title: Bioterrorism-related inhalational anthrax in an elderly woman, Connecticut, 2001.
abstract: On November 20, 2001, inhalational anthrax was confirmed in an elderly woman from rural Connecticut. To determine her exposure source, we conducted an extensive epidemiologic, environmental, and laboratory investigation. Molecular subtyping showed that her isolate was indistinguishable from isolates associated with intentionally contaminated letters. No samples from her home or community yielded Bacillus anthracis, and she received no first-class letters from facilities known to have processed intentionally contaminated letters. Environmental sampling in the regional Connecticut postal facility yielded B. anthracis spores from 4 (31%) of 13 sorting machines. One extensively contaminated machine primarily processes bulk mail. A second machine that does final sorting of bulk mail for her zip code yielded B. anthracis on the column of bins for her carrier route. The evidence suggests she was exposed through a cross-contaminated bulk mail letter. Such cross-contamination of letters and postal facilities has implications for managing the response to future B. anthracis-contaminated mailings.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA. kkg8@cdc.gov
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Griffith
authors.forename: Paul
authors.initials: P
authors.lastname: Mead
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Armstrong
authors.forename: John
authors.initials: J
authors.lastname: Painter
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Kelley
authors.forename: Alex R
authors.initials: AR
authors.lastname: Hoffmaster
authors.forename: Donald
authors.initials: D
authors.lastname: Mayo
authors.forename: Diane
authors.initials: D
authors.lastname: Barden
authors.forename: Renee
authors.initials: R
authors.lastname: Ridzon
authors.forename: Umesh
authors.initials: U
authors.lastname: Parashar
authors.forename: Eyasu Habtu
authors.initials: EH
authors.lastname: Teshale
authors.forename: Jennifer
authors.initials: J
authors.lastname: Williams
authors.forename: Stephanie
authors.initials: S
authors.lastname: Noviello
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Perz
authors.forename: Eric E
authors.initials: EE
authors.lastname: Mast
authors.forename: David L
authors.initials: DL
authors.lastname: Swerdlow
authors.forename: James L
authors.initials: JL
authors.lastname: Hadler
mesh_terms: D000368:Aged; D000881:Anthrax / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D001408:Bacillus anthracis / Q000235:genetics / Q000302:isolation & purification; D023482:Bioterrorism; D003237:Connecticut / Q000453:epidemiology; D004269:DNA, Bacterial / Q000032:analysis; D004196:Disease Outbreaks / Q000706:statistics & numerical data; D004781:Environmental Exposure; D005260:Female; D006801:Humans; D019570:Inhalation Exposure; D011177:Postal Service; D018571:Sentinel Surveillance; D013171:Spores, Bacterial / Q000302:isolation & purification; D013997:Time Factors
chemical_list: D004269:DNA, Bacterial