Emerging Infectious Diseases (Oct 2002)

Investigation of Bioterrorism-Related Anthrax, United States, 2001: Epidemiologic Findings

  • Daniel B. Jernigan,
  • Pratima L. Raghunathan,
  • Beth P. Bell,
  • Ross Brechner,
  • Eddy A. Bresnitz,
  • Jay C. Butler,
  • Marty Cetron,
  • Mitch Cohen,
  • Timothy Doyle,
  • Marc Fischer,
  • Carolyn M. Greene,
  • Kevin S. Griffith,
  • Jeannette Guarner,
  • James L. Hadler,
  • James A. Hayslett,
  • Richard Meyer,
  • Lyle R. Petersen,
  • Michael Phillips,
  • Robert W. Pinner,
  • Tanja Popovic,
  • Conrad P. Quinn,
  • Jennita Reefhuis,
  • Dori Reissman,
  • Nancy Rosenstein,
  • Anne Schuchat,
  • Wun-Ju Shieh,
  • Larry Siegal,
  • David L. Swerdlow,
  • Fred C. Tenover,
  • Marc Traeger,
  • John W. Ward,
  • Isaac Weisfuse,
  • Steven Wiersma,
  • Kevin Yeskey,
  • Sherif Zaki,
  • David A. Ashford,
  • Bradley A. Perkins,
  • Steve Ostroff,
  • James M. Hughes,
  • David Fleming,
  • Jeffrey P. Koplan,
  • Julie L. Gerberding

DOI
https://doi.org/10.3201/eid0810.020353
Journal volume & issue
Vol. 8, no. 10
pp. 1019 – 1028

Abstract

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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.

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