Public health and environmental response to the first case of naturally acquired inhalational anthrax in the United States in 30 years: infection of a new york city resident who worked with dried animal hides.
In Pennsylvania on February 16, 2006, a New York City resident collapsed with rigors and was hospitalized. On February 21, the Centers for Disease Control and Prevention and the New York City Department of Health and Mental Hygiene were notified that Bacillus anthracis had been identified in the patient's blood. Although the patient's history of working with dried animal hides to make African drums indicated the likelihood of a natural exposure to aerosolized anthrax spores, bioterrorism had to be ruled out first. Ultimately, this case proved to be the first case of naturally occurring inhalational anthrax in 30 years. This article describes the epidemiologic and environmental investigation to identify other cases and persons at risk and to determine the source of exposure and scope of contamination. Because stricter regulation of the importation of animal hides from areas where anthrax is enzootic is difficult, public healthcare officials should consider the possibility of future naturally occurring anthrax cases caused by contaminated hides. Federal protocols are needed to assist in the local response, which should be tempered by our growing understanding of the epidemiology of naturally acquired anthrax. These protocols should include recommended methods for reliable and efficient environmental sample collection and laboratory testing, and environmental risk assessments and remediation.
Nguyen
Trang Quyen
TQ
Data Analysis and Syndromic Surveillance Unit, Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, NY, USA. tnguyen@health.nyc.gov
Clark
Nancy
N
Karpati
Adam
A
Goldberg
Allan
A
Paykin
Andrea
A
Tucker
Andrew
A
Baker
Angela
A
Almiroudis
Anna
A
Fine
Annie
A
Tsoi
Ben
B
Aston
Christopher
C
Berg
Debra
D
Weiss
Don
D
Connelly
Ed
E
Beaudry
Gary
G
Weisfuse
Isaac
I
Durrah
James C
JC
Prudhomme
Jeanine
J
Leighton
Jessica
J
Ackelsberg
Joel
J
Mahoney
Kevin
K
Van Vynck
Laurie
L
Lee
Lillian
L
Moskin
Linda
L
Layton
Marci
M
Wong
Marie
M
Raphael
Marisa
M
Robinson
Martha
M
Phillips
Michael
M
Jones
Mickey
M
Jeffery
Nancy
N
Nieves
Ray
R
Slavinski
Sally
S
Mullin
Sandra
S
Beatrice
Sara T
ST
Balter
Sharon
S
Blank
Sue
S
Frieden
Thomas
T
Keifer
Max
M
Rosenstein
Nancy
N
Diaz
Pamela
P
Clark
Thomas
T
Compton
Harry
H
Daloia
James
J
Cardarelli
John
J
Norrell
Neil
N
Horn
Ed
E
Jackling
Sam
S
Bacon
Connie
C
Glasgow
Erich
E
Gomez
Tom
T
Baltzersen
Richard A
RA
Kammerdener
Charles
C
Margo-Zavazky
Dani
D
Colgan
John
J
Pulaski
Phillip
P
D000881:Anthrax / Q000175:diagnosis / Q000635:transmission*; D001408:Bacillus anthracis / Q000302:isolation & purification; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000453:epidemiology; D006801:Humans; D019570:Inhalation Exposure; D009519:New York City / Q000453:epidemiology; D016273:Occupational Exposure; D013171:Spores, Bacterial; D013633:Tanning