Anthrax historical perspective
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
Historical perspective
Ancient Origins of Anthrax
Anthrax is thought to have originated in Egypt and Mesopotamia. Many scholars think that in Moses’ time, during the 10 plagues of Egypt, anthrax may have caused what was known as the fifth plague, described as a sickness affecting horses, cattle, sheep, camels and oxen. Ancient Greece and Rome were also well acquainted with anthrax, and this is illustrated in many of the ancient writings of the most famous scholars from those times. For example, many scholars think anthrax was depicted by Homer in the Iliad from 1230 BC and by Virgil in 70-90 BC. Some even suggest that anthrax may have contributed to the fall of Rome. The first clinical descriptions of cutaneous anthrax were given by Maret in 1752 and Fournier in 1769. Before this, anthrax had only been described through historical accounts.[1]
Koch Postulates
In 1877, scientist Robert Koch studied Bacillus anthracis, the bacterium that causes anthrax. He discovered that the bacteria formed spores that were able to survive for very long periods of time and in many different environments. Koch decided to use anthrax bacteria in one of his most important historical experiments, in which he isolated and grew Bacillus anthracis in pure culture and injected animals with the bacteria. Using what he observed in this study, he described how the microbe he injected into the animals caused the disease. From these studies, he was also able to determine the life cycle of the anthrax bacteria and was able to demonstrate what became known as Koch’s postulates, which demonstrate a causal relationship between a specific microorganism and a disease.[1]
Wool Sorters Disease
During the 1800s, doctors saw cases of anthrax but did not yet have a diagnosis for the disease. During this time, the organism that causes anthrax had not yet been discovered, but doctors had noticed a link between the disease and the animal hair industry. Because of this, the disease became known as “wool sorters disease.” By the middle of the century, early researchers had associated the disease with the presence of rod-shaped bodies that were seen in the blood of infected animals. These bodies were eventually identified as bacteria and given the name Bacillus anthracis.[1]
First Anthrax Vaccine
In 1881, Louis Pasteur, another prominent scientist, took Koch’s work a step further, trying to fully prove how anthrax was spread and how it made people or animals sick. Pasteur also worked to create a vaccine for anthrax. In his experiment, Pasteur gave 25 animals two shots of an anthrax vaccine he had created with weakened anthrax bacteria. After he gave both rounds of the vaccine to these animals, he injected them with live anthrax bacteria. He also injected live bacteria into 25 other animals that had not been vaccinated. Each of the vaccinated animals survived, while the 25 that were not vaccinated died.[1]
Anthrax in the US
Much knowledge was gained about anthrax in the 1800s. As a result, animal and human cases of anthrax in the United States, Britain, and Germany were well documented in the early 1900s. However, there were still places where anthrax cases hadn’t been documented, such as Russia, Asia, India and Africa. Because of the high number of contaminated animal products imported from these countries, however, it was known that anthrax had to be widespread in these regions.[1]
Animal Vaccination Reduces Human Cases
In 1937, Max Sterne successfully created the anthrax live spore vaccine for animals. This vaccine is still used in animals in most countries. Because of the introduction of routine vaccination of animals against anthrax and the improvements in animal product processing procedures, the number of cases of anthrax in humans declined. This decline was so significant that during the entire 20th century there were only 18 cases of inhalation anthrax in the United States.[1]
Penicillin for Anthrax
Penicillin had been discovered in 1928, but it wasn’t until 1944 when it was first used to treat anthrax. Penicillin became the drug of choice for treating anthrax, and it replaced all previous therapies, such as serum therapies and chemotherapies.[1]
First Human Anthrax Vaccine
In 1950, the first anthrax vaccine for humans was created. This anthrax vaccine was tested in a group of goat hair mill workers. Volunteers were given either the vaccine or a placebo (a shot that does not have the vaccine in it). The volunteers were then followed over a 2-year period. This study determined that the vaccine was 92.5% effective in preventing cutaneous anthrax. After the study, the vaccine was made available to people working in goat hair processing mills in the United States.[1]
In 1970, an updated human anthrax vaccine was released, replacing the 1950s vaccine. This is essentially the same vaccine used today.[1]
Drums and Anthrax
In 2006, a drum-maker from New York City got sick while on tour with a dance troupe in Pennsylvania. He had just returned from Africa with four goat skins that he planned to use to make drums. He said that when he processed the goat skins to remove the hair, he did not use chemicals on the skins to kill germs or wear protection while handing the skins. He also reported that while he processed the skins, hair and dust particles floated into the air. Four days after he last had contact with the goat skins, he began having breathing problems and was hospitalized. Five days later he was diagnosed with inhalation anthrax. Public health investigators determined he had been exposed to anthrax while processing the goat skins he brought home from Africa. When he scraped the hair from the skins, the anthrax spores were released into the air and he breathed them in. The spores got into his lungs and caused him to become ill. It was the first time in 30 years that a case of naturally acquired anthrax was reported in the United States.[1]
Gastrointestinal Anthrax in the US
A woman in Connecticut was diagnosed with gastrointestinal anthrax. Public health investigators learned that the woman had participated in a drumming event the day before she became ill. The drums used at the event and the event space were all tested for contamination with anthrax spores. Two animal skin drums were found to have anthrax spores on them, and spores were also found in the room where the drumming took place, and in other rooms in the building. Investigators determined that the spores were released into the air while the contaminated drums were played. After 2 months in the hospital, the woman recovered and was released from the hospital.[1]
