White Powder in the Mail

1. White Powder in the Mail Is it anthrax? How can you tell? What do you do?

2. What is Anthrax? • Bacillus Anthracis • Spores • Bacteria

3. Knight Ridder/Tribune News/UCLA School of Public Health Dept. of Epidemiology

4. What Diseases are Caused by Anthrax? • Cutaneous • Most common naturally occurring form • Low mortality • Gastrointestinal • Results from eating contaminated, undercooked meat • Up to 50% mortality if untreated • Inhalational • Most likely in bioterrorism • High mortality without prompt treatment

5. Inhalation Anthrax • Onset of symptoms 2 days up to 60 days post-exposure • Antibiotics most effective before onset of symptoms • LD50 about 8000 spores • Infective dose probably less than 10 spores in susceptible persons

6. History of Anthrax • Biblical plagues • Fifth and Sixth Plagues in Exodus Believed to be Anthrax • Animal disease • Endemic to horses, cows, goats, sheep • Economically important agricultural disease

7. Natural Incidence of Anthrax • Most common in temperate agricultural regions • Rare in US • More common in India and southern Africa • Human infection unusual • 95% is cutaneous • Result of contact with infected animals

8. Naturally Occurring Human Anthrax • Endemic in south/central Asia, central America, southern Africa • Several thousand human cases each year • Always associated with livestock • Often associated with war • Largest human outbreak Zimbabwe 1978-1980

9. Development of Anthrax as a Biological Weapon • Historical use • US and UK Development • Soviet Development

10. Sverdlovsk Outbreak, 1979 • Spores accidentally released from army microbiology lab • 96 Infected, 66 Dead • All victims lived or worked in a narrow band downwind from lab • Human casualties within 4 km • Animal deaths extended to 50 km downwind

11. Late 1990s: Rising incidence of Mailed Anthrax Hoaxes

12. ...the hundreds of anthrax hoaxes involving envelopes filled with harmless powders lack a plausible delivery system and hence are more of a nuisance than a serious danger. Jonathan Tucker Toxic Terror: Assessing Terrorist Use of Chemical and Biological Weapons, 2000

15. The Anthrax Letters • Five Known Letters to Media and Political Targets • Four letters recovered, mailed on two dates from Trenton, NJ • Letters Contained ~1g anthrax • Fine particle size • Treated to Enhance Dispersion

16. Anthrax Letters: Effects • Anthrax in Second Mailing • <5 micron size • Escaped through pores in envelopes • Contamination throughout US postal service • Cross-contamination to many other letters • Most illnesses and all but one death resulted from spores leaking through envelopes

17. Anthrax Letters: Casualties • 5 dead from inhalational anthrax • 17 ill • 11 cutaneous • 6 inhalational • 10000 people taking antibiotics • All but few survivors still suffering effects

18. Anthrax Letters: Effect on Business • >500 reports of anthrax per day • Investigations • Facility Closures • Side Effects from Cipro • 57% reported serious side effects • 26% missed work

19. Anthrax Letters: Cleanup Costs • AMI Building in Boca Raton remains shuttered • Clean-up of Hart Senate Office Building cost $41.7 million • Building was closed for three months • 23 US Postal Service Facilities Contaminated • Clean-up costs estimated at $800 million

20. Hoaxes and Suspicious Packages Post 9/11 • 2001 before 9/11, 368 incidents, including one simultaneous mailing of 350 letters • 2001 after 9/11, 7089 hoaxes and other reports of suspicious substances

21. Hoaxes and Suspicious Packages Post 9/11 • 2001 before 9/11, 368 incidents, including one simultaneous mailing of 350 letters • 2001 after 9/11, 7089 hoaxes and other reports of suspicious substances

22. After the Anthrax Mailings, Everything is Taken Seriously • Any suspicious powder received full response • FBI director reported that agents responded to over 29,000 reports in the year following the attack • Practical jokes and powdered sugar merited hazmat crews • Attacks inspired other hoaxers

23. Suspicious Powder: Response • First Responders including hazmat teams and FBI arrive • Area is evacuated and possibly closed • Field tests are done • If positive, those exposed are decontaminated • Suspicious package is sent to CDC-certified lab for testing

24. Hoaxes Continue Today • FBI's National Capital Response Squad responds to 5-10 reports per week of suspicious substances in Washington area • U.S. Capitol Police respond to 3-10 reports per day on Capitol Hill Washington Post, 13 April 2004

25. Sometimes the Threat is Real • Ricin in ‘Fallen Angel’ Letters • Intercepted at mail handling facility Greenville SC 10/03 • Intercepted at White House mail handling facility Washington DC 11/03 • Ricin in Senator Frist’s Office 2/04 • No source letter found

26. USPS Guidelines for Suspicious Mail

27. What to do if you see Suspicious Powder • If parcel is closed, don’t open or shake it • Isolate area of package or powder • Turn off fans or ventilation units and shut down the air handling system in the building • Keep track of who has had contact with the powder • Call 911

28. Would USPS Guidelines Have Helped to Recognize Anthrax Letters?

29. USPS Protective Measures • Procedures • Off-site handling for potential targets • Irradiation of Government Mail • Hazardous material detection • BDS in distribution centers • Detects anthrax only • Can potentially be modified to detect other hazards

30. What Your Company Can Do to Protect Itself • Establish mail handling procedures • Establish policies in case of discovery of powder • Include in emergency action plan • Evaluate risk level • Establish plan for keeping business operating in case of facility closure • Clean-up plan • Back-ups of important documents

31. Selected References • Office of the Surgeon General, US Army Medical Aspects of Chemical and Biological Warfare. Washington 1997 • Centers for Disease Control and Prevention, Emergency Preparedness Website http://www.bt.cdc.gov/agent/anthrax/index.asp • Cole, Leonard A. The Anthrax Letters: A Medical Detective Story. Washington: Joseph Henry Press 2003 • Meselson, Matthew et al. “The Sverdlovsk Anthrax Outbreak of 1979” Science, November 18,1994 • Tucker, Jonathan Toxic Terror: Assessing Terrorist Use of Chemical and Biological Weapons Cambridge: Belfer Center 2000