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

Bioterrorism-related Anthrax

First Case of Bioterrorism-Related Inhalational Anthrax, Florida, 2001: North Carolina Investigation

Jean-Marie Maillard*, Marc Fischer†Comments to Author , Kelly T. McKee*, Lou F. Turner*, and J. Steven Cline*
Author affiliations: *North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA; †Centers for Disease Control and Prevention, Atlanta, Georgia, USA;

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Surveillance methods used to identify potential cases of systemic anthrax or a source of exposure for the Florida index case of inhalational anthrax, North Carolina, October 2001

Type of surveillance Targeted population or outcome Locations under surveillance
Intensive-care unit Patients with illness compatible with systemic anthrax infectiona 19 hospitals in North and South Carolinab
Microbiology laboratory Bacterial isolates potentially consistent with Bacillus anthracisc 19 hospitals in North and South Carolina
Medical examiner Unexplained deaths possibly due to anthrax infection Statewide
Veterinarian Unexplained deaths in livestock Statewide
Occupational Unexplained illnesses or absences in employees Tourist park visited by the index patient
Environmental Evidence of B. anthracis spores Residence of index patient’s relative;
tourist park visited by the index patient

aClinical syndromes included fever and 1) severe respiratory disease, 2) mediastinitis or mediastinal lymphadenitis, 3) meningitis, or 4) hemorrhagic gastroenteritis.
bBased on the index patient’s route of travel, surveillance occurred in all 15 hospitals with intensive-care units in five North Carolina counties, as well as four regional referral centers in North Carolina (n=2) and South Carolina (n=2).
cA suspicious isolate was defined as 1) nontyped Bacillus species, 2) unidentified nonhemolytic, nonmotile gram-positive rod, or 3) any other unidentified bacteria that was discarded or sent to a referral laboratory.

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