Field Detection Health and Safety Effect Levels Health Effects Release Scenarios Agent Characteristics Bacillus anthracis Bacillus NRT QuickReference Guide: contaminated animalproducts; thisincludeseatingcontaminatedmeatproductsorcarcasses. Other: Water: not well-known, but itdoesgrow media. readilyonlaboratory anthracis Soil/Surfaces: occur indoors, thoughanoutdoorreleaseispossible. Anaerosolreleaseof is aconsideration dependinguponthesize, purity, ofthemanufactured andchemicalphysical spores. properties Anaerosol Lethality size, lowas highsporeconcentration, uniform particle electrostaticcharge, etc. areconsidered “weapons-grade.” Inanaeros Air/Aerosolization: Person-to-Person Transmission: Duration ofIllness: Description: B.anthracis Classifi Agent minutes. patented immunochemical testsfor specifi c biological agents. They feature rapid identifi cation, minimaloperator training and Immunoassay Tests tickets): (smart continually testfor B. anthracis usingairsamplesand PCR. The BioWatch Program helpsdetectaerosolreleasesofbioagents. buildings, suchaspostal facilities Certain may have autonomo Incubation Period: animal tissue(cutaneousorgastrointestinalanthrax) orwhenexposed toaerosolized anthrax spores(inhalationanthrax). and sporadically occursinwildanddomesticanimals(e.g., cattleandantelope). Anthrax diseasecanalsooccurinhumanswhe Infectivity rates.mortality Inhalationanthrax ishighlylethal. death of50%theanimals)canbeusedinitsplace. Clearly, adosethatcouldpotentiallykill50%ofthepeopleexposed i an infective doseestimaterepresentsasafe level. examine whattheinfectivity numbers represent,includingtheroutesofexposure andtheanimalspeciesusedfor thelabstudie number oforganismsrequiredtocausediseaseinanexposed person. regardingpublished Given infective theuncertainties dose CONCERNS SYMPTOMS EXPOSURE FIRST AID/ MEDICAL ROUTES DECON ONSET SIGNS/ PPE

B. anthracis B. anthracis Note: may remainviable insoilfor 40+years. For thisreason, refl ects therelative easewithwhichanagentcausesdeathinasusceptible populationandcanbe representedquantitatively b refers tohow easilyanagentcancausediseaseinahost. Anagentishighlyinfective whenfew organisms cancausedisease. cation: Sporesareresistanttoadverse environmental conditionsandmay remainviable for years orprocessedhide insoilordried Immunoassay testsshouldnotbeusedalone, but shouldbeconfi withsamplesanalyzed by atLRN lab.rmed culturing Medical Responders decontaminatingincomingvictimsatthesiteorhospital: fi lters. protection factor of1,000for tight-fi hood/helmet-style PAPRstting full-faced andcertain thatareCBRN-approved, whenavail Respirators (PAPRs)Air-Purifying andassignedthemaprotectionfactor of50(e.g., tight-fi tting full-faced PAPR); OSHArecen Response toacontrolled incidentwhenreleasehasstopped: apparatus (SCBA). equivalent), innerandouterdisposable gloves, andboots; protection–NIOSH-approved, respiratory CBRN,positive-pressure sel 1910.120 (q)(6). Operations (HAZWOPER) standardsandattendanon-sitetraining briefi ng. Respondertraining shallmeettherequirements specifi Plan Draft 2005. January EPA documentsareavailable atwww.epaosc.org. Respondersshouldbetrained toHazardous Waste andE CBRN guidancedocument,theEPA’s ProtectionProgram Draft Respiratory 2005ortheEPA’s January Program MedicalSurveillance I onsite. For moreinfo onPPEandhealthsafety decision-making,pleasesee abdominal pain,andsevere diarrhea. black areainthecenter. Swollen lymphnodesandflu-like symptoms. and cyanosis (bluish discoloration oftheskin). Response toanoccurringandongoingreleaseof check withtheEPA NationalDecon Team at513-487-2420(afterhourscall24-hourpager1-800-329-1841 SubjectMatterExperts spores. With respecttospecifi cs (e.g., value compl contact timeofdeconsolution,andneedtorinse ofmechanicalscrubbing, solution may skin)for irritate 10-15minutes. Antibiotics(Ciprofloxacin, Doxycycline) andvaccination canhelpprevent infec Decon outerPPEwitha10%solutionofhouseholdbleach (0.5%sodiumhypochlorite). soapy Decontaminateskinwithwarm water ( Pre-Exposure: onlyforgeneral suggestionsonlyandareappropriate Under ICS, theappointedHealthandSafety Offi PPE,MedicalSurveillance, andSafetycer willdetermine Plans. The PPElevels l high rate ofmortality. Ingestion: enters viacutontheskinuponhandlingcontaminatedobjects; 20%ofuntreatedcasesarefatal. Cutaneous anthrax: Inhalation anthrax: Inhalation anthrax: Symptoms may occurwithin1-7days andupto60days afteraninhalationexposure. Post Exposure: etc. Doxycycline. plan,documentPPElevels Setupamedicalmonitoring thatwere used,exposure incidents, outcome, andif/whatty During Exposure: is naturally occurring andendemictotheUnitedStates, isnaturally andcancauseanthrax occurring diseaseinhumansthroughcontactwithinfected

