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Volume 8, Number 10—October 2002
THEME ISSUE
Bioterrorism-related Anthrax

Anthrax Perspectives

Epidemiologic Responses to Anthrax Outbreaks: A Review of Field Investigations, 1950–2001

Michael E. Bales*, Andrew L. Dannenberg*Comments to Author , Philip S. Brachman†, Arnold F. Kaufmann*, Peter C. Klatsky*‡, and David A. Ashford*
Author affiliations: *Centers for Disease Control and Prevention, Atlanta, Georgia, USA; †Emory University Rollins School of Public Health, Atlanta, Georgia, USA; ‡Mt. Sinai School of Medicine, New York, New York;

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Table 3

Inhalational and cutaneous anthrax in humans in CDC field investigations, United States, 1950–2001a

Year
Location
Occupation
Source
Age, sex
Referenceb
Comments
Inhalational (N=9 cases)
1976 Morro Bay, CA Self-employed weaver Imported yarn 32, M (12) Fatal inhalational anthrax due to contaminated imported yarn containing goat hair.
1966 Manchester, NH Metal shop employee Nearby mill processing goat hair 46, M Epi-Aid 1967-43 Dust from neighboring goat hair mill identified as source. Incidence of anthrax at plant decreased with mandatory vaccination. Patient's coexisting illnesses may have contributed to susceptibility.
1961 Philadelphia, PA Secretary in textile mill Goat hair 50, F Epi-Aid 1961-40 Fatal inhalational anthrax. Unusual because little contact with goat hair in routine work duties.
1957 Manchester, NH Gillboxer in textile mill Goat hair 60, M Epi-Aid 1958-18 Five inhalational cases of anthrax (four fatal) occurred in the 600 employees of a textile mill. Four cutaneous cases occurred during the same outbreak.
Bobbin cleaner and weaver 65, F
Card fixer 49, M
Card tender 61, M (recovered)
Noil remover 33, M
1957 Philadelphia, PA Factory employee Nearby mill processing goat hair 29, M (31,32) Fatal inhalational anthrax in man with sarcoidosis. Possible exposures from glue made from animal hides, or goatskin tannery with sweepings and surfaces testing positive for Bacillus anthracis, which patient walked by daily.
Cutaneousc (n=39 cases)
2001 TX (southwest) Farm worker Infected animal ?, M Epi-Aid 2001-61 Exposure during disposal of infected carcasses.
2000 ND (east) Farm worker Infected animal 67, M Epi-Aid 2000-69 Exposure during disposal of infected carcasses.
1987 Charlotte, NC Maintenance employee West Asian cashmere 42, M Epi-Aid 1987-77 Worked in a goat hair–processing mill.
1978 NH (southeast) Worker at goat hair– processing mill Goat hair 20, M Epi-Aid 1978-65 Loaded hair-carding machine and performed other tasks.
19, M Worked at hair mixing and carding machines during week before onset of symptoms.
1978 Shelby, NC Maintenance worker at goat hair–processing mill Goat hair 59, M Epi-Aid 1978-47
Temporary worker at goat hair–processing mill Goat hair 67, M
1974 Belton, SC Employee at textile mill Goat hair 38, F Epi-Aid 1974-77 Worked in mill spinning area.
1974 Haiti; FL Navy journalist-photographer Goatskin in Haitian handicrafts 22, F Epi-Aid 1974-96 Cutaneous anthrax in FL resident after purchase of B. anthracis–contaminated goatskin drums in Haiti.
1971 Gonzales, LA Two veterinarians Infected cow 52, M; 26, M Epi-Aid 1971-131 Disease contracted during necropsy.
1968 Inyo County, CA Farmhand Unknown 63, M Epi-Aid 1969-20 Suspected human cutaneous case, in region of horsefly bite; patient responsible for burning cattle carcasses. Cattle and horsefly exposures considered.
1966 Manchester, NH Truck driver Goat hair 35, M Epi-Aid 1967-43 Truck driver helped unload delivered bales despite being instructed not to help.
1966 Manchester, NH Unknown Not determined 35, F Epi-Aid 1967-43-3 Source uncertain;three samples from hand-knitted sweater positive for B. anthracis.
1965, 1969, 1975 Camden, NJ Three gelatin manufacturing plant workers Contaminated dry cow bones, used in manufacturing process 29, M;
45, M;
?, M (4143) OSHA fined gelatin factory owners for failure to protect workers.
1964 Oxford, OH Pipe insulation installer Goat hair in pipe insulation 36, M (51) Fatal cutaneous case featured in a 1965 New Yorker article by Berton Roueche (52).
1960 SC Four textile mill employees Goat hair ? Epi-Aid 1960-31
1959 Brownsville, Cameron County, TX Three veterinarians Necropsy, livestock exposure ?, M;
?, M;
?, M Epi-Aid 1960-12 One veterinarian had performed necropsy on a steer; other exposures not specified.
Employee at rendering plant Not specified ?, M
Unspecified Infected steer "adolescent boy" Suspected exposure while skinning steer in Mexico.
1959 NJ (south) Farmer Undetermined 23, M Epi-Aid 1959-38 Possible sources included cows that died of anthrax, and fertilizer with contaminated goat hair.
1957 Vinita, OK Veterinarian Infected cow ?, M Epi-Aid 1958-11 Had performed necropsy on a cow.
1957 Manchester, NH Two weavers and two card tenders at textile mill Goat hair 50, F;
64, F;
35, M;
61, M Epi-Aid 1958-18
1956 Monroe, NC Five textile mill employees Goat hair ? Epi-Aid 1956-29
1953 Monroe, NC Textile mill employee Goat hair 36, F Epi-Aid 1953-14

aCDC, Centers for Disease Control and Prevention; OSHA, Occupational Safety and Health Administration.
bSee Table 2 for additional references.
cExcludes investigations in Paraguay and Kazakhstan, where number of human cases uncertain.

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