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Anthrax

Anthrax is an acute infectious disease caused by a spore-forming bacterium called Bacillus anthracis. It is generally acquired following contact with anthrax-infected animals or anthrax-contaminated animal products. Anthrax is receiving heightened attention because of its use as a biological warfare agent.

Guidance

Occupational Exposure to Anthrax: OSHA Frequently Asked Questions

NOTE: The following answers do not impose and are not intended to result in the imposition of any new legal obligations or constraints on employers or on the States. The guidance presented here is based on OSHA's understanding of currently available National information, which is being re-evaluated continuously. This information may change as additional questions arise and as more information becomes available, please continue to visit this page or OSHA's website for the most updated information.

Appropriate Personal Protective Equipment: Respirators And Gloves

  1. What types of gloves are recommended as a precaution for anthrax exposure?

    Nitrile or vinyl gloves will protect workers from cutaneous anthrax exposure. Latex gloves offer protection similar to nitrile or vinyl gloves, but can result in sensitization or elicit allergic reactions in a small percentage of people. Since mail handling includes a range of tasks and is conducted in various occupational settings, gloves should be provided in a range of sizes and types to fit a variety of workers and job tasks. Employers whose employees work in situations where a gloved hand presents a hazard (e.g., work close to moving machine parts), can minimize risk by ensuring employee training on work practices, proper machine guarding, and correct fit of workers' gloves.

    OSHA's recommendations for assessing workplace risk and determining prudent work practices and personal protective equipment (PPE) are addressed in OSHA's Anthrax in the Workplace Risk Reduction Matrix. Please be aware that OSHA's standards for general PPE cover glove selection and use (29 CFR 1910.132) as well as hand protection (29 CFR 1910.138).

    Note: The US Postal Service (USPS), which continues to work closely with the Centers for Disease Control and Prevention (CDC) regarding the control of anthrax in its facilities [Update: Investigation of Bioterrorism-Related Anthrax and Interim Guidelines for Exposure Management and Antimicrobial Therapy. Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR) 50(42);909-919, (2001, October 26)], has purchased vinyl and nitrile gloves for postal employee protection (USPS News Release Oct 25, 2001).

  2. What personal protective equipment would provide effective protection while handling mail if exposure to anthrax spores is a concern? Would this include respirators?

    OSHA's recommendations for assessing workplace risk, prudent work practices, and personal protective equipment (PPE) are addressed in the Anthrax in the Workplace Risk Reduction Matrix.

    Because the majority of recent cases of confirmed occupational anthrax contamination and infection have been related to mail delivered through the USPS, selecting appropriate personal protective equipment (PPE) depends on the amount of mail a worker handles, how he or she handles the mail, and where he or she works. Some factors to consider include: the current patterns of anthrax spore contamination; the nature of the workplace and amount of mail received; whether the facility receives mail directly from a USPS facility that is known to be contaminated with anthrax; and whether the facility uses equipment that might disperse dust or anthrax spores into the air. Employers also should consider factors such as information from law enforcement agencies in assessing employee risk.

    For the most part, employers whose workers handle small volumes of mail will not need to do more than to establish handling and screening procedures for mail. These employers may consider providing their employees with vinyl or nitrile gloves.

    Workers in USPS facilities often handle an extremely high volume of mail and may work around mail sorting equipment that could disperse anthrax spores contained in processed mail. As a result, the workers in these facilities may be at a higher risk of exposure than workers who handle smaller volumes of mail, and higher levels of PPE may be appropriate.

    As explained, OSHA does not recommend respirators for the vast majority of workers. If workers request respirators, however, and employers provide filtering facepiece respirators for voluntary use by employees, the employers must make sure that employees are provided with the information contained in Appendix D to OSHA's Standard for Respiratory Protection, 29 CFR 1910.134 ("Information for Employees Using Respirators When Not Required Under the Standard").

    To provide effective protection from anthrax spores, the CDC recommends the use of NIOSH-approved respirators that are at least as protective as an N95 respirator. In addition, persons working in areas where oil mist from machinery is present should use respirators equipped with P-type filters (P95 or P100) to prevent the oil mist from degrading the filter.

    At worksites where employers require workers to wear respirators, a respiratory-protection program that complies with the provisions of 29 CFR 1910.134 must be implemented. This includes compliance with the standard's requirements for obtaining medical clearance for wearing the respirator and for conducting fit testing before requiring their employees to use respirators. These latter requirements also apply to voluntary use of respirators that are not filtering facepiece respirators.