isaprobable water threat. 1-7 days,upto60+days In a bioterrorism event, Inabioterrorism 3-5 Days Biological is a naturally-occurring, rod-shapedGram-positive,is anaturally-occurring, bacterium. sporulating Anthrax disease isendemicinanimalpopulations Caused by cooked consumptionofpoorly contaminatedmeat. Intestinalanthrax hastwo forms: upper&lower GItract infections, Annual exams function; toensureproperrespiratory ideally, respondersshouldbefullyvaccinated toex againstanthrax prior

No Monitorrespondersfor signs/symptoms andtreataccordingly. Type: Wear PPEasdesignatedby theHealthandSafety plan. Treat any accidentalexposures withtheantibioticsCiprofloxacin and/or These assays areintendedfor rapid detectionof Inhalation anthrax occurs when bacterial sporesareinhaled,andmay Inhalationanthrax occurswhenbacterial befatal withouttreatment. Fever, ofbreath malaise, distress, fatigue, dyspnea(shortness (noisybreathing),respiratory stridor cough,chestdiscomfort, (Anthrax) Mostcommonmanifestation anthrax ofnaturally disease; occurring Approximately 95%ofskininfections occurwhenbacteria B. anthracis Bacteria Bacteria Intheabsenceofdataoninfectious dose, theLD50(thedoseofsporesinanimal experiments whichresultsinthe (Bacillus anthracis) willmostlikely beaerosolized intheform ofawhitepowder. Powders of Cutaneous anthrax: B. anthracis B. anthracis: B. anthracis , many strains B. anthracis isathreattotheanimalpopulation. The sporeviabilityof Persistence/Stability Infective Dose: LD50: Infectivity/Lethality: ; they may notprovide protectionfor otherpossible contaminantsthatmay bepresent dermal –sameprotection; dermal protection–NIOSHhasapproved respiratory Powered

dermal –hooded,protective coverall dermal (Tyvek® for hazardousparticulate or Raised itchy bump tovesicle whichprogresses topainlessulcer(1-3cm)with B. anthracis would have thepotentialtotravel many kmbefore dissipating. Ingested anthrax: Ingested andfor screeningenvironmental samples. Eachticket employs http://www.ert.org/products/Anthrax.pdf, Moderate/High Same asresponsetoacontrolledincident. Report any release of WMD to the National Response Center 1-800-424-8802 Center Response National the to WMD of release any Report : For References, Please See: Key References Cited/Used in National Response National in Cited/Used References Key See: Please References, For Team (NRT) Quick Reference Guides (QRGs) for Biological Warfare Agents. Warfare Biological for (QRGs) Guides Reference Quick (NRT) Team

