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{{Other uses}}
{{Infobox disease
 | Name = Anthrax
 | Image = Bacillus anthracis Gram.jpg
 | Caption = Microphotograph of a [[Gram stain]] of the bacterium ''Bacillus anthracis'', the cause of the anthrax disease
 | DiseasesDB = 1203
 | ICD10 = {{ICD10|A|22|minor|LinkGroup|LinkMajor}}
 | ICD9 = {{ICD9|022}}
 | ICDO =
 | OMIM =
 | OMIM_mult = {{OMIM2|606410}} {{OMIM2|608041}}
 | MedlinePlus = 001325
 | eMedicineSubj = med
 | eMedicineTopic = 148
 | MeshID = D000881
}}

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'''Anthrax''' is an [[Acute (medical)|acute]] [[disease]] caused by the bacteria ''[[Bacillus anthracis]]''. Most forms of the disease are lethal, and it affects both humans and other animals.   There are effective vaccines against anthrax, and some forms of the disease respond well to antibiotic treatment.

Like many other members of the [[genus]] ''[[Bacillus]]'', ''Bacillus anthracis'' can form dormant [[endospore|spores]] that are able to survive in harsh conditions for decades or even centuries.<ref>"[http://www.thisislondon.co.uk/standard/article-23689394-details/Crossrail+work+stopped+after+human+bones+found+on+site/article.do Crossrail work stopped after human bones found on site]," ''London Evening Standard''</ref> Such spores can be found on all continents, even Antarctica.<ref>"Hudson, J. A.; Daniel, R. M. and H. W. Morgan (2006). "Acidophilic and thermophilic ''Bacillus'' strains from geothermally heated antarctic soil." ''FEMS Microbiology Letters'' '''60'''(3):279–282.</ref> When spores are inhaled, ingested, or come into contact with a skin lesion on a host they may reactivate and multiply rapidly.

Anthrax commonly  infects wild and domesticated herbivorous mammals which ingest or inhale the spores while grazing.  Ingestion is thought to be the most common route by which herbivores contract anthrax. Carnivores living in the same environment may become infected by consuming infected animals. Diseased animals can spread anthrax to humans, either by direct contact (e.g. inoculation of infected blood to broken skin) or consumption of a diseased animal's flesh.

Anthrax spores can be produced [[in vitro]] and used as a [[biological weapon]]. Anthrax does not spread directly from one infected animal or person to another; it is spread by spores. These spores can be transported by clothing or shoes.  The dead body of an animal that died of anthrax can also be a source of anthrax spores.

==Overview==
[[File:Anthrax color enhanced micrograph.JPG|thumb|Color-enhanced [[Scanning electron microscope|scanning electron micrograph]] shows [[spleen|splenic tissue]] from a [[monkey]] with inhalational anthrax; featured are rod-shaped [[bacilli]] (yellow) and an [[erythrocyte]] (red).]]
Anthrax is one of the oldest diseases of grazing animals such as sheep and cattle and is believed to be the [[Plagues of Egypt#Plague of Livestock Death .28.D7.93.D6.B6.D6.BC.D7.91.D6.B6.D7.A8.29: Ex. 9:1.E2.80.937|Fifth]] [[Plagues of Egypt|Plague]] mentioned in the [[Book of Exodus]] in the [[Bible]].<ref name="Blanc1890">{{Cite journal
 | title = Anthrax: the disease of the Egyptian plagues
 | author=Blanc, H. W.
 | year = 1890
 | journal=New Orleans Med Surg J
 | volume = 18
 | pages = 1–25
}}</ref> Anthrax is also mentioned by [[Homer]] (in ''The [[Iliad]]''), [[Virgil]] (''[[Georgics]]''), and [[Hippocrates]]. Infection of humans can result from contact with infected animal hides, fur, wool ("Woolsorter's disease"), leather or contaminated soil. Anthrax is now fairly rare in humans, although it still regularly occurs in [[ruminants]], such as [[cattle]], [[sheep]], [[goat]]s, [[camel]]s, wild [[bovid|buffalo]], and [[antelope]]s, in hind-gut fermenters such as [[zebra]]s and [[Rhinoceros|rhinos]], and in other wildlife such as [[elephant]]s and [[lion]]s in certain endemic areas of the world.

''Bacillus anthracis'' bacteria spores are soil-borne and because of their long lifetime, they are still present globally and at animal burial sites of anthrax-killed animals for many decades; spores have been known to have reinfected animals over 70 years after burial sites of anthrax-infected animals were disturbed.<ref>"Anthrax" by Jeanne Guillemin, University of California Press, 2001, ISBN 0-520-22917-7, p. 3</ref>

Until the twentieth century, anthrax infections killed hundreds and thousands of animals and people each year in Australia, Asia, Africa, North America, and Europe, specifically in the concentration camps during WWII.<ref name="Cherkasskiy1999">{{Cite journal
 | author=Cherkasskiy, B. L.
 | year = 1999
 | title = A national register of historic and contemporary anthrax foci
 | journal=Journal of Applied Microbiology
 | volume = 87
 | issue = 2
 | pages = 192–195
 | doi = 10.1046/j.1365-2672.1999.00868.x
 | pmid = 10475946
}}</ref> French scientist [[Louis Pasteur]] developed the first effective vaccine for anthrax in 1881.<ref>{{Cite web
|url=http://louisville.edu/library/ekstrom/special/pasteur/cohn.html
|accessdate=13 August 2008
|title=Life and Times of Louis Pasteur
|date=11 February 1996
|author=David V. Cohn
|publisher=School of Dentistry, [[University of Louisville]]
|archiveurl = http://web.archive.org/web/20080408070236/http://louisville.edu/library/ekstrom/special/pasteur/cohn.html <!-- Bot retrieved archive --> |archivedate = 8 April 2008}}</ref><ref name="Mikesell1983">{{Cite journal
 | author=Mikesell, P.; Ivins, B. E.; Ristroph, J. D.; Vodkin, M. H.; Dreier, T. M.; Leppla, S. H.
 | title = Plasmids, Pasteur, and Anthrax
 | year = 1983
 | journal=ASM News
 | volume = 49
 | pages = 320–322
 | url = http://www.asm.org/ASM/files/CCLIBRARYFILES/FILENAME/0000000221/490783p320.pdf
|format=PDF}}</ref><ref>{{Cite web|url=http://german.about.com/library/blerf_koch.htm |title=Robert Koch (1843-1910) |publisher=About.com |accessdate=13 August 2008}}</ref>  Thanks to over a century of animal vaccination programs, sterilization of raw animal waste materials and anthrax eradication programs in North America, Australia, New Zealand, Russia, Europe and parts of Africa and Asia, anthrax infection is now relatively rare in domestic animals with normally only a few dozen cases reported every year. Anthrax is even rarer in dogs and cats: there had only ever been one documented case in dogs in the USA by 2001, although the disease affects livestock.<ref>"[http://dogsinthenews.com/issues/0110/articles/011030a.htm Can Dogs Get Anthrax?]" ''Canine Nation'', 30 October 2001. Retrieved 17 February 2007.</ref> Anthrax typically does not cause disease in carnivores and scavengers, even when these animals consume anthrax-infected carcasses. Anthrax outbreaks do occur in some wild animal populations with some regularity.<ref name="Dragon1999">{{Cite journal
 | author=Dragon, D. C.
 | year = 1999
 | title = A review of anthrax in Canada and implications for research on the disease in northern bison
 | journal=Journal of Applied Microbiology
 | volume = 87
 | pages = 208
 | doi = 10.1046/j.1365-2672.1999.00872.x
 | pmid = 10475950
 | last2 = Elkin
 | first2 = BT
 | last3 = Nishi
 | first3 = JS
 | last4 = Ellsworth
 | first4 = TR
 | issue = 2
}}</ref>
The disease is more common in developing countries without widespread veterinary or human public health programs.

