Anthrax history

Despite significant interest in unconventional weapons, there have been few instances of widespread death or incapacitation due to CBRN use by terrorists, and the number of casualties pales in comparison to those killed by more conventional explosives, armed attacks and arson. Since 1968, more than 14,000 people have been killed by bombing, and nearly 6,000 by armed attack, but CBRN attacks have accounted for less than 20 deaths [41]. The two most notorious unconventional attacks in modern history, Aum Shinrikyo s gassing of a Tokyo subway in 1995 and the anthrax attacks in the U.S. in the fall of 2001, killed a total of 17 people. The food poisoning by the Rajneeshees in Oregon in 1984 has also received much attention. While there were no fatalities when the cult poisoned several salad bars with Salmonella, there were more than 700 injuries. 

In December 1997, Secretary of Defense William Cohen announced a departmentwide anthrax immunization program for high-risk military personnel. Implementation began in March 1998. On May 18, 1998, the Secretary authorized the vaccination of all military forces (Cohen, 1998). Almost 2.5 million troop-equivalent doses of vaccine were required to implement the Secretary s decision, much more than had ever been produced by the licensed manufacturer in its entire history. Prior to Desert Storm, the primary vaccine users had been veterinary, laboratory, and industrial workers at risk of infection, for whom an estimated 60,000 doses of Anthrax Vaccine Absorbed (AVA) were distributed between 1974 and 1989, an average of 4,533 doses per year (foellenbeck et al., 2002). During Desert Storm, approximately 150,000 troops received 300,000 doses of AVA, without accurate recording of recipients or adverse reactions. 

The threat of a bioterrorist attack with smallpox is especially disturbing since the eradication of smallpox remains one of the great achievements in human history. Unfortunately, since routine vaccination against smallpox was discontinued in 1978, few people retain immunity today. Although there are only two official repositories of the smallpox virus today, it is still possible that terrorists will be able to obtain the virus. Thus, the government has had to stockpile supplies of the vaccine, and there is some debate about whether to resume routine smallpox vaccinations. Although the smallpox vaccine was discovered by accident, the story of how Louis Pasteur developed the first anthrax vaccine and his use of unvaccinated animals as controls remain as excellent lessons about the process of science (Trachtman 2002). 

The diagnosis of cutaneous anthrax, likewise, is initially difficult. A history of skin contact with anthrax spores or potentially anthrax-contaminated animal products is helpful. In early stages, the skin lesion is very nonspecific, hut the later presence of a painless black eschar accompanied hy severe localized edema is essentially pathognomonic for the diagnosis. Other causes of painful lymphadenopathy such as staph, strep, plague, and tularemia may mimic cutaneous anthrax. Cutaneous anthrax lesions can also resemble the necrotic ulcerated lesions due to brown recluse spider bite. 

Anthrax has plagued man and beast since early recorded history. Scholars have attributed several plagues in antiquity to anthrax. The Plague of Athens (430 27 BC) and two of the plagues of Egypt (the fifth - death of hvestock - and sixth plagues - boils), during the time of the Israehtes captivity... 

Donald R. Hopkins, Princes and Peasants Smallpox in History (Chicago University of Chicago Press, 1983), p. 77, cited in Marglin, "Losing Touch, p. 112. For the scientific career of vaccination and its application to anthrax and rabies, see Gerald L. Geison, The Private Science of Louis Pasteur (Princeton Princeton University Press, 1995). 

A history of influenza vaccination does not help differentiate inhalational anthrax from other causes of ILI. The vaccine does not prevent ILI caused by infectious agents other than influenza, and many persons vaccinated against influenza will still get ILL Therefore, a history of receipt of vaccine does not increase the probability of inhalational anthrax as a cause of ILI, especially among persons who have no probable exposure to anthrax. 

Figures 2.1 and 2.3 summarize the recommended clinical evaluation for patients with possible cutaneous anthrax and inhalational anthrax, respectively (7). Clearly, taking a history is the most essential step in the clinical evaluation. When taking a history, primary care clinicians should ask questions regarding the patient s concern about exposure with two goals in mind ...

One of the most profound developments in the history of modem medicine has been the discovery of antibiotics to control infections. The realization that microbial products could cure infectious diseases spanned approximately sixty-five years of discoveries (8). One of the first modem scientific demonstrations was the observation by Louis Pasteur in 1877 that common bacteria inhibited the growth of a pure anthrax culture. Other observations followed. Then in 1928 it was noted by Alexander Fleming that a culture of a green inhibited the growth of bacteria on an agar plate... 

Doctors are often more confident about using amoxicillin than ciprofloxacin in pregnancy because they have more information on the safety of amoxicillin for die mother and the fetus. But in some situations, amoxicillin may not be effective against anthrax this is because the bacteria diat cause anthrax can sometimes develop reskstance to penicillins such as amoxicillin. Before prescribing amoxicillin for you, your doctor will want to learn more about the specific place and situation of your exposure to anthrax and also about your general medical history. (For instance,. some women cannot take amoxicillin because they are allergic to it.)... 

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