Bioterrorism-related inhalational anthrax in an elderly woman, Connecticut, 2001.
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.
Griffith
Kevin S
KS
Centers for Disease Control and Prevention, Atlanta, Georgia, USA. kkg8@cdc.gov
Mead
Paul
P
Armstrong
Gregory L
GL
Painter
John
J
Kelley
Katherine A
KA
Hoffmaster
Alex R
AR
Mayo
Donald
D
Barden
Diane
D
Ridzon
Renee
R
Parashar
Umesh
U
Teshale
Eyasu Habtu
EH
Williams
Jennifer
J
Noviello
Stephanie
S
Perz
Joseph F
JF
Mast
Eric E
EE
Swerdlow
David L
DL
Hadler
James L
JL
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
D004269:DNA, Bacterial