There are 89 known [[strain (biology)|strains]] of anthrax. The virulent [[Ames strain]], which had been used in the [[2001 anthrax attacks]] in the United States, has received the most news coverage of any anthrax outbreak. However, the [[Vollum strain]], developed but never used as a [[biological weapon]] during the Second World War, is much more dangerous. The ''Vollum'' (also incorrectly referred to as ''Vellum'') strain was isolated in 1935 from a cow in [[Oxfordshire]], UK. This is the same strain that was used during the [[Gruinard Island|Gruinard]] bioweapons trials. A variation of Vollum known as "Vollum 1B" was used during the 1960s in the US and UK bioweapon programs. Vollum 1B is widely believed<ref>{{Cite web
|url=http://www.ph.ucla.edu/epi/bioter/armyanthraxvictimsblood.html
|accessdate=6 August 2009
|title=Army harvested victims' blood to boost anthrax
|date=23 December 2001
|author=Scott Shane
|work=Boston Sun |publisher=UCLA Dept. of Epidemiology site
}}</ref> to have been isolated from William A. Boyles, a 46-year-old scientist at the U.S. Army Biological Warfare Laboratories at Camp (later Fort) Detrick (precursor to [[USAMRIID]]) who died in 1951 after being accidentally infected with the Vollum strain. The ''Sterne'' strain, named after the Trieste-born immunologist Max Sterne, is an attenuated strain used as a vaccine.

==Cause==
===Bacteria===
[[File:Gram Stain Anthrax.jpg|thumb|Gram-positive anthrax bacteria (purple rods) in [[cerebrospinal fluid]] sample. If present, a Gram-negative bacterial species would appear pink. (The other cells are [[white blood cell]]s).]]
{{Main|Bacillus anthracis}}
''Bacillus anthracis'' is a rod-shaped, [[Gram-positive]], aerobic bacterium that is about 1 by 9 micrometers in length. It was shown to cause disease by [[Robert Koch]] in 1876.<ref name="pages 277-310">Koch, R. (1876) "Untersuchungen über Bakterien: V. Die Ätiologie der Milzbrand-Krankheit, begründet auf die Entwicklungsgeschichte des ''Bacillus anthracis''" (Investigations into bacteria: V. The etiology of anthrax, based on the ontogenesis of ''Bacillus anthracis''), Cohns ''Beitrage zur Biologie der Pflanzen'', vol. 2, no. 2, [http://edoc.rki.de/documents/rk/508-5-26/PDF/5-26.pdf pages 277-310].</ref> The bacterium normally rests in [[endospore]] form in the soil, and can survive for decades in this state. Herbivores are often infected whilst grazing or browsing, especially when eating rough, irritant or spiky vegetation: the vegetation has been hypothesized to cause wounds within the [[gastrointestinal tract]] permitting entry of the bacterial endo-spores into the tissues, though this has not been proven. Once ingested or placed in an open cut, the bacterium begins multiplying inside the animal or human and typically kills the host within a few days or weeks. The endo-spores germinate at the site of entry into the tissues and then spread via the circulation to the lymphatics, where the bacteria multiply.

It is the production of two powerful exo-toxins  and ''lethal toxin'' by the bacteria that causes death. Veterinarians can often tell a possible anthrax-induced death by its sudden occurrence, and by the dark, non-clotting blood that oozes from the body orifices. Most anthrax bacteria inside the body after death are out-competed and destroyed by anaerobic bacteria within minutes to hours post-mortem. However, anthrax vegetative bacteria that escape the body via oozing blood or through the opening of the carcass may form hardy spores. One spore forms per one vegetative bacterium. The triggers for spore formation are not yet known, though oxygen tension and lack of nutrients may play roles. Once formed, these spores are very hard to eradicate.

The infection of herbivores (and occasionally humans) via the inhalational route normally proceeds as follows: once the spores are inhaled, they are transported through the air passages into the tiny air particles sacs (alveoli) in the lungs. The spores are then picked up by scavenger cells ([[macrophage]]s) in the lungs and are transported through small vessels ([[lymphatic system|lymphatics]]) to the [[lymph nodes]] in the central chest cavity ([[mediastinum]]). Damage caused by the anthrax spores and bacilli to the central chest cavity can cause chest pain and difficulty breathing. Once in the lymph nodes, the spores germinate into active bacilli which multiply and eventually burst the macrophages, releasing many more bacilli into the bloodstream to be transferred to the entire body. Once in the blood stream these bacilli release three substances: ''lethal factor'', ''edema factor'' and ''protective antigen''. Protective antigen combines with these other two factors to form lethal toxin and edema toxin, respectively. These toxins are the primary agents of tissue destruction, bleeding, and death of the host. If antibiotics are administered too late, even if the antibiotics eradicate the bacteria, some hosts will still die. This is because the toxins produced by the bacilli remain in their system at lethal dose levels.

In order to enter the cells, the edema and lethal factors use another protein produced by ''B. anthracis'' called ''protective antigen''. Edema factor inactivates [[neutrophil]]s (a type of phagocytic cell) so that they cannot phagocytose bacteria. Historically, it was believed that lethal factor caused macrophages to make [[TNF-alpha]] and [[IL1B|interleukin 1, beta]] (IL1B), both normal components of the immune system used to induce an inflammatory reaction, ultimately leading to [[septic shock]] and death. However, recent evidence indicates that anthrax also targets endothelial cells (cells that line serous cavities, lymph vessels, and blood vessels), causing vascular leakage of fluid and cells, and ultimately [[hypovolemic shock]] (low blood volume), and septic shock.

