Anthrax and Bioterrorism Defense

Anthrax Attacks Illustrate Valuable Role Diagnostics Play in First-Line Bioterrorism Defense

Bob Stevens, a 63-year-old photo editor at The Sun newspaper in Boca Raton, Fla., awoke early on Oct. 2, 2001, with nausea, vomiting and confusion. He also had a fever, chills, loss of appetite, and felt listless. Stevens was admitted to a local hospital with a diagnosis of meningitis. His flu-like illness had started five days earlier while on a trip to North Carolina . He died on October 5.

On Sept 24, 73-year-old Ernesto Blanco, a mailroom handler also at The Sun , had begun to feel fatigued and within four days had developed a cough, fever, watery eyes and a runny nose. He was hospitalized for pneumonia. His condition quickly worsened but he ultimately survived (1, 2).

Emergency room physicians had misdiagnosed both Stevens and Blanco. The men were actually the first victims of the anthrax bioterrorist attack in the fall of 2001. They had been deliberately exposed to spores of the anthrax microbe, Bacillus anthracis , which had been sent to their newspaper through the mail. By December 2001, public health officials had identified 22 cases of anthrax, all from powders sent via the mail, and had confirmed five deaths (3, 4).

Rapid Anthrax Diagnostic Testing Critical to Saving Lives

As the public suddenly realized in 2001, anthrax can be used as a weapon. Stevens' and Blanco's cases quickly revealed shortcomings in the ability of front line clinicians to diagnose an outbreak of anthrax or any other type of bioterrorism agent, such as small pox or the plague. Physicians and hospital staff were unfamiliar with the signs and symptoms of anthrax, which are easily mistaken for influenza, and laboratories lacked the availability of specific diagnostic tools. (1)

Because of the severity of anthrax, rapid diagnostic testing is of critical importance. If anthrax is diagnosed very early after exposure, immediate treatment with antibiotics can cure skin infections caused by the organism, and they offer the best, if not only, chance of survival from potentially fatal anthrax lung infections. (5, 6)

Public health officials have determined that diagnostic technologies represent a critical first-line resource for responding to any bioterrorism strike. Diagnostics are not only relevant to accurately identifying specific agents such as anthrax, but they are also essential for determining how certain bacterial or viral strains will respond to drug treatment and for estimating a patient's likelihood of survival. (7)

Within days of Steven's death in October 2001, the federal Centers for Disease Control and Prevention was able to activate the nationwide Laboratory Response Network (LRN) consisting of 80 public health laboratories, 11 military labs and seven food-testing labs (9). As part of that response, medical researchers began developing rapid diagnostics, including the newer tests based on antibodies to anthrax and DNA fingerprinting.

Participating centers in the LRN have been provided with the most up-to-date technology for diagnosing anthrax and other possible bioterrorism agents. According to the Centers for Disease Control and Prevention, “If another anthrax attack were to occur, prevention of deaths would probably depend on heightened surveillance and rapid diagnostics to identify an attack and prompt prophylaxis with antibiotics and vaccination” (6).

Today, hospitals, laboratories, and doctors are better prepared with a variety of blood tests that look directly for the anthrax organism, antibody tests that recognize responses by the immune system to anthrax exposure, skin tests to confirm that sores are causes by anthrax and sputum tests to confirm that anthrax has invaded the lungs.

New Diagnostics Promise Strengthened Bioterrorism Response

Among the latest technologies employed to rapidly diagnose anthrax are DNA fingerprinting tests similar to those used to match criminals and DNA evidence, and increasingly sophisticated antibody tests. The current goal of medical researchers is to develop rapid, on-the-spot DNA and antibody tests that can be used in the field in the event of another bioterrorist attack.

Congress recognizes that public funding is needed to make this possible. To bolster the public health system's ability to respond to bioterrorism, the federal government increased funding from $40 million in 1999 to more than $2 billion since 2001 (8). The best defense against a bioterrorist attack in the future is clearly a combination of heightened surveillance by health care workers and the availability of rapid diagnostics for characterizing specific pathogens.

Sources:

1. Emerging Infectious Diseases, Vol. 7, No. 6, November-December 2001, “Bioterrorism-Related Anthrax: The First 10 Cases Reported in the United States ”.

2. MMWR , October 3, 2003 / 52(39); 937-938.

3. MMWR , Dec. 7, 2001, 50(48): 1077-9.

4. BBC News, Nov. 23, 2001, http://news.bbc.co.uk/1/hi/world/americas/1617049.stm

5. CDC Fact Sheet , Anthrax, What You Need to Know, July 31, 2003, and October 16, 2001, CDC Press Office, Press Release “ Update: Facts about anthrax testing and on-going investigations in Florida, Nevada, New York, and Washington, D.C.”

6. CDC Anthrax Q & A: Laboratory Testing.

7. The Value of Diagnostics: Innovation, Adoption and Diffusion into Health Care , The Lewin Group, 2005.

8. ban.asm.la.cp.031802, Basic Diagnostic Testing Protocols for Level A Laboratories, CDC, ASM, APHL; and Inglesby TV, Henderson DA, Bartlett JG, et al for the Working Group on Civilian Biodefense. Anthrax as a biological weapon: medical and public health management. JAMA. 1999;281:1735-1745.

9. The Scientist  Mar. 9, 2004