Spores HighlyPersistent/Stable;>40yearsinsoil 8000-50,000 spores(estimated) Flu-like symptoms, nausea,lossofappetite, vomiting, fever, s nottobeconsideredsafe. samplepreparation, response timeis5-15 ol releaseof s. releaseof n exposed toinfected animalsorinfected Responders shouldnotassumethat us detectionsystems(ADS)that s for to bioagents, itisimportant B. anthracis B. anthracis y theexposed population B. anthracis Aninfective doseisthe B. anthracis the OSHA/NIOSH interim theOSHA/NIOSHinterim s ofanimals. Sporesof tion withexposure to with characteristics such withcharacteristics able, andfi tted withP100 tly proposedanassigned etely) OSCsshould isted below are on certain surfaces is oncertain f containedbreathing pes antibioticsused, animalsor ed in29CFR , re-aerosolization willmostlikely ). Rev 1a (08/2008) theUnitedStates 10% bleach

mplementation mergency and hasa posure. ), B. Waste/Disposal Decontamination Laboratory Analysis: BSL-3 Sampling Bacillus anthracis Bacillus response to bioterrorist eventsresponse tobioterrorist involving minimize therisk. OSHAprovides guidanceRE: controlsat: alternative situations,workplace tothe OSHAoffers criteria “no growth” alternative practi decongoal,especiallywherePPE,specialwork growth”is “no of Clean-up Adequacy Verifi fumigant adequatelypenetrated allofthecontaminatedareas. ifsporesarelikelyalso beappropriate tore-aerosolize. Iffumigationistobeperformed, usebiologicalindicatorsinhard- todecontamination.contaminated prior Inaddition,statisticallyrelevant samplinginthedecontaminatedarea(s) shouldalso after decontamination. The samplesobtained shouldbeverifi ed viaculture. Targeted orjudgementalsamplingshouldbeperform forcriteria verifying deconeffectiveness. ifcontaminationisextensive. inputisespeciallyimportant Expert Rigorousenviro Decon Effectiveness: liquid andfumigationtodecontaminatethesite(ClO2at750ppmvfor 12hoursataminimum of75°Fand75%relative humidity). may toowners. beusefulindecontaminating itemsthatareintendedtobereturned The Brentwood, Trenton, andCapitolHillrem technologies todestroy Other Decon: 1 relative humidity, conc. &contacttime)thatmust befollowed. account. Fumigants: dioxide, chlorine vaporized hydrogen peroxide, andparaformaldehyde. Eachchemicalhasaspecifi ed range fo compatibility,materials penetration capacity, methodofremoval attheendoffumigation,aswell astheirphysical, chemical, contamination, re-aerosolizationofsporesorifdecontaminationlimitedaccessareasisrequired(e.g. HVAC systems). The h include: dioxide, chlorine hydrogen peroxide, andperoxyacetic acid. Fumigation: Usesgasorvapor todecontaminatefacilities examined for growth of pH-amended bleach canbedeployed asaspray orliquid. c) whenpHisequalto7,d)presenceofothersurface contaminants isminimal,ande)whensurfaces remainwet withamende The productwillbemosteffi cient a)Athighertemperatures (>70F)b)whenplainbleach (e.g., noaddedfragrance) isusedtom water, whitevinegarto8parts bleach isrecommended). (5.25%to6.0%)1part This productaffects surfaces differently in Methods usedonsurfaces: 1) the useofreadilyavailable commercialitemssuchasstandardbleach, at513-487-2420(afterhourscall24-hour pagerat800-3 Decon Methods: Offi ce ofPesticides dependingondecontaminatingagentsused. mightbenecessary The objectives itemsfor ofdecon,includingdeconcritical re-useandthetreatment,removal, orpackaging ofotheritemsf contamination, includingtheamountandpossible pathways thathave orcouldhave spread Culturing: taken fromplatedcolonies. selective,systems arevery but well donotwork withheterogeneousenvironmental samples(e.g., dust,soil). PCRisalsoused not beusedalone. Itisusefulfor analyzinginitialsamplesatsiteswithsuspectedcontamination. Positive resultsshouldbe Polymerase ChainReaction(PCR): http://www.bt.cdc.gov/agent/anthrax/lab-testing/approvedlrntests.asp ResponseNetworkCDC Laboratory Labs: 732-321-6660. at: 614-424-5909. USEPA hasIAGs withAberdeenandDugway a During forWMD response; AnalyticalLabSupport for access, contac Laboratory Information:Laboratory of hallways, baseboards, lightswitches, doorknobs, etc). Ifpointofreleaseoraerosolizationisunconfi thenuseasta rmed, towards oraway fromtheinitialpointofcontamination. aboutothercontaminatedareasduetofoot Beconcerned traffi c/ventil Sampling LocationPlans: local regulatory agency to determine appropriate waste managementpractices. appropriate agencytodetermine local regulatory anthracis waste may beconsideredmunicipal waste, medicalwaste oraninfectious substancewithspecialrequirementsfor handl B. anthracis a planthattakes intoaccount: Decon Planning: Concerns: ResponsePlans”Booklet for RegionalCounterterrorism through ICSchannels. Morespecifi c EPA/NRT samplingprocedures/guidancefor biowarfare agentscanbefound inEPA and TetraTec are general guidelinesanddonotreplaceneedfor asite-specifi c samplingplanthatshouldbereviewed andapproved by approp requirements. See Samples thattestfor re-aerosolization: investigative units(EPA CID/FBI); ensureplanfor chain-of-custody. appropriate types ofmedia. Agreements (BOAs) BasicOrdering for samplinganalysishave laboratory beenestablished withcontract labs. Con procedures oftheanalyticallaboratory. the typeofcontaminatedsurfaces (e.g., porousv. nonporous); ProtocolPackShip.pdf agar platesbasedontheiraerodynamicproperties. growth. thepresenceofbacterial agar platesdetermine neutralized withsodium thiosulfate) bleach) process. oranother sterilization Neutralization oftheresultingsolutionmay tofi berequiredprior nal disposal(e. Samples thatcantestDeconeffi DFUs. downloadfi lename/0000001202/ProtocolPackShip.pdf Details canbefound at by DOT, CDC, USPS, OSHA,andIATA. pac receivingthesamplestodetermine Consultandcoordinatewiththeanalyticallaboratory Sample packaging andshipping: sampling-apr2002.asp of contaminationinlargeareas. Usedonbothporousandnonporoussurfaces. For samplingmethodpleasesee: Vacuum Sampling: collectsamplesinaHEPA sock designedtofi t intoaninletnozzleofavacuum cleaner. Goodfor screeningan nonporous surfaces. CDCstudyshows thatrayon &polyester swabs arenotaseffi cient ascotton/macrofoam swabs insporerecove 2) water. Goodfor smallsampleareasofnonporoussurfaces. Coordinatemethodsandbuffer Re solutionswithdesignatedLaboratory Swab Samples: ormacrofoam Synthetic, moistened,cottonsterile swab moistenedwithbuffer water. solution(PBST)orsterile M The sampleisprepared for elution&plating,inoculatedontosheepblood agarplatesatLRNlabs. The platesareincubated

