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Q&A
Since the terrorist attacks on Sept. 11 destroyed the World Trade Center in New York, damaged the Pentagon and killed more than 5,000 people, the Illinois Department of Public Health, local health departments, health professionals and others have received questions from the public about the possibility of bioterrorism and ways to protect themselves. The following “frequently asked questions” were developed to answer some of those inquiries. Persons also should consider contacting their local health department, physician or local emergency preparedness office for additional information.

What precautions should I take regarding the threat of bioterrorism?

The Illinois Department of Public Health and the federal government are not recommending any specific bioterrorism-related precautions. However, in the event of a natural (for example, tornado, flood or earthquake) or man-made disaster, lives can be saved if people are prepared for the emergency. Every family should have the following emergency supplies on hand:

•A battery-powered radio and a flashlight, with extra batteries to each
•Bottled drinking water – one gallon per day per person, with a three - to seven-day supply recommended
•Canned or sealed package foods that do not require refrigeration or cooking, and a
•Can opener
•A blanket or sleeping bag for each family member
•First-aid kit, including any special prescription medications, such as insulin or heart tablets
•Toilet paper and paper towels
•Extra set of car keys, and a credit card, cash or traveler’s checks
•Special items for infant (disposable diapers), elderly or disabled family members
•Extra eye glasses, and contact lenses and supplies

For more information, please refer to the Illinois Department of Public Health’s Surviving Disasters: A Citizen’s Emergency Handbook.

What is the Illinois Department of Public Health (IDPH) doing to protect the public from bioterrorism?

Preventing an attack is the job of law enforcement -- the FBI, state and local police, and other law enforcement agencies.

If an attack should occur, IDPH has developed plans to minimize the risk and to treat those who may become ill. Working closely with other federal and state agencies, including local health departments, hospitals, laboratories and law enforcement, and with doctors, nurses, paramedics and other medical personnel, IDPH has implemented an enhanced surveillance system that is constantly on guard for unusual clusters of disease. In the past two years,
more than 1,000 medical and public health personnel have been trained to identify diseases that could be caused by bioterrorists. If a cluster is detected, public health is prepared to move quickly to identify the disease and its possible source. Public health information, treatment options and other advice would be provided to the public through the news media. Keep in mind, however, an attack may not be obvious for days to weeks depending on the incubation period of the disease.

The Illinois Department of Public Health is part of the Governor’s Illinois Terrorism Task Force. This task force would direct a coordinated effort among law enforcement, fire departments, emergency management, public health and other agencies at the local, state and federal level in the event of a bioterrorist attack.

How can I tell if a letter or package is suspicious?

According to the FBI, you should look for certain indicators. For example, check the postmark to see if it was mailed from a foreign country. Also check for no return address and for restrictive markings such as “personal” or “confidential.” Look for misspelled words or incorrect title. Suspect letters or packages may be rigid or bulky and have excessive tape or string around them. They may exhibit a strange odor.

What should I do if I receive a suspicious letter or package?

•Do not shake or empty contents of any suspicious envelope or package; DO NOT try to clean up powders or fluids.
•Place the envelope or package in a plastic bag or some other type of container to prevent leakage of contents.
•If you do not have a container, then cover the envelope or package with anything (e.g. clothing, paper, trash can, etc.) available and do not remove this cover.
•Leave the room and close the door, or section off the area to prevent others from entering.
•Wash your hands with soap and water to prevent spreading any powder to your face or skin.

If you are at home, then report the incident to local police. If you are at work, report the incident to local police and notify your building security official or an available supervisor.

If possible, list all people who were in the room or area when this suspicious letter or package was recognized. Give this list to both the local police and local public health authorities for follow up investigation and advice.

Remove heavily contaminated clothing and place in a plastic bag that can be sealed. Give the bag to law enforcement personnel.

Shower with soap and water as soon as possible. Do not use bleach or disinfectant on your skin.

Are vaccinations recommended to protect against a bioterrorist attack?

There are no vaccines recommended for the general public.

What about anthrax vaccine?

The U.S. has an anthrax vaccine that was licensed in 1970 and has been mandated for all U.S. military personnel; the vaccine is not available commercially. Between now and 2005, members of the military between the ages of 18 and 65 will receive a six-shot series of anthrax vaccine. For additional information, consult the current U.S. Public Health Service’s Advisory Committee on Immunization Practices recommendations on anthrax vaccination.

What is anthrax?

Anthrax is a disease caused by an organism acquired following contact with an infected animal or contaminated animal product or following the intentional release of anthrax spores as a biological weapon. In a bioterrorist attack, health authorities are concerned about anthrax spores being released into the air where they can be breathed in a person’s lungs. Anthrax is not spread person to person. The last reported case of anthrax in Illinois was in 1960.

