title: Epidemiologic investigations of bioterrorism-related anthrax, New Jersey, 2001.
abstract: At least four Bacillus anthracis-containing envelopes destined for New York City and Washington, D.C. were processed at the Trenton Processing and Distribution Center (PDC) on September 18 and October 9, 2001. When cutaneous anthrax was confirmed in a Trenton postal worker, the PDC was closed. Four cutaneous and two inhalational anthrax cases were identified. Five patients were hospitalized; none died. Four were PDC employees; the others handled or received mail processed there. Onset dates occurred in two clusters following envelope processing at the PDC. The attack rate among the 170 employees present when the B. anthracis-containing letters were sorted on October 9 was 1.2%. Of 137 PDC environmental samples, 57 (42%) were positive. Five (10%) of 50 local post offices each yielded one positive sample. Cutaneous or inhalational anthrax developed in four postal employees at a facility where B. anthracis-containing letters were processed. Cross-contaminated mail or equipment was the likely source of infection in two other case-patients with cutaneous anthrax.
authors.affiliation: Centers for Desease Control and Prevention , Atlanta, Georgia 30333, USA. cqg4@cdc.gov
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Greene
authors.forename: Jennita
authors.initials: J
authors.lastname: Reefhuis
authors.forename: Christina
authors.initials: C
authors.lastname: Tan
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Fiore
authors.forename: Susan
authors.initials: S
authors.lastname: Goldstein
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Beach
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Redd
authors.forename: David
authors.initials: D
authors.lastname: Valiante
authors.forename: Gregory
authors.initials: G
authors.lastname: Burr
authors.forename: James
authors.initials: J
authors.lastname: Buehler
authors.forename: Robert W
authors.initials: RW
authors.lastname: Pinner
authors.forename: Eddy
authors.initials: E
authors.lastname: Bresnitz
authors.forename: Beth P
authors.initials: BP
authors.lastname: Bell
mesh_terms: D000328:Adult; D000881:Anthrax / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D019072:Antibiotic Prophylaxis; D023482:Bioterrorism / Q000706:statistics & numerical data*; D003710:Demography; D004196:Disease Outbreaks; D004219:District of Columbia; D004784:Environmental Monitoring; D062665:Epidemiological Monitoring; D004866:Equipment Contamination; D005260:Female; D006801:Humans; D019570:Inhalation Exposure; D008297:Male; D008875:Middle Aged; D009515:New Jersey / Q000453:epidemiology; D011177:Postal Service; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D017192:Skin Diseases, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D017132:Workplace