Anthrax - From Russia with Love

Medical Author: Michael C. Fishbein, MD
Previous Medical Editor: Leslie J. Schoenfield, MD, PhD
Medical Reviewer: Melissa Conrad Stöppler, MD

This article recounts the chilling, yet fascinating story of the deadliest outbreak of anthrax in recorded history. Anthrax is a bacterium (germ) that can cause a serious, sometimes fatal infection. Anthrax can be used as a weapon. In 2001, anthrax was spread through the mail in a powder. Twenty-two people were infected. The events that occurred in Sverdlovsk, Russia, in 1979 demonstrate what can happen when anthrax is released into the air.

The Outbreak

This was the ninth day of the mysterious, fatal epidemic that struck Sverdlovsk in early April of 1979. Autopsies already had been performed on 37 victims who died of an unknown disease. Yet neither the clinicians nor the pathologists had identified the cause of the epidemic. Moreover, as you can imagine, the members of the pathology department were frustrated and overburdened with work. So, on this day, Dr. Faina Abramova, who had been chief of pathology at hospital #40, returned from retirement to help perform the autopsies.

The first autopsy Dr. Abramova performed was number 38 of the 42 ultimately performed by the local pathologists. The patient was a 43-year-old man who had had weakness and fever for two days. He was admitted to the hospital where he died four days later.

At the autopsy table, Dr. Abramova was struck by the crimson color of the membranes (meninges) covering the man's brain. In her description, she referred to this covering as the "cardinal's cap" because of its color and location. Astonishingly, she recognized this finding as characteristic of anthrax infection. (Few doctors have ever seen the disease anthrax.) In fact, her diagnosis was based on her recollection of a brain specimen from a patient with anthrax on display in a museum at her medical school.

The Cover-up

Although the epidemic was nine days old, there had been no word from the local authorities regarding the nature of the strange illness. When word finally got out that the epidemic was due to anthrax infection, the citizens promptly suspected that the source was military compound #19. Military compound #19 was a large facility that included many buildings, including apartment houses for about 5,000 people. It was located near the southern end of Sverdlovsk, a city of approximately 1.2 million at that time.

The military compound contained high-security facilities, including a factory that some people actually had thought was producing biological weapons. However, local and federal Russian authorities investigated and concluded that the epidemic was caused by the consumption of anthrax-contaminated meat. (Ingesting anthrax causes a rare form of the disease, called gastrointestinal anthrax.) This was the conclusion that was reported to the Russian people and the outside world at that time.

Articles in Soviet scientific journals then reported an outbreak of anthrax among livestock south of the city. The articles said that the citizens of Sverdlovsk ate anthrax-contaminated meat from these animals. The fact that the victims had chest findings characteristic of inhalation anthrax was not revealed. Additionally, the cover-up included confiscation by the KGB of the hospital and public health records of the epidemic. What's more, Dr. Abramova and her colleagues were asked to turn over all of their personal notes, official records, and specimens they collected from the autopsies they performed.

From the onset, foreign governments and scientists were suspicious about the official explanation for the fatal anthrax epidemic. There were numerous requests to allow independent scientists to investigate, but no one was allowed to go to Sverdlovsk. In this regard, it is important to know that the Russians had signed a treaty at the 1972 Biologic Weapons Convention banning biologic weapons research. The idea that the Russians had violated this treaty by producing anthrax fueled intense interest in the nature of the epidemic. Was the epidemic natural (for example, from contaminated meat), or did it result from an accident in a facility that was producing anthrax?

The Investigation

Finally, in 1992, after collapse of the Soviet Union, a group of scientists, including pathologists and epidemiologists, was allowed to visit Sverdlovsk to perform an on-site investigation. (Epidemiologists study the population and geographic characteristics of diseases.) The investigation was hampered, however, because, as mentioned above, the KGB had confiscated the hospital and public health records of the epidemic. The epidemiological studies, therefore, had to rely on administrative death records, visits to cemeteries, and interviews with family and friends of those who died.

Dr. David Walker, Chief of Pathology at the University of Texas in Galveston and a member of the visiting team, interviewed Dr. Abramova regarding her autopsy findings. Remarkably, Dr. Abramova and a few of her colleagues had hidden some of their personal notes, records from the autopsies they performed, microscopic slides from organs they examined, and even tissue samples preserved in formaldehyde. When Dr. Walker and others examined all of this material, it became clear that the epidemic was due to inhalation anthrax, not from eating contaminated meat. Thus, in 1992, for the first time, the outside world had proof that the epidemic was due to inhalation anthrax. The significance of this fact is that an epidemic of inhalation anthrax can only occur by inhalation of anthrax spores that were produced in an aerosol form.