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*
, Philip S. Brachman†, Arnold F. Kaufmann*, Peter C. Klatsky*‡, and David A. Ashford*
, Philip S. Brachman†, Arnold F. Kaufmann*, Peter C. Klatsky*‡, and David A. Ashford*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 | (41–43) | 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.