New Form of Anthrax
In 2010, a small outbreak of anthrax occurred in the United Kingdom and Germany. All of the patients who came to the hospital were illicit drug users who had used heroin before having symptoms. Anthrax in these patients did not look like typical cutaneous anthrax. Many had swelling and infection of the deeper layers of skin but they didn’t have a raised sore with a black center - the tell-tale sign of cutaneous anthrax. Doctors recognized this anthrax as a new type of anthrax, calling it injection anthrax. Doctors wondered where the anthrax spores came from and how they were injected into the drug users. While no anthrax was found in the heroin itself, the evidence gathered by epidemiologists strongly suggested that was anthrax was in the heroin. Public health officials believe that the anthrax spores were in the heroin and that when the patients injected the drug into their bodies, they also injected anthrax spores.[1]
A Medical Mystery
A retired Florida man and his wife traveled for 3 weeks on a cross-country trip that took them through Wyoming, Montana and the Dakotas. They visited many state parks. The man got sick when they arrived in Minnesota. He went to the emergency room complaining of flu-like symptoms and was originally diagnosed with community-acquired pneumonia. A doctor, who had grown up on a cattle farm and was familiar with anthrax, felt that this diagnosis was not right and ordered more tests. The tests found bacteria in his blood that looked like anthrax bacteria. The samples of his blood were then sent to the Minnesota Public Health laboratory, where his anthrax illness was confirmed. Because the doctors at the hospital were able to quickly diagnose anthrax, the patient got treatment immediately, including a specialized antitoxin (anthrax immunoglobulin) rushed in by the Centers for Disease Control and Prevention. After 3 weeks in the hospital, the patient fully recovered and was sent home.[1]
A case of naturally occurring inhalation anthrax is very rare in the United States, so to rule out any possible bioterrorism threats, the FBI was called in to investigate the case. The FBI determined that the man had inhaled the anthrax spores in a natural environment and there was no threat to anyone else.[1]
Anthrax as Bioterrorism
In 1800, the work of scientist Robert Koch led to the development of more modern microbiology experiments. This increase in more sophisticated experiments also created the knowledge of how to grow and produce large stocks of specific germs.
World War I
In 1900, the first deliberate uses of anthrax as an act of aggression were recorded in the early decades of the 1900s, during World War I. Betwwen 1914 and 1918, there is evidence that the German army used anthrax to secretly infect livestock and animal feed traded to the Allied Nations by neutral partners. An example of this undercover biological warfare was the infection of Argentinian livestock intended for trade with the allied forces, resulting in the death of 200 mules in 1917 and 1918. In 1925, after the many chemical and biological horrors of WWI, a diplomatic attempt was made to limit the use and creation of this kind of warfare. The Geneva Protocol for the Prevention of the Use in War of Asphyxiating, Poisonous or other Gases and Bacteriological Methods of Warfare was created. This treaty was a great step in trying to stop the use of biologic agents during war. However, it did not specifically outlaw the research or production of biologic agents. Many countries agreed to the treaty but then created amendments to allow for use of biologic weapons during retaliation. After the Geneva Convention, interest in anthrax mostly focused on preventing disease in livestock and on improving the Pasteur vaccine.
Anthrax as a Weapon
In 1932, Japan began producing anthrax to be used as a weapon and conducted research with biological weapons in Japanese-occupied Manchuria. During this time, prisoners were infected with anthrax and other deadly diseases. It was later discovered that during this program, the Japanese attacked at least 11 Chinese cities with anthrax and other biological agents by spraying them directly onto homes from aircraft. In 1942, a bioweapons program was started in the United States. The United States conducted experiments with anthrax, among other biologic agents, at testing sites in Mississippi and Utah. More than 5,000 bombs were filled with anthrax in preparation for a response to any possible attacks from Germany. Great Britain also began to experiment with anthrax for bioweapons on a small island off the coast of Scotland called Gruinard Island. They tested the widespread release of anthrax by releasing bombs containing the germ over the island, where 80 sheep had been placed. All of the sheep died from anthrax. One of the most important findings from this experiment was how long anthrax stays in the environment after a release. The island remained uninhabitable until 1986, when Great Britain decided to decontaminate it by killing all of the anthrax spores. After a year of soaking the island in a mixture of formaldehyde and seawater, the island was considered disinfected.
In 1950, during the Korean War, U.S. bioweapon programs were expanded. This expansion included the creation of a program to develop vaccines and treatments to protect troops against biological agents.
In 1960, the United States possessed a large collection of bioweapons, including many types of bacteria, fungi, and toxins. During the late 1960s, there was growing concern, internationally, about the use of biological weapons and the ineffectiveness of the Geneva Protocol. In July of 1968, Great Britain submitted a proposal to the Committee on Disarmament of the United Nations, which would prohibit the development, production, and stockpiling of biological agents. This proposal also outlined the need for inspections for alleged violators. Several months later, The Warsaw Pact nations submitted a similar proposal. In 1969, President Nixon terminated the U.S. bioweapons program through an executive order. This executive order stopped offensive bioweapon research and production of the weapons, and it also called for destruction of the arsenal. The United States also adopted the policy to never use any biological or toxic weapons under any circumstances. After this, research efforts in the United States became solely directed toward the creation of defensive methods like vaccines, treatments, and diagnostic tests for potential biologic threats.