ASK THE DOCTOR: Anthrax: Just the facts
By DR. JIM MITTERANDO
The Patriot Ledger

In the wake of the Sept. 11 tragedies, people are naturally concerned about further terrorism. The recent anthrax outbreak in Florida raises the specter of bioterrorism and has spurred many people to call their doctors' offices to ask about vaccines and antibiotics.

Bioterrorism creates fear in the public imagination like nuclear threats did during the Cold War. Bioterrorism using chemical or infectious agents has the potential to kill thousands of people at a time, whereas nuclear radiation exposure could kill millions.

Worst-case scenarios depict that if a population of 100,000 people were exposed with a high tech, toxic anthrax aerosol cloud, that 50,000 people would contract the disease and 33,000 would die.

Fortunately, terrorists do not have the technology to deliver anthrax efficiently to such a large area, so potential exposures would involve much fewer people.
Despite this, it still invokes public fear knowing that if you contract anthrax that there is an 80 percent chance of dying from it.

Fortunately, anthrax is not contagious.

If you were in contact with an infected person, you could not catch the disease. People get the disease from spores released into the air. It can be anywhere from several days to six weeks before the infection develops.

Early symptoms can be flu-like, such as fever, headache and body aches and progress to worsening shortness of breath and severe illness.

I do not recommend that people visit their doctor for basic viral symptoms of fever, headaches or cough that are simply treated with fluids, rest and time. Antibiotics do not treat cold and flu viruses. As always, follow up with your doctor if you have worsening shortness of breath, which could be a sign of pneumonia or asthma.

Cutaneous anthrax, which affected the NBC employee, is not a public health risk, affecting only several people who would handle a contaminated letter or object. To contract cutaneous anthrax you need a break in the skin such as a sore or paper cut for the bacteria to enter. Anthrax will then cause a black blister or ulcer on the affected skin. Most cutaneous anthrax is curable with antibiotics.

Doctors' offices are not testing for anthrax. If a local outbreak did occur, testing would be handled by Department of Health officials and hospitals in conjunction with federal officials from the Centers of Disease Control, or CDC.

People have been requesting antibiotics to have in case of an outbreak. All medical authorities recommend against people hoarding antibiotics.

First of all, the risk is small that someone would be exposed to anthrax. Secondly, there are not enough antibiotics in civilian supply for every man, woman and child, and this would simply contribute to already existing shortages of drugs.

The CDC has antibiotics stockpiled for 2 million people if there were an anthrax attack. This is an adequate supply for a theoretical worst-case scenario that would involve hundreds to thousands.

Most of the medications are stored near Atlanta as well as in regional stockpiles that can be distributed to any part of the country within 12 hours.

Prescribing unnecessary antibiotics could result in everyday bacteria developing resistance to antibiotic treatment, which would be a great public risk.

Lastly, antibiotics can be harmful, causing severe reactions.

Ciprofloxacin and doxycycline, antibiotics commonly recommended for treating anthrax, normally are not given to young children because these drugs can affect developing teeth and joints.

Vaccines for anthrax are only available to military personnel and frequently have side effects.

People have also called to ask doctors about smallpox vaccines, which have not been given to the civilian public since 1972, when smallpox was eliminated.

Smallpox is a very contagious, viral disease that causes pus-filled blisters on the skin and severe illness, killing up to 30 percent of unimmunized people. People born before 1972 were most likely vaccinated, but it is estimated that only 20 percent to 30 percent of persons vaccinated still have immunity. Fortunately, the chance of a smallpox attack is low because it is a very difficult organism to work with in a laboratory.

Antibiotics kill bacteria but not viruses such as smallpox. The CDC does stockpile enough vaccines to treat six to seven million people if smallpox were to emerge. Unfortunately, the smallpox vaccine can cause severe side effects.

Additionally, the CDC would distribute antiviral pills to people at risk that can be taken to prevent the smallpox infection. The vaccine and antiviral pills are not available through your physician.

These are unsettling times. The psychological threat of terrorism is far greater than the physical threat. People feel they have no control over recent events and want to protect their family.

During the height of the Cold War with its nuclear threat, bomb shelters were not going to protect families. Today, gas masks and personal stockpiles of antibiotics will not, either.

Bioterrorism is not a new problem. It just has been brought to the front of American consciousness in recent weeks. The CDC and federal government have had contingency plans in place for years.

Life is full of risks - some more likely than others. The chance of dying in an automobile accident is far greater than the chance of dying from a terrorist attack. We continue to drive despite the risk of a car accident; during this difficult time, we must continue to live our lives as normally as we can to preserve our sanity, to preserve our economy and to preserve our liberties.

Dr. Jim Mitterando is a family doctor at Health Care South/Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.

Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.

Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.

Copyright 2001 The Patriot Ledger
Transmitted October 16, 2001