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Anthrax: Q&A With Student-Doctor

Q: Is the water supply safe?
A: During the present emergency, City, State, and Federal agencies are carefully monitoring the water supply and it is likely that any problems will be rapidly detected. Results to date indicate that the water supply remains safe.

Q: What about chemical or biological attacks?
A: Using biological material as a weapon requires technical know-how that makes it more difficult then terrorist organizations can easily handle. However, although the possibility is remote, the US is vigilant and is taking the appropriate steps, including frequent communications bulletins with healthcare providers.

Q: Should I buy gas masks?
A: Don’t buy a gas mask. For a gas mask to be effective, you must put it on at the right time–you must be wearing the gas mask before exposure, and continue wearing it until the danger is past. It is unlikely that you will know exactly when to put on the gas mask. Most masks can only be worn for a few hours before the filters need to be changed, and in any case it is impractical to wear a gas mask for extended periods. They are simply too uncomfortable–I had to wear one day in and day out for six months, and it sucked the life out of me, not to mention leaving me smelling like PVC. You should also be aware that there are many different masks available for sale, and they vary in quality and in what they are designed to filter out. In addition, masks need to be properly fitted to work properly, and can make breathing difficult in people with impaired respiratory function.

Q: What about antibiotics?
A: Several antibiotics are effective against such possible bacterial threats as anthrax or plague. Given appropriately, they are life saving. I do not recommend that patients stockpile antibiotics. It is very difficult, if not impossible, to know when to take the antibiotic. In most cases, people are very likely to take them when they are not needed. To use antibiotics when they are not needed undermines their effectiveness, by encouraging resistance in our common pathogens. In addition, there are risks of side effects. Therefore, antimicrobials should be prescribed only when clinically indicated.

The federal government has stockpiled supplies of antimicrobials and other emergency supplies, called “Push Packs,” that can rapidly be deployed for just such emergencies as possible bioterrorist attack. After the Sept 11th event, New York City requested these supplies, and they were rapidly delivered, demonstrating that the system does work as expected.

Q: What are some of the possible bioterrorist threats?
A: Among the possible bioterrorist threats most often mentioned are Anthrax, Smallpox, and Plague.

Anthrax is a bacterial agent (Bacillus anthracis). The organism is a spore former, and infection is caused by exposure to spores. Anthrax does not spread person to person. Inhalation anthrax generally requires inhaling relatively large doses–typically 10,000 spores or more. It is controlled by giving the appropriate antibiotics and, when available, vaccine, to those who may have been exposed. If vaccine is not available, antibiotics alone can be given for 60 days. The reason for giving vaccine is to prevent the possibility of disease after antimicrobials have been withdrawn–although likely to be rare, animal studies suggest that cases could possibly occur up to 60 days after exposure.

The vaccine is given in 6-8 doses spread over the course of a month. There have been episodes of auto-immunity–where the body attacks itself–reportedly caused by the vaccine. For more information on anthrax and other matters pertaining to bioterrorism, visit the NYC DOH Website: at //NYC.gov/html/doh/html/cd/wtc8.html

Bubonic Plague, which is caused by Yersinia pestis, can spread person to person, but can readily be controlled by the appropriate antibiotics. Fatality rates are low if appropriately diagnosed and treated early.
For more information, visit the NYC DOH Website: Under Infectious Diseases, //NYC.gov/html/doh/html/cd/cd.html

Smallpox is caused by a virus, and can spread person to person. It was once a dreaded natural disease, but was eradicated as a natural infection over 20 years ago. As a result, it would be difficult for many terrorists to obtain. Past experience indicates that a rapid public health response, involving early recognition of cases and vaccination of those exposed, would succeed in controlling the outbreak. CDC reports that there are presently about 15 million doses of vaccine available on short notice in the event of an outbreak.

The thought of biological terrorism is, of course, frightening. The fear and uncertainty it engenders is one of its most potent benefits to a terrorist. Therefore, it is important to demystify this threat and see it in its rightful context, as an outbreak of infectious disease. Public health and the medical system have had considerable experience in dealing with unexpected outbreaks of infectious disease.

October 22, 2001
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