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

Bioterrorism-related Anthrax

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

Daniel B. Jernigan*Comments to Author , Pratima L. Raghunathan*, Beth P. Bell*, Ross Brechner†, Eddy A. Bresnitz‡, Jay C. Butler*, Marty Cetron*, Mitch Cohen*, Timothy Doyle*, Marc Fischer*, Carolyn Greene*, Kevin S. Griffith*, Jeannette Guarner*, James L. Hadler§, James A. Hayslett*, Richard Meyer*, Lyle R. Petersen*, Michael Phillips*, Robert 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 R. Zaki*, David A. Ashford*, Bradley A. Perkins*, Steve Ostroff*, James M. Hughes*, David Fleming*, Jeffrey P. Koplan*, Julie L. Gerberding*, and the National Anthrax Epidemiologic Investigation Team1
Author affiliations: *Centers for Disease Control and Prevention, Atlanta, Georgia, USA; †Maryland Department of Health and Hygiene, Baltimore, Maryland USA; ‡New Jersey Department of Health and Senior Services, Trenton New Jersey, USA; §Connecticut Department of Public Health, Hartford Connecticut, USA; ¶District of Columbia Department of Health, Washington D.C., USA; #New York City Department of Health, New York New York, USA; **Florida Department of Health, Tallahassee, Florida USA;

Main Article

Table 2

Comparison of inhalational and cutaneous bioterrorism-related anthrax cases, United States, 2001

Case characteristic All cases, n=22 (%) Inhalational cases n=11, (%) Cutaneous cases n=11, (%) p value
(inhal. vs. cutan.)
Median age (range), yearsa 46 (0.6–94) 56 (43–94) 35 (0.6–51) <0.01
Male sex (percent) 12 (55) 7 (64) 5 (45) 0.7
Occupation/exposure sitea
Mail handler 12 (55) 8 (73) 4 (36) 0.13
Media company employees 6 (27) 1 (9) 5 (45)
Other 4 (18) 2 (18) 2 (18)
No./deaths (case-fatality ratio) 5 (23) 5 (45) 0 (0) 0.04
No. of cases following contaminated lettersb
September 18 mailing 11 (50) 2 (18) 9 (81) <0.01
October 9 mailing 8 (36) 7 (64) 1 (9)

aAssociations suggest that age and occupation varied between inhalational and cutaneous cases; however, it is uncertain if age or occupation were significant independent factors for having a case of anthrax. Wilcoxon two-sample test for nonparametric data was used. All other measurements used two-sided Fisher’s exact test.
bBased on documented or presumed paths of contaminated envelopes; excludes three cases-patients who could not be linked to a particular mailing.

