ANTHRAX

Other useful links and further reading:

BNF guidance for Anthrax treatment

Things to know at the moment

2nd May 2025: Finally something to add to the Anthrax portal (sadly). Involves a dead cow and a dead man... Thailand reports first anthrax death in decades. Health authorities race to track hundreds of people who may have been exposed to the deadly bacteria

FEB 2017 Green book last updated. I'm taking this as a GOOD sign.

From the Green Book: Sporadic outbreaks of severe anthrax infection have occurred among drug users following injection of heroin contaminated with spores (Scottish Drugs Forum, 2013), and isolated cases of inhalational anthrax have been reported in individuals making drums with imported animal skins (Anaraki et al, 2008; Pullan et al, 2015). Anthrax spores have been released deliberately as biological weapons in the USA (Plotkin, Orenstein and Offit, 2013).

Cutaneous Anthrax lesion. In Greek Anthrax means 'coal' - named after it's black appearance. See more pictures by clicking the photo which will also take you to the source of this photo. Thankyou for the pics immunize.org!!

• Anthrax Vaccine (AVA / AVP) – UK uses Anthrax Vaccine Precipitated (AVP)

• AVP used in the UK does not appear on the EMC (Electronic Medicines Compendium) website because it is an unlicensed product supplied under special authorisation. It is not a routinely marketed, licensed medicine in the same way as other vaccines. It’s used under control of the UKHSA or MoD and available only through special access schemes such as for lab workers, military personnel or as post-exposure prophylaxis (PEP) as part of biodefence plans

• Schedule: 3 doses (0, 3, 6 weeks) + 2 boosters (6 and 12 months) + annual boosters if ongoing risk

• Administered IM or SC

• Not part of routine or travel vaccines—strictly occupational or specialist indication

• Store at 2–8°C

What is Anthrax anyway?

Anthrax is a rare but serious disease caused by the spore-forming bacterium Bacillus anthracis. It primarily affects herbivores like cattle and sheep, but humans can become infected through contact with infected animals or contaminated products. Spores can be found in animal products such as wool, hair, hides, skins, bones and bone meal, and in the carcasses of infected animals. The spores can also contaminate soil and may survive for many years. Anthrax has also been used as a biological weapon.

What happens If you catch it?

There are four recognised forms of anthrax in humans:

• Cutaneous (most common): painless black ulcer with surrounding swelling; can become systemic

• Inhalation: flu-like symptoms progress rapidly to severe breathing problems, sepsis, and often death without treatment

• Gastrointestinal: nausea, vomiting, bloody diarrhoea, and systemic infection

• Injectional: linked to contaminated heroin; causes severe soft tissue infection, often without the classic ulcer, and is frequently fatal

Even cutaneous anthrax can become life-threatening if untreated. Inhalation anthrax has the highest mortality.

How does It Spread?

Through contact with spores—via broken skin, inhalation, or ingestion. No person-to-person spread. Most cases are occupational (e.g. handling animal hides or wool), or linked to contaminated heroin in drug users. Prevention depends on controlling anthrax in livestock and on disinfecting, washing and scouring imported animal products. Processing of hides, wool and bone by tanning, dyeing, carbonising or acid treatment also reduces the risk of infection.

Does getting Anthrax make you Immune?

Infection may offer some immunity, but vaccination is required for long-term protection in high-risk individuals. The vaccine stimulates antibody production against the protective antigen of the bacterium.

Can it be treated?

Yes—with high-dose intravenous antibiotics and, if needed, antitoxin therapy. Early treatment is vital, especially for inhalation anthrax. If untreated, the infection can cause septicaemia, toxaemia or meningitis, and is fatal in around 5% of cases. However, from 4 October to 20 November, 2001, 22 cases of anthrax (11 inhalational, 11 cutaneous) were identified in the US; 5 of the inhalational cases were fatal. Twenty (91%) case-patients were either mail handlers or were exposed to worksites where contaminated mail was processed or received.

Who’s most at risk?

• Laboratory workers handling B. anthracis

• Military personnel in areas of biological threat

• People who handle animal hides, wool, or bone meal

• Drug users (especially in outbreak regions)

• Workers exposed to imported animal products or contaminated soil