The lethality of the anthrax disease owes itself to the bacterium's two principle virulence factors: (i) the [[polyglutamic acid|poly-D-glutamic acid capsule]], which protects the bacterium from phagocytosis by host neutrophils, and (ii) the tripartite protein toxin, called [[anthrax toxin]]. Anthrax toxin is a mixture of three [[proteins|protein]] components: (i) protective [[antigen]] (PA), (ii) [[edema]] factor (EF), and (iii) lethal factor (LF). PA plus LF produces lethal toxin, and PA plus EF produces edema toxin. These toxins cause death and tissue swelling ([[edema]]), respectively.

===Exposure===
Occupational exposure to infected animals or their products (such as skin, wool, and meat) is the usual pathway of exposure for humans. Workers who are exposed to dead animals and animal products are at the highest risk, especially in countries where anthrax is more common. Anthrax in livestock grazing on open range where they mix with wild animals still occasionally occurs in the United States and elsewhere. Many workers who deal with wool and animal hides are routinely exposed to low levels of anthrax spores but most exposures are not sufficient to develop anthrax infections. Presumably, the body's natural defenses can destroy low levels of exposure. These people usually contract cutaneous anthrax if they catch anything. Historically, the most dangerous form of inhalational anthrax was called Woolsorters' disease because it was an occupational hazard for people who sorted wool. Today this form of infection is extremely rare, as almost no infected animals remain.
The last fatal case of natural inhalational anthrax in the United States occurred in California in 1976, when a home weaver died after working with infected wool imported from Pakistan. The autopsy was done at UCLA hospital. To minimize the chance of spreading the disease, the deceased was transported to UCLA in a sealed plastic body bag within a sealed metal container.<ref name="Suffin1978">{{Cite journal
 | author=Suffin, S. C.; Carnes, W. H.; Kaufmann, A. F.
 | title = Inhalation anthrax in a home '''''craftsman'''''
 | year = 1978
 | month = September
 | journal=Human Pathology
 | volume = 9
 | issue = 5
 | pages = 594–597
 | url = http://www.ncbi.nlm.nih.gov/pubmed/101438
 | doi = 10.1016/S0046-8177(78)80140-3
 | pmid = 101438
}}</ref>

In November 2008, a drum maker in the United Kingdom who worked with untreated animal skins died from anthrax.<ref>"[http://news.bbc.co.uk/2/hi/uk_news/7705328.stm Man who breathed in anthrax dies]," ''BBC News'', 2 November 2008. Retrieved 2 November 2008.</ref>  In December 2009 The New Hampshire Department of Health and Human Services confirmed a case of gastrointestinal anthrax in an adult female.  The [[Centers for Disease Control and Prevention|CDC]] is currently investigating the source and the possibility that it was contracted from an African drum recently used by the woman.<ref name="promedmail.org">[http://www.promedmail.org/pls/otn/f?p=2400:1001:747000751311471::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,80634]</ref> Gastrointestinal anthrax is exceedingly rare in the United States, with only one case on record, reported in 1942, according to the Centers for Disease Control and Prevention.<ref name="boston.com">The Boston Globe  http://www.boston.com/news/health/articles/2010/01/04/nh_anthrax_case_linked_to_animal_skinned_drums/</ref>  In December 2009 an outbreak of anthrax occurred amongst heroin addicts in  [[Glasgow]], Scotland, resulting in ten deaths.<ref>{{cite news|url=http://news.bbc.co.uk/2/hi/uk_news/scotland/south_of_scotland/8528734.stm|title=Addict death as anthrax spreads|work=BBC News|date=22 February 2010|accessdate=25 February 2010|postscript=<!--None-->}}</ref> The source of the anthrax is believed to be dilution of the heroin with bone meal in Afghanistan.<ref>{{Cite news|url=http://www.nytimes.com/2010/01/12/health/12glob.html?partner=rss&emc=rss|title=Anthrax: In Scotland, Six Heroin Users Die of Anthrax Poisoning|newspaper=The New York Times|date=12 January 2010|postscript=<!--None--> | first=Donald G. | last=McNeil Jr}}</ref>

Also during December 2009, The New Hampshire Department of Health and Human Services confirmed a case of gastrointestinal anthrax in an adult female.  The [[Centers for Disease Control and Prevention|CDC]] investigated the source and the possibility that it was contracted from an African drum recently used by the woman taking part in a drumming circle.<ref name="promedmail.org"/> Gastrointestinal anthrax is exceedingly rare in the United States, with only one case on record, reported in 1942, according to the Centers for Disease Control and Prevention.<ref name="boston.com"/>
The woman apparently inhaled anthrax [in spore form] from the hide of the drum.  She became critically ill, but with gastrointestinal anthrax rather than inhaled anthrax, which made her unique in American medical history. The building where the infection took place was cleaned and reopened to the public and the woman recovered.  Jodie Dionne-Odom, New Hampshire state epidemiologist, states, "It is a mystery. We really don't know why it happened."<ref>[http://www.promedmail.org/pls/otn/f?p=2400:1001:130058575417351::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,82333]</ref>

===Mode of infection===
[[File:Anthrax - inhalational.jpg|thumb|Inhalational anthrax, [[mediastinum|mediastinal]] widening]]
Anthrax can enter the human body through the intestines ('''ingestion'''), lungs ('''inhalation'''), or skin ('''cutaneous''') and causes distinct clinical symptoms based on its site of entry. An infected human will generally be quarantined. However, anthrax does not usually spread from an infected human to a noninfected human. But if the disease is fatal to the person's body, its mass of anthrax bacilli becomes a potential source of infection to others and special precautions should be used to prevent further contamination. Inhalational anthrax, if left untreated until obvious symptoms occur, may be fatal.

Anthrax can be contracted in laboratory accidents or by handling infected animals or their wool or hides. It has also been used in [[biological warfare]] agents and by [[terrorism|terrorists]] to intentionally infect as exemplified by the [[2001 anthrax attacks]].