How is anthrax transmitted?

Anthrax infection can occur in three forms: cutaneous (skin), inhalation and gastrointestinal.
B. anthracis spores can live in the soil for many years, and humans can become infected
with anthrax by handling products from infected animals or by inhaling anthrax spores from
contaminated animal products. Anthrax can also spread by eating undercooked meat from
infected animals. It is rare to find infected animals in the United States.

What are the symptoms of anthrax?

Symptoms of disease usually develop within 7 days of exposure depending on how the
disease was contracted, with most cases occurring within 48 hours of exposure. However,
incubation periods of up to 60 days are possible.

Cutaneous: Most (about 95 percent) anthrax infections occur when the
bacterium enters a cut or abrasion on the skin, such as when handling
contaminated wool, hides, leather or hair products (especially goat hair) of
infected animals. Skin infection begins as a raised itchy bump that resembles
an insect bite but within 1-2 days develops into a vesicle and then a painless
ulcer, usually 1-3 cm in diameter, with a characteristic black necrotic (dying)
area in the center. Lymph glands in the adjacent area may swell. About 20
percent of untreated cases of cutaneous anthrax will result in death. Deaths are
rare with appropriate antimicrobial therapy.

Inhalation: Initial symptoms may resemble a common cold. After several days,
the symptoms may progress to severe breathing problems and shock. After the
onset of symptoms, inhalation anthrax is usually fatal. Early antibiotic treatment
of disease before onset of symptoms increases the chances for survival.

Intestinal: The intestinal disease form of anthrax may follow the consumption of
contaminated meat and is characterized by an acute inflammation of the
intestinal tract. Initial signs of nausea, loss of appetite, vomiting, fever are
followed by abdominal pain, vomiting of blood and severe diarrhea. Intestinal
anthrax results in death in 25 percent to 60 percent of cases.

Should I have a supply of antibiotics?

There are numerous germs a bioterrorist may use in an attack: anthrax, botulism, cholera,
plague, Q fever, salmonella, smallpox, tularemia and viral hemorrhagic fever. Many
antibiotics are effective for a variety of diseases, but there is no antibiotic effective against
all diseases. Keeping a supply of antibiotics poses other problems because there is a
limited shelf life before they lose their strength. There is currently no justification for taking
antibiotics. Antibiotics should only be taken with medical supervision.

The federal government has stockpiled antibiotics for large-scale distribution in the event of
a bioterrorist attack. Known as the CDC’s National Pharmaceutical Stockpile, it was
designed to ensure the availability and rapid deployment of life-saving pharmaceuticals,
antidotes, other medical supplies and equipment to any U.S. location in the event of a
terrorist attack involving a biological or chemical agent.

What about smallpox vaccine?

As the result of a successful worldwide effort to eradicate smallpox, smallpox vaccine was
removed from the commercial market in 1983. Routine vaccinations were stopped in the
U.S. in 1972 because many people experienced side effects and there was almost no risk
of getting smallpox. The United States Public Health Service maintains an emergency
stockpile of approximately 15 million doses of smallpox vaccine and the federal government
has recently announced plans to accelerate production of a new smallpox vaccine.

The U.S. Centers for Disease Control and Prevention (CDC) would only recommend
vaccination if there was clear evidence that the disease had resurfaced and people in the
U.S. were at risk of acquiring infection. For more information, consult the current U.S. Public
Health Service’s Advisory Committee on Immunization Practices recommendations on
smallpox vaccination.

If I was vaccinated against smallpox before 1980, am I still protected?

Probably not. Vaccination has been shown to wear off in most people after 10 years, but
may last longer if the person has been successfully vaccinated on multiple occasions. If
health authorities determine you have been exposed to smallpox and are at risk of infection,
they would recommend that you be re-vaccinated immediately.

What is smallpox?

Smallpox is a disease caused by the Variola virus. It can be easily spread from person to person and transmission usually occurs only after the patient develops a fever and rash. After the incubation period, the patient experiences high fever, malaise, headache and backache. Severe abdominal pain and delirium are sometimes present. The last naturally acquired case of smallpox in the world occurred in October 1977 in Somalia.

All known Variola virus stocks are held under security at the CDC or at the State Research Centre of Virology and Biotechnology in Russia.

Should I buy a gas mask?

No. A mask would only offer some protection if you were wearing it at the exact moment that a bioterrorist attack occurred. Most likely, a release of a biological agent would be done without anyone’s knowledge. To wear a mask at all times, or just in case of a bioterrorist attack, is impractical, if not impossible.

(SOURCES: Illinois Department of Public Health, U.S. Centers for Disease Control and Prevention, U.S.
Department of Defense and Johns Hopkins University Center for Civilian Biodefense Studies)