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Volume 9, Number 6—June 2003
Research

Isolated Case of Bioterrorism-related Inhalational Anthrax, New York City, 2001

Timothy H. Holtz*†Comments to Author , Joel Ackelsberg†, Jacob L. Kool‡, Richard Rosselli†, Anthony Marfin‡, Thomas Matte*§, Sara T. Beatrice†, Michael B. Heller†, Dan Hewett*, Linda Moskin†, Michel L. Bunning‡¶, Marcelle Layton†, and the New York City Anthrax Investigation Working Group
Author affiliations: *Centers for Disease Control and Prevention, Atlanta, Georgia, USA; †New York City Department of Health, New York, New York, USA; ‡Centers for Disease Control and Prevention, Fort Collins, Colorado, USA; §New York Academy of Medicine, New York, New York, USA; ¶Office of the Surgeon General, Bolling Air Force Base, Washington, D.C., USA

Main Article

Table

Summary of environmental test sampling in inhalational anthrax investigation, New York City, 2001a

Date in 2001 Location Items Wet swabs Dry swabs Vacuum filters
10/29
 Case-patient’s hospital workplace: old and new mail room
 Mail cubby spaces, air intake, lights, desk top, computer keyboard, and air-conditioning air-intake filters
10
Case-patient’s workplace: workroom, basement rooms, and elevator
 Desk tops, floor, lighting and vents, door casings, walls, and ceilings
24
Admitting hospital
 Case-patient’s clothing and personal property from admission
7
Case-patient’s workplace
 Nasal swabs of hospital coworkers
28
10/30
 Case-patient’s apartment
 Appliance tops, mail bins, table tops, post office receipts, window sills, light fixtures, trash cans, and bank cards
40
10/31
 Case-patient’s workplace locker and workspace
 Locker contents (clothing, shoes, lab coat, personal belongings), elevator exhaust blades and cages, air-intake grills, door jambs, and computer cooling fans
52
 4
11/1
 Manhattan post office A
 Computer fan intakes, light fixtures, teller computer monitors, air-intake grills, counter surfaces, and vacuum sample of multiple mail-sorting cubbies
12
 1
Case-patient’s apartment
 Mailbox, adjacent mailboxes, elevator fans, refrigerator, baseboards, personal items, clothes hampers, television screen, boxes containing recent mail, light fixtures, vacuum cleaner dust, and cooling fans
29
Case-patient’s apartment
 Closet, hanging garments, bedroom clothes, and hallway bureau
8
Personal items from case-patient’s apartment
 Slippers, shoes, hats, pieces of recent mail, address book, pictures, and stuffed animal
9
Office of the Chief Medical Examiner
 Autopsy room, sink, table, cutting floor, and floor
31
11/2
 Bronx post office A
 Multiple mail slots, sorting areas, and intake grills of ventilation systems
15
 3
Manhattan post office B
 Mail-sorting areas and ventilation system, fluorescent light fixtures
9
11/3
 Case-patient’s workplace (basement storage)
 Door jams, light fixtures, conduits, air-conditioner intake filters, pipes
8
11/4
 Bronx mail sorting and distribution center
 Optical character readers, air intake of ventilation system, manual sorting stations, dead-letter repository, digital bar code sorters (including the machine that sorts mail to case-patient’s home), overhead air filters
25
Bronx parcel post office B
 Sorting stations, registered mail cage and delivery trucks
8
Case-patient’s apartment
 Powder samples
9
11/5
 Bronx post office box A
 Case-patient’s post office box
1
Friend’s home
 Dining room and bedroom surfaces
2
Case-patient’s workplace (basement storage)
 Storage lockers, urinal, plumbing, switches, and bulbs
7
Case-patient’s workplace work station
 Fan, light, and pipe
5
11/6
 Case-patient’s personal effects from apartment
 Unspecified substance in case-patient’s wallet
1
11/11
 Subway line, #6 Lexington Ave line (including Grand Central Station) and 1 N/R station used by case-patient
 Multiple dust-collecting areas along platform and multiple air-intake filters of recently installed air-conditioner system in Grand Central Station
 120
19
Four subway stations not known to be used by case-patient (control stations)
 Multiple dust-collecting areas along platform
 76
11/30
 Two businesses near to case-patient’s apartment that received mail from Trenton postmarked October 9
 Mail bins, scissors, letter openers, desk, phone, window, computer, air-conditioner, and copier
40
12/12
 Case-patient’s personal effects from apartment associated with hypothesized exposure locations or pathways
 Coat, shoes, tennis shoes, slippers, hats, scarf and lab coat, hospital identification card, documents dated in mid-October including mail, money orders, bank withdrawal slips, receipts, phone, and perfume bottles
18
Total 196 372 53

