The Postal Service delivers approximately 208 billion pieces of mail per year. Presently, there have been only two confirmed incidents of anthrax bacteria being sent through the mail.

Some typical characteristics which ought to trigger suspicion include letters or parcels that:

• have any powdery substance on the outside.
• are unexpected or from someone unfamiliar to you.
• are addressed to someone no longer with your organization or are otherwise outdated.
• have no return address, or have one that can't be verified as legitimate.
• are of unusual weight, given their size, or are lopsided or oddly shaped.
• have an unusual amount of tape on them.
• are marked with restrictive endorsements, such as "Personal" or "Confidential."
• have strange odors or stains.
• show a city or state in the postmark that doesn't match the return address.

• Do not try to open the mailpiece!
• Isolate the mailpiece.
• Evacuate the immediate area.
• Call a Postal Inspector to report that you've received a parcel in the mail that may contain biological or chemical substances.

• Do not handle the mail piece or package suspected of contamination.
• Notify your supervisor, who will immediately contact the Inspection Service, local police, safety office, or designated person.
• Make sure that damaged or suspicious packages are isolated and the immediate area cordoned off.
• Ensure that all persons who have touched the mail piece wash their hands with soap and water.
• The Inspectors will assess the threat situation and coordinate with the FBI.
• Designated officials will notify local, county, and state health departments.
• Designated officials will notify the state emergency manager.
• List all persons who have touched the letter and/or envelope. Include contact information. Provide the list to the Inspection Service.
• Place all items worn when in contact with the suspected mail piece in plastic bags and keep them wherever you change your clothes and have them available for law enforcement agents.
• As soon as practical, shower with soap and water.
• If prescribed medication by medical personnel, take it until otherwise instructed or it runs out.
• Notify the Center for Disease Control Emergency Response at 770-488-7100 for answers to any questions.

Anthrax is a bacterial, zoonotic disease caused by Bacillus Anthracis. Anthrax occurs in domesticated and wild animals, including goats, sheep, cattle, horses, and deer.

The skin form of the disease may be contracted by handling contaminated hair, wool, hides, flesh, blood, or excreta of infected animals and from manufactured products such as bone meal. Infection is introduced through scratches or abrasions of the skin, wounds, inhalation of spores, eating insufficiently cooked infected meat, or from flies. The spores are very stable and may remain viable for many years in soil and water. They will resist sunlight for varying periods.

After an incubation period of 1-7 days, the onset of inhalation anthrax is gradual.

Possible symptoms include:

• fever
• malaise
• fatigue
• cough
• mild chest discomfort followed by severe respiratory distress

This mild illness can progress rapidly to respiratory distress and shock in 2-4 days followed by a range of more severe symptoms, including breathing difficulty and exhaustion. Death usually occurs within 24 hours of respiratory distress.

Anthrax is an acute bacterial infection of the skin, lungs, or gastrointestinal tract. Infection occurs most commonly via the skin.

The cutaneous or skin form of the infection occurs most frequently on the hands and forearms of persons working with infected livestock or contaminated animal products and represents 95% of cases of human anthrax. It is initially characterized by a small solid elevation of the skin, which progresses to a fluid-filled blister with swelling at the site of infection. The scab that typically forms over the lesion can be black as coal, hence the name anthrax - Greek for coal. With treatment, the case fatality rate is less than 1% among people who get the skin form of the disease. The fatality rate for untreated inhaled or intestinal anthrax is over 90%.

The inhaled form of anthrax is contracted by inhalation of the spores, occurs mainly among workers handling infected animal hides, wool, and furs. Under natural conditions, inhaled anthrax is exceedingly rare, with only 18 cases reported in the United States in the 20th century.

Treatment with antibiotics beginning one day after exposure has been shown to provide significant protection against death in tests with monkeys, especially when combined with active immunization. Penicillin, doxycycline, ciprofloxacin, are all effective against most strains of the disease. Penicillin is the drug of choice for naturally occurring anthrax. If untreated, inhaled anthrax is fatal.

A vaccine is available and consists of a series of 6 doses over 18 months with yearly boosters. This vaccine, while known to protect against anthrax acquired through the skin, is also believed to be effective against inhaled spores.

Effective decontamination can be accomplished by boiling contaminated articles in water for 30 minutes or longer and using common disinfectants. Chlorine is effective in destroying spores and vegetative cells. Remember, anthrax spores are stable, able to resist sunlight for several hours, and able to remain alive in soil and water for years.