Who is at risk for anthrax exposure?



In October 2001, five workers died from inhalation anthrax and an additional 13 developed cutaneous or inhalational disease as a result of intentional terrorist activity. In most cases seen so far, the disease was linked to unexpected workplace exposures to anthrax spores contained in letters mailed through the United States Postal Service. Fortunately, the number of workplaces contaminated with the spores has also been quite limited. Nevertheless, employers and workers are concerned about possible exposure to Bacillus anthracis in the workplace.

 

Use the following link to help you decide if there is a credible risk of anthrax exposure at your worksite:  

  • The Anthrax Risk Reduction Matrix

The following categories of employees could potentially be exposed to anthrax:

  • Workers Exposed Through Criminal/Terrorist Acts
  • Emergency Response Workers
  • Health Care Workers

The anthrax exposures that occurred as a result of the criminal/terrorist acts received a great deal of media attention.  However, anthrax exposure is most common in animal handling and related occupations, where Bacillus anthracis spores can exist naturally.  The following link provides more information regarding other occupations that are at-risk of anthrax exposure:

  • Animal Handling and Related Occupations

 

 

 

 

 

 

 

 

 

 

 

 

 

Anthrax Risk Reduction Matrix

This matrix was developed to offer basic advice and suggest protective measures that OSHA believes will reduce the risk of exposure in light of current concerns about the presence of anthrax spores in the workplace. To help employers determine appropriate precautions, OSHA categorizes worksites into three risk zones - green, yellow, and red - based on the likelihood of contamination with anthrax spores.

  • Green Zone: Workplaces where contamination with anthrax spores is unlikely

This zone covers the vast majority of workplaces in the United States.  Since October 2001, anthrax spores have been discovered only in a very limited number of workplaces. If your workplace falls into the Green Zone, it is unlikely that specific measures to protect against anthrax exposure are necessary.

  • Yellow Zone: Workplaces where contamination with anthrax spores is possible

Examples of workplaces in the Yellow Zone may include:

§       Workplaces that handle bulk mail (especially, working near equipment such as high-speed processors/sorters that could aerosolize anthrax spores),

§       Workplaces that handle mail from other facilities that are known to be contaminated,

§       Workplaces in close proximity to other facilities known to be contaminated, and

§       Workplaces that may be targets of bio-terrorists.

The following link provides additional information for workplaces that fall into the Yellow Zone:

§       How should I prepare if my company has a credible risk or anthrax exposure?

  • Red Zone: Workplaces where authorities have informed you that contamination with anthrax spores has been confirmed or is strongly suspected

Red Zone guidance addresses two situations:

§       Workplaces where authorities have informed you that contamination with anthrax spores has been confirmed or is strongly suspected, and

§       Sites where emergency response workers are engaged in emergency response to, and cleanup of, bio-terrorist releases of anthrax spores.

Actions taken by an employer under these circumstances may vary depending on the specific facts and the nature of the incident.  Employers should follow instructions given by law enforcement and public health agencies and convey appropriate information to employees.

The following links provide additional information for workplaces that fall into the Red Zone:

§       What should I do if I have an anthrax threat at my worksite?

§       How do I clean up my worksite that has been contaminated with anthrax?


 

 

 

Workers Exposed Through Criminal/Terrorist Acts
  • Workers whose jobs would not ordinarily involve anthrax exposure could be exposed through acts of terrorism.
  • Conventional thinking is that terrorists are likely to target places where large populations can be found such as large buildings, sporting events, or mass transit systems.
  • Recent events have shown that there is a wider range of physical locations that could be targeted and this expands the range of employees who could be exposed.

 

 

 

Emergency Response Workers
  • Emergency responders, including police, firefighters, emergency medical services workers, and others who are responsible for responding to acts of terrorism may be exposed to anthrax.
  • Health and safety precautions, including personal protective equipment (PPE) and respirators, used by emergency response workers will help protect them against anthrax exposure.

The following link will help you determine if your normal health and safety precautions will protect you or your employees against anthrax exposure during an emergency response.

  • Interim Recommendations for the Selection and Use of Protective Clothing and Respirators Against Biological Agents, Centers for Disease Control and Prevention, Public Health Emergency Preparedness and Response

 

Health Care Workers
  • Health care workers in occupational settings such as hospitals, clinics, and medical laboratories may be exposed to anthrax as a result of contact with patients whose skin, clothing, or personal effects are contaminated with anthrax spores, or through contact with contaminated equipment.
  • Anthrax is not a contagious disease.
  • Because the most likely exposure route for health care workers is dermal contact, normal health and safety precautions (such as wearing latex/nitrile examination gloves) will protect these workers against cutaneous anthrax exposure. 