  3. What precautions should healthcare workers (HCWs) take when treating patients who may be infected and/or contaminated with anthrax (Bacillus anthracis)?

    Healthcare workers should use Universal Precautions for all patient care activities. "Universal Precautions" are standard approaches to infection control designed to reduce the risk of transmitting microorganisms from both known and unknown sources of infection. Universal Precautions can include, but are not limited to, appropriate use of gloves, masks, protective clothing, work practices, and housekeeping.

    Clinical anthrax illness occurs days or weeks after exposure to the anthrax spores and person-to-person spread of this disease has not been documented. Therefore, after the onset of clinical illness, no precautions specific to anthrax have been recommended.

    However, if healthcare workers are providing initial care to a patient with suspected recent exposure to anthrax, they should take precautions against the potential for reaerosolizing any anthrax spores remaining on the exposed individual or clothing. Further direction for appropriate personal protective equipment is available on OSHA's Anthrax in the Workplace Risk Reduction Matrix.

  4. How should contaminated PPE used to handle mail (e.g. gloves) be disposed of? Can it go in regular trash?

    Unless the PPE has been used to handle a suspicious piece of mail, gloves and other personal protective clothing and equipment can be discarded in regular trash once removed. If a worker recognizes and handles a suspicious piece of mail, the worker's protective gear should be treated as potentially contaminated; it should be placed in an appropriately labeled and/or color-coded container that is closable and leak-proof. This container should then be disposed of as infectious/regulated waste.

  5. What are the health and safety precautions for laboratory workers handling anthrax samples?

    The Centers for Disease Control and Prevention (CDC) has published advice for laboratory personnel. [Update: Investigation of Anthrax Associated with Intentional Exposure and Interim Public Health Guidelines, October 2001. Centers for Disease Control and Prevention (CDC) Morbidity and Mortality (MMWR) 50(41);889-893, (2001, October 19)]. Lab personnel are advised to:

    • Use Biological Safety Level 2 facilities and practices (BSL-2 laboratories are suitable for work involving agents of moderate potential hazards) or Biological Safety Level 3 facilities and practices (BSL-3 laboratories are suitable for work involving indigenous or exotic agents that have a potential for respiratory transmission and may cause serious or potentially lethal disease) when working with clinical samples considered potentially infectious;

    • Wear protective eyewear (e.g., safety glasses or eye shields) and handle all specimens in a BSL-2 laminar flow hood, use closed-front laboratory coats with cuffed sleeves, and stretch gloves over the cuffed sleeves;

    • Avoid any activity that places them at risk for infectious exposure, especially activities that might create aerosols or disperse droplets;

    • Decontaminate laboratory benches after each use and dispose of supplies and equipment in proper receptacles;

    • Avoid touching mucosal surfaces with hands (gloved or ungloved), and never eat or drink in the laboratory; and

    • Remove and reverse gloves before leaving the laboratory, dispose of them in a biohazard container, remove laboratory coat, and wash hands.
    For additional information, see Protocols: Interim Recommended Notification Procedures for Local and State Public Health Department Leaders in the Event of a Bioterrorist Incident. Centers for Disease Control and Prevention (CDC).

  6. What respirators are recommended for protection against smallpox?

    Unlike anthrax, which is acquired only from direct exposure to anthrax spores, smallpox is a highly contagious disease, often spread from person to person. No general workplace guidance exists regarding respiratory protection for smallpox.

    For laboratory work, current recommendations require BSL-4 facilities and practices (laboratories suitable for work with dangerous and exotic agents posing high individual risk of laboratory infections and life-threatening disease) for laboratory personnel. Other recommendations are not available, however the CDC offers additional information regarding the smallpox vaccination.

Emergency Response

  1. What personal protective equipment is recommended for emergency responders in the event of a suspected anthrax threat?

    The type of personal protective equipment (PPE) needed for effective protection depends on different response situations, what is known or unknown about the situation, and the potential risk. Please be aware that emergency response to an anthrax spore release is covered by the Hazardous Waste Operations and Emergency Response Standard (HAZWOPER), so the PPE that is selected and used must be consistent with the standard. The standard is performance-oriented and requires the selection and use of PPE to be proportional to the anticipated risk of exposure and appropriate to the nature of the anticipated hazard.

    Recent releases and contamination have generally been associated with mail sent through the US Postal Service (USPS). When mail-handling equipment has already been locked and tagged out, thus providing a reliable assurance that anthrax will not be reaerosolized due to equipment start-up or operation, workers responding to these types of releases have worn modified Level C protection with a full-face tight-fitting Powered Air Purifying Respirator (PAPR). However, activities which may result in spore release, such as removal of a suspect contaminated mail item, or after releases where the agent or method of disbursal is unknown, and/or the release is ongoing will require higher levels of protection.

