Anthrax Health Risks
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RAY SUAREZ: Joining me from Atlanta is Dr. David Fleming, Deputy Director for Science and Public Health at the Federal Centers for Disease Control. Well, Dr. Fleming, we’ve been given numbers, numbers that are moving on the people who have both contracted the disease and been confirmed as exposures. What is someone with a confirmed exposure? Is that someone who, untreated, might develop anthrax?
DR. DAVID FLEMING: Well, in each of these instances in Florida and Washington and New York, our epidemiologists in conjunction with the local authorities go in and make an assessment based on the history of what happened as to what might have been exposed. For those individuals, we recommend that they take antibiotic prophylaxis. There are some additional tests that we can do in the context of the investigation to determine whether or not this assessment of who may have been exposed is correct. In some of those instances those tests have turned positive. I need to be clear though that in these instances where we’re going in and testing folks, we don’t use the results of those tests to guide our treatment decisions for any particular individual. Rather, it’s the epidemiologic investigation that guides that. So regardless of whether or not someone tests positive or negative in the situation, if it’s our judgment that they may be at risk we do recommend the antibiotic prophylaxis.
RAY SUAREZ: Some of the sites that have been targets of the mailings are publishers, a public building in the case of the Senate Office Building, a network news room, a publisher, they involve large numbers of people who must be very hard to track. Is there a point at which testing each individual becomes unwieldy and they may go on a prophylactic dose of antibiotic?
DR. DAVID FLEMING: Yes is the short answer. Basically in each of these situations there are a fair number of people that go in and out of the building. But local authorities and owners of these establishments have been very cooperative. So actually it’s been fairly easy for us to identify those folks who may be at risk and folks have been very cooperative as far as working with us and going along with our recommendations for antibiotic prophylaxis.
RAY SUAREZ: In the case of the seven-month-old baby he was a casual visitor to ABC. Is this a disease that, like some diseases, is more dangerous to children and the elderly?
DR. DAVID FLEMING: Well, anthrax is a disease that is a potential danger to healthy folks as well as children and the elderly the really good things to know about anthrax– if there are good things– is that number one it’s not contagious. So one individual cannot spread it to another person. And secondly it is treatable with antibiotics, particularly the cutaneous form of the disease, the skin form of the disease that we’ve been seeing in New York. So although this is an illness that we’re tracking very carefully, we’re confident that with our investigation and with the cooperation of the folks on the ground in these places that we’re going to be able to do what’s needed to be done.
RAY SUAREZ: When you hear about the small number of cases over the last hundred years in the United States, are there doctors who would actually know anthrax if they saw it? Is this something that you would only read about in the literature when you’re in med school?
DR. DAVID FLEMING: Most physicians probably have not seen a case of anthrax, but many of the medical society as well as CDC have been getting information out to clinicians about the signs and symptoms of the disease particularly the cutaneous form. In addition, the standard laboratory testing that a clinician would follow for a sick patient coming in is a testing regiment that would, in fact, enable the diagnosis of anthrax if that’s what’s present. So the system is prepared to deal with this.
RAY SUAREZ: Well, in its early phases doesn’t it mimic other more common better known more frequently identified diseases and does that or should that worry us?
DR. DAVID FLEMING: The cutaneous form of the disease that we’re seeing in New York, the skin form of the disease, can start off looking like a spider bite with a black center, but fairly quickly it progresses to a larger blackened s-scar or scab that is fairly diagnostic in which clinicians would recognize. The inhalational form of the disease that we’re seeing in Florida can start off with some early symptoms of fever, stiff joints, achiness, like a more severe influenza, but again over the course of a couple of days that progresses to signs and symptoms that are more clearly diagnostic of anthrax.
RAY SUAREZ: Several appointed and elected officials have warned about pranks and apparently there have been a lot of joke mailings and malicious mailings. They’ve been mentioned as a strain on law enforcement. Just how time consuming, just how difficult is the screening that’s being done on these false reports?
DR. DAVID FLEMING: Yes, in addition to being a strain on law enforcement, the situation nationally is also a great strain on our public health infrastructure at the state and at the local level. We’re in the process now of compiling some information about how commonly local health department are getting involved in these investigations, but our preliminary results show that many of the health departments across the country are investing time, energy and resources into dealing with not only these hoaxes but situations that may be accidental where folks do think that they may have been exposed. I think that this is a real test of our public health system. We’re passing that test. But it really shows all of us, I think, the need to make sure that in the future we make the proper investments so that we can be even better prepared than we are now to deal with these threats.
RAY SUAREZ: Is it difficult to rule out anthrax?
DR. DAVID FLEMING: The thing that I think is most challenging is in the early stages of these threats to try to separate these hoaxes or these accidental occurrences from the very small number of events that may be real. That’s where the local law enforcement folks and the local public health folks need to work together very carefully. In addition it does require the assistance of our state public health laboratory network to aid in testing of those specimens that may be most suspicious. We’re working to identify those places in the country that are reaching capacity and those places that still have the ability to test more specimens so we can triage what needs to be done so these tests can be performed in an expeditious way.
RAY SUAREZ: Well, among the actual tested specimens that have turned out to be positive for anthrax, the attorney general said today that the CDC is checking the strains. When you screen these samples that have turned up across the country, what will you be able to find out from the samples?
DR. DAVID FLEMING: The thing that we’re looking for when we do more in- depth analysis of the bacteria that have been isolated is to see whether or not they match one another. So, for example, in Florida, fairly early on, we were able to determine that the strains of bacteria in the two patients as well as the environmental strains that were isolated from the building were the same. And that gave us great confidence that we were on track in identifying the building as the source of exposure and could provide some information to the community that, in fact, the community as a whole was not at risk. We’re now cooperating with other laboratories around the country to perform the same kind of testing on the anthrax bacteria that have been isolated in New York and in Washington to determine whether or not there is a common link across all of these three sites.
RAY SUAREZ: Does the CDC already have a library, a bank of strains so that once you test these samples that have been collected in the field, you might be able to tell where in the world they come from?
DR. DAVID FLEMING: There are banks of these strains that are present in this country at laboratories other than CDC. It’s really not going to be possible looking at these strains to say with certainty which part of the world they came from. The more important thing that we are going to be able to determine is whether they came from a common source and, therefore, whether or not these events are linked.
RAY SUAREZ: Finally, Dr. Fleming, part of your agency’s brief is to monitor for public health threats — still a pretty small number of cases, pretty small number of exposures. Can we call this a public health emergency yet in any way?
DR. DAVID FLEMING: I think that we’re in a situation now where CDC as well as public health agencies across the country are on heightened alert. We have a situation where the right things are happening at the state, local and federal level, and we are confident that we’re going to be able to continue to deal with this situation as it progresses.
RAY SUAREZ: Dr. David Fleming, thank you very much.
DR. DAVID FLEMING: Thank you.