====Pulmonary====
Respiratory infection in humans initially presents with cold or [[flu-like symptoms]] for several days, followed by severe (and often fatal) respiratory collapse. Historical mortality was 92%, but when treated early (seen in the [[2001 anthrax attacks]]) observed mortality was 45%.<ref name="bravata">Bravata DM, Holty JE, Liu H, McDonald KM, Olshen RA, Owens DK (2006), Systematic review: a century of inhalational anthrax cases from 1900 to 2005, Annals of Internal Medicine; 144(4): 270–80.</ref> Distinguishing pulmonary anthrax from more common causes of respiratory illness is essential to avoiding delays in diagnosis and thereby improving outcomes. An algorithm for this purpose has been developed.<ref name="kyriacou">Kyriacou DN, Yarnold PR, Stein AC, Schmitt BP, Soltysik RC, Nelson RR, Frerichs RR, Noskin GA, Belknap SM, Bennett CL. Discriminating inhalational anthrax from community-acquired pneumonia using chest radiograph findings and a clinical algorithm. Chest. 2007 Feb;131(2):489-96.</ref>  Illness progressing to the fulminant phase has a 97% mortality regardless of treatment.

A lethal infection is reported to result from inhalation of about 10,000–20,000 spores, though this dose varies amongst host species.<ref>{{Cite web|url=http://www.medicinenet.com/script/main/art.asp?articlekey=18812&page=2 |title=Anthrax, Then and Now |publisher=MedicineNet.com |accessdate=13 August 2008}}</ref> Like all diseases there is probably a wide variation to susceptibility with evidence that some people may die from much lower exposures; there is little documented evidence to verify the exact or average number of spores needed for infection. Inhalational anthrax is also known as woolsorters' or ragpickers' disease as these professions were more susceptible to the disease due to their exposure to infected animal products. Other practices associated with exposure include the slicing up of animal horns for the manufacture of buttons, the handling of hair bristles used for the manufacturing of brushes, and the handling of animal skins. Whether these animal skins came from animals that died of the disease or from animals that had simply laid on ground that had spores on it is unknown. This mode of infection is used as a bioweapon.

====Gastrointestinal====
Gastrointestinal infection in humans is most often caused by eating anthrax-infected meat and is characterized by serious gastrointestinal difficulty, [[vomiting]] of blood, severe diarrhea, acute inflammation of the intestinal tract, and loss of appetite. Some lesions have been found in the intestines and in the mouth and throat. After the bacteria invades the bowel system, it spreads through the bloodstream throughout the body, making even more toxins on the way. Gastrointestinal infections can be treated but usually result in fatality rates of 25% to 60%, depending upon how soon treatment commences.<ref name="CDC-Anthrax">{{Cite web|title=Anthrax Q & A: Signs and Symptoms |work=Emergency Preparedness and Response |publisher=Centers for Disease Control and Prevention |year=2003 |url=http://www.bt.cdc.gov/agent/anthrax/faq/signs.asp |accessdate=19 April 2007 }}</ref>

====Cutaneous====
[[File:Anthrax PHIL 2033.png|thumb|Anthrax skin lesion]]
Cutaneous (on the skin) anthrax infection in humans shows up as a boil-like skin lesion that eventually forms an ulcer with a black center (eschar). The black eschar often shows up as a large, painless [[necrotic]] ulcer (beginning as an irritating and itchy skin lesion or blister that is dark and usually concentrated as a black dot, somewhat resembling bread mold) at the site of infection. Cutaneous infections generally form within the site of spore penetration between 2 and 5 days after exposure. Unlike bruises or most other lesions, cutaneous anthrax infections normally do not cause pain.<ref name="CDC-Anthrax" />

Cutaneous anthrax is rarely fatal if treated,<ref name="bravata" /> but without treatment about 20% of cutaneous skin infection cases progress to [[toxemia]] and death.

Treatment typically includes antibiotic therapy.  Specific guidelines are available for adults, children, pregnant women, and immunocompromised persons. The differential diagnosis includes multiple entities and thus accurate diagnosis is imperative.  Clinical examination coupled with culture and cutaneous biopsy can aid in accurate diagnosis.

==Diagnosis==
Other than Gram Stain of specimens, there are no specific direct identification techniques for identification of ''Bacillus sp''. in clinical material. These organisms are Gram positive but with age can be Gram variable to Gram negative. A specific feature of ''Bacillus sp''. that makes it unique from other aerobic microorganisms is its ability to produce spores. Although, spores are not always evident on a Gram stain of this organism, the presence of spores confirms that the organism is of the genus ''Bacillus''.

All ''Bacillus sp''. grow well on 5% Sheep blood agar and other routine culture media. PLET (polymyxin-lysozyme-EDTA-thallous acetate) can be used to isolate ''B.anthracis'' from contaminated specimens and bicarbonate agar is used as an identification method to induce capsule formation.

''Bacillus sp''. will usually grow within 24 hours of incubation at 35 degrees C, in ambient air (room temperature) or in 5% CO<sub>2</sub>. If bicarbonate agar is used for identification then the media must be incubated in 5% CO<sub>2</sub>.

''B.anthracis'' appears as medium-large, gray, flat, irregular with swirling projections, often referred to as "medusa head" appearance, and is non-hemolytic on 5% sheep blood agar. It is non-motile, is susceptible to penicillin and produces a wide zone of lecithinase on egg yolk agar. Confirmatory testing to identify B.anthracis includes gamma bacteriophage testing, indirect hemagglutination and enzyme linked immunosorbent assay to detect antibodies.
<ref>Forbes, B.A. Bailey & Scott's Diagnostic Microbiology 11th Edition. 2002.</ref>

==Prevention==
===Vaccines===
An anthrax vaccine licensed by the [[Food and Drug Administration (United States)|U.S. Food and Drug Administration]] (FDA) and produced from one non-virulent strain of the anthrax bacterium, is manufactured by BioPort Corporation, subsidiary of [[Emergent BioSolutions]]. The trade name is '''BioThrax''', although it is commonly called Anthrax Vaccine Adsorbed (AVA). It is administered in a six-dose primary series at 0, 2, 4 weeks and 6, 12, 18 months; annual booster injections are required thereafter to maintain immunity.