isnotregulatedunderSubtitleCofRCRA, but shouldbe handledwithcaution. Insomestatesandlocalities, waste management Different detection/analyticalequipmentandsamplingtechniqueswillbehighlysite-specifi c anddependon: ) Ethylene oxide chamber. isusedtodecontaminate itemsinanoff-sitesterilization sterilization B. anthracis OSCsshouldcheck withtheEPA NationalDecon Team regardingspecifi SubjectMatterExperts c decontaminationparameters, aswe Sitespecifi c decon/cleanup planshouldbedeveloped andapproved organizations/SMEsviaICSchannels. by allnecessary Respon http://hazmat.dot.gov/training/rmgmt/guide_anthrax.htm . todisposal,wastewater Prior fromcontaminatedsitesshould bepre-treatedusingachemicallike 5.25-6.0 %sodiumhypoch Multi-agency, shouldbeconsultedfor experts adviceindeveloping multi-disciplinary apost-deconverifi cation samplingstrat B. anthracis www.cdc.gov/od/ohs/biosfty/shipregs.htm orhttp://www.cdc.gov/od/sap/ B. anthracis For BiologicalandChemicalAgentAnalysesContract Vehicles for EPA 24-hour contactBattelleSecurity emergencylabsupport, cation: onpost-deconsamples. Viable sporesmay remain,but ofcontracting anthrax therisk inthatareawould beconsideredextremel If releasewas limitedtoaletterorcontainer, inconcentric withanareathoughttobefreeofcontaminationandwork start 1) (Anthrax)(side2) Sourcereductionsteps, includingHEPA vacuuming; The natureofcontaminationincludingpurity, sporesize, chemical/physical how itenteredthefacility, properties, etc.; cacy: There iscurrentlynoscientifi cally soundbasisfor a determining “safe” number ofresidualviable sporesinadecontaminated colonies inmail,andotherpapergoodsatoff-sitelocations. This proceduremay destroy magneticmedia. Irradiation andchemicalster Packaging samplescontainingorpossibly containing andtransporting Amplifi es DNAsequencesandcomparesthemtostandardgene for Note: B. anthracis