The following links will provide additional emergency response information for health care workers:

  • U.S. Department of Labor, Occupational Safety and Health Administration (OSHA), Hospitals and Community Emergency Response -- What You Need to Know, OSHA 3152, 1997
  • Anthrax Page for Lab and Health Professionals. CDC Public Health Emergency Preparedness and Response (2002)

 

 

 

Animal-Handling Occupations
  • Anthrax is most common in occupations involving animals, animal hides, or fibers. Grazing animals such as cattle, sheep, goats, and horses are chief animal hosts of anthrax.
  • Occupations susceptible to exposure include shepherds, farmers, butchers, handlers of imported hides or fibers, weavers, veterinarians, and veterinary pathologists.
  • Anthrax can be found globally. However, it is more common in developing countries or countries without veterinary public health programs.

Employers in animal-handling occupations who anticipate exposure may find the following information useful:

  • Anthrax, Veterinary Services, USDA 10/2001

 

 

 

 

 

 

 

 

How should I prepare if my company has a credible risk of anthrax exposure?



The following information will help you prepare for potential emergencies if you determine that your facility fits into the Yellow or Red Zones on the Anthrax Risk Reduction Matrix (such as if your facility has a credible risk of anthrax exposure):

  • Emergency Action Plan
  • Mail-Handling Procedures

 

 

 

Emergency Action Plan

An emergency action plan (EAP) describes the actions employees should take to ensure their safety if a fire or other emergency situation occurs. Well-developed emergency plans and proper employee training (such that employees understand their roles and responsibilities within the plan) will result in fewer and less severe employee injuries and less structural damage to the facility during emergencies. A poorly prepared plan is likely to lead to a disorganized evacuation or emergency response, resulting in confusion, injury, and property damage. If your facility fits into the Yellow Zone on the Anthrax Risk Reduction Matrix (such as if your facility has

a credible risk of anthrax exposure), you should add anthrax-specific information to your EAP. This may include:

  • Emergency identification:  Provide guidance on how to recognize a potential emergency situation (such as an anthrax threat or release, suspicious mail, etc.).  
  • Initial actions: Upon identification of a potential anthrax threat or release:
    • Do not panic.
    • Isolate contaminated areas.
    • Minimize exposure to others.
    • Turn off local fans or ventilation units and shut down the air handling system in the building, if possible.
    • Keep track of people who may have come into contact with the anthrax. Give this list to both the local public health authorities and law enforcement officials.
  • Notify the proper authorities once the area has been isolated.
    • Call 9-1-1 for local fire and law enforcement assistance. Call the Federal Protective Service if your building is managed by GSA.
    • Notify the National Response Center at (800)424-8802. The NRC will notify the appropriate parties responsible for aiding in mitigation of these events.
    • Contact the owner or operator of the facility.
  • Notification:  A description of the alarm system to be used to notify employees (including disabled employees) to evacuate and/or take other actions.
  • Evacuation policy:  An evacuation policy, procedures, and escape route assignments so employees understand who is authorized to order an evacuation, under what conditions an evacuation would be necessary, how to evacuate, and what routes to take.
  • Account for employees:  Procedures to account for employees after the evacuation to ensure that everyone got out.
  • Organizational structure:  Define an organizational structure that defines the roles and responsibilities of employees in the event of an emergency.
  • Employee training:  A description of how employees will be informed of the contents of the plan and trained in their roles and responsibilities.
  • Contact information:  The names, titles, departments, and phone numbers of employees who can be contacted for additional information or clarification of some aspect of the plan.
  • Off-hour contacts:  A list of key personnel who should be contacted during off-hours emergencies.
  • Emergency drills:  Conduct emergency drills to help ensure that the actions outlined in the EAP are carried out properly and safely.

The following eTool link provides information on how to write and implement an EAP (including OSHA's Expert System, which will help you write your own EAP):

  • U.S. Department of Labor, Occupational Safety and Health Administration, Evacuation Plans and Procedures eTool.

 

Mail-Handling Procedures

In light of the terrorist attacks involving anthrax being transported through mail and packages, mail handling has become a concern for many employees and facilities.  If your facility fits into the Yellow Zone of the Anthrax Risk Reduction Matrix (your facility has a credible risk of anthrax exposure), the following mail handling information may be useful:

  • Centers for Disease Control and Prevention (CDC) Health Advisory, Updated Information About How To Recognize and Handle a Suspicious Package or Envelope, Distributed via the Health Alert Network October 31, 2001, CDCHAN-00050-01-10-31-ADV-N.
  • Federal Bureau of Investigation (FBI) Advisory Poster, If you receive a suspicious letter or package, what should you do?, General Information Bulletin 2000-3.
  • United States Postal Service, Mail Center Security Website.
  • Public Health Foundation, Bioterrorism/Emergency Preparedness, Protecting Your Health for People Who Process, Sort, and Deliver the Mail

 

Upon discovery of a suspicious package, the facility's Emergency Action Plan should be implemented.