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MARGARET WARNER: And for more on today’s new anthrax case and type, we’re joined by Dr. Philip Brachman, professor at Emory University’s Rollins School of Public Health. He’s a medical doctor and until the mid-1980s, an epidemiologist at the Federal Centers for Disease Control; there he worked on the CDC’s anthrax investigation program. Welcome Dr. Brachman.
DR. PHILIP BRACHMAN: Thank you very much.
MARGARET WARNER: Explain to us how the form of the anthrax diagnosed today, this cutaneous anthrax is different from the anthrax diagnosed in the gentleman who died in Florida?
DR. PHILIP BRACHMAN: Well, the case in New York City is reported to be a case of cutaneous anthrax, which means the bacillus anthraces was — got on to the skin and in some way got through the skin either through a previous small wound in the skin or possibly she, in attempting to in some way she injured her skin so the organism got through into the subcutaneous tissue where it began to multiply and produce toxin and produce the local lesion.
MARGARET WARNER: And this form is what both more common and less deadly than the type in Florida?
DR. PHILIP BRACHMAN: Yes, in the United States, about 95-97% of the cases that have been reported of human anthrax have been cutaneous anthrax. We’ve had only 18 cases of inhalational anthrax since 1900 where we’ve had maybe close to 300 or more cases of cutaneous anthrax.
MARGARET WARNER: And what are the symptoms?
DR. PHILIP BRACHMAN: Well, the cutaneous anthrax is usually the first evidence is a small little bleb vesicle on the skin. There might be slight swelling around the vesicle, some redness that becomes more pustular with pus-looking material inside, and the vesicle breaks and clear liquid comes out, and there is an ulcer and within five or seven days a black escarp forms. During all of this a patient might have a low grade fever, headache. They’re not very dramatic systemic symptoms.
MARGARET WARNER: And it’s treated with?
DR. PHILIP BRACHMAN: Any common antibiotic. If it is the usual bacillus anthraces organism, any antibiotic, penicillin is usually the drug of choice, and normal oral dosage should be perfectly adequate.
MARGARET WARNER: Where does this anthrax come from?
DR. PHILIP BRACHMAN: Well, in natural times, we would have some cases due to contact with dead animals, a veterinarian or veterinary assistant in autopsying a dead animal might become contaminated with the animal’s secretions and the organism gets into the skin and cutaneous anthrax occurs. In industry, it would be in an industry that processes animal products, hides, wool, goat hair. They would develop primarily cutaneous anthrax by getting anthrax spores into the skin through the cutaneous tissue. Occasionally a worker, especially in the goat hair processing mill would inhale spores and get inhalational anthrax but that again was very rare.
MARGARET WARNER: What about the type this person at NBC got it in a letter in a powdery substance. Where does that come from?
DR. PHILIP BRACHMAN: Well, that has to be a man-created situation. That has to be bioterrorism. And somebody would have had to have grown anthrax organisms producing spores, dried them, put them in some type of a powder like a talcum powder and put them into an envelope. I assume what happened, though I don’t have definite data, that when she opened up the envelope, the powder fell out and again some of that must have gotten on to her skin. I’m not sure where the lesion is. And again the organisms in some way, the spores got through the skin causing the cutaneous legion.
MARGARET WARNER: Okay. But where is — the original substance that you have to work with, where is it available? Is it in research labs? Where is it?
DR. PHILIP BRACHMAN: Yes, the bacillus anthraces it is not necessarily found in every lab, but certainly it will be found in diagnostic laboratories where they will keep stock strains of organism in case they uncover something, an organism they can’t identify. They pull down stock strains to try to compare so they can identify. So you’ll find it in a– you might find it in a diagnostic laboratory such as a state or large city lab or even in some private labs. You’ll find it in a veterinary lab and every state will undoubtedly have a veterinary lab where if they have anthrax occurring in their animals, they’ll have that as a stock strain. And research labs; it is an organism used in various research. You’ll find it in various laboratories throughout the country.
MARGARET WARNER: And what kind of controls are there as to who has access to it?
DR. PHILIP BRACHMAN: Well, if a laboratory has it, I don’t know of any specific controls that only certain labs can hold the organism. It used to be….
MARGARET WARNER: For an individual who wanted to get ahold of it?
DR. PHILIP BRACHMAN: Well, you would have to either know somebody in the laboratory who could get you some of the subculture from a stock strain or maybe you could steal it or somebody would steal it for you. Those would be the ways. It’s been suggested that somebody could go into agricultural land where animals have died of anthrax and get some soil, but that would take a very specific knowledge of where there’s land that’s contaminated with spores and then knowledge of how to recover the spores from the soil.
MARGARET WARNER: Now the FBI and investigators are trying to figure out whether these cases are connected. First of all, there’s another case in New York, a reporter at the “New York Times” received an envelope with a powdery substance and in fact a press conference that was held by the FBI after we went on the air, they said that the letters to NBC and to the Times had come from the same place, St. Petersburg, Florida. But as a scientific matter, would you be able to test what was in both envelopes and tell if they were from the same source?
DR. PHILIP BRACHMAN: If there was– I don’t know if there was anthrax in the second envelope.
MARGARET WARNER: I don’t either.
DR. PHILIP BRACHMAN: If there had been bacillus anthraces in the second envelope, by genetic typing you could indicate whether they came from the same parent strain. But that parent strain could well be the parent strain that’s in all laboratories or most laboratories in the country, so that you could only say that is a common strain. If that strain had some unusual genetic markings, then you could be more specific and say they came from the same parent.
MARGARET WARNER: Could you do the same-excuse me for cutting you off but could you do the same to test whether the anthrax strain in Florida and, if they discover one in New York were the same?
DR. PHILIP BRACHMAN: Oh, yes. And I’m sure that will be done if they recover a strain in New York I’m sure they will do the genetic typing on that strain as well as the genetic typing they’re doing on the strain from Florida now. And again, it’s either going to be the same parent or closely related or maybe they’re unrelated.
MARGARET WARNER: And finally Dr. Brachman, very briefly but Americans are wondering what they can do to protect themselves other than not opening suspicious mail. Would you recommend they get vaccinated, that they go ahead get the antibiotics what would you recommend?
DR. PHILIP BRACHMAN: No, I would rather they not get the– the vaccine is actually not available today. Even if it were, I do not suggest at all that Americans should be vaccinated and I do not believe Americans that should take antibiotics unless there is evidence that they have been exposed to contamination and then indeed yes antibiotics would be very appropriate.
MARGARET WARNER: I’m sorry. We’ll have to leave it there. But thank you so much.
DR. PHILIP BRACHMAN: Thank you.