1)

1) Wipe Samples: Synthetic, non-cotton(Dacron/rayon) solution,buffer wipespre-moistenedwithanutrient solution,orsterile Wipe samplingoftheairductsystem(fi deposition)ifexposurelters, occurredindoors. areasofparticulate CDC Bioterrorism PreparednessandResponseProgram:CDC Bioterrorism 404-639-0385 Before canhandleall tobeused,asnotalllaboratories identifyandcoordinatewithlaboratory obtainingsamples, clearly 4) , EPA follows therecommendationofNationalAcademy ofSciencesthat decontaminationbecontinued untilthere Dry fi Dry lter units(DFUs)arethemostdirectindicatorofairborne 3) TDD: S05-0302-004 Note: Andersen Air Sampler & Single Stage Impactors with settle plates capture airborne particulates on a series of onaseries particulates Andersen AirSampler&SingleStageImpactorswithsettleplatescaptureairborne 3) Store-bought bleach doesdegrade withtime–check theexpiration date. antimicrobialproducts Alternate the phases/purposes ofsampling(initialidentifi thephases/purposes cation v. post-deconsampling); and http://www.osha.gov/SLTC/etools/anthrax/transition_program.html or http://www.asm.org/ASM/fi les/LEFTMARGINHEADERLIST/downloadfi lename/0000001202/ B. anthracis 2) Liquid Antimicrobial products such as pH amended bleach (A mixture of 1 part LiquidAntimicrobialproductssuchaspHamendedbleach (Amixtureof1part sporesaresubject toDOT regulationsand theCDC’s Select Agent program B. anthracis OR http://www.asm.org/ASM/fi les/LEFTMARGINHEADERLIST/ spores. Itisadvisable toisolatethecontaminatedarea; and B. anthracis 2) http://www.bt.cdc.gov/agent/anthrax/environmental- Irradiation usescobalt-60andelectronbeam B. anthracis B. anthracis sporesaresubjecttovarious regulationsestablished g. wastewater treatedwithbleach canbe 1) to-reach areastoprovide assurance thatthe nmental samplingshouldbeperformed the characteristics of the terrorist agents; oftheterrorist thecharacteristics confi culturing. withbacterial rmed FieldPCR tistically basedsamplingmethod. & toxicological properties shouldbetaken &toxicological into properties or disposal. be performed. Airsamplingafterdeconmay terms ofcorrosiveness,terms staining,andresidue. ation systems(elevator buttons, mail,corners ces, and engineering controlscanbeusedto ces, andengineering in whichthereisevidence ofhighlevels of istory of usageoftheagentsasfumigants, istory ake thepH-amendedbleach solution, as afi nal confi ofpositive samples rmation 29-1841). ediation teams used Chloride Dioxideediation teamsusedChloride spores. Check for theirpresence/install riate Subject Matter Experts and/or SubjectMatterExperts riate ed inareaswhichwere known tobe d determining theextentd determining andlocation . PCRisascreeningmethodthatshould ing anddisposal. Contactthestateor tact EPA ERT for details; coordinatewith r processvariables (e.g., temperature, ost usefulfor hard-to-reach, sponse Network (LRN)laboratory.sponse Network d bleach solutionfor 60minutes. ry. swabs. Donotusedry kaging orshippingrequirements. h

t theEPA ERT 24-hournumber: “Biological SamplingProcedures Note: at 37°Cfor uptothreedays & willvary; for instance, B. Crisis exemptionsCrisis fromEPA egy andestablishing 4) lorite (household lorite 2) thesampling Circles either ders shoulddevelop Rev 1a(08/2008) 2) ll asspecifi cs on The extent of Sheepblood control center Note: y low. In 3) area. In HEPA ilization These 2) 3)