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Background
In April and May of 1979 an Anthrax epidemic broke out in humans in the city of Sverdlovsk in the former Soviet Union. While Soviet officials attributed this outbreak to contaminated meat, the US Government maintains its position that the outbreak was due to a leakage from a biological weapons facility. This case seeks to explore the sources of the anthrax spores as well as the methods of treatment used by the Soviets according to both US and Soviet sources.

Anthrax Facts (from the The Encyclopedia Brittanica Online ⁱ):

Anthrax in humans occurs as a cutaneous, pulmonary, or intestinal infection; the most common type occurs as a primary localized infection of the skin in the form of a carbuncle bacteremia. It usually results from handling infeced material, lesions occurring mostly on the hands, arms, or neck as a small pimple that develops rapidly into a large vesicle with black necrotic centre (the malignant pustule). Should this condition become generalized, a fatal septicemia (blood poisoning) may ensue. The pulmonary form (woolsorters' disease) affects principally the lungs and pleura and results from inhaling anthrax spores in areas where hair and wool are processed. This form of the disease usually runs a rapid course and terminates fatally. The intestinal form of the disease, which sometimes follows the consumption of contaminated meat, is characterized by an acute inflammation of the intestinal tract, vomiting, and severe diarrhea. Anthrax is occasionally transmitted to humans by spore-contaminated brushes or by weraing apparel such as futs and leather goods. Prompt diagnosis and early treatment are of great importance. Antianthrax serum, arsenicals, and antibiotics are used with excellent results.

Case
"Anthrax is an acute disease that primarily affects domesticated and wild herbivores and is caused by the spore-forming bacterium Bacillus anthracis."ⁱⁱ Anthrax outbreaks among humans usually occur as skin infections resulting from touching contaminated hides, leather, and animals. It is rare that that an infection results from inhalation or ingestion. While the outbreak sparked an international debate as to whether the outbreak was the result of natural causes or an accidental release, the reported methods of dealing with the case are similar.

According to Soviet sources, "people had become sick...from eating bad meat they bought from 'private butchers'."ⁱⁱⁱ According to a report given by visiting Soviet doctors, the crisis began on the morning of the 7th of April, when Soviet officials were notified of a 'spate of deaths' over the previous weekend.^iv Vladimir Nikiforov, infectious diseases chief at the Moscow Institute for the Advanced Training of Physicians, was flown out to Sverdlovsk and "treated suspected victims with near-toxic doses of antibiotics"^v upon deeming the infection to be anthrax, which was confirmed by laboratory tests 3 days later.

The epidemic ran intensely from 4 April to 19 April, the day the epidemic reached its peak with ten new cases...There were 96 victims in all, according to Nikiforov. Seventeen had skin infections and survived. Seventy-nine had intestinal infections; of these, 64 died. ...The source of the outbreak was traced to a single 29-ton lot of bone meal (cattle feed) sold in March from a factory in Aramil, 15 kilometers to the southeast of Sverdlovsk. ^vi

While "many scientists" at the time said the new evidence supported the Soviet view, Science Magazine released a study in 1994, that appears to corroborate the US Government view.

...Most people who contracted anthrax worked, lived, or attended daytime military reserve classes during the first week of April 1979 in a narrow zone, with its northern end in a military microbiology facility in the city and its other end near the city limit 4 km to the south; livestock died of anthrax in villages located along the extended axis of this same zone, out to a distance of 50 km...
...We conclude that the outbreak resulted from the windborne spread of an aerosol of anthrax pathogen, that the source was at the military microbiology facility, and that the escape of pathogen occurred during the day on Monday, 2 April. ... Most or all infections resulted from the escape of anthrax pathogen on that day.
...A single date of inhalatory infection is also consistent with the steady decline of onset of fatal cases in successive weeks of the epidemic.
Accepting 2 April as the only date of inhalatory exposure, the longest incubation period for fatal cases was 43 days and the modal incubation period was 9 to 10 days...Experiments with nonhuman primates have shown, however, that anthrax spores can remain viable in the lungs for many weeks ant that the average incubation period depends inversely on does, with individual incubation periods ranging between 2 and approximately 90 days.ⁱⁱ

The Soviets claimed that accusations about the epidemic's source being an airborne infection were false, because there would not have been a trend in the number of victims. However, since incubation time can vary based on the health of the individual, there still could have been a trend reflective of other sources of infection.

While the source of the anthrax infection and whose account is accurate may seem irrelevant, when considering methods of treatment it is essential. Treatment of an anthrax infection is contained mainly to penicillin. However, if the source of the infection is indeed inhalatory, the chances of curtailing and surviving the infection are much lower.

...Inhalation anthrax is characterized by the severe local effects of the toxin at its primary site of production, thoracic hemorrhagic necrotizing lymphadenitis and hemorrhagic necrotizing mediastinitis, as well as the systemic effects of bacteremia and toxemia. These thoracic lesions are not expected to occur in toxemic cutaneous or intestinal anthrax because spread from the cutaneous or intestinal portal of entry by the lymphatic vessels would involve the regional lymphatic drainage of the primary skin or intestinal lesion, but there would be no spread to the lymphatic drainage of the lungs in the mediastinum.^vii

Unfortunately, while a 1993 report in the Proceedings of the National Academy of Sciences in the USA contains an analysis of the autopsy reports of 42 victims, the secrecy that surrounded the outbreak prevented any significant knowledge to be gained from the treatment of anthrax inhalation.^viii The lack of

... clinical information impairs extensive clinicopatholigic correlations including the effects of various therapeutic approaches. Some deaths occurred outside the hospital, at home, or even in the street or in a field. Medical personnel accompanying the emergency transport vehicles often made an initial diagnosis of pneumonia. The chest pain, which was severe enough to suggest an initial diagnosis of myocardial infarction, undoubtedly resulted from the hemorrhagic thoracic lymphadentisis and mediastinitis.^ix

While the medical personnel at the time had difficulty identifying the cases of inhalation anthrax, the secrecy surrounding the release has served to prevent another outbreak from being less lethal. According to the same report, curtaneous anthrax infections reported at the same time could conceivably have come from animals infected by the same airborne anthrax spores as humans.^x

Conclusion
While it may not be entirely clear whose account of the Sverdlovsk anthrax outbreak is correct, it is certain that if indeed the source was airborne anthrax spores, the medical community has gained little from the events in Sverdlovsk. Medical personnel must undertake to diagnose mass casualties with pneumonia like symptoms carefully, especially during warfare. In order to prevent digestive tract anthrax infection, the monitoring of food sources must remain precise and consistent. Lastly, any outbreak in an infectious disease must be monitored and reported openly, despite the potential embarrassment, in order to further science and the human conditions.

Written and compiled by Alex Neifert for the Camber Corporation

Sverdlovsk information
Sverdlovsk City now Ekaterinburg:http://dasun3.essex.ac.uk/ekaterinburg.html

Anthrax information
New York State Department of Health gopher site. http://gopher.health.state.ny.us:70/00/.consumer/.files/anthrax.txt. 7/22/96
Army Field Manual 8-9: Handbook On The Medical Aspects Of NBC Defensive Operations..<PART II, chapter4.htm