November 16, 2001

By Julia Ann Easley

There were lessons in microbiology and antibiotics at a brown bag talk on anthrax and other infectious diseases last Friday, but the most practical advice for UC Davis employees came down to good hygiene and remembering what your mother always told you: Wash your hands with soap and water.

"There are all kinds of contaminants everywhere," said Carl Foreman, director of Environmental Health and Safety and one of five panelists responding to questions. "In fact, if you follow the protocols that have been talked about - washing your hands and not touching your eyes and nose - if everybody were to do that this year, I guarantee you'd see a big drop in colds and flus."

The meeting - which featured a presentation by interim director Dr. Michael O'Malley of Employee Health Services and the participation of representatives from the fire and police departments - was organized to provide basic information about anthrax and other potential biological threats. About 60 people attended.

"We feel strongly about the importance of providing a safe working environment for all of our employees," said Dennis Shimek, associate vice chancellor for human resources.

More than one of the audience's questions focused on the safe handling of mail.

"When I get a package from New York or Washington, I don't personally see a risk in opening the package," O'Malley told the audience, "but I think those questions are quite reasonable."

The doctor said hand-washing can protect against cutaneous anthrax that enters through the skin. And he added that people also can use gloves to protect against cutaneous anthrax and respirators to protect against inhaling anthrax spores.

Foreman said individuals who want to use a respirator can ask their supervisor to contact Environmental Health and Safety to arrange for a medical evaluation and fitting. The medical evaluation is necessary because the respirator can make breathing more difficult, he said.

In his presentation, O'Malley discussed the three forms of anthrax, which is caused by spore-forming bacteria, and the antibiotics used to treat them.

Cutaneous anthrax

Cutaneous or skin infection accounts for 95 percent of anthrax cases, O'Malley said. Usually two or three days after infection through the skin, small pimple-like marks appear on the skin and develop over several days into larger lesions, most commonly appearing on the hands, face and arms. Lymph glands in the adjacent area may swell. Systemic infection follows in several days or a week. Death results in about 20 percent of untreated cases but is rare with treatment.

Inhalation anthrax

To be infected with this form of anthrax, O'Malley said, the Centers for Disease Control and Prevention estimate an individual must inhale at least 4,000 to 5,000 anthrax spores. After an incubation period of usually two to 10 days but sometimes as long as 43, initial flu-like symptoms develop. In several more days, the infected individual experiences shortness of breath, and the lymph glands inside the chest swell. While inhalation anthrax has a fatality rate of 70 to 80 percent, O'Malley said he is encouraged by the higher survival rate among the current U.S. cases.

Intestinal anthrax

O'Malley said public health inspection programs in the United States appear to have eliminated this form of anthrax, which is caused by eating undercooked meat from an infected animal. Following an incubation period of two to 10 days, the infected individual experiences abdominal pain, bloody diarrhea and may progress to a generalized infection similar to inhalation anthrax.

Regarding treatment, O'Malley said anthrax is highly sensitive to several antibiotics including the currently preferred ciprofloxin and doxycycline. Ciprofloxin is commonly used to treat sexually transmitted diseases, urinary infections and for those allergic to penicillin, animal bites; doxycycline is used to treat bronchitis, traveler's diarrhea, and forms of chlamydia including parrot fever.

Because inhalation anthrax can have a long incubation period, O'Malley said, a 60-day treatment of the antibiotics can cause high-risk side effects - diarrhea and allergic reactions with both ciprofloxin and doxycycline, and gastrointestinal problems and sensitivity to light with doxycycline.

One member of the audience asked how people should respond this winter when their children show signs of the flu since the initial phase of inhalation anthrax has flu-like symptoms.

O'Malley said the odds are that the illnesses will be the same as in every other cold and flu season. However, he did say that a high fever, problems with the lower respiratory system and rapid progress of the illness would be signs to seek medical attention.

For those who have concerns that an illness could be anthrax, O'Malley said evaluating the potential for exposure to anthrax may be the best indicator. But, he added, a chest X-ray and a test measuring the level of white cells in the blood can help doctors distinguish between upper respiratory or viral infections and the potential for inhalation anthrax.

O'Malley said vaccination against anthrax - currently limited to members of the military - requires a series of five shots followed by annual booster shots and has side effects. "It's a somewhat cumbersome vaccination compared to giving a tetanus (shot)."

In a later interview, O'Malley added that current research is evaluating whether the vaccine, when administered with antibiotics, could reduce the length of time an individual would need to take antibiotics after a potential exposure to anthrax.

Smallpox has been discussed as another biological weapon that could be used by terrorists. A highly contagious disease believed to have been eradicated by 1980, it is characterized by an illness resembling influenza and a rash that spreads over the body 11 or 12 days after exposure.

According to a report in the New York Times, the lesions initially appear as raised bumps and, over a period as long as 19 days, become painful lesions that are firm, filled with pus and form scabs. Smallpox can scar and even blind its victims.

O'Malley characterized the smallpox vaccination as a "nasty" one, causing a lesion that can take two to three weeks to heal. The immunity is known to last 10 to 15 years.

Amy Barden of Food Science and Technology, who supervises students handling mail, said that she appreciated that the meeting was held and that she learned from O'Malley's overview of anthrax.

And she endorsed the reminder to wash hands after handling mail. "That's an easy recommendation anybody can give - from the president to an MSO (management services officer)."