    OSHA's recommendations concerning prudent work practices and PPE for emergency responders are addressed in Anthrax in the Workplace Risk Reduction Matrix.

  2. For those security personnel who may be asked to secure a room or area because of potential contamination:

    What personal protective equipment should be supplied and worn? What should such personnel do to prevent access to that area or prevent exposed persons from leaving the area?

    If an exposure to anthrax spores is suspected, proper emergency response protocols should be followed. Individuals not specifically trained to handle situations involving anthrax should not be in or near the potentially contaminated area. Emergency responders should secure affected areas.

    If security personnel secure the area they are considered emergency responders. Depending on the tasks that they are likely to perform, these individuals may be first responders at either the "awareness" or "operations" level. See the responses to Question #1 and Question #2 for information regarding the use of appropriate personal protective equipment.

    Security personnel who will not take any actions other than to cordon off the affected area and/or initiate the emergency response sequence are considered "first responders at the awareness level." Security personnel who are required to close doors, physically isolate the area, or take any other defensive action are considered "first responders at the operations level."

    For additional information about emergency responders and training levels, please refer to Inspection Procedures for 29 CFR 1910.120 and 1926.65, Paragraph (q): Emergency Response to Hazardous Substance Releases. OSHA Directive CPL 02-02-073, (2007, August 27). Also available as a 444 KB PDF, 119 pages. Updates enforcement procedures for compliance officers who need to conduct inspections of emergency response operations. It defines additional terms and expands on training requirements for emergency responders and other groups such as skilled support personnel. This OSHA instruction revises CPL 02-02-059, issued April 24, 1998.

Mail-Related Work Practices

  1. It is standard procedure for the post office employees to use compressed air to clean the mail processing machines (address/zip code reader optics). Is this acceptable? If not, what cleaning method is acceptable?

    The US Postal Service (USPS) has banned the use of compressed air ("blowout") as a method of machine maintenance because compressed air has a high risk potential for aerosolizing anthrax spores.

    Other employers should also avoid practices like dry sweeping and blowing off machinery with compressed air; instead employers should use wet-clean, mop, or vacuum methods. When vacuuming mail handling and sorting equipment is chosen, an industrial vacuum that is equipped with a High Efficiency Particulate Air (HEPA) filter should be used. Do not use a standard industrial vacuum or a "HEPA" equipped home-style vacuum.

    Additionally, proper procedures and work practices should be followed during maintenance of machinery in order to protect workers from other potential injuries.

  2. Should mail-handling facilities take air and/or surface samples for traces of anthrax?

    No. Routine sampling is not recommended, unless an employer has a reason to suspect that anthrax contamination has occurred. If there is a suspected exposure or contamination, established emergency response procedures must be followed.

  3. What is the safest way to handle individual letters or packages?

    • Be on the lookout for suspicious envelopes or packages.

    • DO NOT open suspicious mail.

    • Open all mail with a letter opener or other method that minimizes skin contact with the mail and is least likely to disturb contents.

    • Open mail with a minimum amount of movement.

    • DO NOT blow into envelopes.

    • DO NOT shake or pour out contents.

    • Keep hands away from nose and mouth while working with and opening mail.

    • While opening mail, turn off fans, portable heaters, and other equipment that may create air currents.

    • Wash hands thoroughly with soap and water after handling mail.

    • More information is available in OSHA's Workplace Response to Anthrax Threat: OSHA Recommendations for Handling Mail.
  4. What do I do if I come across a suspicious piece of mail?

    • DO NOT open the package or letter.

    • DO NOT shake, empty, or otherwise disturb its contents.

    • Put the package down and do not handle it further.

    • DO NOT touch or try to clean up the substance.

    • Alert others nearby.

    • DO NOT remove ANY items from area.

    • Leave the area and gently close the door.

    • Wash hands well with soap and water.

    • Contact your supervisor, designated responder or other appropriate authority.

    • Limit movements within the building to prevent spread of substance.

Employee Exposure

  1. Is an employer obligated to pay for pre-exposure anthrax tests (i.e. blood, titer, etc.)?

    Employers are not legally required to offer or pay for anthrax exposure tests. Employees may wish to contact the Centers for Disease Control and Prevention (CDC) to obtain information about low-cost or no-cost testing and treatment at (404) 639-3534.

