Public Health and Environmental Response to the First Case of Naturally Acquired Inhalational Anthrax in the United States in 30 Years

Abstract

In Pennsylvania on February 16, 2006, a New York City resident collapsed with rigors and was hospitalized. On February 21, the Centers for Disease Control and Prevention and the New York City Department of Health and Mental Hygiene were notified that Bacillus anthracis had been identified in the patient's blood. Although the patient's history of working with dried animal hides to make African drums indicated the likelihood of a natural exposure to aerosolized anthrax spores, bioterrorism had to be ruled out first. Ultimately, this case proved to be the first case of naturally occurring inhalational anthrax in 30 years. This article describes the epidemiologic and environmental investigation to identify other cases and persons at risk and to determine the source of exposure and scope of contamination. Because stricter regulation of the importation of animal hides from areas where anthrax is enzootic is difficult, public healthcare officials should consider the possibility of future naturally occurring anthrax cases caused by contaminated hides. Federal protocols are needed to assist in the local response, which should be tempered by our growing understanding of the epidemiology of naturally acquired anthrax. These protocols should include recommended methods for reliable and efficient environmental sample collection and laboratory testing, and environmental risk assessments and remediation.

Efficacy of liquid spray decontaminants for inactivation of Bacillus anthracis spores on building and outdoor materials

“…In 2006, an apartment, workshop and van in the New York City area were contaminated with B. anthracis spores because of drum making activities involving animal hides imported from Africa. The total cost of remediation of these buildings was estimated to be $1·7 million (Nguyen et al. 2010).…”

Operation United Assistance: Infectious Disease Threats to Deployed Military Personnel

“…The occurrence of inhalation anthrax from dried skins for drums has been described most notably where a drum was made from hard-dried goat hides from Cote d'Ivoire. [192][193][194] In 1982, in Zorzor District in Liberia, there were 31 people bitten by rabid dogs and another 6 exposed, of which 3 died, but no recent evaluations have been reported.197 Risk is likely present; however, bites often go unreported. In 2011, a 25-year-old U.S. Army soldier died of rabies infection con tracted in eastern Afghanistan.…”

Efficacy of sporicidal wipes for inactivation of a Bacillus anthracis surrogate

“…; Nguyen et al . ). While much smaller in scale than the coordinated attacks through the mail system, several of the African hide incidents required extensive decontamination efforts.…”