Anthrax essentially ceased to be regarded as a disease of major health or economic importance after the enormous successes of Max Sterne’s veterinary vaccine developed in the 1930s, and subsequent analogs in the former Soviet Union, in dramatically reducing the incidence of the disease in livestock throughout the world in the ensuing two decades. The 1980s saw a resurgence of interest in the disease, partly stimulated by a renewed focus on Bacillus anthracis, the agent of anthrax, as a potential agent for a biological weapon, after the largest reported outbreak of human inhalational anthrax that took place in 1979 in the city then called Sverdlovsk (now Ekaterinburg) in the former Soviet Union, and partly because of increasing recognition that anthrax had by no means “gone away” as a naturally occurring disease in animals and humans in many countries.

The production of the first edition of what has now become familiarly referred to as the “WHO anthrax guidelines” was written by Howard Whitford in 1987,¹ reflecting the new interest in anthrax in the 1980s. It was not formally published but was a highly regarded and timely reference document. The same new focus on anthrax in the 1980s led to the formation of a WHO working group on anthrax,² and the second edition of the “WHO anthrax guidelines” in 1993³ was the direct result of a resolution by the working group to update Dr Whitford’s edition. The second edition again was not formally published and, with no decline in the global interest in anthrax, it was again updated and on this occasion formally published in 1998 as the third edition.⁴ By this time, the World Wide Web was well established, and the third edition has been accessible electronically⁵ as well as in printed form.

The present fourth edition was commissioned in April 2001, initially as a simple update and expansion of the highly popular third edition. It was well on its way to completion when the notorious “anthrax letter events” took place in the USA in September to December that same year. The result of these events was a massive surge in critical analyses of detection, diagnostic, epidemiological, decontamination, treatment and prophylaxis procedures for anthrax, accompanied by a rapid and equally massive rise in the number of associated research activities receiving unprecedented levels of funding. The fourth edition was consequently put on hold until the results of these new analyses and research activities had become available.

Thus the fourth edition is now being issued seven years after it was commissioned, but it is certainly greatly improved as a result of the new information that emerged in the 3–4 years after the anthrax letter events. Formally dedicated to Max Sterne, whose remarkable work in the 1930s made naturally occurring anthrax a controllable disease, it is also dedicated to the 22 persons who contracted anthrax as a result of the anthrax letter events, and particularly to the memory of the five who regrettably died from their infections, as well as to the unknown number of people that become sick and die of the naturally occurring disease, mainly among the poor in developing countries.

• Peter Turnbull
  Executive editor