An Anthrax Primer
Steve Burt
Director of Education

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Who would have thought even a few months ago that Postal Service employees would be sick and dying from germs placed in the mails. Even though the targets were apparently media figures and politicians, the criminals who used the mails to deliver their deadly germs were trying to murder people and didn't care if we were numbered among the casualties.

In my long life, I have made my share of enemies, but have never had anyone try to kill me before. Now I can't say that anymore, which has changed my view of the world. It has also made my friends and family for ever more precious! I love letter carriers and am proud to be one. But I have never been more proud of all of my brothers and sisters as we continue to deliver the mail in spite of some real risk. For good to prevail over evil, good has to be very strong. We are equal to this challenge!

The Postal Service and the NALC have disseminated a large quantity of literature on anthrax in our workplaces. This paper will discuss some of the more basic facts about anthrax with the aim of increasing our fundamental knowledge about this deadly germ. Knowledge will not make anthrax go away, but may help us make better decisions in our work environments as we try to make things as safe as possible. For in-depth information on anthrax visit www.osha.gov and www.cdc.gov.

What is Anthrax?

Anthrax is an acute infectious disease cause by a spore-forming germ, Bacillus anthraxus. Anthrax can infect animals and humans in its vegetative state (as an actively-growing germ) when exposed to the flesh of infected animals. Anthrax is not contagious in the sense that it spreads easily from person to person like a cold or the flu. But anthrax is particularly dangerous in its inactive state as a dormant spore, waiting to find conditions favorable for growth. These conditions are satisfied by the warm, moist quality of bodily tissues such as found in the lungs or broken skin. The spores are able to survive in their dormant state for many years.

Anthrax germs can infect us in three different ways:

• Cutaneous--Anthrax spores or germs can enter the skin through a cut or abrasion. Such infections start as a raised, itchy bump and proceed to an ulcerated area with a blackened (necrotic, or dying) area in the center. Such blackened lesions gave rise to the name anthrax, due to their similarity in color and appearance to coal (anthracite). Untreated cutaneous anthrax will be fatal in about 20% of cases.
• Inhalation--Anthrax spores inhaled into the respiratory system can produce symptoms which initially resemble the common cold. The disease progresses to severe breathing problems and shock. Common medical wisdom holds that inhalation anthrax is usually fatal. However, a majority of the inhalation anthrax cases to date have survived the illness due to early intervention with appropriate antibiotics. Only five have been fatal in the current outbreak to date.
• Intestinal--Anthrax in its active (or vegetative) state can cause infection if one consumes the meat of an infected animal. No cases of intestinal anthrax have been reported in the current outbreak. Intestinal anthrax is reportedly fatal in 25% or more of known cases.

It is true that a vaccine for anthrax exists, but due to the rarity of this illness in America, it has not been widely used. Systemic adverse reactions occur in about 2 per thousand recipients, making the risks of vaccination a factor to be weighed in vaccination decisions. The vaccine has been used largely to vaccinate military personnel who might be at greater risk if destined to go overseas. Veterinarians in areas with significant animal anthrax are candidates for vaccination. Finally, the vaccination is only reported to be 93% effective.

The current vaccination protocol is three subcutaneous vaccinations, two weeks apart, followed by additional vaccinations at 6, 12, and 18 months. Annual booster injections are then recommended. As one can see, this is a significant amount of medical intervention to maintain a only a 93% immunity.

OWCP Policy on Anthrax

The Office of Workers' Compensation Programs has published a position on anthrax exposure. Their cautious position is somewhat frustrating, given that the exposed worker still has the burden to prove the association between illness and factors of federal employment. It is significant that OWCP time limits for COP have been modified to 45 days after a positive test result. When employees file CA-1 forms claiming anthrax exposure, OWCP's position is for the employing agency to hold the CA-1 in the personnel file of the employee unless there is actual illness or a positive test requiring non-prophylactic treatment and/or time loss. Also note that any prophylactic (preventative) measures such as testing or antibiotic treatment which are the proximate cause of injury or illness due to mechanical injury or adverse reaction are potentially work injuries. See OWCP's position, as copied from their website, www.dol.gov/dol/esa/public/OWCP_Policy_Anthrax.htm below, in its entirety:

OWCP Guidance on Filing for Workplace Anthrax Exposure

Initial guidance by the Office of Workers' Compensation Programs (OWCP) addressed workers' compensation coverage in instances where Federal employees were being tested for possible exposure to anthrax in the workplace. OWCP's policy in these instances has not changed. Employers may provide for testing under the provisions of 5 U.S.C. 7901 or other related legal authority, and are advised not to pursue Federal Employees' Compensation Act (FECA) coverage unless an employee actually tested positive for exposure. It should be noted that the FECA, 5 U.S.C. 8101 et seq., is applicable to covered employees as defined by statute and regulations. 

In some areas Federal and Postal employees who have worked in a facility which has possible anthrax contamination are being immediately provided with antibiotic therapy. The antibiotic therapy offered to these individuals is generally of a prophylactic nature rather than treatment of an established injury. As such, this treatment does not represent a reimbursable service under FECA (unless the employee has tested positive for anthrax exposure or is diagnosed as having been infected). See 20 C.F.R. 10.303 and 10.313.

Understandably, employees are concerned for their health and may wish to protect any rights to workers' compensation entitlement. Employees who opt to file a claim, but who have not experienced a known injury, should not be discouraged from filing. The employer should hold the CA-1 in the employee's personnel file unless the employee experiences an illness or a positive exposure test requiring non-prophylactic treatment and/or time loss. Only at that point would it be necessary to forward the claim to OWCP for adjudication. Following this guideline will enable OWCP to direct maximum effort toward prompt resolution of claims for actual injuries.

The employee generally has three years from the time of injury to claim wage loss compensation and medical care by filing with their agency. Thus, employees who do not file until such time as they receive a positive test or diagnosis of illness will be covered for effects of exposure at work. For this emergency, OWCP will also consider a CA-1 to be timely filed for Continuation of Pay if it is filed within 30 days of receiving a positive test or diagnosis of illness as due to anthrax exposure at work. 

Federal employees with no known anthrax exposure illness, but who have experienced illness as a result of the prophylactic treatment, would generally be covered under FECA. The employee will have the burden to submit medical evidence of an injury attributable to this treatment. These employees should be given a CA-2 (unless the treatment was confined to one day).

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