Rationale:

• Anthrax is commonly found in Africa, Asia, South America, and the Middle East where it exists in the soil.
• Textile workers, woolsorters, and agricultural workers are at risk of exposure to anthrax with exposure to animal hides.
• A powdered form of anthrax has been produced as a biological weapon.
• During the U.S. anthrax outbreak of 2001, certain groups were at a higher risk for cutaneous and inhalational anthrax.

Evidence:

• A review detailing the epidemiology, pathogenesis, and clinical characteristics of anthrax identifies the Middle East, Africa, South America, and Asia as regions where anthrax is endemic (21).
• A historical editorial emphasizes that textile workers are at an increased risk of anthrax (22).
• At least 66 people died in Sverdlovsk, Russia, of inhalational anthrax as a result of an accidental release from a facility producing anthrax as a biological weapon. Although this outbreak was initially reported as a naturally occurring outbreak of GI anthrax, a subsequent epidemiologic investigation suggested that aerosolized anthrax had been accidentally released from a Russian bioweapons plant (18).
• During the U.S. anthrax outbreak of 2001, postal workers and media employees were at an increased risk of exposure to powdered anthrax. An epidemiologic investigation showed that postal workers in Washington, DC, were at risk of coming into contact with anthrax spores from contaminated envelopes. Environmental sampling showed contamination of several facilities in Washington, DC. (23).

Comments:

• None.