title: First case of bioterrorism-related inhalational anthrax in the United States, Palm Beach County, Florida, 2001.
abstract: On October 4, 2001, we confirmed the first bioterrorism-related anthrax case identified in the United States in a resident of Palm Beach County, Florida. Epidemiologic investigation indicated that exposure occurred at the workplace through intentionally contaminated mail. One additional case of inhalational anthrax was identified from the index patient's workplace. Among 1,076 nasal cultures performed to assess exposure, Bacillus anthracis was isolated from a co-worker later confirmed as being infected, as well as from an asymptomatic mail-handler in the same workplace. Environmental cultures for B. anthracis showed contamination at the workplace and six county postal facilities. Environmental and nasal swab cultures were useful epidemiologic tools that helped direct the investigation towards the infection source and transmission vehicle. We identified 1,114 persons at risk and offered antimicrobial prophylaxis.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, USA. Marc.Traeger@mail.ihs.gov
authors.forename: Marc S
authors.initials: MS
authors.lastname: Traeger
authors.forename: Steven T
authors.initials: ST
authors.lastname: Wiersma
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Rosenstein
authors.forename: Jean M
authors.initials: JM
authors.lastname: Malecki
authors.forename: Colin W
authors.initials: CW
authors.lastname: Shepard
authors.forename: Pratima L
authors.initials: PL
authors.lastname: Raghunathan
authors.forename: Segaran P
authors.initials: SP
authors.lastname: Pillai
authors.forename: Tanja
authors.initials: T
authors.lastname: Popovic
authors.forename: Conrad P
authors.initials: CP
authors.lastname: Quinn
authors.forename: Richard F
authors.initials: RF
authors.lastname: Meyer
authors.forename: Sharif R
authors.initials: SR
authors.lastname: Zaki
authors.forename: Savita
authors.initials: S
authors.lastname: Kumar
authors.forename: Sherrie M
authors.initials: SM
authors.lastname: Bruce
authors.forename: James J
authors.initials: JJ
authors.lastname: Sejvar
authors.forename: Peter M
authors.initials: PM
authors.lastname: Dull
authors.forename: Bruce C
authors.initials: BC
authors.lastname: Tierney
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Jones
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Perkins
mesh_terms: D000881:Anthrax / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000635:transmission*; D019072:Antibiotic Prophylaxis; D001408:Bacillus anthracis / Q000302:isolation & purification; D023482:Bioterrorism / Q000706:statistics & numerical data; D004784:Environmental Monitoring; D062665:Epidemiological Monitoring; D017809:Fatal Outcome; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D019570:Inhalation Exposure; D008297:Male; D008875:Middle Aged; D009305:Nasopharynx / Q000382:microbiology; D011159:Population Surveillance; D012307:Risk Factors; D017132:Workplace