CDC Guidelines for Handling the Anthrax Threat

HOW TO HANDLE ANTHRAX AND OTHER BIOLOGICAL AGENT

THREATS - CDC Health Advisory

Recently, many facilities in communities around the world have received anthrax threat letters. Most were empty envelopes; some of them contained powdery substances. The purpose of these guidelines is to recommend procedures for handling such incidents.

DO NOT PANIC

1. Anthrax organisms can cause infection in the skin, gastrointestinal system, or the lungs. To do so, the organism must be rubbed into abraded skin, swallowed, or inhaled as a fine, aerosolized mist. Disease can be prevented after exposure to anthrax spores by early treatment with the appropriate antibiotics. ANTHRAX IS NOT SPREAD FROM ONE PERSON TO ANOTHER.
2. For anthrax to be effective as a covert agent, it must be aerosolized into vary small particles. This is difficult to do, and requires a great deal of technical skill and special equipment. If these small particles are inhaled, life-threatening lung infection can occur, but prompt recognition and treatment are effective.
3. If a suspicious unopened letter or package MARKED WITH A THREATENING MESSAGE, SUCH AS "ANTHRAX", is received.
4. Do not open, shake or empty the contents of this suspicious envelope or package.
5. PLACE the envelope or package in a plastic bag or some other type of container to prevent leakage of contents.
6. If you do not have any container, then COVER the envelope or package with anything (e.g., clothing, paper, trash can, etc.) and do not remove this cover.
7. Then LEAVE the room and CLOSE the door, or section off the area to prevent others from entering (i.e. keep others away).
8. WASH your hands with soap and water to prevent spreading any powder to your face.
9. What to do next :
10. If you are at HOME, then report the incident to a physician, hospital emergency room.
11. If you are at WORK, then report the incident to your supervisor, who will immediately inform infection control and refer them to ER.
12. LIST all people who were in the room or area when this suspicious letter or package was recognized. Give this list to your supervisor and infection control.

If you receive an envelope with powder and the powder spills out onto surface:

1. DO NOT try to CLEAN UP the powder. COVER the spilled contents immediately with anything (e.g., clothing, paper, trash can, etc.) and do not remove this cover!
2. Then LEAVE the room and CLOSE the door, or section off the area to prevent others from entering (i.e., keep others away).
3. WASH your hands with soap and water to prevent spreading any powder to your face.
   What to do next:
4. REMOVE heavily contaminated clothing as soon as possible and place in a plastic bag or some other container that can be sealed. This clothing bag should be give to emergency responders for proper handling.
5. SHOWER with soap and water as soon as possible. Do not use bleach or other disinfectants on your skin.
6. If possible, list all the people who were in the room or area, especially those who had actual contact with the powder. Give this list to both the local public health authorities so that proper instruction can be given for medical follow-up, and to law enforcement officials for further investigations.

QUESTION OF ROOM CONTAMINATION BY AEROSOLIZATION:

For example: a small device is triggered, warning that the air handling system in contaminated, or warning that a biological agent is released in a public space.

1. Turn off local fans or ventilation units in the area.
2. LEAVE area immediately.
3. CLOSE the door, or section off the area to prevent others from entering (i.e., keep others away).
   What to do next..
4. SHUT down air handling system in the building.
5. If possible, list all the people who were in the room or area. Give this list to both the local public health authorities so that proper instructions can be given for medical follow-up, and to law enforcement officials for further investigation.

HOW TO IDENTIFY SUSPICIOUS PACKAGES AND LETTERS

Some characteristics of suspicious packages and letters include the following:

• Excessive postage
• Handwritten or poorly typed addresses
• Incorrect titles
• Title, but no name
• Misspellings of common words
• Oily stains, discolourations or odour
• No return address
• Excessive weight
• Lopsided or uneven envelope
• Protruding wires or aluminium foil
• Excessive security material such as masking tape, string, etc.
• Visual distractions
• Ticking sound
• Marked with restrictive endorsements, such as "Personal" or "Confidential"
• Shows a city or province in the postmark that does not match the return address