Anthrax Outbreak at Remote Russian Outpost

In July 2016 the Russian Army's elite bioterrorism response team was sent to the Yama Peninsula in the far north of the country above the Arctic Circle. First 2350 reindeer died, and then 72 reindeer herders also became sick, a 12-year-old boy dying from a mysterious infection that turned out to be the deadly disease anthrax. 

Russian scientists are not sure how the reindeer and people caught the infection, but the whole peninsula had been enduring searing heat of up to 95 degrees F (35 degrees C), which possibly melted the permafrost over the corpse of a reindeer or of a human who had died of anthrax long ago. The long-dormant spores entered the atmosphere and caused a new outbreak of an old disease.

Just how often are there outbreaks of anthrax?

• Shortly after the 9/11 terror attacks in the United States, there were 22 cases of anthrax contracted by handling intentionally infected mail. Five people who inhaled the dust died.
• In 1979, an accident at a biowarfare defense center in Sverdlosk, also in Russia, resulted in 66 deaths.
• In 1978, failure to vaccinate cattle against the disease in Zimbabwe resulted in 6500 people's becoming infected. Of these, 100 people died.
• In 1976, an American textile worker died after exposure to the bacterium from infected yarn imported from Pakistan. From 1955 to 1994, there were over 250 cases of the disease in the United States, usually in leather workers who were exposed to it while working with cow hides.
• In the late 1950's, up to 100,000 people every year died of anthrax in Asia and Africa, usually after coming in contact with the body of an animal that had died of the disease. 

Survival depends on how quickly doctors recognize the disease and administer antibiotics, and whether the infection is cutaneous, oropharyngeal, intestinal, or inhalational.

• Cutaneous anthrax is an infection of the skin. It develops one to seven days after anthrax spores enter the skin through a bug bite, a scrape, or a cut. First the skin turns black around the infection, and then it dissolves into an open ulcer.
• Oropharyngeal anthrax is an infection of the mouth and throat. It usually occurs after eating contaminated meat. The infected area swells, dies, and becomes covered with a membrane. This is painful and makes breathing difficult. Then there will be dramatic swelling of the lymph nodes, but most people make a full recovery within a month if treated with antibiotics.

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• Intestinal anthrax is rare, and usually occurs after eating contaminated, raw meat. The disease damages the lining of the intestines. It causes severe diarrhea and death from dehydration quickly follows without aggressive treatment with antibiotics and fluid replacement in a hospital.
• Inhalational anthrax is caused by breathing in the spores of the bacteria that cause anthrax. Most cases of inhalational anthrax are not the result of terrorism. More commonly, it occurs after handling contaminated wool, hair, or hides. One to sixty days after exposure there will first be mild fever and general feelings of distress. Later there will be high fever, severe shortness of breath, coughing up blood, and intense chest pain. Death is inevitable without treatment, and about 45 percent of people die even with aggressive treatment.

What You Need to Know About Treatment of Anthrax After You Have Been Exposed 

Exposure to anthrax is common enough that some people get a vaccine for it. These include veterinarians, leather workers, sheep shearers, wool workers, some textile workers, and some members of the military of all the major armed forces. The vaccine does not contain any live bacteria and will not give you the disease. It takes five injections over the course of 18 months to establish immunity to the disease, and an annual shot is needed to maintain immunity to the infection. Shots are given into the muscle, and are painful.

• Ordinarily anthrax vaccine is not supposed to be given after exposure to the disease, although there may be some disaster protocols that allow for post-exposure vaccination when terrorists have used a particularly virulent strain of the bacteria. In these situations, the protocol is to get three shots of the vaccine over a period of four weeks (instead of five shots over a period of 18 months) plus antibiotics for 60 days.
• Homeopathic medications have been developed by the US military for use in emergencies in which there aren't enough medications of other types to go around. These are not preparations based on the "touchy feely" kind of homeopathic practice. They are designed to help the body resist anthrax toxins. 
• It can take up to 60 days after exposure for symptoms to develop. During that time, antibiotics can stop the disease. The preferred drug to prevent development of the infection after exposure is penicillin, although the drugs most commonly mentioned in news reports are Ciprofloxacin (Cipro) and doxycycline (Doryx, Oracea, Monodox, Atridox, Morgidox, Vibra-Tabs, Alodox, Ocudox, Doxy, Acticlate, and Vibramycin). You would not need a doctor's prescription to take these drugs in an emergency situation.

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• There is also an immune globulin called Anthralin for treating the disease in both children and adults. It works in a way similar to gamma-globulin for hepatitis or the globulin shots for rabies. It contains the actual immune substances that fight the disease rather than stimulating the immune system to fight the disease. There are also monoclonal antibodies (obiltoxaximab and raxibacumab) that fight the disease. In a mass emergency, these would likely be in short supply.
• Some people stockpile Ciprofloxacin and doxycycline for your personal protection. Be aware that both antibiotics have serous side effects, especially in children and in women who are pregnant. They may be effective after their expiration date, and chances are that the general public would also be given expired antibiotics that had been tested for efficacy in a mass emergency. However, you can't know for sure that expired antibiotics will save your life if you don't have the means of testing their potency.