America At War:
Bioterrorism: Anthrax & Smallpox
With Ronald M. Atlas, Ph.D.
Co-chair of the ASM Task Force on Biological Weapons
Thursday, Oct. 11, 2001; 10:30 a.m. EDT

Three employees at a Florida company have now tested positive for the presence of Anthrax. Speculation about how the bacteria entered the building, who brought it there and why continue as the case becomes a criminal investigation. Thus far, the Anthrax has not been linked to the terrorism events of Sept. 11. However, alarmed Americans are stocking up on antibiotics, gas masks and extremely concerned with any flu-like symptoms.

Ronald Atlas, Ph.D., president-elect of the American Society for Microbiology and co-chair of the ASM Task Force on Biological Weapons was online Thursday, Oct. 11 at 10:30 a.m. EDT to talk about bioterrorism.

Dr. Atlas is professor of Biology and Graduate Dean at the University of Louisville. He is a member of the American Academy of Microbiology and was the recipient of the American Society for Microbiology award in Applied and Environmental Sciences. His studies include the development of "suicide vectors" for the containment of genetically engineered microorganisms and the use of gene probes and the polymerase chain reaction for environmental monitoring, including the detection of pathogens and indicator bacteria for water quality monitoring. He received a B.S. degree from the State University of New York at Stony Brook in 1968, an M.S. from Rutgers University in 1970 and a Ph.D. from Rutgers University in 1972.

A transcript follows.

Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.

Pittsville, Md.: Anthrax, an ancient disease, can be traced back many centuries. How does it appear to be evolving, compared to its documented historical virulence? Is it becoming less transmissable, or more or less lethal?

Do you believe the smallpox immunizations we all received in the 1960's and 70's are still providing us the lifelong immunity we had expected?

Ronald Atlas, Ph.D.: Regarding antrax evolution, we really have little evidence for changes in specific strains. Recent studies have shown the mechanism for virulence. If symptoms develop the virulent strains have very high mortality rates.

The smallpox immunizations may not be providing life-long immunity as we expected. If we ever reinstitute smallpox vaccination, which would only be done if there was a "real" threat, we would probably use booster vaccines every five to ten years to ensure continued immunity in the way we do for tetanus.

Wilmington, Del.: Were the strains isolated in Florida tested against all classes of antibiotics, for example the carbapenems like Merrem, and 3rd generation cephs like ceftriaxone, should patients develop meningitis.

Ronald Atlas, Ph.D.: I do not know which anti-microbes this strain was specifically tested against, however, no evidence has immerged for any particular antibiotic resistance for this strain. Unfortunately, once meningitis develops, antibiotic treatment is not particularly effective as evidenced by the first case in Florida.

Pittsville, Md: Preliminary reports indicate this strain of anthrax was discovered as a natural occurence in Ames, Iowa, in the 1950's, and then cultivated as a standard lab research species. Would this indicate that those responsible are merely using a finite legacy supply obtained either by theft or on the black market, rather than a product of a bio-terrorist lab?

Ronald Atlas, Ph.D.: At this point, despite the fact that this is a criminal investigation, the source of the anthrax strain remains unknown. If it proves to be the Ames strain, it could well still be present in many environmental samples. When the investigation is done, hopefully we'll know if it came from a laboratory or another source.

Virginia: What are the differences between biological warfare and bioterrorism?

Ronald Atlas, Ph.D.: Biological warfare occurs when biological agents are used by nations in battles and the targets are the opposing military. Bioterrorism occurs when the targets are civilian populations and the purpose is to terrorize a larger population. Bioterrorism may be state sponsored or may involve cults or other extremist organizations. There are also "biocrimes" where biological agents are targetted against individuals as in an assassination or murder.

Alexandria, Va.: Is there anything that we private citizens ought to be doing to prepare for the possibility that terrorists might attack Washington with chemical or biological weapons?

Fleeing to West Virginia is of course one option, but I would hope there are other less drastic ones.

Ronald Atlas, Ph.D.: Individuals should be remaining very calm. Despite the death of one individual in Florida, the situation actually demonstrates how well the Public Health System is working. The first case was quickly identified. The site of exposure was rapidly found. People who might have been exposed were notified and receiving prophylactic doses of antibiotics. During the last few years, the CDC and public health authorities have been preparing. The key for an individual, whenever they experience an illness, is to consult his or her physician. That really is what each of us should be doing.

Greenbelt, Md: Hi--

I'd like to ask you a few questions about 'Marburg virus'.

I was watching CBS News last week and they mentioned that Iraq had been able to 'weaponize' Marburg virus into a form which could be delivered on the warhead of a missile.