Unlike [[NATO]] countries, the Soviets developed and used a live spore anthrax vaccine, known as the STI vaccine, produced in [[Tbilisi, Georgia]]. Its serious side effects restrict use to healthy adults.<ref>ANTHRAX, the investigation of a Deadly Outbreak, Jeanne Guillemin, University of California Press, 1999, ISBN 0-520-22917-7, p. 34</ref>

==Treatment==
Anthrax cannot be spread directly from person to person, but a patient's clothing and body may be contaminated with anthrax spores. Effective decontamination of people can be accomplished by a thorough wash down with [[antimicrobial]] effective soap and water. Waste water should be treated with bleach or other anti-microbial agent. Effective decontamination of articles can be accomplished by boiling contaminated articles in water for 30 minutes or longer. Chlorine bleach is ineffective in destroying spores and vegetative cells on surfaces, though formaldehyde is effective. Burning clothing is very effective in destroying spores. After decontamination, there is no need to immunize, treat or isolate contacts of persons ill with anthrax unless they were also exposed to the same source of infection. Early antibiotic treatment of anthrax is essential—delay significantly lessens chances for survival. Treatment for anthrax infection and other bacterial infections includes large doses of intravenous and oral [[antibiotic]]s, such as fluoro[[quinolone]]s, like [[ciprofloxacin]] (cipro), [[doxycycline]], [[erythromycin]], [[vancomycin]] or [[penicillin]]. In possible cases of inhalation anthrax, early [[prophylaxis|antibiotic prophylaxis]] treatment is crucial to prevent possible death. In May 2009, [[Human Genome Sciences]] submitted a [[Biologic License Application]] (BLA, permission to market) for its new drug, raxibacumab (brand name ABthrax) intended for emergency treatment of inhaled anthrax.<ref>"[http://www.forbes.com/feeds/ap/2009/05/21/ap6450866.html HGSI asks for FDA approval of anthrax drug ABthrax]". [[Associated Press]], 21 May 2009, published in Forbes.com</ref> If death occurs from anthrax the body should be isolated to prevent possible spread of anthrax germs. Burial does not kill anthrax spores.

If a person is suspected as having died from anthrax, every precaution should be taken to avoid skin contact with the potentially contaminated body and fluids exuded through natural body openings. The body should be put in strict quarantine. A blood sample taken in a sealed container and analyzed in an approved laboratory should be used to ascertain if anthrax is the cause of death. Microscopic visualization of the encapsulated bacilli, usually in very large numbers, in a blood smear stained with polychrome methylene blue (McFadyean stain) is fully diagnostic, though culture of the organism is still the gold standard for diagnosis. Full isolation of the body is important to prevent possible contamination of others. Protective, impermeable clothing and equipment such as [[rubber glove]]s, rubber apron, and rubber boots with no perforations should be used when handling the body. No skin, especially if it has any wounds or scratches, should be exposed. Disposable personal protective equipment is preferable, but if not available, decontamination can be achieved by autoclaving. Disposable personal protective equipment and filters should be autoclaved, and/or burned and buried. Bacillus anthracis bacillii range from 0.5–5.0 μm in size. Anyone working with anthrax in a suspected or confirmed victim should wear respiratory equipment capable of filtering this size of particle or smaller. The US [[National Institute for Occupational Safety and Health]] (NIOSH) and [[Mine Safety and Health Administration]] (MSHA) approved high efficiency-respirator, such as a half-face disposable respirator with a high-efficiency particulate air (HEPA) filter, is recommended.<ref>National Personal Protective Technology Laboratory [http://www.cdc.gov/niosh/npptl/default.html Respirators]. National Institute for Occupational Safety and Health. 30 April 2009.</ref> All possibly contaminated bedding or clothing should be isolated in double plastic bags and treated as possible bio-hazard waste. The victim should be sealed in an airtight body bag. Dead victims that are opened and not burned provide an ideal source of anthrax spores. Cremating victims is the preferred way of handling body disposal. No embalming or autopsy should be attempted without a fully equipped biohazard laboratory and trained and knowledgeable personnel.

Delays of only a few days may make the disease untreatable and treatment should be started even without symptoms if possible contamination or exposure is suspected. Animals with anthrax often just die without any apparent symptoms. Initial symptoms may resemble a common cold—sore throat, mild fever, muscle aches and malaise. After a few days, the symptoms may progress to severe breathing problems and shock and ultimately death. Death can occur from about two days to a month after exposure with deaths apparently peaking at about 8 days after exposure.<ref>ANTHRAX, the investigation of a Deadly Outbreak, Jeanne Guillemin, University of California Press, 1999, ISBN 0-520-22917-7, chart of Russian deaths at Sverdlovsk, 1979, p. 27</ref> Antibiotic-resistant strains of anthrax are known.

In recent years there have been many attempts to develop new drugs against anthrax, but existing drugs are effective if treatment is started soon enough.

Early detection of sources of anthrax infection can allow preventive measures to be taken. In response to the anthrax attacks of October 2001 the [[United States Postal Service]] (USPS) installed BioDetection Systems (BDS) in their large scale mail cancellation facilities. BDS response plans were formulated by the USPS in conjunction with local responders including fire, police, hospitals and public health. Employees of these facilities have been educated about anthrax, response actions and [[prophylaxis|prophylactic]] medication. Because of the time delay inherent in getting final verification that anthrax has been used, prophylactic [[antibiotic]] treatment of possibly exposed personnel must be started as soon as possible.

==History==
===Etymology===
The name 'anthrax' comes from ''anthrax [άνθραξ]'', the Greek word for 'coal', because of the black skin [[lesion]]s  developed by victims with a cutaneous anthrax [[infection]].

===Discovery===
[[Robert Koch]], a German physician and scientist, first identified the bacteria which caused the anthrax disease in 1875.<ref name="pages 277-310"/><ref name="Brock">{{Cite book|author=Madigan M; Martinko J (editors). |title=Brock Biology of Microorganisms |edition=11th |publisher=Prentice Hall |year=2005 |isbn=0-13-144329-1 }}</ref> His pioneering work in the late nineteenth century was one of the first demonstrations that diseases could be caused by microbes. In a groundbreaking series of experiments he uncovered the life cycle and means of transmission of anthrax. His experiments not only helped create an understanding of anthrax, but also helped elucidate the role of microbes in causing illness at a time when debates were still held over [[spontaneous generation#Spontaneous generation|spontaneous generation]] versus [[cell theory]]. Koch went on to study the mechanisms of other diseases and was awarded the 1905 [[Nobel Prize in Physiology or Medicine]] for his discovery of the bacteria causing tuberculosis. Koch is today recognized as one of history's most important biologists and a founder of modern bacteriology.

