title: Investigation of bioterrorism-related anthrax, United States, 2001: epidemiologic findings.
abstract: In October 2001, the first inhalational anthrax case in the United States since 1976 was identified in a media company worker in Florida. A national investigation was initiated to identify additional cases and determine possible exposures to Bacillus anthracis. Surveillance was enhanced through health-care facilities, laboratories, and other means to identify cases, which were defined as clinically compatible illness with laboratory-confirmed B. anthracis infection. From October 4 to November 20, 2001, 22 cases of anthrax (11 inhalational, 11 cutaneous) were identified; 5 of the inhalational cases were fatal. Twenty (91%) case-patients were either mail handlers or were exposed to worksites where contaminated mail was processed or received. B. anthracis isolates from four powder-containing envelopes, 17 specimens from patients, and 106 environmental samples were indistinguishable by molecular subtyping. Illness and death occurred not only at targeted worksites, but also along the path of mail and in other settings. Continued vigilance for cases is needed among health-care providers and members of the public health and law enforcement communities.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. DJernigan@cdc.gov
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Jernigan
authors.forename: Pratima L
authors.initials: PL
authors.lastname: Raghunathan
authors.forename: Beth P
authors.initials: BP
authors.lastname: Bell
authors.forename: Ross
authors.initials: R
authors.lastname: Brechner
authors.forename: Eddy A
authors.initials: EA
authors.lastname: Bresnitz
authors.forename: Jay C
authors.initials: JC
authors.lastname: Butler
authors.forename: Marty
authors.initials: M
authors.lastname: Cetron
authors.forename: Mitch
authors.initials: M
authors.lastname: Cohen
authors.forename: Timothy
authors.initials: T
authors.lastname: Doyle
authors.forename: Marc
authors.initials: M
authors.lastname: Fischer
authors.forename: Carolyn
authors.initials: C
authors.lastname: Greene
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Griffith
authors.forename: Jeannette
authors.initials: J
authors.lastname: Guarner
authors.forename: James L
authors.initials: JL
authors.lastname: Hadler
authors.forename: James A
authors.initials: JA
authors.lastname: Hayslett
authors.forename: Richard
authors.initials: R
authors.lastname: Meyer
authors.forename: Lyle R
authors.initials: LR
authors.lastname: Petersen
authors.forename: Michael
authors.initials: M
authors.lastname: Phillips
authors.forename: Robert
authors.initials: R
authors.lastname: Pinner
authors.forename: Tanja
authors.initials: T
authors.lastname: Popovic
authors.forename: Conrad P
authors.initials: CP
authors.lastname: Quinn
authors.forename: Jennita
authors.initials: J
authors.lastname: Reefhuis
authors.forename: Dori
authors.initials: D
authors.lastname: Reissman
authors.forename: Nancy
authors.initials: N
authors.lastname: Rosenstein
authors.forename: Anne
authors.initials: A
authors.lastname: Schuchat
authors.forename: Wun-Ju
authors.initials: WJ
authors.lastname: Shieh
authors.forename: Larry
authors.initials: L
authors.lastname: Siegal
authors.forename: David L
authors.initials: DL
authors.lastname: Swerdlow
authors.forename: Fred C
authors.initials: FC
authors.lastname: Tenover
authors.forename: Marc
authors.initials: M
authors.lastname: Traeger
authors.forename: John W
authors.initials: JW
authors.lastname: Ward
authors.forename: Isaac
authors.initials: I
authors.lastname: Weisfuse
authors.forename: Steven
authors.initials: S
authors.lastname: Wiersma
authors.forename: Kevin
authors.initials: K
authors.lastname: Yeskey
authors.forename: Sherif
authors.initials: S
authors.lastname: Zaki
authors.forename: David A
authors.initials: DA
authors.lastname: Ashford
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Perkins
authors.forename: Steve
authors.initials: S
authors.lastname: Ostroff
authors.forename: James
authors.initials: J
authors.lastname: Hughes
authors.forename: David
authors.initials: D
authors.lastname: Fleming
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Koplan
authors.forename: Julie L
authors.initials: JL
authors.lastname: Gerberding
mesh_terms: D000328:Adult; D000368:Aged; D000881:Anthrax / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D019072:Antibiotic Prophylaxis; D001408:Bacillus anthracis / Q000302:isolation & purification*; D023482:Bioterrorism / Q000706:statistics & numerical data*; D002487:Centers for Disease Control and Prevention, U.S.; D004196:Disease Outbreaks; D004781:Environmental Exposure; D004784:Environmental Monitoring; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D007223:Infant; D019570:Inhalation Exposure; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure; D011177:Postal Service; D011208:Powders; D011634:Public Health; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D017192:Skin Diseases, Bacterial / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D013171:Spores, Bacterial / Q000302:isolation & purification; D014481:United States / Q000453:epidemiology
chemical_list: D011208:Powders