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Information Paper Anthrax as a Biological Warfare Agent * Anthrax is the preferred biological warfare agent because:

* It is highly lethal.

* 100 million lethal doses per gram of anthrax material (100,000 times deadlier than the deadliest chemical warfare agent). * Silent, invisible killer. * Inhalational anthrax is virtually always fatal.

* There are low barriers to production.

* Low cost of producing the anthrax material. * Not high-technology. Knowledge is widely available. * Easy to produce in large quantities.

* It is easy to weaponize.

* It is extremely stable. It can be stored almost indefinitely as a dry powder. * It can be loaded, in a freeze-dried condition, in munitions or disseminated as an aerosol with crude sprayers.

* Currently, we have a limited detection capability. * What is Anthrax?

* Anthrax is a naturally occurring disease of plant eating animals (goats, sheep, cattle, wine, etc.) caused by the bacterium Bacillus anthracis. * It is an illness which has been recognized since antiquity. Anthrax was common in essentially all areas where livestock are raised. Intensive livestock immunization programs have greatly reduced the occurrence of the disease among both animals and humans in much of the world, an most outbreaks occur in areas where immunization programs have not been implemented or have become compromised (primarily Africa and Asia; however, outbreaks occurred during the mid- I 990's in Haiti and the former Soviet Union). * Anthrax spores can remain viable for several decades under suitable environmental conditions; thus, absence of cases does not equate to absence of risk.

* Humans can contract anthrax in three ways:

* Through cuts or breaks in the skin resulting from contact with an infected animal (cutaneous anthrax), resulting in local and possibly systemic (bloodstream) infection.

* From breathing anthrax spores (termed "woolsorters" disease) resulting in an infection of the lungs (inhalational anthrax).

* From eating infected meat, resulting in gastrointestinal infection (gastrointestinal anthrax). Gastrointestinal anthrax is generally not considered a threat to U.S. forces. * What are the symptoms?

* Symptoms of anthrax begin after a 1 to 6 day incubation period following exposure.

* For contact or cutaneous anthrax, itching will occur at the site of exposure followed by the formation of a lesion. Untreated contact anthrax has a fatality rate of 5-20 percent, but with effective antibiotic treatment, few deaths occur. * Initial symptoms for inhalational anthrax are generally non-specific: low grade fever, a dry hacking cough, and weakness. The person may briefly improve after 2 to 4 days; however within 24 hours after this brief improvement, respiratory distress occurs with shock and death following shortly thereafter.

* Almost all cases of inhalational anthrax, in which treatment was begun after patients have exhibited symptoms, have resulted in death, regardless of post-exposure treatment. * What is the medical countermeasure?

* Prior to exposure, prevention through vaccination, using the FDA-licensed vaccine. * Otherwise, antibiotics such as penicillin, ciprofloxacin, and doxycycline are the drugs of choice for treatment of anthrax. * Treatment with antibiotics must begin prior to the onset of symptoms and must include vaccination prior to discontinuing their use. * The use of antibiotics keep the patient alive until their body can build an immunity to anthrax via vaccination. After symptoms appear however, inhalational anthrax is almost always fatal, regardless of treatment.

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