  2. Should I visit my doctor if I have a fever, congestion, or flu-like symptoms?

    If you have not been present in an area where there is a potential for exposure to anthrax spores, the chance of anthrax infection is remote, and antibiotic therapy is usually not indicated. Anthrax is not spread by person-to-person contact. Therefore, there are no recommendations to immunize or treat contacts of persons with clinical anthrax illness, such as household contacts, friends, or coworkers, unless they were also exposed to the same source of infection.

    The CDC recommends the anthrax vaccine for employees working in laboratories involved in testing for anthrax, workers who decontaminate sites known to be contaminated with anthrax, and workers who typically work in areas with high naturally occurring concentrations of anthrax (e.g., wool-sorters).

    Further information may be obtained on-line at the CDC's Emergency Preparedness and Response; or CDC's newly established toll-free CDC Public Response Hotline. For English, call (888) 246-2675; por Español, llame al (888) 246-2857.

  3. Should I get an anthrax vaccination?

    At this time, vaccination against anthrax for the general public to prevent disease is not recommended. Further information can be obtained on-line at CDC's Anthrax: Prevention Vaccine page.

  4. Should I start taking preventive antibiotics?

    The CDC strongly recommends against the use of preventive antibiotics for the general population. Unless there is strong or compelling evidence to suggest that you may have been exposed to anthrax, you should not take preventive antibiotics. However, if you are concerned, you should discuss this with your healthcare provider.

  5. What types of businesses would be expected to prepare for terrorist attacks?

    Terrorist activity is unpredictable, though current anthrax contamination has been primarily isolated to mail handling facilities. For more information regarding potential anthrax exposures in a workplace, refer to OSHA's Anthrax in the Workplace Risk Reduction Matrix.

OSHA Compliance

  1. Since the anthrax hazard is an emergency/unexpected hazard, will OSHA waive the requirements for medical evaluations (medical questionnaire and examinations) for employees required to wear respiratory protection and employees who voluntarily use such protection?

    In worksites where respiratory protection is required to be worn, a respiratory protection program that complies with the provisions of OSHA's Respiratory Protection Standard, 29 CFR 1910.134, must be implemented, including medical examinations as indicated. Medical evaluations are not required for employees who are wearing filtering facepiece respirators on a voluntary basis.

  2. Does 29 CFR 1910.120 (HAZWOPER) apply to initial responders for anthrax releases?

    Yes. The release of anthrax spores into a workplace as an act of terrorism is an emergency situation. Compliance with Hazardous Waste Operations and Emergency Response, 29 CFR 1910.120, is required for emergency response personnel responding to a possible anthrax release. (See response to Question #7, above.)

  3. Does OSHA have a protocol for testing for anthrax?

    No. OSHA does not analyze samples for the presence of anthrax spores. A list of qualified laboratories and laboratory procedures can be found on OSHA's webpage.

  4. If I require my employees to wear respirators for potential anthrax exposure, what must I do to ensure that I am in compliance with OSHA's Respiratory Protection standard?

    Required use of respirators triggers the requirements under 29 CFR 1910.134, OSHA's Respiratory Protection standard. Guidance on complying with OSHA's standard may be found in Inspection Procedures for the Respiratory Protection Standard, CPL 02-00-120 [CPL 2-0.120].

OSHA Formal/Informal Complaints

  1. How will OSHA offices handle the cases involving the hospitalization of three or more employees (catastrophe) due to anthrax or other biohazard exposure?

    OSHA offices will handle a catastrophe or fatality caused by exposure to anthrax spores or other biohazards like any other fatality or catastrophe. OSHA requires an employer to report the incident to OSHA within eight hours of an employee's death or the hospitalization of three or more employees.

  2. How will OSHA offices handle safety and health complaints from USPS workers and other workers who handle mail regarding:

    A. Provision or lack of provision of PPE or vaccinations/titers?
    B. Cleaning mail equipment with compressed air?
    C. Possible, but unproven, exposure to anthrax?


    To date, OSHA has handled safety and health complaints received from the USPS through established phone and fax procedures. Complaints received from other employees working in mail handling operations will be conducted in a similar fashion. The callers should also be made aware of the information on workplace anthrax exposures, which is available on and through OSHA's website.

    • See response to Question #1 and Question #2 regarding the provision of gloves and respiratory protection. With regard to the provision of vaccinations or titers for anthrax exposure, vaccinations are neither required nor routinely recommended for mail handlers.

    • The USPS no longer sanctions the use of compressed air to clean equipment; all equipment is cleaned using HEPA-filtered vacuums. (See response to Question #9, above.)

