Kansas Department of Health and Environment

Responding to the Receipt of Envelopes or Packages Suspected to Contain Anthrax or Other Biological Agents - August 23, 2002

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BACKGROUND AND SCOPE OF THIS DOCUMENT

Last year, many facilities in communities around the country received anthrax threat letters or packages. Some were empty envelopes; some had talcum powder or other non-toxic substances in them. A few were found to actually contain anthrax. With the anniversary of these events and that of September 11^th, we may see a resurgence of copycat anthrax threat letters and packages.

This document includes the most current KDHE guidelines to respond to envelopes or packages suspected to contain Anthrax or other biological agents. We encourage local public health departments and law enforcement to familiarize themselves with the following guidelines for response to these threats. 

DO NOT PANIC

Anthrax organisms can cause infection in the skin (cutaneous), gastrointestinal (digestive) system, or the lungs (pulmonary). To do so, the organism must be rubbed into abraded (irritated) skin, swallowed, or inhaled as a fine aerosolized mist. The disease can be prevented, after exposure to the anthrax spores, by early treatment with the appropriate antibiotics. Anthrax is not spread from one person to another.

For anthrax to cause lung disease, it must be aerosolized (that is, spread in the air) into particles between 0.4 and 2/10,000ths of an inch, smaller than a red blood cell. This is difficult to do. If these small particles are inhaled, life-threatening lung infection can occur. Prompt recognition and initiation of antibiotic treatment are very important to a good outcome in such cases.

IDENTIFYING SUSPICIOUS PACKAGES AND ENVELOPES:

According to the United States Postal Service, characteristics of suspicious packages and envelopes include the following:

Inappropriate or unusual labeling

·         Excessive postage

·         Handwritten or poorly typed addresses

·         Misspellings of common words

·         Strange return address or no return address

·         Incorrect titles or title without a name

·         Not addressed to a specific person

·         Marked with restrictions, such as "Personal," "Confidential," or "Do not x-ray"

·         Marked with any threatening language

·         Postmarked from a city or state that does not match the return address

Appearance

·         Powdery substance felt through or appearing on the package or envelope

·         Oily stains, discolorations, or odor

·         Lopsided or uneven envelope

·         Excessive packaging material such as masking tape, string, etc.

Other suspicious signs

·         Excessive weight

·         Ticking sound

·         Protruding wires or aluminum foil

·         If a package or envelope appears suspicious by these criteria, DO NOT OPEN IT. Do not shake it. Leave it where it is. If at work, notify your supervisor and local law enforcement (call 911). Local law enforcement will determine whether the FBI should be notified and will instruct you about how to dispose of the suspicious package or envelope.

UNOPENED LETTER OR PACKAGE OR LETTER THAT APPEARS EMPTY - NO THREAT MESSAGE OR VISIBLE POWDER:

If a person receives a letter, package, or other item that does not appear suspicious (based on the characteristics listed above) and is not accompanied by a threat message, but the recipient is still fearful, the safest course of action is to dispose of the item without opening it. Since there is no evidence that such items represent a danger, it is acceptable to dispose of them as normal trash. To prevent the object from being retrieved from the trash by someone trying to be helpful, place the item inside a bag when disposing of it. It is unnecessary and unfeasible to submit these items for testing.

·         Bag the letter or package and throw it away.

·         Wash hands with SOAP and WATER.

·         No medical attention or individual decontamination recommended.

PACKAGE OR ENVELOPE MARKED WITH OR CONTAINING THREATENING MESSAGE SUCH AS "ANTHRAX", NO VISIBLE POWDER INSIDE OR OUTSIDE:

·         If package or letter is not open, DO NOT OPEN IT.

·         LEAVE it and EVACUATE the room.

·         KEEP others from entering the room.

·         If at work, NOTIFY your supervisor and local law enforcement (call 911). Local law enforcement will determine whether the FBI should be notified.

·         Local and state law enforcement and emergency response agencies will decide whether the threat is credible and if the package or letter should be tested.

·         No medical attention or individual decontamination recommended.

