Investigation of bioterrorism-related anthrax, United States, 2001: epidemiologic findings.
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.
Jernigan
Daniel B
DB
Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. DJernigan@cdc.gov
Raghunathan
Pratima L
PL
Bell
Beth P
BP
Brechner
Ross
R
Bresnitz
Eddy A
EA
Butler
Jay C
JC
Cetron
Marty
M
Cohen
Mitch
M
Doyle
Timothy
T
Fischer
Marc
M
Greene
Carolyn
C
Griffith
Kevin S
KS
Guarner
Jeannette
J
Hadler
James L
JL
Hayslett
James A
JA
Meyer
Richard
R
Petersen
Lyle R
LR
Phillips
Michael
M
Pinner
Robert
R
Popovic
Tanja
T
Quinn
Conrad P
CP
Reefhuis
Jennita
J
Reissman
Dori
D
Rosenstein
Nancy
N
Schuchat
Anne
A
Shieh
Wun-Ju
WJ
Siegal
Larry
L
Swerdlow
David L
DL
Tenover
Fred C
FC
Traeger
Marc
M
Ward
John W
JW
Weisfuse
Isaac
I
Wiersma
Steven
S
Yeskey
Kevin
K
Zaki
Sherif
S
Ashford
David A
DA
Perkins
Bradley A
BA
Ostroff
Steve
S
Hughes
James
J
Fleming
David
D
Koplan
Jeffrey P
JP
Gerberding
Julie L
JL
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
D011208:Powders