title: Surveillance for anthrax cases associated with contaminated letters, New Jersey, Delaware, and Pennsylvania, 2001.
abstract: In October 2001, two inhalational anthrax and four cutaneous anthrax cases, resulting from the processing of Bacillus anthracis-containing envelopes at a New Jersey mail facility, were identified. Subsequently, we initiated stimulated passive hospital-based and enhanced passive surveillance for anthrax-compatible syndromes. From October 24 to December 17, 2001, hospitals reported 240,160 visits and 7,109 intensive-care unit admissions in the surveillance area (population 6.7 million persons). Following a change of reporting criteria on November 8, the average of possible inhalational anthrax reports decreased 83% from 18 to 3 per day; the proportion of reports requiring follow-up increased from 37% (105/286) to 41% (47/116). Clinical follow-up was conducted on 214 of 464 possible inhalational anthrax patients and 98 possible cutaneous anthrax patients; 49 had additional laboratory testing. No additional cases were identified. To verify the limited scope of the outbreak, surveillance was essential, though labor-intensive. The flexibility of the system allowed interim evaluation, thus improving surveillance efficiency.
authors.affiliation: Centers for Desease Control and Prevention , Atlanta, Georgia 30333, USA. christina.tan@doh.state.nj.us
authors.forename: Christina G
authors.initials: CG
authors.lastname: Tan
authors.forename: Hardeep S
authors.initials: HS
authors.lastname: Sandhu
authors.forename: Dana C
authors.initials: DC
authors.lastname: Crawford
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Redd
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Beach
authors.forename: James W
authors.initials: JW
authors.lastname: Buehler
authors.forename: Eddy A
authors.initials: EA
authors.lastname: Bresnitz
authors.forename: Robert W
authors.initials: RW
authors.lastname: Pinner
authors.forename: Beth P
authors.initials: BP
authors.lastname: Bell
mesh_terms: D000328:Adult; D000881:Anthrax / Q000175:diagnosis / Q000453:epidemiology*; D001408:Bacillus anthracis; D023482:Bioterrorism / Q000706:statistics & numerical data*; D003334:Coroners and Medical Examiners; D003691:Delaware / Q000453:epidemiology; D004866:Equipment Contamination; D005260:Female; D006761:Hospitals; D006801:Humans; D019570:Inhalation Exposure; D009515:New Jersey / Q000453:epidemiology; D010414:Pennsylvania / Q000453:epidemiology; D011159:Population Surveillance; D011177:Postal Service; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D017192:Skin Diseases, Bacterial / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D013997:Time Factors