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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 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*, 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 1

Demographic, clinical, and exposure characteristics of 22 cases of bioterrorism-related anthrax, United States, 2001

Case no. Onset date, 2001 Date of anthrax diagnosis by lab testing Statea Age (yrs) Sex Race Occupation Case statusb Anthrax presentationb Outcome Diagnostic tests
1 9/22 10/19 NY 31 F W NY Post employee Suspect Cutaneous Alive Serum IgG reactive
2 9/25 10/12 NY 38 F W NBC anchor assistant Confirmed Cutaneous Alive Skin biopsy IHC+ /
serum IgG reactive
3 9/26 10/18 NJ 39 M W USPS machine mechanic Suspect Cutaneous Alive Serum IgG reactive
4 9/28 10/15 FL 73 M W, H AMI mailroom worker Confirmed Inhalational Alive Pleural biopsy IHC+ /
serum IgG reactive
5 9/28 10/18 NJ 45 F W USPS mail carrier Confirmed Cutaneous Alive Skin biopsy IHC+ and PCR+ / serum IgG reac.
6 9/28 10/12 NY 23 F W NBC TV news intern Suspect Cutaneous Alive Serum IgG reactive
7 9/29 10/15 NY 0.6 M W Child of ABC employee Confirmed Cutaneous Alive Skin biopsy IHC+ /
blood PCR+
8 9/30 10/4 FL 63 M W AMI photo editor Confirmed Inhalational Dead Cerebrospinal fluid culture +
9 10/1 10/18 NY 27 F W CBS anchor assistant Confirmed Cutaneous Alive Skin biopsy IHC+ / serum IgG reactive
10 10/14 10/19 PA 35 M W USPS mail processor Confirmed Cutaneous Alive Blood culture + / serum IgG reactive
11 10/14 10/28 NJ 56 F B USPS mail processor Confirmed Inhalational Alive Blood PCR+ / pleural fluid cytology IHC+ / serum IgG reactive
12 10/15 10/29 NJ 43 F A USPS mail processor Confirmed Inhalational Alive Pleural fluid IHC+ /
bronchial biopsy IHC+ / serum IgG reactive
13 10/16 10/21 VA 56 M B USPS mail worker Confirmed Inhalational Alive Blood culture +
14 10/16 10/23 MD 55 M B USPS mail worker Confirmed Inhalational Dead Blood culture +
15 10/16 10/26 MD 47 M B USPS mail worker Confirmed Inhalational Dead Blood culture +
16 10/16 10/22 MD 56 M B USPS mail worker Confirmed Inhalational Alive Blood culture +
17 10/17 10/29 NJ 51 F W Bookkeeper Confirmed Cutaneous Alive Skin biopsy IHC+ and PCR+ / serum IgG reactive
18 10/19 10/22 NY 34 M W, H NY Post mail handler Suspect Cutaneous Alive Skin biopsy IHC+
19 10/22 10/25 VA 59 M W Government mail processor Confirmed Inhalational Alive Blood culture +
20 10/23 10/28 NY 38 M W NY Post employee Confirmed Cutaneous Alive Skin biopsy culture +
21 10/25 10/30 NY 61 F A Hospital supply worker Confirmed Inhalational Dead Pleural fluid and blood culture +
22 11/14 11/21 CT 94 F W Retired at home Confirmed Inhalational Dead Blood culture +

aNY, New York; FL, Florida; NJ, New Jersey; PA, Pennsylvania; VA, Virginia; DC, District of Columbia; MD, Maryland; CT, Connecticut; W, white; B, black; A, Asian; W,H, white with Hispanic ethnicity; NY, New York; NBC, National Broadcasting Company; AMI, American Media Inc.; USPS, United States Postal Service; CBS, Columbia Broadcasting System; PCR, polymerase chain reaction; IHC, immunohistochemical staining; + positive; IgG, immunoglobulin G.
bCase status and anthrax presentation are described in the anthrax surveillance case definition in the Methods section.

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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