On June 19, the U.S. Centers for Disease Control and Prevention (USCDC) announced the suspected exposure of laboratory employees to Bacillus anthracis (anthrax). An epidemiologist sent by the Taiwan Centers for Disease Control (CDC) for training at the USCDC, Dr. Hsiu Wu, informed the CDC of this anthrax exposure incident immediately. The incident occurred at the laboratories of the USCDC in the U.S. city of Atlanta. Because specimens were not properly sterilized when being transferred between laboratories and employees did not use personal protective equipment in compliance with laboratory safety regulations, about 75 laboratory employees may have been exposed to anthrax between June 6 and June 13. Suspected symptoms have yet to be seen in any of these employees. The USCDC has administered prophylaxis and is monitoring the health of those exposed. Taiwan has a long history of cooperation with the USCDC. Sound friendships and mutual trust have been established between the Taiwan CDC and the USCDC, and information on disease prevention is exchanged smoothly. The Taiwan CDC will continue to follow the development of this incident and track whether its employees show any sign of infection. 

The Taiwan CDC stated that Bacillus anthracis is listed as a Risk Group-3 (RG3) microorganism. Laboratories possessing, storing, or handling (adding, destroying, furnishing, and depositing) RG3 microorganisms must be examined and approved by the unit’s biological safety association and approved by the CDC in accordance with the Regulations Governing Management of Infectious Biological Materials before conducting these activities. These laboratories must also actively and regularly establish files and provide updates on items and quantities on the CDC’s Laboratory Biosafety Management Information System. Laboratory employees must use appropriate protective equipment (such as face masks, gloves, properly fastened cuffs, and lab coats with back straps). According to monitoring data from the CDC, the most recent case of anthrax in humans in Taiwan was reported in 1972. The case occurred because of an injury that led to a skin infection in Lienchiang County. The most recent case of anthrax in animals was reported in 1999. It occurred accidentally in horses at a horse farm in northern Taiwan. No human or animal anthrax cases have occurred since this time. 

Anthrax is listed as a class 2 notifiable disease in Taiwan. It is caused by Bacillus anthracis. Because the spores of this bacterium are extremely tolerant of the environment and can be transmitted through the air, it can be used as a biological warfare agent for terrorist attacks and has received global attention. The incubation period of anthrax is generally 1 to 7 days but can be as long as 60 days. If infection occurs through skin contact with Bacillus anthracis, the symptoms will be pustules, papules, and eschar, and the mortality rate is approximately 10%. If Bacillus anthracis spores are inhaled, they cause lung infection or sepsis and lead to mortality rates as high as 100%. Prevention and treatment measures include prompt isolation of cases, the use of antibiotic treatment, environmental disinfection, the use of appropriate personal protective measures by caregivers, and prophylaxis administered to those who make contact. 

The Taiwan CDC has sent three epidemiologists to the USCDC for infectious disease epidemiology and outbreak investigation training (the Epidemic Intelligence Service) since 2007. In 2009, Taiwan and the United States signed Arrangement Number 4 to the Guidelines for a Cooperative Program in Public Health and Preventive Medicine. This arrangement continues the sending of exceptional epidemiological professionals to the United States for training to prepare epidemic investigation and prevention talent for Taiwan. This long-standing partnership has already strengthened epidemic cooperation with the United States and improved Taiwan’s domestic epidemic prevention abilities. In the future, Taiwan will continue to cooperate with the USCDC to learn new knowledge on epidemic prevention and enhance its epidemic prevention abilities, creating a win-win situation to share with the world. 
Note: Pathogenic microorganisms are divided into four risk groups (RG) based on their pathogenic risk of harm: 

1.RG1 Microorganisms: E. coli K-12, Type 1 to Type 4 adeno-associated viruses, and other microorganisms that do not affect human health. 

2.RG2: Staphylococcus aureus, hepatitis B, plasmodium falciparum, and other microorganisms with minor impacts on human health for which prevention and treatment methods generally exist. 

3.RG3: Mycobacterium tuberculosis, Type 1 and Type 2 human immunodeficiency virus, and other microorganisms that seriously affect human health or may lead to death though there may be prevention and treatment methods. 

4.RG4: Ebola virus, smallpox virus, and other microorganisms that seriously affect human health or may lead to death with no prevention or treatment methods in general.