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a) To be quite honest, the most shocking thing I learned about Anthrax was that it was actually a bacteria, Bacillus anthracis. Prior to my deployment, I had to get the anthrax vaccine, which was absolutely the most painful vaccine I've ever had (yes, worse than COVID, smallpox, or the penicillin shot), but I didn't put too much thought into what it was. Then to learn that it caused an infection that could have roots back to biblical times was astounding to me. I'm definitely grateful for modern science because anthrax is certainly not the way I'd want to go.

b) I was surprised how quickly anthrax kills someone, especially if it is inhaled. I'd read one case study from the 1800's that depicted the patients progress from exposure to their death, which took 7 days. It progressed so rapidly, basically from a cold with a painless sore, to delirium, epigastric distress followed by death (A.M. Macher, 2002).

c) I think that the full impact of anthrax didn't hit me until I read about what anthrax does to the body. As mentioned in part b, reading about how the disease progresses in the human body and how quickly it was able to take a perfectly healthy individual and bring them to their untimely death really put anthrax into perspective for me. I think it would have been a valuable addition to the Padlet assignment.

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Padlet 1: Pick a Disease of Study 7.16.2023

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Padlet 1: Pick a Disease of Study 7.16.2023

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Common Name: Anthrax
Scientific Name: Bacillus anthracis

Kingdom: Bacteria
Phylum: Firmicutes
Class: Bacilli
Order: Bacillales
Family: Bacillaceae
Genus: Bacillus
Species: B. anthracis

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a) Two plasmids contribute to the virulence of Anthrax, pXO1 and pXO2. pXO1 is responsible for encoding the Anthrax toxin, while pXO2 carries the genes that synthesize and degrade the capsule, where pathogenic activity is expressed. Without pXO1 and pXO2, Anthrax loses its virulence. Without pXO1, there is no production of toxins, and without pXO2, the bacteria are easily targeted by the body's phagocytotic processes (Fasanella, 2013). There are three different types of Anthrax, all with different mortality rates. The least fatal is the cutaneous, which has a 20% mortality rate. Then gastrointestinal with a 50% mortality rate, followed by inhalation, which is almost always fatal (Center for Biologics Evaluation and Research, 2023).
The only numerical data I was able to find was mortality rates in a district of Ghana. Using this data, I found that the average CFR rate between 2006 and 2014 in this district was approximately 43% (Blackburn et al., 2021).

b) Again, using the numerical data from Ghana tracking mortality rates from a single district between 2006 and 2014 and creating a graph from the provided data, it appears that the CFR value is increasing over time. Using this data, we can say that virulence increased over time. An estimated 1.8 billion people are at risk worldwide since they reside in areas that are especially susceptible to Anthrax. Anthrax is able to lay dormant without a host for many years, so spores can reemerge after long periods of time and cause infection. Another study looking at the number of reported cases of Anthrax in animals in Europe from 2013-2023 saw the highest number of recorded cases in 2016, 2018, and 2021 (Kozytska et al., 2023). Since Anthrax is a zoonotic infection, it is reasonable to correlate human CFR with an increase in reported animal cases and conclude that Anthrax virulence is increasing.

c) "Virulence is the harm done by a pathogen to the host following an infection" (Michels, n.d.).

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a) Anthrax can be found worldwide, but it is typically found in Central and South America, sub-Saharan Africa, central and southwestern Asia, southern and Eastern Europe, and the Caribbean. It is generally found in agricultural areas, and because of this, there have even been outbreaks in the United States. However, it predominantly affects developing countries without access to veterinary care.
The largest recorded outbreak of Anthrax was in 1979 in Sverdlovsk, Union of Soviet Socialist Republics. During this outbreak, it was found to be a narrow zone approximately 4 km long that went from the southern limit of the city to the microbiology facility located on the military base.

b) The 1979 outbreak lasted for 6 weeks, thought to span from April 4 to May 15. Most of the infected lived and worked in the city's southern region. The ones that lived outside of the south region of the city had recently undergone Military Reserve training during the first week of April.

c) During the Sverdlovsk, Union of Soviet Socialist Republics outbreak, there were 77 infected individuals. Of the 77, 66 patients died, and 11 survived.

d) The caption for the map linked above, "Probable locations of patients when exposed. The part of the city shown in the photograph is enclosed by a rectangle in the inset. Case numbers, in red, correspond to those in Table 1 [not included] and indicate probable daytime locations of patients during the period 2 to April 6 1979. Of the 66 patients mapped as explained in the text, 62 mapped in the area shown. This distribution may be somewhat biased against residence locations, because daytime workers not on vacation who both resided and worked in the high-risk zone are mapped at their workplaces. Proceeding from north to south, Compound 19, Compound 32, and the ceramics factory are outlined in yellow. The five patients residing in Compound 32 are mapped at their apartments. Within the compound, the placement of an additional, part-time resident and of the five reservists is arbitrary, as is that of the five residents and a nonresident employee in Compound 19. Patients known to have worked in the ceramics pipe shop are mapped in the eastern part of the factory area, where the pipe shop is located. Calculated contours of constant dosage are shown in black. Approximately 7000 people lived in the area bounded by the outermost contour of constant dosage, Compound 32, and the ceramics factory. The terrain slopes gently downward by about 40 m from Compound 19 to the ceramics factory" (Meselson et al., 1994).

