You inhaled anthrax and survived÷what do you do now?

Meryl Nass, MD

Thousands of people were exposed to potentially lethal anthrax spores in the last 2 ö 3 months.Ê Those who are known to have inhaled spores were given antibiotics to prevent infection.Ê Some exposures were undetected. It is still uncertain how the two deceased women in NYC and Connecticut were exposed, and how many spores postal workers, Senate staffers and others may have inhaled.Ê No one has yet provided the media with an estimate of how many spores of this weaponized anthrax preparation it takes to induce illness.

When people were treated early for suspected anthrax disease, or for exposure to spores without illness, survival was extremely high.Ê In fact, survival in those treated before becoming ill remains 100%.Ê Since medicine virtually never bats a thousand, the survival rate using antibiotics has been incredibly good, much better than suggested by past animal studies.

Recent reports by Dr. Gregory Knudson at the Armed Forces Radiobiology Research Institute showed that growing a strain of anthrax in solutions containing low concentrations of antibiotics creates resistance to doxycycline, ciprofloxacin and other antibiotics.Ê This is no surprise -ö the researchers used a well known method to cause bacterial resistance.Ê Is this information relevant to those on prophylactic antibiotics?Ê Does it imply that you need to do something different, even though no one using antibiotics has struck out yet?

To further complicate matters, the Centers for Disease Control (CDC) has recently announced that scientists have recalculated spore exposures, and now believe that some people may have inhaled 3,000 times the lethal dose of spores.Ê That is a scary number.Ê What does this mean in terms of optimizing prevention?Ê How did they come up with this number, when they donât seem to know what a lethal dose is, and canât tell how many spores entered peoplesâ lungs?

Experiments done by Dr. Arthur Friedlander at Fort Detrick, Maryland showed that giving monkeys 30 days of antibiotics after inhaling lethal doses of anthrax led to 70-90% survival rates. Ten monkeys were vaccinated at the same time, were not given antibiotics, and 20% survived.Ê

After the 30 days, antibiotics were stopped, and the surviving monkeys were simply observed.Ê Another 20% of the survivors slowly developed anthrax, and died.Ê Autopsies revealed that ungerminated spores remained in their lungs, and it has been assumed that these spores germinated after antibiotics were stopped, causing infection and death.Ê (While in the spore form, anthrax bacteria are unaffected by antibiotics.Ê Only after they germinate and start to grow do antibiotics kill them.)

What does this experiment tell us?Ê

First, antibiotics seem to have worked much better in humans than in the monkeys.Ê Or perhaps, the humans did not breathe in nearly as many lethal doses as CDC thinks they did.Ê Since the number of surviving spores continues to decline after exposure, at some point you will no longer be at risk of developing the disease.

Ê Second, it takes 4-6 weeks before the vaccinations produce immunity.Ê If you get vaccinated now, it will be weeks before you benefit.Ê Even then, it is not known to what extent you will be protected.Ê In some species, such as mice, only 10% survived whenÊ exposed to Ames spores many weeks after vaccination .

CDC has said you need to take antibiotics for 100 days, the point at which the risk from remaining spores becomes negligible.Ê Yet the vaccine will only really start working after three vaccine doses, which will be about 100 days after exposure.Ê That means it may start protecting you when the risk is minimal or nonexistent.

Third, the fact that monkeys died after antibiotics were stopped does not mean that humans will do the same thing. ÊIf humans get sick, they will not simply be observed ö they will be aggressively treated for anthrax.Ê CDC has recommended using 3 antibiotics simultaneously for anthrax infections.Ê This led to high survival rates in those who became ill with anthrax.Ê The ãtriple antibioticä treatment will also circumvent problems with antibiotic resistance.Ê

I personally find the issue of antibiotic resistance overblown.Ê If resistance had been developing, people on prophylactic antibiotics would have become ill with anthrax.Ê None have done so.Ê I also am not overly concerned about adverse effects from long-term antibiotic use, having used long-term antibiotics in Gulf War veterans with excellent results, and few side effects.Ê In fact, the Veterans Administration just completed a study of Gulf War veterans with mycoplasma infections, in which veterans were given doxycycline continuously for 6 months.Ê Naturally, this is not a treatment that should be used willy-nilly.Ê It may cause vaginal yeast infection, abnormal gastrointestinal bacteria, and other problems.Ê But if patients are closely followed by knowledgeable doctors, and if safe supplements such as acidophilus are used to treat or prevent side effects, such antibiotic use need not be unpleasant for patients who need the treatment.

Reportedly, over a thousand of the exposed people stopped antibiotics before sixty days.Ê None have become ill.Ê Furthermore, we now know that treatment soon after symptoms develop is usually lifesaving.Ê (Before October, we thought that inhalation anthrax was a death sentence.)Ê Even Dr. Anthony Fauci, head of NIHâs National Institute of Allergy and Infectious Disease, and a government spokesperson on dealing with the attacks, has pointed out that adding vaccine to antibiotics does not improve on survival rates from antibiotics alone.

But if the vaccine is safe, and it might provide an additional measure of safety, why not take it?Ê The problem is that there is no proof that it is safe, despite the fact that it has been licensed for thirty years.Ê The National Academy of Sciences, asked to comment on its safety last year, reviewed the worldâs literature and reported that there exist no data showing long-term safety.Ê There is a lot of evidence to suggest it is unsafe, including several studies on Gulf War veterans.Ê Many recent vaccine recipients have developed illnesses resembling Gulf War Syndrome, which consists of fatigue, muscle and joint pains, confusion and difficulty concentrating.

What would I do? Take antibiotics for 4-6 months. (Some military experts recommended this plan years ago.)Ê See a doctor who can treat antibiotic side effects if they develop.Ê I recommended in October that it was time to do research on animals to see whether encouraging spore germination, while on antibiotics, would be helpful at preventing late development of anthrax.Ê I also suggested washing out the lungs of anesthetized animals, to see if this could reduce the number of retained spores to a level that would not cause disease.Ê If we had information from experiments like these we might know better how to reduce the risk.Ê

For now, I say stick with the tried and true.Ê Find an antibiotic that does not make you feel ill, and you should be able to relax about anthrax.Ê Alternatively, watch your health very closely for the next several months.Ê If you develop a cough, aching or fever, do get examined immediately.Ê And be sure to tell your doctor you were exposed to anthrax.