White Powder in the Mail

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White Powder in the Mail

• Is it anthrax?
• How can you tell?
• What do you do?

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What is Anthrax?

• Bacillus Anthracis
• Spores
• Bacteria

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Knight Ridder/Tribune News/UCLA School of Public
Health Dept. of Epidemiology
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What Diseases are Caused by Anthrax?

• Cutaneous
• Most common naturally occurring form
• Low mortality
• Gastrointestinal
• Results from eating contaminated, undercooked
  meat
• Up to 50 mortality if untreated
• Inhalational
• Most likely in bioterrorism
• High mortality without prompt treatment

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Inhalation Anthrax

• Onset of symptoms 2 days up to 60 days
  post-exposure
• Antibiotics most effective before onset of
  symptoms
• LD50 about 8000 spores
• Infective dose probably less than 10 spores in
  susceptible persons

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History of Anthrax

• Biblical plagues
• Fifth and Sixth Plagues in Exodus Believed to be
  Anthrax
• Animal disease
• Endemic to horses, cows, goats, sheep
• Economically important agricultural disease

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Natural Incidence of Anthrax

• Most common in temperate agricultural regions
• Rare in US
• More common in India and southern Africa
• Human infection unusual
• 95 is cutaneous
• Result of contact with infected animals

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Naturally Occurring Human Anthrax

• Endemic in south/central Asia, central America,
  southern Africa
• Several thousand human cases each year
• Always associated with livestock
• Often associated with war
• Largest human outbreak
• Zimbabwe 1978-1980

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Development of Anthrax as a Biological Weapon

• Historical use
• US and UK Development
• Soviet Development

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Sverdlovsk Outbreak, 1979

• Spores accidentally released from army
  microbiology lab
• 96 Infected, 66 Dead
• All victims lived or worked in a narrow band
  downwind from lab
• Human casualties within 4 km
• Animal deaths extended to 50 km downwind

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Late 1990s Rising incidence of Mailed Anthrax
Hoaxes
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• ...the hundreds of anthrax hoaxes involving
  envelopes filled with harmless powders lack a
  plausible delivery system and hence are more of a
  nuisance than a serious danger.
• Jonathan Tucker
• Toxic Terror Assessing Terrorist Use of
  Chemical and Biological Weapons, 2000

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The Anthrax Letters

• Five Known Letters to Media and Political Targets
• Four letters recovered, mailed on two dates from
  Trenton, NJ
• Letters Contained 1g anthrax
• Fine particle size
• Treated to Enhance Dispersion

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Anthrax Letters Effects

• Anthrax in Second Mailing
• lt5 micron size
• Escaped through pores in envelopes
• Contamination throughout US postal service
• Cross-contamination to many other letters
• Most illnesses and all but one death resulted
  from spores leaking through envelopes

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Anthrax Letters Casualties

• 5 dead from inhalational anthrax
• 17 ill
• 11 cutaneous
• 6 inhalational
• 10000 people taking antibiotics
• All but few survivors still suffering effects

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Anthrax Letters Effect on Business

• gt500 reports of anthrax per day
• Investigations
• Facility Closures
• Side Effects from Cipro
• 57 reported serious side effects
• 26 missed work

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Anthrax Letters Cleanup Costs

• AMI Building in Boca Raton remains shuttered
• Clean-up of Hart Senate Office Building cost
  41.7 million
• Building was closed for three months
• 23 US Postal Service Facilities Contaminated
• Clean-up costs estimated at 800 million

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Hoaxes and Suspicious Packages Post 9/11

• 2001 before 9/11, 368 incidents, including one
  simultaneous mailing of 350 letters
• 2001 after 9/11, 7089 hoaxes and other reports of
  suspicious substances

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Hoaxes and Suspicious Packages Post 9/11

• 2001 before 9/11, 368 incidents, including one
  simultaneous mailing of 350 letters
• 2001 after 9/11, 7089 hoaxes and other reports of
  suspicious substances

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After the Anthrax Mailings, Everything is Taken
Seriously

• Any suspicious powder received full response
• FBI director reported that agents responded to
  over 29,000 reports in the year following the
  attack
• Practical jokes and powdered sugar merited hazmat
  crews
• Attacks inspired other hoaxers

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Suspicious Powder Response

• First Responders including hazmat teams and FBI
  arrive
• Area is evacuated and possibly closed
• Field tests are done
• If positive, those exposed are decontaminated
• Suspicious package is sent to CDC-certified lab
  for testing

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Hoaxes Continue Today

• FBI's National Capital Response Squad responds to
  5-10 reports per week of suspicious substances in
  Washington area
• U.S. Capitol Police respond to 3-10 reports per
  day on Capitol Hill
• Washington Post, 13 April 2004

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Sometimes the Threat is Real

• Ricin in Fallen Angel Letters
• Intercepted at mail handling facility Greenville
  SC 10/03
• Intercepted at White House mail handling facility
  Washington DC 11/03
• Ricin in Senator Frists Office 2/04
• No source letter found

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USPS Guidelines for Suspicious Mail
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What to do if you see Suspicious Powder

• If parcel is closed, dont open or shake it
• Isolate area of package or powder
• Turn off fans or ventilation units and shut down
  the air handling system in the building
• Keep track of who has had contact with the powder
• Call 911

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Would USPS Guidelines Have Helped to Recognize
Anthrax Letters?
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USPS Protective Measures

• Procedures
• Off-site handling for potential targets
• Irradiation of Government Mail
• Hazardous material detection
• BDS in distribution centers
• Detects anthrax only
• Can potentially be modified to detect other
  hazards

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What Your Company Can Do to Protect Itself

• Establish mail handling procedures
• Establish policies in case of discovery of powder
• Include in emergency action plan
• Evaluate risk level
• Establish plan for keeping business operating in
  case of facility closure
• Clean-up plan
• Back-ups of important documents

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Selected References

• Office of the Surgeon General, US Army Medical
  Aspects of Chemical and Biological Warfare.
  Washington 1997
• Centers for Disease Control and Prevention,
  Emergency Preparedness Website http//www.bt.cdc.g
  ov/agent/anthrax/index.asp
• Cole, Leonard A. The Anthrax Letters A Medical
  Detective Story. Washington Joseph Henry Press
  2003
• Meselson, Matthew et al. The Sverdlovsk Anthrax
  Outbreak of 1979 Science, November 18,1994
• Tucker, Jonathan Toxic Terror Assessing
  Terrorist Use of Chemical and Biological Weapons
  Cambridge Belfer Center 2000