Anthrax Shipments: Can't Keep a Good Spore Down

The eagerly anticipated release of the US Department of Defense's report on the inadvertent live anthrax shipments that originated from Dugway Proving Grounds contains a lot of important information but--as expected--no smoking gun or scandal. 

The biggest takeaway from the report, to me, is that anthrax has evolved to become a very hardy organism with spores that are very resistant to being killed, even withstanding some irradiation procedures. This is not too surprising given what the entire function of a bacterial spores is: to protect the bacterium from harsh environmental and nutritional conditions. 

The issue with the mistaken shipments, in my view, is not that live anthrax was transferred between labs but that the recipients and senders did not know that the anthrax was live (which is indicated by a special sticker on the package).

The report contains several important recommendations to prevent such an occurrence from happening in the future. The DoD panel contained experts who offered well-reasoned analysis  derived from a comprehensive examination of the facts and science.

However, from many of the media interviews I did on the topic, the general public and lay press do not have a great understanding of the topic and harbor many misconceptions about anthrax. Several facts that I had to repeat many times included:

• The fact that anthrax is not contagious.
• The realization that anthrax is a worldwide natural disease, not just a biowarfare concern.
• Live anthrax research occurs in specific labs.
• Infectious pathogens are mailed from lab-to-lab on a regular basis, including live anthrax.
• There is effective post-exposure prophylaxis for anthrax (vaccine and antibiotics).
• That defensive research on anthrax, which is vital, is not a violation of the Biological Weapons Convention.

It's been 14 years since the US was in the midst of an anthrax attack and it is understandable that the level of knowledge of this microbe has waned, however it remains a threat and research on preparedness is crucial--points that are worth repeating as many times as necessary.

Return to Sender: The Biosafety of Unknowingly Shipping Live Anthrax

The NY Post front page during the 2001 anthrax attacks

A couple of things to note regarding the mistaken shipment of live anthrax spores from Dugway Proving Grounds in Utah:

• The biggest concern, to me, is that there was a failure to know what was being shipped. Live anthrax spores can be shipped, but must be done in a proper fashion to prevent package damage as well as to assure that those who receive it are prepared (e.g. vaccinated, appropriate lab setting)
• Why did irradiation fail in this setting?

I don't believe anyone will be sickened by this lapse (those exposed who were not vaccinated are received post-exposure prophylaxis) but it is concerning chiefly because there clearly is a biosafety problem that remains at the nation's labs and each lapse, when it is splashed across the front pages, alarms the public who understandably may begin to question what is very vital research.  

Meticulous biosafety at government labs tasked with doing such important research is essential given that the FBI's (somewhat disputed) conclusions regarding the source of the anthrax employed during the Amerithrax attacks (see an interesting new twist on this here). 

Lions, Tigers, & Bears or Anthrax, Smallpox, & Bird Flu

Today it was announced that the recently discovered smallpox vials contained viable virus that was infectious. This is not too unexpected given that these were freeze-dried specimens.

However, the other piece of news that accompanied this announcement was that, over the last decade, there were 5 lapses in which dangerous pathogens, including the H5N1 influenza virus, were sent improperly to other laboratories from the CDC. The revelation of these incidents has prompted CDC to cease operations at two labs and impose a "moratorium" on specimen shipping from some CDC labs. 

What strikes me as the most important part of the story, however, is the issue of the Select Agent Rules. After the anthrax attacks of 2001 there was a major effort by the US government to impose strict control on the laboratories doing work on certain pathogens that were particularly dangers (hence, select agents).

Many university laboratories, including the ones in my own institution, struggled to meet these requirements. I personally know of one tularemia researcher who had particular difficulty meeting all the regulatory requirements to receive a non-virulent strain of the bacterium.

This laxity by some government personnel gives the impression that although university labs work diligently to comply with such regulations, their government counterparts have not exerted the same level of diligence. The belief that a two-tiered system exists coupled with the lapses that have occurred is something that could harm the public's confidence in this vital research and potentially jeopardize it -- a scenario that is more dangerous than finding decades-old smallpox vials.

CDC Anthrax Exposure: Likely a Contained Biosafety Lapse

Today it was announced that 75 individuals were possibly exposed to anthrax on June 13 while working at the CDC. The exposure is the result of an inactivation procedure not being performed properly. While many questions remain to be answered, a few points regarding anthrax are important to keep in mind:

1. The actual risk of contracting anthrax after an exposure like this is probably very low. As such, of the 75 individuals possibly exposed only 7 are believed to have significant exposures.
2. There is effective post-exposure prophylactic treatment available. Antibiotics such as ciprofloxacin and doxycyline coupled with 3 doses of the vaccine is the recommended regime. 
3. None of the 10,000 exposed in 2001 who were given post-exposure prophylaxis--and poorly complied with it--developed anthrax.

The questions surrounding this exposure will undoubtedly mount as such a biosafety lapse raises serious concerns. However, I do not anticipate that even one case of clinical anthrax will result.

It's Elementary, Anthrax is Not Contagious

I like detective stories and detective work. That's why I love infectious diseases so much. Sherlock Holmes is probably the most famous literary detective archetype of all time and I enjoy reading Sir Arthur Conan Doyle's (who, by the way, was a physician) tales of his and Dr. Watson's adventures.

In that same vein, I enjoy watching the CBS program Elementary which portrays a modern day NYC-set version of Holmes and Dr. Watson. Last week's episode, which I was especially looking forward to, was focused on a death of a man from anthrax and the subsequent threat of its use in a mass casualty setting. 

One glaring factual inaccuracy, however, detracted from my viewing pleasure: on two occasions anthrax was mentioned in connection with quarantine. 

Quarantine, a measure that is scarcely used, is the exclusive province of communicable (i.e. contagious) diseases.

Anthrax is not contagious and the mistaken belief by the public that it is can pose problems during actual events, hampering response and needlessly causing unwarranted panic.

For example, as a medical student doing an ER rotation in New York City during October 2001, at the height of the Amerithrax attacks, I was "locked" down in an ED in which someone exposed to white powder presented. Predictably, no one would believe the medical student (albeit one that was a burgeoning ID physician) that anthrax was not communicable.

Anthrax does a lot of bad things to people but it doesn't spread between them.