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a) Anthrax is believed to have been around since 700 BC in Egypt and Mesopotamia. It could actually be the cause of the fifth plague, which affected horses, cattle, sheep, camels, and oxen. It may have even been present in Ancient Rome and Greece, making a debut in The Iliad by Homer and poems by Virgil. Some even speculate that it could have ties leading to the Roman Empire's collapse. However, it first appeared in medical texts in 1752 by Maret and in 1769 by Fournier.

b) Anthrax is an infection caused by a bacteria known as Bacillus anthracis. This bacteria is gram-positive and rod-shaped. It is a naturally occurring bacteria that is found in soil and predominantly affects animals worldwide.

c) Anthrax is considered a zoonotic infection. This means that it is able to be transferred from animals to humans. People become infected with anthrax by coming into contact with either infected animals or contaminated animal products.

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a) The only way to confirm anthrax diagnosis is to measure antibodies or toxins in the blood or to take a sample from either blood, skin lesion, spinal fluid, or respiratory secretions and test for Bacillus anthracis. This must be done prior to the administration of antibiotics. Laboratories within the United States are equipped to quickly identify anthrax, especially due to the use of anthrax as a biological weapon.

b) In America one of the biggest changes to the medical field was the creation of the Laboratory Response Network (LRN). This was concocted by the Department of Health and Human Services, CDC, FBI, and Association of Public Health and Laboratories. It serves as a way to link all state laboratories to quickly identify biological threats, such as anthrax, and it plays a large role in emergency response planning.

c) In 1877 Robert Koch used Bacillus anthracis to inject into animals and observed how it caused disease. From these experiments he created Koch's Postulates, which are still used today. Following Koch's work, in 1881 Louis Pasteur worked to create a vaccine for anthrax that he created with a weakened anthrax bacteria. When exposed to the live bacteria, the animals that had received both rounds of the vaccine survived. 1937 Max Sterne created a live spore vaccine for livestock, which is still widely used today. This in conjunction with the implementation of better animal processing procedures have drastically reduced the amount of anthrax cases. In the 1950's a vaccine was created and trialed on humans, demonstrating a 92.5% efficacy against cutaneous anthrax. Then, in the 1970s a newer human vaccine was introduced and is still used today.

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Padlet 6: Leadership Response 08.06.2023

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Padlet 6: Leadership Response 08.06.2023

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a) There is evidence as early as 1914 that anthrax was utilized as a biological weapon by the German army. In 1925 the "Geneva Protocol for the Prevention of the Use in War of Asphyxiating, Poisonous or other Gases" attempted to limit its use by putting a treaty into place (CDC, n.d.). However, countries quickly found loopholes in the treaty and continued to research biological weapons. In 1942 the United States had more than 5,000 bombs filled with anthrax for use against the Germans. In a proof of concept, Great Britain placed 80 sheep on Gruinard Island and released a bomb, killing all 80 sheep and making the island uninhabitable until 1986 when it was disinfected. During the Korean War, the United States expanded their biological weapons program and worked to develop vaccines and treatment to protect their military against biological agents. In 1969 the biological weapon program was terminated by Nixon, converting research efforts purely towards vaccines, treatments, and diagnostic testing. The 1972 Convention on the Prohibition of the Development, Production, and Stockpiling of Biological and Toxin Weapons and on Their Destruction formed a similar treaty and was signed by more than 100 nations. In 2001, letters filled with anthrax spores were mailed to two U.S. Senators' offices and news media agencies. 22 people got infected, 5 of whom died.

b) Unfortunately, leadership's primary innovations regarding anthrax were used towards the creation of biological weapons, such as bombs.  However, research was also devoted to treatments and vaccines for Anthrax due to the imminent threat of it's use as a biological agent. In 1944 penicillin was used to treat anthrax and that replaced all previous treatments. Then in the 1950s a human vaccine was released and again in the 1970s. In 1999 the Laboratory Response Network was developed to respond to biological and chemical threats. It has since expanded to include local public health, veterinary, military, and international labs, which is a new approach to public health.

c) Overall, I believe that world leadership could have handled anthrax better. With the ongoing World Wars and general paranoia, there was unnecessary time and money invested in the creation of biological weapons, which have since been destroyed.