aLeft column indicates the date samples were taken. Aggressive sampling was performed by intensively and individually vacuuming each item by using a HEPA filter vacuum sock. Collected material was processed through a membrane to selectively remove extraneous material (e.g. hairs, which can be saved for later forensic examination) and concentrate spores in the filtrate. Filtrate was then analyzed by polymerase chain reaction and cultured for Bacilllus anthracis. Material in perfume bottles was cultured directly. Tests on samples were completed on 12/12/2001.

Main Article

1New York City Anthrax Investigation Working Group: New York City Department of Health: Sharon Balter, Katie Bornschlegel, Darcy Carr, Neal Cohen, Debjani Das, Annie Fine, Jane Greenko, Laura Mascuch, Benjamin Mojica, Farzad Mostashari, Denis Nash, Beth Nivin, Sheila Palevsky, Sarah Perl, Michael Phillips, Jeanine Prud’homme, Barbara N. Samuels, Karen Schlanger, Polly Thomas, Isaac Weisfuse, Don Weiss; New York City Public Health Laboratory: Alice Agasan, Joselito Amurao, Josephine Atamian, Debra Cook, Erica DeBernardo, Philomena Fleckenstein, Anne Marie Incalicchio, Ed Lee, William Oleszko, Lynn Paynter, Chiminyan Sathyakumar, George Williams, Marie T. Wong, Ben Yang Zhao; Lenox Hill Hospital: Dilcia Ortega, Sarah Petrello, Michael Tapper; Centers for Disease Control and Prevention/Division of Vector-Borne Diseases: May Chu, David Dennis, Kathleen Julian, Lyle R. Petersen; National Institute of Safety and Health: Josh Harney, Robert McCleery, Ken Martinez; Centers for Disease Control and Prevention: McKenzie Andre, Mick Ballesteros, Mary Brandt, Shadi Chamany, Daniel Feikin, Collette Fitzgerald, Jessica Gardom, Alex Hoffmaster, Kristy Kubota, Richard Leman, Naile Malakmadze, Els Mathieu, Leonard Mayer, Shawn McMahon, Juliette Morgan, Tim Naimi, Steve Ostroff, John Painter, Harald Pietz, Tanya Popovic, Joe Posid, Efrain Ribot, Dejana Selenic, Tanya Sharpe, Montserrat Soriano-Gabarro, Allison Stock, Phil Talboy, Sara Whitehead, William Wong, Weigong Zhou; University of North Carolina Medical School: Manoj Menon; U.S. Department of Defense: Francis S. Baluyot, Marcelo V. Bayquen, Monicka J. Boyd, Lisa A. De Los Santos, Martin E. France, Lora L. Galloway, Theron J. Hudson, Angel Lorenzo, Ludwig Mantay, Patrick H. Murray, Debra M. Niemeyer, Len Peruski, Christopher M. Sekula; New York City Police Department: Michael T. Corr, Kevin G. Frazer, John Galasso, Evelyn M. Harris, Joseph M. Herbert, Kevin J. Kehoe, Patrick E. Pogan, Phil T. Pulaski, Joseph J. Reznick; Port Authority of New York and New Jersey Police Department: Michael J. Podolak; Federal Bureau of Investigation: William P. Hyland, Gregory Jones, Howard Leadbetter II, Anthony Willett, and William A. Zinnikas.

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