Emergency responders should be immunized against anthrax

Emergency responders arrived at Sen. Tom Daschle’s Capitol Hill office on Oct. 15, 2001 suited in personal protective equipment (PPE). One of Daschle’s staffers had opened an anthrax-laced letter, yet another in a string of bioterrorist attacks that tormented the U.S. psyche in the immediate aftermath of 9/11. Nasal swabs taken of those first responders as they exited the building revealed that some had been exposed to anthrax, despite their PPEs and the miniscule amount of spores contained in that letter.

Thus, the question was raised: How can first responders provide necessary medical treatment following an anthrax attack while preserving their own health and safety?

Last Friday at the annual EMS Today Conference in Baltimore, Dr. Thomas Waytes added to the continuing discussion, addressing an audience of EMS personnel on what specific medical countermeasures are available for protecting emergency responders against anthrax bioterrorism. Waytes is a vice president at Emergent BioSolutions, manufacturer of BioThrax, the only currently licensed anthrax vaccine in the U.S.

“In a lot of circles, anthrax is called the poor man’s nuclear bomb,” says Waytes. According to Waytes, merely 6.5 kilograms of anthrax spores, if appropriately distributed, would have the kill potential of a small nuclear bomb, a sobering reality for EMS personnel and first responders to confront, especially considering the relatively easy availability of anthrax.

Because it’s a “naturally-occurring disease,” says Waytes, anthrax can be found from natural sources throughout the world; indeed, areas of Africa and the Middle East have outbreaks of anthrax on a regular basis. Anthrax spores are easy to grow, cheap to produce, well suited for aerosol delivery, completely tasteless and colorless, and resistant to the environment, which means they can last for decades. According to Congress’s bipartisan Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism, the U.S. now has a gap in its anthrax preparedness, compounded by the fact that anthrax can be genetically modified to be antibiotic-resistant.

“You can’t absolutely count on the fact that . . . anthrax is going to be susceptible to the common antibiotics,” says Waytes.

Of greatest concern to EMS personnel and the general American public is inhalational anthrax, caused by breathing in anthrax spores. According to Waytes, even with aggressive medical treatment, the mortality range can reach upwards of 90 percent. In the 2001 attacks, of the 22 cases of anthrax confirmed, 11 were inhalational, with five of those cases being fatal.

For EMS on the scene, PPEs aren’t always enough to prevent inhalation. And while anthrax itself isn’t contagious, spores residing on clothing or skin can be passed to EMS workers who come into physical contact with carriers.

“The most effective way to protect people against anthrax is to immunize people pre-exposure,” says Waytes.

The military has been immunizing service men and women since 1998, and the Department of Health and Human Services (HHS) has a biodefense strategy predicated on the possibility of two major metropolitan areas getting hit with anthrax. They estimate that up to 25 million people would be exposed to anthrax; their goal, then, is to build up a national stockpile of 75 million doses of anthrax vaccine (three per person). But HHS has not distributed the vaccine widely to emergency responders, says Waytes.

But with unused doses of already purchased anthrax vaccine sitting in the Strategic National Stockpile and reaching their expiry date (the vaccine has a four-year shelf life), Waytes thinks the time is right to take some of these expiring doses and make them available free to EMS personnel.

“You shouldn’t routinely say that all emergency responders should be immunized, but there are groups that may find themselves at increased risk of exposure,” says Waytes. “These are the people that should be identified. Give them the benefit of pre-exposure immunization.”

Such people include environmental sampling and hazmat teams, as well as EMS and fire rescue personnel. At Michigan State University, members of their campus security that have to respond to white powders are immunized with the vaccine. According to Waytes, it’s the first university that has pre-protected emergency personnel on their university police team.

Ultimately, for Waytes, the key to providing effective emergency response to an anthrax attack while keeping EMS personnel safe is to anticipate another attack.

“We need to understand that certain people in certain occupations may be at increased risk for exposure,” says Waytes. “Identify those people at higher risk and offer them pre-exposure immunization.”