    • When an Area Office or OSHA Consultation Office receives an employer request for OSHA to "sample for possible workplace exposure to anthrax," the employer should first be queried about the steps he or she has taken to ascertain whether there is a credible threat of exposure to anthrax. OSHA will then explain that it does not conduct analyses for anthrax samples, and employers should be encouraged to contact outside private firms in order to determine whether there is anthrax contamination in the workplace.
  3. How will OSHA handle safety and health complaints alleging exposure to anthrax?

    Any complaint alleging a workplace hazard requires basic inquiry to determine whether any evidence of a hazard exists. If a complainant alleges an immediate exposure to anthrax, the employer or employer's representative must notify the proper emergency response personnel. If the complainant is concerned about PPE or exposure to anthrax spores, but no immediate exposure has been alleged, the complaint will be handled as an informal complaint.

  4. Does OSHA require licensed professionals to monitor the workplace for anthrax?

    No. OSHA does not require monitoring; thus OSHA does not have licensing requirements for professionals who monitor for anthrax.

Recordkeeping

  1. If an employee dies or is injured or infected as a result of terrorist attacks, should it be recorded on the OSHA Injury and Illness Log? Should it be reported to OSHA?

    Yes, injuries and illnesses that result from a terrorist event or exposure in the work environment are considered work-related for OSHA recordkeeping purposes. OSHA does not provide an exclusion for violence-related injury and illness cases, including injuries and illnesses resulting from terrorist attacks.

    Within eight (8) hours after the death of any employee from a work-related incident or the in-patient hospitalization of three or more employees as a result of a work-related incident, an employer must orally report the fatality/multiple hospitalization by telephone or in person to the OSHA Area that is nearest to the site of the incident. An employer may also use the OSHA toll-free central telephone number, 1-800-321-OSHA (1-800-321-6742).

  2. An employee is provided antibiotics for anthrax, although the employee does not test positive for exposure/infection. Is this a recordable event on the OSHA log?

    No. A case must involve a death, injury, or illness to be recordable. A case involving an employee who does not test positive for exposure/infection would not be recordable because the employee is not injured or ill.

  3. An employee tests positive for anthrax exposure/infection and is provided antibiotics. Is this a recordable event on the OSHA log?

    Yes. Under the most recent Recordkeeping requirements, which will be effective in January 2002, a work-related anthrax exposure/infection coupled with administration of antibiotics or other medical treatment must be recorded on the log. Until the new Recordkeeping requirements become effective, an employer is required to record a work-related illness, regardless of whether medical care is provided in connection with the illness.

Discrimination/Whistleblower Provisions

  1. Do Occupational Safety and Health (OSH) Act Whistleblower provisions apply to employees who believe that they are being discriminated against because of their beliefs, fears, or occupational risks?

    Whistleblower provisions protect employees against employer retaliation for having exercised certain "rights" detailed in the OSH Act and its implementing regulations (29 CFR 1977). Among those rights are the right to file a formal complaint regarding safety and health conditions with OSHA; notify or complain to management about unsafe or unhealthful working conditions; and, in limited circumstances, refuse to perform a task that exposes the employee to a real danger of death or serious physical harm (See Question #30, below, for more information regarding work refusals). Employers or other persons are prohibited from discharging or taking other adverse personnel actions against an employee in retaliation for the employee's involvement in a protected activity. Employees who feel they have been discriminated against in violation of Section 11(c) may file a complaint with the local OSHA Area Office.

  2. Can I refuse to go to work in a facility where anthrax is known to be present and will I be covered under Section 11(c) of the Occupational Safety and Health Act (OSH Act)?

    The regulations and court decisions interpreting the OSH Act provide that employees do not have an absolute right to "walk off the job" because of potential unsafe working conditions. However, occasions might arise when an employee is confronted with a choice between refusing to perform an assigned task and subjecting him or herself to serious injury or death arising from a hazardous condition at the work place. If the employee chooses to not perform the assigned task, the situation must meet four specific criteria in order to qualify for protection under Section 11(c) of the OSHA Act:

    • The condition must be such that a reasonable person would conclude that there is a real danger of death or serious physical harm,

    • There is no reasonable alternative way of performing the work,

    • The employee must have sought and been unable to obtain correction of the hazard from the employer, and

    • There is insufficient time to eliminate the danger through resort to regular statutory enforcement channels (e.g., calling OSHA).
    Additional information is available on OSHA's Worker's Page.

