Abstract
In October 2001, four cases of inhalational anthrax occurred in workers in a Washington, D.C., mail facility that processed envelopes containing Bacillus anthracis spores. We reviewed the envelopes’ paths and obtained exposure histories and nasal swab cultures from postal workers. Environmental sampling was performed. A sample of employees was assessed for antibody concentrations to B. anthracis protective antigen. Case-patients worked on nonoverlapping shifts throughout the facility. Environmental sampling showed diffuse contamination of the facility, suggesting multiple aerosolization events. Potential workplace exposures were similar for the case-patients and the sample of workers. All nasal swab cultures and serum antibody tests were negative. Available tools could not identify subgroups of employees at higher risk for exposure or disease. Prophylaxis was necessary for all employees. To protect postal workers against bioterrorism, measures to reduce the risk of occupational exposure are necessary.
Highlights
In October 2001, four cases of inhalational anthrax occurred in workers in a Washington, D.C., mail facility that processed envelopes containing Bacillus anthracis spores
The urgent public health response was directed at preventing new cases of inhalational anthrax through the use of prophylactic antimicrobial drugs for persons potentially exposed to B. anthracis spores
The suspected case-patient worked in an area of the DCPDC where the envelope had not been processed; he worked in a second mail facility in Setting and Background On October 15, 2001, in an office of the Washington, D.C., U
Summary
In October 2001, four cases of inhalational anthrax occurred in workers in a Washington, D.C., mail facility that processed envelopes containing Bacillus anthracis spores. I n October 2001, four cases of inhalational anthrax occurred in employees at the Washington, D.C., Postal Processing and Distribution Center (DCPDC) [1,2] These cases were part of a multistate outbreak of inhalational and cutaneous anthrax associated with intentional distribution of envelopes containing Bacillus anthracis spores to media and federal government offices [2,3,4]. The public health response provided useful information about occupational exposure to aerosolized spores in this type of workplace and the performance of potential tools for determining exposure, such as work history, nasal swabs, immune response markers, and environmental sampling. The suspected case-patient worked in an area of the DCPDC where the envelope had not been processed; he worked in a second mail facility in
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