===First vaccination===
In May 1881 [[Louis Pasteur]] performed a public experiment to demonstrate his concept of vaccination. He prepared two groups of 25 [[sheep]], one goat and several cows. The animals of one group were injected with an anti-anthrax [[vaccine]] prepared by Pasteur twice, at an interval of 15 days; the control group was left unvaccinated. Thirty days after the first injection both groups were injected with a culture of live anthrax [[bacterium|bacteria]]. All the animals in the non-vaccinated group died, while all of the animals in the vaccinated group survived.<ref>Decker, Janet. ''Deadly Diseases and Epidemics, Anthrax.'' Chelesa House Publishers, 2003. ISBN 0-7910-7302-5 pp. 27–28.</ref>
The human vaccine for anthrax became available in 1954. This was a cell-free vaccine instead of the live-cell Pasteur-style vaccine used for veterinary purposes. An improved cell-free vaccine became available in 1970.<ref>"[http://www.cdc.gov/vaccines/vpd-vac/anthrax/downloads/ed-vpd2006-anthrax.ppt Anthrax and Anthrax Vaccine - Epidemiology and Prevention of Vaccine-Preventable Diseases]", National Immunization Program, Centers for Disease Control and Prevention, January 2006. (PPT format)</ref>

==Society and culture==
===Site cleanup===
Anthrax spores can survive for long periods of time in the environment after release. Methods for cleaning anthrax-contaminated sites commonly use [[oxidizing agent]]s such as [[peroxides]], ethylene oxide, Sandia Foam,<ref>{{Cite web|url=http://www.eurekalert.org/pub_releases/2007-04/dnl-sdf042607.php |title=Sandia decon formulation, best known as an anthrax killer, takes on household mold |date=26 April 2007 |accessdate=13 August 2008}}</ref> chlorine dioxide (used in Hart Senate office building), and liquid bleach products containing sodium hypochlorite. These agents slowly destroy bacterial spores.
A bleach solution for treating hard surfaces has been approved by the EPA.<ref>{{Cite web|url=http://ehso.com/bleach.htm |publisher=Society for Applied Microbiology |title=Using Bleach to Destroy Anthrax and Other Microbes |accessdate=13 August 2008}}</ref> Bleach and vinegar must not be combined together directly, as doing so could produce [[chlorine]] gas. Rather some water must first be added to the bleach (e.g., two cups water to one cup of bleach), then vinegar (e.g., one cup), and then the rest of the water (e.g., six cups). The pH of the solution should be tested with a paper test strip; and treated surfaces must remain in contact with the bleach solution for 60 minutes (repeated applications will be necessary to keep the surfaces wet).

[[Chlorine dioxide]] has emerged as the preferred biocide against anthrax-contaminated sites, having been employed in the treatment of numerous government buildings over the past decade. Its chief drawback is the need for ''[[in situ]]'' processes to have the reactant on demand.

To speed the process, trace amounts of a non-toxic [[catalyst]] composed of [[iron]] and tetro-amido macrocyclic [[ligand]]s are combined with [[sodium carbonate]] and [[bicarbonate]] and converted into a spray. The spray formula is applied to an infested area and is followed by another spray containing [[tert-Butyl hydroperoxide]].<ref name="Pesticide Disposal Goes Green">{{Cite web|url=http://www.sciencenews.org/view/generic/id/5581/title/Pesticide_Disposal_Goes_Green |publisher=Science News |title=Pesticide Disposal Goes Green |accessdate=8 June 2009}}</ref>

Using the catalyst method, a complete destruction of all anthrax spores can be achieved in under 30 minutes.<ref name="Pesticide Disposal Goes Green" /> A standard catalyst-free spray destroys fewer than half the spores in the same amount of time.  They can be heated, exposed to the harshest chemicals, and they do not easily die.

Cleanups at a Senate office building, several contaminated postal facilities and other U.S. government and private office buildings showed that decontamination is possible, but it is time-consuming and costly. Clearing the Senate office building of anthrax spores cost $27&nbsp;million, according to the Government Accountability Office. Cleaning the Brentwood postal facility outside Washington cost $130&nbsp;million and took 26 months. Since then newer and less costly methods have been developed.<ref>{{PDFlink|[http://www.bnl.gov/bnlweb/pubaf/bulletin/2003/bb101703.pdf The Bulletin Vol. 57 - No. 36 October 17, 2003]|332&nbsp;[[Kibibyte|KiB]]<!-- application/pdf, 340763 bytes -->}}{{Verify source|date=August 2008}}</ref>

Clean up of anthrax-contaminated areas on ranches and in the wild is much more problematic. Carcasses may be burned, though it often takes up to three days to burn a large carcass and this is not feasible in areas with little wood. Carcasses may also be buried, though the burying of large animals deeply enough to prevent resurfacing of spores requires much manpower and expensive tools. Carcasses have been soaked in formaldehyde to kill spores, though this has environmental contamination issues. Block burning of vegetation in large areas enclosing an anthrax outbreak has been tried; this, while environmentally destructive, causes healthy animals to move away from an area with carcasses in search of fresh graze and browse. Some wildlife workers have experimented with covering fresh anthrax carcasses with shadecloth and heavy objects. This prevents some scavengers from opening the carcasses, thus allowing the putrefactive bacteria within the carcass to kill the vegetative B. anthracis cells and preventing sporulation. This method also has drawbacks, as scavengers such as hyenas are capable of infiltrating almost any exclosure. The occurrence of previously dormant anthrax, stirred up from below the ground surface by wind movement in a drought-stricken region with depleted grazing and browsing, may be seen as a form of natural culling and a first step in rehabilitation of the area.

===Biological warfare===
Anthrax was first tested as a biological warfare agent by [[Unit 731]] of the Japanese Kwantung Army in [[Manchuria]] during the 1930s; some of this testing involved intentional infection of prisoners of war, thousands of whom died. Anthrax, designated at the time as Agent N, was also investigated by the allies in the 1940s. Weaponized anthrax was part of the U.S. stockpile prior to 1972, when the United States signed the Biological Weapons Convention.<ref>Croddy, Eric, and James J. Wirtz.  ''Weapons of Mass Destruction: an encyclopedia of worldwide policy.''  ABC-CLIO, 2005.  [http://books.google.com/books?id=ZzlNgS70OHAC&pg=PA21&lpg=PA21&dq=weaponized+anthrax+united+states+stockpile+1972&source=bl&ots=q8f31hjRM1&sig=2LwiDki_KMerP0Y4lpNTrd3mE9E&hl=en&ei=m10rTMKdOMP48Aa8mbnUCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CC0Q6AEwBg#v=onepage&q&f=false web]. Retrieved 30 June 2010.</ref>