Exposure

In humans, three types of anthrax infections can occur, based on the route of exposure: cutaneous (skin exposure), inhalational (inhalation exposure), and gastrointestinal (ingestion exposure). Symptoms are dependent on the route of exposure. Those most often associated with skin infections are itching, boils, and formation of a black scab. Symptoms most often associated with inhalation infections are fever, chest pain, and difficulty breathing. Symptoms most often associated with ingestion infections are nausea, vomiting and diarrhea. Additional information about anthrax can be found in the following resources:

  • Emergency Preparedness and Response. Centers for Disease Control and Prevention (CDC). Provides step by step guidance on the preparedness actions to take that will help people deal with disasters of all sorts most effectively. An A-Z Index of All Agents, Diseases & Other Threats includes:
    • Anthrax. Contains basic information about the disease, questions & answers about worker safety, specific recommendations for mail handlers, fact sheets and additional links to diagnosis/evaluation, infection control, surveillance & investigation, and treatment.
  • Anthrax: Frequently Asked Questions. Centers for Disease Control and Prevention (CDC). Answers questions about how anthrax is transmitted, where is it found, who should get vaccinated, and is there treatment for anthrax.

Workers Exposed Through Criminal/Terrorist Acts

Workers whose jobs would not ordinarily involve anthrax exposure could be exposed through acts of terrorism. Conventional thinking is that terrorists are likely to target places where large populations may be found such as large buildings, sporting events, or mass transit systems. Recent events have shown that there is a wider range of physical locations that could be targeted and this expands the range of employees who could be exposed.

Health Care Workers

Health care workers in occupational settings such as hospitals, clinics, and medical laboratories may be exposed to anthrax as a result of contact with patients whose skin, clothing, or personal effects are contaminated with anthrax spores, or through contact with contaminated equipment. Anthrax is not a contagious disease, so exposure will not result from contact with an infected patient.

Emergency Response Workers

Emergency responders, including police, firefighters, emergency medical services workers, and others who are responsible for responding to acts of terrorism may be exposed to anthrax.

Animal Handling Occupations

Anthrax is most common in occupations involving animals, animal hides or fibers. Grazing animals such as cattle, sheep, goats and horses are chief animal hosts of anthrax. Occupations susceptible to exposure may include shepherds, farmers, butchers, handlers of imported hides or fibers, weavers, veterinarians, and veterinary pathologists.

Prevention and Controls

Anthrax exposures that result from a criminal or terrorist act are more difficult for unsuspecting employers to prevent and control. Nevertheless, OSHA, the Centers for Disease Control and Prevention (CDC), US Postal Service (USPS) and Federal Bureau of Investigation (FBI) have developed recommendations to address the exposures resulting from contaminated mail and packages:

  • Workplace Response to Anthrax Threat: OSHA Recommendations for Handling Mail. OSHA.

  • We Are Taking Every Possible Measure To Assure Safety Of Customers And The Mail. US Postal Service (USPS) Message to Customers, (2001, October 17). Describes characteristics of suspicious letters and packages, and advises what to do if you receive a threat by mail.

  • Protect Your Workplace: Learn All About Suspicious Packages. Federal Bureau of Investigation (FBI), (2006, September 20). Describes the new poster developed through the joint efforts of four federal agenciesthe US Department of Homeland Security (DHS); the US Postal Service and its Postal Inspection Service; the Bureau of Alcohol, Tobacco, Firearms and Explosives; and the FBI.
    • Suspicious Letters or Packages [186 KB PDF, 1 page]. US Postal Service (USPS) Poster. Advises that if you receive a suspicious letter or package:
      • Stop. Don't handle.
      • Isolate it immediately.
      • Don't open, smell or taste.
      • Activate your emergency action plan. Notify a supervisor.
    • Distributable Materials. Department of Homeland Security (DHS), United States Computer Emergency Readiness Team (US-CERT). Download and print the Department of Homeland Security (DHS) "Protect Your Workplace" posters and the "Protect Your Workplace" brochure.

The methods for preventing and controlling anthrax exposure and infection vary by workplace.

Animal Handlers

Employers in animal handling occupations who may anticipate exposure may find the following useful.

  • Animal Health - Infectious: Bacteria. US Department of Agriculture (USDA), Animal and Plant Health Inspection Service (APHIS). Provides links to anthrax studies in livestock populations.