I hadn't heard of Malburg virus before, so I researched it and discovered that it's similar to Ebola virus. I was shocked that Iraq had 'weaponized' a virus that could cause severe hemorrhagic fevers. This news makes more nervous than any news about Anthrax which can be treated with antibiotics.

I understand the mortality rate during the few outbreaks of Marburg virus have been very high.

Do you think Marburg virus could be manufactured in a form that could be used for bioterrorism?

And if Marburg virus were used as a biological agent, is there any conventional treatment to prevent the high mortality rates?

Ronald Atlas, Ph.D.: There are lots of potential biothreat agents, including those that cause hemorrhagic fevers. Public health authorities are aware of these threats and are doing the best they can to offer protection. Fortunately, these sorts of viruses are more difficult to obtain and cultivate and are less likely to present a bioterrorism threat. Anthrax is the more likely threat and public health is clearly geared up to battle the use of anthrax by bioterrorists.

Pittsburgh, Pa.: Scientists at Fort Dietrik refer to the Ames strain of anthrax as vaccine resistant. Is the current US vaccine against anthrax effective against the Ames strain?

Ronald Atlas, Ph.D.: Vaccine and antibiotics are effective against the Ames strain, which may prove to be the strain isolated in Florida. It is used to ensure the effectiveness of vaccine in challenge experiments and so we have great certainty that the vaccine provides protection.

Baltimore, Md: I've been told that Cipro is not appropriate to administer to children because of possible cartilage damage. Are there medicines that are safe for children in case of a bioterrorism attack with anthrax?

Ronald Atlas, Ph.D.: There are a number of antibiotics that can be used against anthrax. Ciprofloxacin is the drug of choice, at least for adults. But for individuals who are allergic or when there are other contraindications, physicians can select from a number of other antibiotics.

The question of how to protect children was raised in the Senate earlier this week by Senator Clinton. She has been on the news today indicating that she will be submitting a bill to try and develop better preparedness for protecting children against bioterrorism. This may be an important addition to the ongoing public health efforts to provide the best protection against the threat of bioterrorism for all Americans and other peace-loving citizens of the world.

Silver Spring, Md: While I don't want to panic, I do want to be vigilant. If I develop flu or cold-like symptoms what are the first indications that I have smallpox, anthrax or some other pathogen that might be used by bioterrorists.

Ronald Atlas, Ph.D.: Unfortunately, the initial symptoms of some of these serious diseases are not easily differentiated from influenza. While none of us should be panicking, when in doubt contact your physician. The threat of bioterrorism remains extremely low.

Arlington, Va.: Good Morning! How has the strain found in Florida been modified (reportedly originally in Iowa) so that it is recognizable as not wild-type anthrax? And why?

Ronald Atlas, Ph.D.: The news reports have not been accurate. CDC has not reported any modification of the organism. The organism has been typed at least with some confidence. The epidemiology is very unusual and has certainly given rise to suspicion and hence the FBI has taken the lead. As D.A. Henderson testified before the Senate this week, we are often fooled during epidemiological investigations. In the end, we should be able to figure out the source. At this point, I wouldn't rule out any number of hypotheses. We all need to be cautious and patient and not over-react to all the speculations appearing in the media.

Reston, Va.: Good morning Dr. Atlas,

As you know, most of us are concern about the NBC weapons. My wife and I work in DC and every day she will ask if I already ordered two gas masks(GM). I'm not sure yet that buying a GM is necessary. Can you explain PROS and CONS of buying a GM today, your opinion about buying a GM today? And, if you think it's a good idea to buy a GM, what should we be looking for in a GM? This is going to cause me a divorce. Thanks!

Ronald Atlas, Ph.D.: I do not have a gas mask, and I'm not running out to purchase one. Gas masks are effective in combat situations when there is a "real" threat of chemical attack. Unless you were going to carry the gas mask with you at all times and had some way of knowing that a chemical poison was in the air near you so that you could put on the mask, you would not gain any protection. And in the case of a biological attack, no one would see the microbes floating through the air. As in the case in Florida, it is only after the fact that we recognize potential exposure to a disease. And except for the individuals actually entering the building where contaminants may be present. Even just outside the building, no one is wearing a gas mask.

Corning, N.Y.: What would be involved for a company to now develop and manufacture a vaccine against anthrax in terms of time, procedure, approvals, etc.?

Ronald Atlas, Ph.D.: It takes many years to develop vaccines and to gain FDA approval. This is a very costly and time consuming process. There is an anthrax vaccine but even producing quantities for mass protection is not easy due to quality control issues. The situation is even more difficult if a new smallpox vaccine were to be developed.

