Handling Anthrax Letters and Packages--County Director Advisory #6

County Directors:

The attached document was designed in conjunction with the Department of
Health and Family Services and Wisconsin Emergency Management. It is interim
guidance. Dr. Jeff Davis, State Epidemiologist, is developing more
comprehensive guidance to be distributed later this week.

This guidance is not designed to be distributed to the public in its
entirety, but rather to be used by public safety personnel to prepare their
response and provide local guidance.

To date, there are over 100 cases currently being tracked by the Department
of Health and Family Services.  All tests to date have been negative. Some
threats, upon reflection, were not very credible and significant time and
energy were expended when it was not necessary. The simplest way to avoid
the problem is not to open unusual packages. The guidance we have provided
repeats the characteristics of a suspicious package.(Screening the mail
prior to opening it cannot be stressed enough)

Ed Gleason

 -----Original Message-----
From:   Gleason, Edward  
Sent:   Thursday, October 11, 2001 12:35 PM
To:     *DMA-WEM CO DIR; Lessner, Laura
Cc:     *DMA-WEM Regional Offices; *DMA-WEM Central
Subject:        County Director Advisory # 4

County Directors:

There have been a number of calls received today throughout the state about
letters received in the mail containing powdery substances. The attached
guidance from the Postal Service should help. Please disseminate widely in
your area including schools, hospitals, media, etc

Ed Gleason

Laura Lessner: Please disseminate to cabinet

                
Tip Sheet
October 2001


United States Postal Inspection Service


The United States Postal Service has not had one confirmed incident
involving the use of the mails to transmit any weapons of mass destruction
to include chemical or biological agents. 

Weapons of Mass Destruction 
How likely is it that someone would receive Weapons of Mass Destruction
(WMD) in the mail?
The Postal Service delivers approximately 208 billion pieces of mail per
year, and presently we have not found any real WMD incidents (which includes
Anthrax) only threats or hoaxes (no biological agent present).

How often do these threats and hoaxes occur?
During FY 1999 and FY 2000, there were approximately 178 Anthrax threats
received at courthouses, reproductive health service providers (clinics
offering abortion services and/or counseling), churches, schools, and post
offices. During FY 2001 we have had only approximately 60 threats or hoaxes
which included Anthrax, Hoof and Mouth Disease, the Klingerman Virus Hoax
and others.

Chemical and biological weapons are sometimes referred to as the "poor man's
nuclear weapons" and pose a significant threat in the post-Cold War
environment.  The relative low cost and simplicity of design and technology
make them the weapons of mass destruction choice for a variety of rogue
states and terrorist and non-state organizations. Although acts of chemical
and biological agent terrorism have not been prevalent in the U.S. up to
now, these acts or threats of acts is enough to disrupt operations 

The Federal Bureau of Investigation (FBI) has been designated as the Lead
Federal Agency for crisis management in all acts of terrorism and uses or
threats of Weapons of Mass Destruction (WMD). 

What Should I do if I Receive an Anthrax Threat by Mail?
Double bag the letter or package in zipper-type or zip-lock type plastic
bags using latex gloves, if possible, and a particulate mask;
Wash your hands with soap and water;
Notify your immediate supervisor and local police, Postal Inspectors and the
FBI, who will arrange to collect the letter or the threat and assess the
threat situation;
Notify the local, county, and state health departments;
Notify the state emergency manager;
Ensure that all persons who have touched the letter wash their hands with
soap and water;
List all persons who have touched the letter and/or envelope with locating
and contact information and provide the list to appropriate people;
Place all items worn at the time in plastic bags and keep them wherever you
change your clothes and have them available for law enforcement, should they
request them.
Shower with soap & water
Take medication until otherwise instructed or it runs out;
Notify Center for Disease Control (CDC) Emergency Response at 770-488-7100
for any questions or if you require further information.


What is Anthrax?
Anthrax is a bacterial, zoonotic disease caused by Bacillus Anthracis, a
rod-shaped, gram positive, sporulating organism with the spores constituting
the usual infective form.  Anthrax occurs in domesticated and wild animals,
primarily herbivores, including goats, sheep, cattle, horses, and deer, but
other animals may be infected.  

The skin form of the human disease may be contracted by handling
contaminated hair, wool, hides, flesh, blood or excreta of infected animals
and from manufactured products such as bone meal.  Infection is introduced
through scratches or abrasions of the skin, wounds, inhalation of spores,
eating insufficiently cooked infected meat or flies.  The spores are very
stable and may remain viable for many years in soil and water.  They will
resist sunlight for varying periods.  