Healthcare and Emergency Responders

For health care employers and emergency responders, there is a larger body of response planning information. The US Department of Health and Human Services (DHHS), Centers for Disease Control and Prevention (CDC), the American Hospital Association (AHA), Department of Defense (DoD), and OSHA have several resources about how hospitals can plan and prepare for terrorist events:

  • The AHA's Hospital Readiness Efforts. American Hospital Association (AHA). Describes AHA position on the readiness issue and lists chemical and biological agents that are most likely to be used in an attack.

  • Hospital Preparedness for Mass Casualties [269 KB PDF, 60 pages]. American Hospital Association (AHA), (2000, August). Defines mass casualty incidents as incidents which overwhelm the resources of individual hospitals. Equally important, a mass casualty incident is likely to impose a sustained demand for health services rather than the short, intense peak customary with many smaller scale disasters adding a new dimension and many new issues to preparedness planning for hospitals.

  • Hospitals and Community Emergency Response. OSHA Publication 3152, (1997). Identifies elements of a Hospital Emergency Response Plan, basic employee training in emergency response, selecting PPE, respirators, and decontaminating patients.

Local Emergency Responders

Local Emergency Responders also have an important role in recognizing and responding to terrorist events. The US Department of Homeland Security (DHS), Federal Emergency Management Administration (FEMA), Centers for Disease Control and Prevention (CDC), and OSHA provide several resources that address readiness and response by emergency responders:

  • National Domestic Preparedness Consortium. Federal Emergency Management Administration (FEMA). Identifies, develop, tests, and delivers training to state and local emergency responders. The NDPC membership includes Grants & Training's Center for Domestic Preparedness (CDP) in Anniston, Alabama, the New Mexico Institute of Mining and Technology (NMIMT), Louisiana State University (LSU), Texas A&M University (TEEX), and the Department of Energy's Nevada Test Site (NTS).

  • Preparation & Planning. Centers for Disease Control and Prevention (CDC). Lists general resources for personal preparedness, business and healthcare preparedness, state, local, national and legal preparedness, and links to specific types of emergencies such as:
    • Anthrax: Preparedness. Identifies communication resources, including the First Hours Program, response planning, scenarios and modeling.
  • Emergency Preparedness and Response. OSHA Safety and Health Topics Page.

In the event that anthrax is released, controls such as personal protective equipment (e.g., respirators) and decontamination will be needed to limit exposure and prevent secondary infection. You can find additional technical information in the following resources:

Mail Security

OSHA Recommendations for Handling Mail

These guidelines address small mailroom operations (sorting, distributing, and handling). They can be distributed to all employees who may handle mail. For guidelines for large volume operations, see Additional Information - Training.

Anthrax organisms can infect the skin, the gastrointestinal system, or the lungs. To cause infection, the anthrax spores must come into contact with broken or abraded skin, swallowed, or inhaled as a fine dust. However, anthrax infection can be prevented even after exposure to anthrax spores by early treatment with the appropriate antibiotics. Anthrax spores can be dispersed in the air as a dust or can be carried on items such as mail or clothing. However, unlike the common cold or flu, anthrax infection itself is NOT spread from one person to another. These guidelines emphasize preventing the spread of anthrax spores through careful handling and isolation of suspicious packages and their contents.

General Mail Handling

  • Be on the lookout for suspicious envelopes or packages.

  • DO NOT open suspicious mail.

  • Open all non-suspicious mail with a letter opener or another method that minimizes skin contact with the mail and is least likely to disturb contents.

  • Open mail with a minimum amount of movement.

  • DO NOT blow into envelopes.

  • Keep hands away from nose and mouth while opening mail.

  • Turn off fans, portable heaters, and other equipment that may create air currents.

  • Wash hands after handling mail.

Characteristics of Suspicious Packages and Letters

  • Discoloration, oily stains, or an unusual odor

  • Crystals, powder, or powder-like residue on the surface

  • Suspicious or threatening language on the outside of package or letter

  • Postmark that does not match return address or no return address

  • Restrictive endorsements such as "Personal" or "Confidential"

  • Distorted handwriting, block-printed or poorly typed addresses

  • Excessive tape or string

  • Rigid, uneven, irregular, or lopsided package

  • Package with soft spots, bulges, or excessive weight

  • Handwritten, block-printed or poorly typed addresses

  • Excessive postage

  • Title but no name or incorrect title

  • Misspelled addressees name, title, or location

  • Misspelled common words

  • Addressee unknown or no longer with organization

  • Protruding wires or aluminum foil

  • Ticking sound

  • Unexpected mail from a foreign country

If You Receive or Discover a Suspicious Package or Letter

  • DO NOT open the package or letter.

  • DO NOT shake, empty, or otherwise disturb its contents.