OPEN ENVELOPE OR PACKAGE WITH POWDER, OR POWDER SPILLS OUT ONTO SURFACE OF UNOPENED LETTER OR PACKAGE:

·         DO NOT shake or empty the contents of any suspicious package or envelope.

·         DO NOT carry the package or envelope, show it to others or allow others to examine it.

·         DO NOT try to identify the powder by touching, smelling, or tasting it.

·         DO NOT clean powder up. Keep others away.

·         WASH hands with soap and water.

·         DO NOT brush off your clothes.

·         EVACUATE the room.

·         KEEP others from entering the room.

·         If at work, NOTIFY your supervisor and local law enforcement (call 911). Law enforcement will determine whether the FBI should be notified and will assure proper custody and packing of the letter or package, as well as any other evidence as necessary.

·         REMOVE your clothing, place in a double plastic bag, and wash your hands with water and soap. Put on fresh clothing.

·         SHOWER with SOAP and WATER as soon as possible at home.

·         If law enforcement or public health authorities decide to run a test on the powder, keep the plastic bags with your clothes sealed in a secure environment until the test results are known (make sure you communicate with the person or agency submitting the specimen to the laboratory so that you can promptly learn the test results, since the laboratory may not send that information directly to you). If the results are negative, wash the clothes, as you would regularly do. If the results are positive, turn the bag in to local law enforcement or public health authorities. If the authorities decide not to run tests because a credible threat is not deemed to exist, the clothing can be washed, or it can be left in the bag and discarded in the regular trash.

·         MAKE list of all people who had direct contact with the powder and give to local public health authorities.

·         No medical attention or individual decontamination recommended at this time.

AEROSOLIZATION (FOR EXAMPLE, CLOUD OF DUST), SMALL EXPLOSION, OR LETTER STATING "ANTHRAX IN HEATING OR AC SYSTEM":

·         LEAVE letter or package where it is; do not carry it with you.

·         LEAVE room immediately.

·         SECURE entry to the room.

·         If at work, NOTIFY your supervisor.

·         SHUT down air handling system.

·         CALL local law enforcement (call 911). Local law enforcement will determine whether the FBI should be notified.

·         REMAIN on premises until responders arrive.

·         Follow the procedures regarding clothing outlined in the section above ("OPEN ENVELOPE OR PACKAGE WITH POWDER, OR POWDER SPILLS OUT ONTO SURFACE OF UNOPENED LETTER OR PACKAGE").

·         MAKE list of all people who have directly breathed the suspect aerosol and give it to local public health authorities.

·         No medical attention or individual decontamination recommended at this time.

FIELD TESTING OF SAMPLES:      

The Federal Bureau of Investigation (FBI), in collaboration with the Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC), conducted experiments to validate the performance of commercially available handheld assays for the detection of Bacillus anthracis, or anthrax. These studies found that all of the commercially available assays had low sensitivities, most had the potential to produce false-positives and some produced false negative results on samples that were truly positive. The White House, in response to these tests, issued a memo to 250 federal agencies and to firefighters, police, and local officials across the country warning that the commercially available anthrax field tests might produce unreliable results in certain circumstances.

KDHE does not support the use of these devices for the testing of suspect anthrax samples. The decision to submit samples to KDHEL will not be affected, neither negatively nor positively, by the results of commercially available anthrax field tests.

CRITERIA FOR TESTING:

All threats shall be assessed, by law enforcement, to determine their credibility. KDHE is to be notified of all threats that law enforcement deems to be credible. KDHE will then determine, based on information presented, what samples meet the criteria for testing at KDHEL. Law enforcement is responsible for assuring that samples do not contain radiological, chemical, or explosive elements. KDHEL is not equipped to handle these types of materials.

CONTACT NUMBERS

Kansas Division of Emergency Management 24 hour duty officer .......... 785-296-3176

Kansas Department of Health and Environment (KDHE), 24 hour number ..... 1-877-427-7317

FBI KC field office 24 hour response line .................... 816-512-8200

State Fire Marshal's Office, Hazard Materials Response Program .......... 785-296-3401

For further information contact Kansas Department of Health and Environment Bureau of Epidemiology and Disease Prevention at the 24 hour response number: 1-877-427-7317.

Updated: August 23, 2002