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a) Due to the threat of anthrax as a bioweapon and the 2001 bioterrorist attack, there is a lot of fear and anxiety surrounding anthrax. For staff at Capitol Hill following the attack period, there was a 24.9% increase in psychiatric disorders such as PTSD, depression, panic disorder, anxiety, and alcohol use (North et al., 2009).

b) After the 2001 bioterrorist attacks involving the mailing of anthrax to Senators and News Stations, the U.S. Postal system increased their surveillance and enhanced their screening procedures. This included implementing trainings to promote readiness and responsiveness to future attacks. Biohazard Detection Systems were recommended for all mail processing facilities.

c) Many countries started developing their own biological weapons, resulting in the implementation of treaties to prevent further harm from being done. A silver lining to the creation of biological weapons was that a lot of time and money went into researching biological agents allowing for further development of vaccines and treatments. Koch's Postulates were also formulated using Bacillus anthracis which still holds validity within the scientific community today.

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Anthrax. (2012, May 30). European Centre for Disease Prevention and Control. https://www.ecdc.europa.eu/en/anthrax#:~:text=Anthrax%20is%20a%20zoonotic%20disease,spore%2Dproducing%20bacterium%20Bacillus%20anthracis.

Anthrax Infection Diagnosis & Testing | CDC. (n.d.). https://www.cdc.gov/anthrax/lab-testing/index.html

Anthrax (malignant edema, woolsorters’ disease). (n.d.). https://www.health.ny.gov/diseases/communicable/anthrax/fact_sheet.htm#:~:text=It%20is%20more%20common%20in,Middle%20East)%20than%20in%20others.

Bacillus_anthracis. (n.d.). https://www.bionity.com/en/encyclopedia/Bacillus_anthracis.html#:~:text=Binomial%20name,bacterium%20of%20the%20genus%20Bacillus.

Blackburn, J. K., Kenu, E., Asiedu-Bekoe, F., Sarkodie, B., Kracalik, I., Bower, W. A., Stoddard, R. A., & Traxler, R. M. (2021). High Case-Fatality Rate for human anthrax, Northern Ghana, 2005–2016. Emerging Infectious Diseases, 27(4), 1216–1219. https://doi.org/10.3201/eid2704.204496

Center For Biologics Evaluation And Research. (2023). Anthrax. U.S. Food And Drug Administration. https://www.fda.gov/vaccines-blood-biologics/vaccines/anthrax#:~:text=The%20death%20rates%20from%20anthrax,be%20treated%20with%20certain%20antibiotics.

Fasanella, A. (2013). Bacillus anthracis, virulence factors, PCR, and interpretation of results. Virulence, 4(8), 659–660. https://doi.org/10.4161/viru.26517

History of Anthrax | CDC. (n.d.). https://www.cdc.gov/anthrax/basics/anthrax-history.html#:~:text=Anthrax%20is%20thought%20to%20have,%2C%20sheep%2C%20camels%20and%20oxen.

Kozytska, T., Bassiouny, M., Chechet, O., Ordynska, D., Galante, D., Neubauer, H., & Wareth, G. (2023). Retrospective Analysis of Official Data on Anthrax in Europe with a Special Reference to Ukraine. Microorganisms, 11(5), 1294. https://doi.org/10.3390/microorganisms11051294

Laboratory Response Network (LRN)|CDC. (n.d.). https://emergency.cdc.gov/lrn/

Macher, A. (2002). An Industry-Related Outbreak of Human Anthrax: Massachusetts, 1868. Emerging Infectious Diseases. https://doi.org/10.3201/eid0810.010509

Meselson, M., Guillemin, J., Hugh-Jones, M., Langmuir, A., Popova, I., Shelokov, A., & Yampolskaya, O. V. (1994). The Sverdlovsk anthrax outbreak of 1979. Science, 266(5188), 1202–1208. https://doi.org/10.1126/science.7973702

Michels, K. (n.d.). Lecture 7. Evolution of Virulence [Video]. https://d2l.arizona.edu/d2l/le/content/1292342/viewContent/14474955/View

North, C. S., Pfefferbaum, B., Vythilingam, M., Martin, G. J., Schorr, J. K., Boudreaux, A. S., Spitznagel, E. L., & Hong, B. A. (2009). Exposure to Bioterrorism and Mental Health Response among Staff on Capitol Hill. Biosecurity and Bioterrorism-biodefense Strategy Practice and Science, 7(4), 379–388. https://doi.org/10.1089/bsp.2009.0031

The U.S. Postal Inspection Service Looks Back At the 20th Anniversary of the Anthrax Mailings – United States Postal Inspection Service. (n.d.). https://www.uspis.gov/press-release-anthrax-mailing-20th-anniversary

What is Anthrax? | CDC. (n.d.). https://www.cdc.gov/anthrax/basics/index.html