[[File:Powell-anthrax-vial.jpg|thumb|[[Colin Powell]] holding a model vial of anthrax while giving a presentation to the [[United Nations Security Council]]]]
Anthrax spores can and have been used as a [[biological warfare]] weapon. Its first modern incidence occurred when Scandinavian freedom fighters ("the rebel groups") supplied by the German General Staff used anthrax with unknown results against the Imperial Russian Army in Finland in 1916.<ref>Bisher, Jamie, "During World War I, Terrorists Schemed to Use Anthrax in the Cause of Finnish Independence," Military History, August 2003, pp. 17–22. [http://www.geocities.com/jamie_bisher/anthrax.htm Anthrax Sabotage in Finland]. [http://www.webcitation.org/5knILODnE Archived] 25 October 2009.</ref> There is a long history of practical [[bioweapons]] research in this area. For example, in 1942 British bioweapons trials<ref>[http://www.sonicbomb.com/v1.php?vid=military/anthrax_island.wmv&id=533&ttitle=Anthrax%20Island]</ref> severely contaminated [[Gruinard Island]] in Scotland with anthrax spores of the Vollum-14578 strain, making it a no-go area until it was decontaminated in 1990.<ref>{{Cite book|last=Cole|first=Leonard A.|title=Clouds of Secrecy: The Army’s Germ Warfare Tests Over Populated Areas|publisher=Rowman and Littlefield|year=1990|isbn=0-8226-3001-X|url=http://leonardcole.com/otherworks.htm}}</ref><ref>"[http://www.timesonline.co.uk/article/0,,2-1726745,00.html Saddam's germ war plot is traced back to one Oxford cow]," ''The Times''</ref> The Gruinard trials involved testing the effectiveness of a [[submunition]] of an "N-bomb"—a biological weapon. Additionally, five million "cattle cakes" impregnated with anthrax were prepared and stored at [[Porton Down]] in "Operation Vegetarian"—an anti-livestock weapon intended for attacks on Germany by the [[Royal Air Force]].<ref>{{Cite news
|url=http://www.fpp.co.uk/bookchapters/WSC/Bwar2.html
|title=UK planned to wipe out Germany with anthrax
|work=Sunday Herald
|location=Glasgow
|accessdate=13 August 2008
|date=14 October 2001
}}</ref> The infected cattle cakes were to be dropped on Germany in 1944. However neither the cakes nor the bomb were used; the cattle cakes were incinerated in late 1945.

More recently the [[Rhodesia]]n government used anthrax against cattle and humans in the period 1978–1979 during its war with black nationalists.<ref>Southern African News Feature : [http://www.sardc.net/editorial/sanf/2001/iss21/specialreport.html the plague wars]</ref>

[[Military of the United States|American military]] and [[British Army]] personnel are routinely vaccinated against anthrax prior to active service in places where biological attacks are considered a threat. The [[anthrax vaccine]], produced by [[BioPort Corporation]], contains non-living bacteria, and is approximately 93% effective in preventing infection.{{Citation needed|date=February 2007}}

Weaponized stocks of anthrax in the US were destroyed in 1971–72 after President [[Richard Nixon|Nixon]] ordered the dismantling of US biowarfare programs in 1969 and the destruction of all existing stockpiles of bioweapons.

The Soviet Union created and stored 100 to 200 tons of anthrax spores at [[Kantubek]] on [[Vozrozhdeniya Island]]. They were abandoned in 1992 and destroyed in 2002.

;Soviet "accident": 2 April 1979
{{Main|Sverdlovsk anthrax leak}}
Despite signing the 1972 agreement to end bioweapon production the government of the Soviet Union had an active bioweapons program that included the production of hundreds of tons of weapons-grade anthrax after this period. On 2 April 1979 some of the over one million people living in Sverdlovsk (now called [[Ekaterinburg, Russia]]), about 850 miles east of Moscow, were exposed to an [[Sverdlovsk anthrax leak|accidental release of anthrax]] from a biological weapons complex located near there. At least 94 people were infected, of whom at least 68 died. One victim died four days after the release, ten over an eight-day period at the peak of the deaths, and the last six weeks later. Extensive cleanup, vaccinations and medical interventions managed to save about 30 of the victims.<ref>ANTHRAX, the investigation of a Deadly Outbreak, Jeanne Guillemin, University of California Press, 1999, ISBN 0-520-22917-7, names of victims, pp. 275–277</ref> Extensive cover-ups and destruction of records by the [[KGB]] continued from 1979 until Russian President [[Boris Yeltsin]] admitted this anthrax accident in 1992. Jeanne Guillemin reported in 1999 that a combined Russian and United States team investigated the accident in 1992.<ref>Guillmin, op. cit.</ref><ref>{{Cite web|url=http://www.pbs.org/wgbh/pages/frontline/shows/plague/sverdlovsk/ |title=Plague war: The 1979 anthrax leak |work=Frontline |publisher=PBS |accessdate=13 August 2008}}</ref><ref>{{Cite web|url=http://www.medicinenet.com/script/main/art.asp?articlekey=18982 |title=Anthrax - From Russia with Love |work=Infectious Diseases: Causes, Types, Prevention, Treatment and Facts |publisher=MedicineNet.com |accessdate=13 August 2008 |author=Michael C. Fishbein}}</ref>

Nearly all of the night shift workers of a ceramics plant directly across the street from the biological facility (compound 19) became infected, and most died. Since most were men, there were suspicions by [[NATO]] governments that the Soviet Union had developed a sex-specific weapon.<ref name="Alibek">{{Cite book|last=Alibek |first=K. |title=Biohazard |location=New York |publisher=Delta Publishing |year=1999 |isbn=0385334966 |postscript=<!--None--> }}.</ref> The government blamed the outbreak on the consumption of anthrax-tainted meat and ordered the confiscation of all uninspected meat that entered the city. They also ordered that all [[stray dog]]s be shot and that people not have contact with sick animals. There was also a voluntary evacuation and anthrax vaccination program established for people from 18–55.<ref name="Meselson">{{Cite journal|last=Meselson |first=M. |last2=et al. |year=1994 |title=The Sverdlovsk anthrax outbreak of 1979 |journal=Science |volume=266 |issue=5188 |pages=1202–1208 |doi=10.1126/science.7973702 |pmid=7973702 |first2=J |last3=Hugh-Jones |first3=M |last4=Langmuir |first4=A |last5=Popova |first5=I |last6=Shelokov |first6=A |last7=Yampolskaya |first7=O |postscript=<!--None--> }}.</ref>

To support the [[cover-up]] story Soviet medical and legal journals published articles about an outbreak in livestock that caused GI anthrax in people who consumed infected meat, and cutaneous anthrax in people who came into contact with the animals. All medical and public health records were confiscated by the KGB.<ref name="Meselson" /> In addition to the medical problems that the outbreak caused, it also prompted Western countries to be more suspicious of a covert Soviet Bioweapons program and to increase their surveillance of suspected sites. In 1986 the US government was allowed to investigate the incident, and concluded that the exposure was from aerosol anthrax from a military weapons facility.<ref>{{Cite journal|last=Sternbach |first=G. |year=2002 |title=The History of Anthrax |journal=Journal of Emergency Medicine |volume=24 |issue=4 |pages=463–467 |doi=10.1016/S0736-4679(03)00079-9 |pmid=12745053 |postscript=<!--None--> }}.</ref> In 1992, President Yeltsin admitted that he was "absolutely certain" that "rumors" about the Soviet Union violating the 1972 Bioweapons Treaty were true. The Soviet Union, like the US and UK, had agreed to submit information to the UN about their bioweapons programs but omitted known facilities and never acknowledged their weapons program.<ref name="Alibek" />

;Anthrax bioterrorism

Theoretically anthrax spores can be cultivated with minimal special equipment and a first-year collegiate [[microbiology|microbiological]] education, but in practice the procedure is difficult and dangerous. To make large amounts of an [[Particulate|aerosol]] form of anthrax suitable for biological warfare requires extensive practical knowledge, training, and highly advanced equipment.