Main Article

1 Members of the National Anthrax Epidemiologic Investigation Team were Paul P. Abamonte, Joel Ackelsberg, S. Adams, John Agwunobi, Chidinma Alozie-Arole, Matt Arduino, Paul Arguin, Greg Armstrong, Kip Bagget, Sharon Balter, L. Barakat, D.M. Barden, Nancy Barrett, Michael J. Beach, Sarah Beatrice, Kenneth Bell, Robert Benson, Debra Berg, B.P. Bernard, Richard Besser, Susan Blank, David Blythe, Katie Bornschlegel, Mike Bowen, Joseph Bresee, S. Bresoff-Matcha, John Brooks, Dave Brownell, Sherrie Bruce, James Buehler, Mike Bunning, J. Burans, Joe Burkhart, Greg Burr, L. Bush, David Callahan, George Carlone, Matt Cartter, W. Carver, Mei Castor, Shadi Chamany, Bryan Cherry, C. Chiriboga, Nicole Coffin, Richard Collins, Dana Crawford, Donita R. Croft, Colleen Crowe, Larry Cseh, Debjani Das, J. Davies-Coles, Stephanie I. Davis, Scott Deitchman, David Dennis, Catherine Dentinger, Debbie Deppe, Puneet Dewan, George DiFerdinando, Timothy Dignam, Mary Dillon, Mary Dott, Peter Dull, Rick Ehrenberg, J. Eisold, Stephanie Factor, Leigh A. Farrington, Danny Feikin, Barry Fields, Annie Fine, Anthony Fiore, Mark Foggin, Susan Forlenza, D. Frank, Michael Fraser, Scott Fridkin, Cindy Friedman, Dara S. Friedman, Alicia Fry, M. Galbraith, Bill Gallo, J. Garcia, Jessica Gardom, Carol Genese, Dawn Gnesda, Kate Glynn, Susan Goldstein, Mike Grout, J. Hadler, Jeffrey Hageman, Rana Hajjeh, Tom Hales, Jennifer Hamborsky, David Hansell, Scott Harper, L. Hathcock, Rita Helfand, Thomas Hennessy, Tami Hilger, Alex Hoffmaster, Harvey Holmes, Timothy Holtz, Beth C. Imhoff, John Jernigan, Greg J. Jones, Renee Joskow, Ali Kahn, Marion Kainer, Pavani Kalluri, Adam Karpati, Sean G. Kaufman, Melody Kawamoto, Katherine Kaye, Katherine A. Kelley, Malinda Kennedy, Rima Khabbaz, Max Kiefer, Bradley King, Jonathon D. King, David Kirshke, Jakob Kool, John Kornblum, Matthew Kuehnert, Leslye LaClaire, Ashley LaMonte, Kayla Laserson, Marci Layton, Susan Lukacs, Perrianne Lurie, Neil Lustig, Andrea Lyman, T.A. Mackey, Julie Magri, Hadi Makki, J. Malecki, Anthony Marfin, Stacie Marshall, Chung Marston, G. Martin, Michael Martin, K.F. Martinez, Laura Mascuch, Eric Mast, Tom Matte, D.R. Mayo, Jennifer McClellan, Susan McClure, Michelle McConnell, Patrick McConnon, Peter D. McElroy, Kenneth R. Mead, Paul Mead, R. Leroy Mickelsen, Michael Miller, James Miller, Benjamin Mojica, Matt Moore, Linda Moskin, Farzad Mostashari, Patricia Mshar, K. Nalluswami, Dennis Nash, Randy Nelson, Bruce Newton, Beth Nivin, Stephanie Noviello, Otilio Oyervides, Christopher Paddock, E.H. Page, John Painter, Anil Panackal, Umesh D. Parashar, Mita Patel, Sheila Pavlesky, Michele Pearson, Cindi Pecoraro, Sarah Perl, Bobbie Person, Joseph Perz, E. Peterson, Marion Pierce, Jeanine Prudhomme, H. Quentzel, M. Richardson, Stephen Redd, Renee Ridzon, Richard Rosselli, Lisa Roth-Edwards, Ron Sanders, Hardeep Sandhu, Charles Schable, Donald Schill, T.A. Seitz, Jim Sejvar, Michael Sells, Andi Shane, Don Sharp, Colin Shepard, Tom Skinner, Montserrat Soriano-Gabarro, Karen Spargo, S. Spear, Rick Steketee, David Stephens, Jennifer Stevenson, Ellen Stevenson, Adrian Stoica, R. Stroube, David Sylvain, Tina Tan, Kathi Tatti, A.L. Tepper, Eyasu Teshale, Polly Thomas, Bruce Tierney, Lusia Torian, Tracee Treadwell, Nicole Tucker, Tim Uyeki, Chris Van Beneden, David Valiante, Reuben Varghese, Ivan Walks, J. Todd Weber, Don Weiss, Robert Weyant, Anne Whitney, Ellen Whitney, Ian Williams, Alicia A. Williams, Jennifer Williams, Kevin Winthrop, Scott Wright, Heather Wurtzel, Daniel J. Yereb, Ronald Zabrocki, Juan Zubieta, Jane Zucker, Angela Weber, Steve Lenhart, Dan Hewett, Josh Harney, Rob McCleery, Chris Piacitelli, Lauralynn Taylor, Francisco Alvarado-Ramy, MacKenzie Andre, MaryKate Appicelli, Mick Ballesteros, Mark Beatty, Omotayo Bolu, Louise Causer, Soju Chang, Ilin Chuang, John Crump, Marvin DeBerry, Rachel Gorwitz, Michelle Goveia, Thomas Handzel, Josh Harney, Dan Hewett, Vincent Hsu, Young Hur, Marialena Jefferds, Joshua Jones, Kathleen Julian, Richard Kanwal, Jane Kelly, Dennis Kim, Judy Kruger, Richard Leman, Steve Lenhart, Jill Levine, Naile Malakmadze, Els Mathieu, Rob McCleery, Shawn McMahon, Manoj Menon, Kelly Moore, Jill Morris, James Andy Mullins, Melanie Myers, Timothy Naimi, Lori Newman, Chima John Ohuabunwao, Michael O'Reilly, Lisa Pealer, Chris Piacitelli, Joe Posid, John Redd, Mary Reynolds, Julia Rhodes, Louie Rosencrans, Lisa Roth, Denise Roth-Allen, Sharon Roy, Taraz Samandari, Dejana Selenic-Stanacev, Jina Shah, Tanya Sharp, Allison Stock, Lauralynn Taylor, Pauline Terebuh, Christopher Thomas, Beth Tohill, Barna Tugwell, Angela Weber, Dana White, Sara Whitehead, Wally Wilhoite, Leigh Winston, Brad Winterton, Katharine Witgert, William Wong, Susie Wootton, and Weigong Zhou.

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