Maryland: WHO has a Web site about anthrax but there were nothing about the anthrax breakout in 1979. Why?

Ronald Atlas, Ph.D.: The 1979 anthrax outbreak was due to an accidental release and not a natural disease outbreak, which WHO would have investigated. For a good description of the 1979 outbreak in the former Soviet Union, there is a book entitled, "Anthrax" by Guillemin which is available in many bookstores.

Pittsville, Md: I understand that biological weapons, anthrax in particular, are difficult to effectively aerosolize in a liquid form. However, recent reports seem to indicate a powdered anthrax medium was used to deliver the spores to the Florida building. If the concentration of spores necessary to produce active infection is fairly high, does this mean an effective and devastating mass airborne release of anthrax in a population center is likely to have limited effect outside a "ground zero" area?

Ronald Atlas, Ph.D.: It is typically thought that more than a thousand spores are needed to initiate an anthrax infection. Thus, exposing lots of people to high concentrations of spores is difficult. For aerosols the particle size has to be just right to float oas a fog through the air and to get into the lungs. Similarly, a powder would not disperse well, necessarily, over a wide area. Exposure to high concentrations of spores in a powdered form or as a localized aerosol could cause illness in people in the immediate vicinity of the release. The working hypothesis is that something of this sort occurred within the building in Boca Raton.

Pittsville, Md: I've read that the presence of a few spores is not sufficient to produce actual anthrax infection. Is this because the body is able to successfully mount a defense against a relatively small number of anthrax spores? Or is it because the human body is actually not a particularly good environmental host, and the majority of spores are not able to release their bacterial form?

Ronald Atlas, Ph.D.: Many of the spores may not germinate. It usually takes a significant change in environmental conditions to trigger spore germination. The more spores you have, the more likely it is for one or more to germinate and to overcome the body's immune defenses. The probability of just a couple of spores doing this is not great.

Saginaw, Mich.: Dr. Atlas,
You said recently that we needn't fear the spread of anthrax from the nozzles of conventional crop-dusters. Would this then apply to Plague or Tularemia? How should we protect our water supplies from biological weapons, or is this to a symptom of my media induced paranoia?
-Mike

Ronald Atlas, Ph.D.: Conventional crop dusters produce aerosols with particle sizes that tend to settle. Indeed the purpose of crop dusting is to get a substance to settle on the crop directly below. Thus, not only will these aerosols not spread bacteria typically over wide distances, but the particle sizes also tend to be too large for inhalation that will cause infections via the lungs. This would apply to a number of biological agents--at least in terms of the distance the aerosol would spread.

This is not to say that one cannot spray bacteria or viruses and infect a localized population. But it is really difficult to achieve the aerosol spread that would result in mass casualties as feared when biological weapons are described as a weapon of mass destruction.

As far as water supplies, there probably is a greater danger from chemical weapons than from biological weapons, but even here the threat is reduced by the large dilution factor for a major municipal water supplies.

Regarding microorganisms, we assume that rivers contain potential pathogens. Thus, we treat our water supplies by chlorination, filtration, and other means to protect the public from waterborne infections. These same disinfection methods would work against most potential biothreat agents. We also routinely test the bacterial quality of water and when in doubt municipal water suppliers advise the public to boil water, which is an effective way of eliminating bacterial pathogens.

Roanoke, Va.: What kind of preparations should local hospitals be making? Since initial symptoms mimic flu and other "normal" ailments, at what point should health care workers trigger emergency protocols?

Ronald Atlas, Ph.D.: The emergency room physicians are likely to be the first responders in a bioterrorism incident. Over the last few years we had begun to provide additional education for physicians and clinicians as to how to detect and to respond to bioterrorism. The CDC and public health departments and laboratories have formed networks to facilitate a protective response.

As the Senate was told earlier this week, more needs to be done, however, in order to ensure that all physicians and clinicians are adequately trained. At the University of Louisville, we are establishing a bioterrorism response center and joining local authorities in providing additional training for physicians throughout the state. We have also been working with local public health responders to develop a coordinated municipal response which we are confident will function in the event of a moderate bioterrorism attack. Many other municipalities have done the same and with additional funding, the system will be greatly enhanced.

Warsaw, Poland: Why is anthrax so rare (thankfully)?

Ronald Atlas, Ph.D.: Anthrax is rare in part because we have been vaccinating animals which are the normal hosts. Thus, we have reduced the amplification of the bacterium within the animal reservoirs that would be the source of human infection. It used to be that individuals combing wool had a high incidence of inhalation anthrax. Today, that is rare because of our protection of animals.