  • Put the package down and do not handle it further.

  • DO NOT touch or try to clean up the substance.

  • Alert others nearby.

  • DO NOT remove ANY items from area.

  • Leave the area and gently close the door.

  • After leaving the area:

    • Wash hands well with soap and water.

    • Contact your supervisor, designated responder, or other appropriate authority.

    • Limit movements within the building to prevent spread of substance.
    Designated responders or other appropriate authority will determine the need for further action, which may include:

    • Directing further evacuation.

    • Reporting the incident to building security and notifying the appropriate authorities, such as the local police or federal authorities.

    • Perform additional decontamination activities as directed by the proper authorities.

    • Reporting the incident to facility managers so they can cut off electrical power and shut down ventilation systems serving the potentially contaminated areas.

    • Compiling a list of the names of all potentially affected individuals, including those who were in area when the suspicious mail was encountered.

    • Providing this list to the appropriate authorities.

*Employers should designate individuals who are trained to respond in the event that an employee receives a suspicious mailing. As a minimum, the designated responders should know how to contact facility managers, local emergency responders, and local law enforcement officials. Additionally, the designated responders should have authority to secure potentially contaminated areas or to direct other individuals to do so.

Other Resources

Centers for Disease Control and Prevention (CDC)

US Postal Service (USPS)

  • Securing the Mail. Provides information on identifying and responding to security threats in mail centers including:
    • U.S. Postal Inspection Service Guide to Mail Security Center. Publication 166, (2008, March). Provides general advice and recommends protective measures to help you assess, prevent, and respond to three types of threats: weapons of mass destruction; mail bombs and bomb threats; and mail center theft. This guide specifies procedural responses for a biological threat (anthrax) delivered by mail.
  • USPS Message to Customers: We Are Taking Every Possible Measure To Assure Safety Of Customers And The Mail. (2001, October 17). Describes typical characteristics of a suspicious letter or parcel and advises what to do if an anthrax threat is received by mail. "Suspicious Mail Alert" posters are available for download.

Additional Information

Related Safety and Health Topics

Training

  • Anthrax. Centers for Disease Control and Prevention (CDC). Includes videos, slide sets & training materials, textbook information, historical archives and links to other training.
  • Mail Security Center. US Postal Service (USPS). Contains links to FAQs, posters, best practices, a mail center security handbook and other mailroom safety resources.

Other Resources

  • Plan and Prepare. Federal Emergency Management Administration (FEMA). Links to Ready.gov and CitizenCorps.gov as well as FEMA resources.
    • Are You Ready? Guide Provides a step-by-step approach to disaster preparedness by walking the reader through how to get informed about local emergency plans, how to identify hazards that affect their local area, and how to develop and maintain an emergency communications plan and disaster supplies kit.

Hotlines and Helplines

For additional assistance about specific aspects of worker health and safety associated with potential anthrax exposure, contact the following hotlines or helplines.

To report suspicious letter or package:

For vaccination information:

  • Notices to Readers Immunization Hotline. Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR) 46(35);826, (1997, September 5). Provides vaccine information through the National Immunization Hotline. For English, call 1-800-232-2522; por Español, llame al 800-232-2522.

  • Contact AVIP Agency. US Department of Defense (DOD). Provides the Anthrax Vaccine Immunization Program (AVIP) Information Line: TOLL FREE: 1-877-GET-VAC (1-877 438-8222).

For state and local response planning:

  • Contact Us. US Department of Homeland Security (DHS), Federal Emergency Management Administration (FEMA). Provides grants to state and local training programs for terrorist preparedness.

  • Contact Us. Centers for Disease Control and Prevention (CDC). Provides the Emergency Preparedness & Response Branch Hotline for local, state and federal agencies: 770-488-7100 (24/7 Emergency Operations Center). This line also assists health care providers with questions on emergency patient care. NOTE: This line is not intended for the general public.

  • National Disaster Medical System. US Department of Health and Human Services (DHHS). Provides a hotline: (301) 443-1167 or 800-USA-NDMS.

  • The Laboratory Response Network Partners in Preparedness. Centers for Disease Control and Prevention (CDC). Maintains an integrated network of state and local public health, federal, military, and international laboratories that can respond to bioterrorism, chemical terrorism and other public health emergencies.

For general worker health and safety information:

  • Contact Us. OSHA: 1-800-321-OSHA (1-800-321-6742).

Accessibility Assistance: Contact the OSHA Directorate of Technical Support and Emergency Management at (202) 693-2300 for assistance accessing PDF materials.