Inhalational Anthrax Outbreak among Postal Workers, Washington, D.C., 2001

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.

Rabbit and Nonhuman Primate Models of Toxin-Targeting Human Anthrax Vaccines

“…The most thorough documentation of the pathology in human anthrax cases revolves around the Sverdlovsk epidemic of 1979, in which a large quantity of B. anthracis spores was released from a military installation in the former Soviet Union (62). In addition, several sporadic cases of inhalation anthrax in humans have been documented over the years (6,10,18,39). The comparison of the documented pathologic changes in human infection with those due to experimentally induced anthrax in laboratory animals can provide useful information concerning the suitability of a species for a model.…”

In Vitro and In Vivo Characterization of Anthrax Anti-Protective Antigen and Anti-Lethal Factor Monoclonal Antibodies after Passive Transfer in a Mouse Lethal Toxin Challenge Model To Define Correlates of Immunity

“…Protective immunity induced by immunization with rPA correlates with LeTx neutralization titers measured in the macrophage toxicity assay (28,51). Despite the ability to induce protective immunity with AVA or rPA immunization, widespread immunization against anthrax may not be practical due to the cost required to vaccinate the entire population, and the number of people actively infected after the release of anthrax spores used as a biological weapon may represent only a fraction of the entire population (6,12,13,16,24,33,54). Therefore, the development of effective passive immunotherapies for anthrax is needed, and correlates of protective immunity are needed to ensure that protective levels of immunity are attained after passive immunotherapy.…”

“…The combination of PA and LF produces lethal toxin (LeTx) that is lethal in several animal models including mice (11,37). The distribution of B. anthracis spores through the mail in the United States in 2001 and the resulting anthrax morbidity and deaths indicate that infectious pathogens may be distributed through the environment for use as biothreats (6,12,13,16,24,33,54), and B. anthracis is listed as a category A pathogen by the National Institutes of Health (40).…”

Efficacy of Multiple- or Single-Dose Cidofovir against Vaccinia and Cowpox Virus Infections in Mice

“…The search for new antiviral agents that are effective against orthopoxvirus infections has escalated recently due to concerns about potential bioterrorist use of smallpox (4,14,15), especially in light of recent activities using anthrax (10) and the growing number of cases of human monkeypox in recent years (11). Variola virus, the causative agent for smallpox disease, poses a real threat to human health through potential bioterrorist activities, since vaccination programs ended during the 1970s.…”