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Who is at Highest Risk for Getting Anthrax?
NORMAL EXPOSURE TO ANTHRAX
Exposure to anthrax most commonly occurs via contact with an infected animal or animal waste and by-products. Veterinarians, farmers, or researchers working with animals are at higher risk, as well as occupations that require the handling of animal by-products like meat and animal skins. Most cases of cutaneous anthrax resolve without treatment, and only between five and 20 percent of untreated cutaneous anthrax cases are fatal. With treatment, nearly all exposed persons survive. Ninety-five percent of all anthrax cases are cutaneous anthrax.1
Traveling to areas where anthrax is more common can also place persons at a higher risk for developing anthrax infection. These regions include the Caribbean, Eastern and Southern Europe, Central and southwestern Asia, Sub-Saharan Africa, and South and Central America. Persons who travel to these regions should be cautious about the foods consumed and items they touch.2
BIOTERRORISM EXPOSURE TO ANTHRAX
If anthrax bacteria is used as a biological weapon to kill large numbers of people, it will most likely be used in the deadly aerosol form so that large numbers of people will inhale it. This will mean that the anthrax strain and size of spores will have to be designed explicitly for weapons purposes and will require an effective delivery system.3
In July 1993, an attempted anthrax attack occurred in Japan by members of a religious organization. This attack, however, was not confirmed at the time since there were no reports of anthrax-associated illnesses during the days in question. Confirmation that the liquid suspension aerosolized from the rooftop of a building in Tokyo contained anthrax spores did not occur until November 1999, when the one remaining sample was sent to a lab in Arizona for identification. This lab confirmed the presence of anthrax with a genotype found to be identical to the strain used in the anthrax vaccine targeting animals in Japan.4
In 2001, a bioterrorism attack caused 22 individuals to develop anthrax (11 inhalation and 11 cutaneous) when envelopes containing anthrax spores were mailed to several U.S. government officials and news media outlets. Twenty of the 22 cases were linked to handling mail items, and five people died.5
So far, there has never been a successful delivery of inhalation anthrax to any large population through a bomb, missile, crop duster, or any other means; however, government agencies have plans in place should an attack occur.6
 Takahashi H, Keim P, Kaufmann AF et al. Bacillus anthracis Bioterrorism Incident, Kameido, Tokyo, 1993. Emerg Infect Dis. Jan. 2004;10(1):117-120.
 Jernigan DB, Raghunathan PL, Bell BP et al. Investigation of Bioterrorism-Related Anthrax, United States, 2001: Epidemiologic Findings. Emerg Infect Dis. Oct. 2002;8(10):1019-1028.