Concentrated anthrax spores were used for [[bioterrorism]] in the [[2001 anthrax attacks]] in the United States, delivered by mailing postal letters containing the spores.<ref>{{Cite book|last=Cole|first=Leonard A.|title=The Anthrax Letters: A Bioterrorism Expert Investigates the Attacks That Shocked America--Case Closed?|publisher=SkyhorsePublishing|year=2009|isbn=978-1-60239-715-6|url=http://leonardcole.com}}</ref> Only a few grams of material were used in these attacks and in August 2008 the US Department of Justice announced they believed that [[Bruce Edwards Ivins|Dr. Bruce Ivins]], a senior biodefense researcher employed by the United States government, was responsible.<ref>{{cite news
 | last = Bohn
 | first = Kevin
 | authorlink =
 | coauthors =
 | title = U.S. officials declare researcher is anthrax killer
 | work=
 | publisher=CNN
 | date = 6 August 2008
 | url = http://www.cnn.com/2008/CRIME/08/06/anthrax.case/index.html
 | doi =
 | accessdate = 7 August 2008}}</ref> These events also spawned many [[anthrax hoaxes]].

Due to these events, the [[U.S. Postal Service]] installed biohazard detection systems at its major distribution centers to actively scan for anthrax being transported through the mail.<ref>{{Cite web
 | last =
 | first =
 | authorlink =
 | coauthors =
 | title = Cepheid, Northrop Grumman Enter Into Agreement for the Purchase of Anthrax Test Cartridges
 | work=
 | publisher=Security Products
 | date = 16 August 2007
 | url = http://secprodonline.com/articles/2007/08/16/cepheid-northrop-grumman.aspx
 | format =
 | doi =
 | accessdate = 26 March 2009}}</ref>

;Decontaminating mail
In response to the postal anthrax attacks and hoaxes the [[US Postal Service]] sterilized some mail using a process of gamma [[irradiation]] and treatment with a proprietary [[enzyme]] formula supplied by [[Sipco Industries Ltd]].<ref>{{Cite web
|url=http://www.usps.com/news/facts/lfu_021202.htm
|accessdate=13 August 2008
|title=Latest Facts Update
|date=12 February 2002
|publisher=USPS
}}</ref>

A scientific experiment performed by a high school student, later published in The Journal of Medical Toxicology, suggested that a domestic [[ironing|electric iron]] at its hottest setting (at least {{convert|400|°F}}) used for at least 5 minutes should destroy all anthrax spores in a common postal envelope.<ref>"[http://www.pittsburghlive.com/x/tribune-review/trib/pittsburgh/s_425621.html High school senior discovers ironing deactivates anthrax]," ''Pittsburgh Tribune-Review'', 20 February 2006</ref>

==See also==
{{top}}
* [[2001 anthrax attacks]]
* [[Anthrax hoaxes]]
* [[Ames strain]]
* [[Gruinard Island]], site of British bioweapons trials in 1942
* [[Sverdlovsk Anthrax leak]]
* [[Anthrax toxin]]
{{mid}}
* [[Anthrax Detection Device]]
* [[Anthrax Vaccine]]
* [[Anthrax Vaccine Immunization Program]], or AVIP: the program for vaccinating all members of the armed services in the United States.
* [[Black death]]
* [[Unit 731]]
{{bottom}}

==Notes==
{{Reflist|colwidth=30em}}

==External links==
{{Wikinews|9/11 Anthrax investigation quietly loses urgency}}
{{Wikinews|US Military To Buy Anthrax And Bioweapons Production Systems}}
{{Commons category|Bacillus anthracis}}
*[http://www.bt.cdc.gov/agent/anthrax/index.asp Anthrax], [[Centers for Disease Control and Prevention]] (CDC)
*{{ECDC|anthrax/|Anthrax|}}
*[http://www.upmc-biosecurity.org/website/focus/agents_diseases/fact_sheets/anthrax.html Agent Fact Sheet: Anthrax], [[Center for Biosecurity]]
* {{Cite web|title=Anthrax |work=CDC Division of Bacterial and Mycotic Diseases |url=http://www.cdc.gov/nczved/dfbmd/disease_listing/anthrax_gi.html |accessdate=17 June 2005 }}
*[http://www.logicalimages.com/resourcesBTAgents.htm Bioterrorism Category A Agents - Information Resources]
* {{Cite web|title=''Bacillus anthracis'' and anthrax |work=Todar's Online Textbook of Bacteriology (University of Wisconsin-Madison Department of Bacteriology) |url=http://textbookofbacteriology.net/Anthrax.html |accessdate=17 June 2005 }}
* {{Cite web|title=Focus on anthrax |work=Nature.com |url=http://www.nature.com/nature/anthrax/index.html |accessdate=17 June 2005 }}
*[http://publicservice.evendon.com/DOJAnthraxIvinsM.htm 2008 Ivins Court Documents and DOJ Report] in convenient form.
* [http://patricbrc.org/portal/portal/patric/Taxon?cType=taxon&cId=1392 Bacillus anthracis] genomes and related information at [http://patricbrc.org/ PATRIC], a Bioinformatics Resource Center funded by [http://www.niaid.nih.gov/ NIAID]

{{U.S. biological weapons}}
{{Gram-positive bacterial diseases}}
{{Use dmy dates|date=September 2010}}

[[Category:Zoonotic bacterial diseases]]
[[Category:Biological weapons]]
[[Category:Bovine diseases]]
[[Category:Livestock]]
[[Category:Anthrax]]
[[Category:Zoonoses]]
[[Category:Health disasters]]
[[Category:Microbiology]]
[[Category:Bacterium-related cutaneous conditions]]
[[Category:Occupational diseases]]

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