What Are the Symptoms and Effects of Anthrax?
After an incubation period of 1-7 days, the onset of inhalation anthrax is
gradual.
Possible symptoms include:
fever
malaise 
fatigue
cough 
mild chest discomfort followed by severe respiratory distress

This mild illness can progress rapidly to respiratory distress and shock in
2-4 days followed by a range of more severe symptoms including difficulty
breathing, exhaustion, tachycardia, cyanosis and terminal shock can occur.
Death usually occurs within 24 hours of respiratory distress onset.

What Are the Clinical Features of Anthrax?
Anthrax is an acute bacterial infection of the skin, lungs, or
gastrointestinal tract.  Infection occurs most commonly via the skin route
and only very rarely via the others.  

The cutaneous or skin form occurs most frequently on the hands and forearms
of persons working with infected livestock or contaminated animal products
and represents 95% of cases of human anthrax.  It is initially characterized
by a papule which progresses to a fluid filled blister with swelling at the
site of infection.  The scab that typically forms over the lesion can be
black as coal, hence the name anthrax, Greek for coal.  With treatment, the
case fatality rate should be less than 1% among cutaneous cases.  The
fatality rate for untreated inhalational or intestinal anthrax is over 90%.

The inhalational form is contracted by inhalation of the spores, occurs
mainly among workers handling infected animal hides, wool, and furs.  Under
natural conditions, inhalational anthrax is exceedingly rare, with only 18
cases having been reported in the United States in the 20th century.  

What Is the Treatment for Anthrax?
Treatment with antibiotics beginning one day after exposure to a lethal
aerosol challenge with anthrax spores (8,000 - 22,000 spores) has been shown
to provide significant protection against death in monkeys, especially when
combined with active immunization.  Penicillin, doxycycline, ciproflaxin,
are all effective against most strains of B anthracis.  Penicillin is the
drug of choice for naturally ocurring anthrax.  If untreated, inhalational
anthrax is fatal.  For post-exposure prophylaxis the administration of
antibiotics should be continued for at least 4 weeks in those exposed and if
available, those exposed should receive 3 doses of vaccine before
antibiotics are discontinued.  

A vaccine is available and consists of a series of 6 doses over 18 months
with yearly boosters.  The first vaccine of the series must be given at
least 6 weeks before exposure to the disease.  This vaccine, while known to
protect against anthrax acquired through the skin, is also believed to be
effective against inhaled spores.  While a vaccine does exist for anthrax,
its availability to the general public is not widespread.  

Effective decontamination can be accomplished by boiling contaminated
articles in water for 30 minutes or longer and using some of the common
disinfectants.  Chlorine is effective in destroying spores and vegetative
cells.  Remember, anthrax spores are stable, able to resist sunlight for
several hours and able to remain alive in soil and water for years.


Additional Resources:

The Federal Bureau of Investigation (FBI) is the lead Federal agency for
crisis management for all acts of terrorism and in all threats or incidents
of WMD.  The FBI will coordinate the Federal Government's efforts to prepare
the nation's response community for threats involving Weapons of Mass
Destruction (WMD).  The National Domestic Preparedness Office (NDPO) works
in conjunction with other Federal, State and Local Crisis Managers specific
to WMD and will perform an Interagency Threat Assessment and deploy a
Domestic Emergency Support Team (DEST) if a threat is received.  To contact
them call:   202-324-0259, FBI Special Information Operations Center, SIOC 

The Defense Threat Reduction Agency (DTRA) is a new agency that is charged
with reducing the present threat to the U.S. and its allies from WMD and
preventing future threats.  DTRA focuses Department of Defense efforts to
prepare for and respond to chemical or biological attacks.  The CB Hotline
is 1-800-424-8802.  The web site is http://www.dtra.mil/. 

The Centers for Disease Control and Prevention(CDC) is responsible for
coordinating all public health and would be contacted at the Emergency
Preparedness and Response Branch, National Center for Environmental Health
to report an incident at 770-488-7100.   Their web site is http://cdc.gov.

What constitutes a "suspicious parcel?"
Some typical characteristics Postal Inspectors have detected over the years,
which ought to trigger suspicion, include parcels that may:

Be unexpected or from someone unfamiliar to you.
Be addressed to someone no longer with your organization or otherwise
outdated (e.g., improper title).
Bear no return address, or one that can't be verified as legitimate.
Be of unusual weight, given its size, or be lopsided.
Be marked with restrictive endorsements, such as "Personal" or
"Confidential."
Exhibit protruding wires, strange odors or stains.
Exhibit a city or state in the postmark that doesn't match the return
address. 

What should I do if I've received a suspicious parcel in the mail?
Do not try to open the parcel, as they are usually designed to withstand
handling while in the mail, and to explode when opened or when an item is
removed.
Isolate the parcel.
Evacuate the immediate area.
Call a Postal Inspector to report that you've received a parcel in the mail
that may be a bomb.