Washington, D.C.: Dear Dr. Atlas,
A friend says he wants to start taking ciprofloxacin prophylactically, just in case of an anthrax attack. This is a bad idea, right?

Ronald Atlas, Ph.D.: Yes, taking any antibiotic without the supervision of a physician is a bad idea. There are possibilities of adverse reactions and unless one really was at high risk of potential exposure, as were the individuals who worked in the building in Boca Raton, this is not a prudent thing to do.

Over the last few years, the biomedical community has been working very hard to reduce the overuse of antibiotics. Inappropriate and excessive use of antibiotics favors the development of antibiotic resistant strains. This is something we certainly do not want to have happen.

Saginaw, Mich.: Dr. Atlas,

Where do the funds for bioterrorism research and preparedness come from? Which congressional leaders/reps should we lobby to increase these funds. Is there ample support in Congress; is the Bush administration receptive to information presented by you and your peers? What policy challanges do we face?

Ronald Atlas, Ph.D.: The funds to combat bioterrorism come from many sources. There seem to be committees meeting daily this week to consider appropriations to combat the threat of bioterrorism. From the bio-medical perspective, HHS is the appropriate agency. Senator Kennedy's hearing this week highlighted the needs of the bio-medical community for educational programs, training, networking, and the development of new vaccines and drugs. It does seem that the entire congress and full Bush administration is aware of the needs for increased bio-medical funding.

Various policy changes are also being considered by the judiciary committee in the Senate and by the Commerce committee in the House. Proposals are also being submitted by the Attorney General. Some of these proposals could greatly restrict bio-medical research. We need to carefully balance our national security needs, including those to deter bioterrorism, with the needs to develop vaccines and pharmaceuticals that can protect us against natural diseases and those that might be inflicted upon us by bioterrorists. Balancing conflicting views will be difficult.

Fortunately, a dialog is ongoing between the scientific and bio-medical communities and the Congress and Administration. I am confident we can achieve the appropriate balance.

Washington, D.C.: Is there any chance that the highly contagious and often deadly Ebola virus could be used as a biological weapon?

Ronald Atlas, Ph.D.: Ebola would probably not be the best choice. That is the good news. The bad news is there are many agents that cause natural diseases and that represent global security threats.

Brooklyn, N.Y.: Media reports give the impression the nations supply of effective antibiotics is inadequate. If so, can more be produced quickly enough to satisfy the country's needs in a worst case scenario?

Ronald Atlas, Ph.D.: We have developed an adequate supply of antibiotic stockpiles for responding to "moderate" bioterrorism attacks. Bayer announced today that it is increasing the production of Ciprofloxacin. Thus it is possible to increase the supply. But it is possible to overwhelm any system. Distribution may be more of an issue than production.

England: Can you shed any light on the reasons why some people believe anthrax is not a useful potential bioterrorism weapon?

Ronald Atlas, Ph.D.: Anthrax is a serious biothreat agent as it was developed by various governments when they were engaged in military development of biological warfare programs. Those programs demonstrated that a reasonably high degree of technical expertise is needed to produce microorganisms in the form that can cause mass casualties. Thus, some of us feel that it is very difficult for terrorists to use biological agents. The Aum in Tokyo, was unsuccessful in several attempts to use biological weapons.

Vancouver, Canada: How effective could a mass-mailing of anthrax be? (Consider some of these "You-Have-Won!" mailings that are irresistable to open.) Post Offices will deliver hundreds and thousands of these mailings using bulk rates.

Germantown, Md: Could a biological or chemical agent be distributed using a newspaper?

Ronald Atlas, Ph.D.: It's unlikely that sufficient spores would be distributed on the surface of newspapers. While some microbes can be distributed in dry form in envelopes, I am still opening my mail. Locally, we are advising individuals that if they open an envelope with a suspecious powder that they should place it in a "zip-lock" type plastic bag and seal it, and then contact the local postmaster or other authorities. We do see a number of hoaxes concerning anthrax-probably more than one a day, even before September 11.

Pittsville, Md.: Dr. Atlas, your work has focused on the contaiment of bio-engineered organisms. My first question is, what marker differentiates a "man-made" strain, versus a "naturally occurring" one?

Secondly, is this containment within a living being, or surface "bio-decontamination"?

Ronald Atlas, Ph.D.: Microorganisms are normally contrained by the environments in which they can grow. Some organisms such as smallpox, can only grow within humans. This is why the smallpox vaccination program was successful in the total elimination of smallpox virus from nature. Other organisms are naturally contained within animal populations and only occasionally--often without great success--infect humans.

