CDC Urges Ricin Poisoning Awareness

Mysterious Letter Found With Vial of Poison Warns of Jan. 4 Action

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Nov. 20, 2003 -- A vial of deadly ricin toxin and a threatening note -- found last month at a South Carolina mail facility -- worry federal health officials.

Despite questionable handling of the incident by postal workers and local health authorities, nobody was exposed to the dangerous biological poison. There were no illnesses or deaths and no contamination of mail or mail equipment.

A Terroristic Deadline

But a letter placed in an envelope with the small, metal, watertight vial of ricin carried a threat. The FBI, which is leading the investigation of the incident, has not released the exact contents of the note. But local law enforcement authorities told Greenville News reporter Tim Smith that it carried a warning.

That threat, according to the Greenville News: If a new federal rule limiting the hours a truck driver can stay on the road goes into effect, large quantities of ricin would be added to the water supply. The rule becomes effective on Jan. 4, 2004.

"We are well aware of that date," Martin Belson, MD, medical toxicologist at the CDC's National Center for Environmental Health, tells WebMD.

Belson says it isn't clear exactly where or what kind of water supply the would-be terrorist has in mind.

"At this point in time we do not feel, based on information in hand, that there is any imminent public health threat," Belson says. "But until this investigation is closed, we have to be vigilant. Ricin is a very toxic poison."

Less Than Perfect Handling

The letter containing the vial of ricin wasn't stamped or addressed to anyone. It's not clear how it got into the Greenville mail facility, which is not a post office but a warehouse-like building that each day handles about 20,000 pieces of mail.

A postal worker found the envelope about 2:30 a.m. on Oct. 15. Typed on the outside were the words, "caution -- Ricin -- poison." At 8 a.m., the envelope was turned over to a supervisor. At 1:30 p.m., somebody alerted the Greenville Sheriff's office. A deputy delivered the package to an FBI agent, who took it to the State Law Enforcement Division for inspection, which sent it to the state health department. On Oct. 20, the vial was FedExed to the CDC, which on Oct. 21 confirmed that it truly contained ricin. The public was not informed, nor the mail facility closed, until Oct. 22.

Continued

The FBI -- and the CDC -- have interviewed all 36 workers at the mail facility, as well as truckers who carry mail to and from the site. The FBI, as a matter of policy, has no comment on this or any other ongoing investigation, says Tom O'Neill, spokesman for the FBI's South Carolina Headquarters in Columbia.

"All logical leads are being pursued," O'Neill tells WebMD.

But with no end to the investigation in sight, the CDC wants citizens and health-care workers to know what to look out for.

Ricin Poisoning

Ricin comes from castor beans. It's a natural byproduct of castor oil production. It doesn't take much technology to make it, although it's not so easy to turn it into a weapon.

Ricin is most toxic when inhaled. Weaponized ricin is milled to a very fine powder, which can hang in still air for hours. Exactly how ricin might work if used to poison a water supply is -- fortunately -- unknown.

"There is no history of ricin poisoning of a water supply. But that is a scenario we have to think about," Belson says. "There are a lot of variables. It depends on how pure it is, on the way it is processed, and on the way it is placed in the water. ... If we're talking about a large reservoir, that threat would be very, very low possibility. You'd have to have a lot of ricin. But putting ricin into a person's drink, or into a very local water supply, that is a potential threat."

Belson says the CDC does not yet know how pure, or how finely milled, the ricin found in South Carolina is.

Today's issue of the CDC's Morbidity and Mortality Weekly Report carries an overview of what is known about ricin poisoning. The main points:

  • Ricin poisoning can come after eating or drinking the toxin, after inhaling the toxin, or after injection of the toxin.
  • Ricin poisoning looks, at first, like a viral illness. If swallowed, mild poisoning causes nausea, vomiting, diarrhea, and/or abdominal pain. Moderate to severe poisoning progresses -- in four to 36 hours -- to low blood pressure, liver and kidney failure, and possibly death.
  • Inhaled ricin causes illness within eight hours. Coughing progresses to breathing difficulty and often death. Other than direct injection, this is the most dangerous form of ricin poisoning.
  • Ricin poisoning should be suspected if these symptoms are happening to a lot of people in the same area, or if lots of people start getting severe intestinal or respiratory problems. If there's a credible reason to believe that there's been a ricin attack in one's community, people with early symptoms should seek immediate help.
  • Anyone who thinks they might have ricin poisoning should call their local poison control center -- (800) 222-1222 -- and local health department.

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There's no lab test that can tell whether a person has been poisoned with ricin.

"It's difficult to recognize ricin poisoning. It can resemble a simple viral illness," Belson says. "Recognition should go with certain clues like an increased number of patients coming to hospital, or an illness progressing unexpectedly, or illness where there is a credible threat of ricin exposure."

There's no specific treatment for -- or vaccine against -- ricin poisoning. A person who has suffered ricin poisoning is given intravenous fluids and drugs, such as dopamine, that support blood pressure. Activated charcoal can be given to people with known or suspected ricin poisoning if they are not yet vomiting and if they are breathing properly. Stomach pumping can be done only within an hour of ricin ingestion.

WebMD Health News

Sources

SOURCES: Morbidity and Mortality Weekly Report, Nov. 20, 2003; vol 52: pp 1129-1131.Tom O'Neill, spokesman, South Carolina Headquarters, Federal Bureau of Investigation. Martin Belson, MD, National Center for Environmental Health, CDC. Tim Smith, Greenville News. The Greenville News.USAMRIID's Medical Management of Biological Casualties Handbook, February 2001, U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Md.
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