, which means it contains no dead or live bacteria in the preparation. The final product contains no more than 2.4 mg of aluminum hydroxide as adjuvant. Anthrax vaccines intended for animals should not be used in humans.

Who should get vaccinated against anthrax?

The Advisory Committee on Immunization Practices has recommend anthrax vaccination for the following groups:

• Persons who work directly with the organism in the laboratory
• Persons who work with imported animal hides or furs in areas where standards are insufficient to prevent exposure to anthrax spores.
• Persons who handle potentially infected animal products in high-incidence areas. (Incidence is low in the United States, but veterinarians who travel to work in other countries where incidence is higher should consider being vaccinated.)
• Military personnel deployed to areas with high risk for exposure to the organism (as when it is used as a biological warfare weapon).

The anthrax Vaccine Immunization Program in the U.S. Army Surgeon General's Office can be reached at 1-877-GETVACC (1-877-438-8222). http://www.anthrax.osd.mil

Pregnant women should be vaccinated only if absolutely necessary.

What is the protocol for anthrax vaccination?

The immunization consists of three subcutaneous injections given 2 weeks apart followed by three additional subcutaneous injections given at 6, 12, and 18 months. Annual booster injections of the vaccine are recommended thereafter.

Are there adverse reactions to the anthrax vaccine?

Mild local reactions occur in 30% of recipients and consist of slight tenderness and redness at the injection site. Severe local reactions are infrequent and consist of extensive swelling of the forearm in addition to the local reaction. Systemic reactions occur in fewer than 0.2% of recipients.

How is anthrax diagnosed?

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

Is there a treatment for anthrax?

Doctors can prescribe effective antibiotics. To be effective, treatment should be initiated early. If left untreated, the disease can be fatal.

South African Links

The South African Pharmacy Council

http://www.pharmcouncil.co.za/