As far as what differentiates naturally-occurring from "man-made", the latter term indicates that someone has intentionally genetically modified an organism, for example by adding antibiotic resistance genes. Despite some press reports, I am not aware of any evidence that the strain isolated in the Florida case was genetically modified. The press appears to be misusing the term "man-made" or manufactured to indicate the possibility that a naturally occuring strain of the bacterium that causes anthrax was cultured in a laboratory and then intentionally introduced into the building in Boca Raton.

Easton, Maine: Can you contract anthrax by touching a doorknob, stair railing or any object like that?

Ronald Atlas, Ph.D.: The form of anthrax that we are most worried about is inhalation anthrax. This is not acquired by simply touching an object. There is another form called cutaneous anthrax where the bacterium may enter the skin through a wound. This form is also rare, particularly in the US. It has a relatively low fatality rate. I would not worry about coming in contact with inanimate objects.

Washington, D.C.: How could someone make antharax without becoming infected? -Assuming it was a regular citizen not using a lab. While I assume it is unlikely, have the investigators considered the possibility that one the people who are sick could have been involved in making the antharax?

Ronald Atlas, Ph.D.: Clinical laboratories grow pathogens on a daily basis. We use containment systems to prevent our own exposure. For the really dangerous pathogens that are diseminated via the air, we work only in specialized containment laboratories where the air cannot get outside. I do not think there is any indication that the afflicted individual was anything but a victim.

Pittsville, Md.: Do you think we'll see our children one day receive routine immunization for bio-terrrism agents, much like we vaccinate our children against measles, rubella, diphtheria, and so on?

Ronald Atlas, Ph.D.: We would only initiate vaccination of our children against biothreat agents if the threat was really deemed high enough. Otherwise, the costs and risks would outweigh the benefits. There are potential side-effects with all vaccines. In the case of smallpox vaccine, for example, it is estimated that 1 in 500,000 individuals receiving the vaccine would suffer fatal adverse reactions. This is not something we would do if the risk of exposure is really low.

Tel-aviv, Israel: Can one catch the anthrax from another?

Ronald Atlas, Ph.D.: No, anthrax is not a communicable disease. One would not contract it from another individual. Thus, even family members in very close proximity with an infected individual would have no increased risk of contracting anthrax.

Knoxville, Tenn.: I keep hearing how dangerous smallpox is but that it is very hard to get hold of the virus. Is it truly that difficult to get a hold of? And if I was immunized (I was in the early 70's as a child) how much protection does this offer?

Ronald Atlas, Ph.D.: Smallpox does not exist in nature. Thus, unlike other biothreat agent, one could not simply obtain it from natural sources. It also is not present in the various culture collections of the world. The only known stocks of the virus are in two locations--the US and Russia.

Washington, D.C.: I have heard that many of these biological agents are unable to survive when exposed to sunlight, and therefore any attack would have to be at night or indoors. Is this true?

Ronald Atlas, Ph.D.: Ultraviolet light (sunlight) will kill many bacteria and inactivate many viruses. Thus, exposure to sunlight will reduce viability. A bioterrorist attack would not have to be at night or indoors but limiting exposure to sunlight makes it more likely that a higher concentration of viable organisms may be spread.

Alexandria, Va.: Why does the Anthrax vaccine takes a year to provide full protection after a series of immunizations?

Ronald Atlas, Ph.D.: Like any vaccine, the body must learn to recognize a foreign substance. This is a physiological response that is not instantaneous. For many vaccines, we require multiple exposures through booster vaccinations to ensure the buildup of the cellular memory system needed to confer immunity.

Fairfax, Va.: Has there been any indication of how much of the "Iowa" strain is missing and how long has it been missing.

Ronald Atlas, Ph.D.: There is no indication that any strain is missing in Iowa. This is a misinterpretation of the fact that the strain may be similar or identical to a strain that was isolated in Ames, Iowa decades ago. This strain actually exists in many locations.

Charlottesville, Va.: If there is a cure (there is a vaccine) for this disease, why not make it available for the public. If infected by anthrax, what happens to the body? Is there a chance of survival? Thank you for your time.

Ronald Atlas, Ph.D.: We only use vaccines and antibiotics when appropriate. Both vaccines and antibiotics have potential side-effects, thus, we only prescribe these medicinals when absolutely necessary.

Ronald Atlas, Ph.D.: Thank you for all of your questions. My advice is to rely upon the bio-medical and public health community. Our physicians are our front line defense. In the future, we will certainly enhance their response cabilities.

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