http://www.cnn.com/2001/COMMUNITY/10/05/gupta/index.html

Dr. Sanjay Gupta: What is anthrax?

October 5, 2001 Posted: 3:44 PM EDT (1944 GMT)

Dr. Sanjay Gupta is a CNN medical correspondent. Gupta, a practicing neurosurgeon, contributes health news stories to CNN.com. He joined the CNN.com chat room from CNN Center in Atlanta.

CNN: Welcome to CNN.com Newsroom, Dr. Sanjay Gupta. Thank you for being with us today.

GUPTA: Good afternoon, everyone, from Atlanta. I'm anxious to hear your questions.

CNN: Dr. Gupta, what is anthrax? And terrorism aside, what are the ways that people can contract it?

GUPTA: Anthrax is a bacteria that forms spores that we've known about for a long time. In fact, anthrax was categorized as one of the first occupational hazards of ancient wool-sorters. It was a much more common infection years ago, but we've had very few natural cases over the last hundred years. Anthrax typically infects the skin in more than 95 percent of cases. It can also affect the GI tract, or actually be breathed in as inhalational anthrax. There have only been 18 confirmed inhalational cases from 1900 to 1976, and not a single case, before yesterday, over the last 25 years. Typically, the way people get it now is through the handling of animals or soil that contain the bacteria and its spores.

CHAT PARTICIPANT: Is it true anthrax is really not detectable, and when you get sick is when you first know you have it?

GUPTA: For the most part, that is true. Some of the early symptoms may be vague, and resemble flu-like symptoms. It is a duty of the public health system to screen people in areas where anthrax is known to exist, so that people can be found before symptoms develop. CHAT PARTICIPANT: Are there any particular signs or preventative measures we can take to ensure our safety and that of our loved ones?

GUPTA: There are no particular safeguards with this particular bacteria, as there are none with most bacteria. Most of what we do know, regarding treatment for anthrax is based on laboratory studies and animal studies. The reason human trials don't exist is because that would require exposing people to a potentially deadly bacteria. At this point, there is more that we don't know than we do.

CHAT PARTICIPANT: Is anthrax airborne and if so would you explain the difference between airborne disease and other diseases? GUPTA: I want to be clear about a couple of terms that get thrown around with regards to anthrax. When we talk about anthrax as a bioterrorism weapon, that usually refers to the "weaponizing" of anthrax. This involves obtaining anthrax, drying it, and grinding it up into very small particles. This is a very difficult process, and oftentimes, the bacteria is rendered inactive in the process. Specifically, regarding "airborne," it means that the bacteria itself can persist in the air, and be transmitted in the air. But that does NOT mean that humans spread it to each other. Airborne does not necessarily imply contagious, as anthrax is not contagious.

CHAT PARTICIPANT: Dr. Gupta, how long does the vaccine last? And is it 100% preventive?

GUPTA: From what we know of the vaccine at this point, it is about 93 percent effective. There is only one company making it, located in Lansing, Michigan. At this point, the shot sequence includes shots at 0, two, and four weeks, and again at six months, 12 months and 18 months. Booster shots are also recommended annually after that.

CHAT PARTICIPANT: How long does it take to manifest symptoms?

GUPTA: The usual course for someone infected is that they'll develop symptoms within one to six days. They'll often get a temporary recovery, then have a worsening of symptoms after that. That's a typical course. As I said earlier, sometimes the symptoms can take weeks, if the spores don't germinate right away.

CHAT PARTICIPANT: But what does it physically do to humans?

GUPTA: There is a misconception that anthrax causes pneumonia. This is not typical, in terms of the actual effect on humans. Typically, inhalational anthrax will get into the smallest part of the lungs, called the alveoli, because the particles are usually less than a few microns in size. From there, anthrax often releases toxins that can affect the lymphatic system, and ultimately seep into the blood. In more than half the cases, the infection will also spread to the brain. The specific cause of death from anthrax is related to breathing difficulties, but mainly to overwhelming uncontrollable infection, also known as sepsis.

CNN: What kind of investigation are health officials conducting regarding the man in Florida?

GUPTA: From what I've heard, and the public health teams have certainly been involved with this case. They are going down and investigating all the locations where he may have acquired anthrax, and possibly screening others who may have been exposed.

CNN: Do you have any final thoughts for us today?

GUPTA: Certainly, there is a lot of justified fear over bioterroristic activities, and I think many would agree that it would be a strange coincidence that we've had our first case of inhaled anthrax in over 25 years, with everything else that's going on. Having said that, it's also important to keep in mind that the public health systems, along with medical hospitals, are very sensitive to this possible infection. Because of the fact that we're really looking for it, it may be easier to find. To be more specific, some would argue that we did have more cases of anthrax over the last years, but they're often named as unknowns, since anthrax was such an obscure possibility. We may see more cases, as our screening is heightened, but that won't necessarily mean terrorism. The public health system deserves mention in this case, since they were able to find it, diagnose it, and treat it, despite the fact that no one has seen it in over a quarter of a century.

CNN: Thank you for joining us today, Dr. Sanjay Gupta.

Dr. Sanjay Gupta joined CNN.com via telephone from CNN Center in Atlanta. This an edited transcript of the interview, which took place on Friday, October 05, 2001.

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