Surveillance for anthrax cases associated with contaminated letters, New Jersey, Delaware, and Pennsylvania, 2001

In October 2001, two inhalational anthrax and four cutaneous anthrax cases, resulting from the processing of Bacillus anthracis-containing envelopes at a New Jersey mail facility, were identified. Subsequently, we initiated stimulated passive hospital-based and enhanced passive surveillance for anth...

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Bibliographic Details
Published in:Emerging infectious diseases 2002-10, Vol.8 (10), p.1073-1077
Main Authors: Tan, Christina G, Sandhu, Hardeep S, Crawford, Dana C, Redd, Stephen C, Beach, Michael J, Buehler, James W, Bresnitz, Eddy A, Pinner, Robert W, Bell, Beth P
Format: Article
Language:English
Subjects:
Adult
Anthrax
Anthrax - diagnosis
Anthrax - epidemiology
Bacillus anthracis
bioterrorism
Bioterrorism - statistics & numerical data
Coroners and Medical Examiners
Delaware
Delaware - epidemiology
Diagnosis
Dispatch
Equipment Contamination
Female
Health aspects
Hospital patients
Hospitals
Humans
Infection
Infection control
infectious diseases
Inhalation Exposure
Medical examination
Methods
New Jersey
New Jersey - epidemiology
Pennsylvania
Pennsylvania - epidemiology
Population Surveillance
Postal Service
Practice
Prevention
Public health
Respiratory Tract Infections - diagnosis
Respiratory Tract Infections - epidemiology
Respiratory Tract Infections - microbiology
Safety and security measures
Skin Diseases, Bacterial - diagnosis
Skin Diseases, Bacterial - epidemiology
Skin Diseases, Bacterial - microbiology
Time Factors
United States
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Summary:In October 2001, two inhalational anthrax and four cutaneous anthrax cases, resulting from the processing of Bacillus anthracis-containing envelopes at a New Jersey mail facility, were identified. Subsequently, we initiated stimulated passive hospital-based and enhanced passive surveillance for anthrax-compatible syndromes. From October 24 to December 17, 2001, hospitals reported 240,160 visits and 7,109 intensive-care unit admissions in the surveillance area (population 6.7 million persons). Following a change of reporting criteria on November 8, the average of possible inhalational anthrax reports decreased 83% from 18 to 3 per day; the proportion of reports requiring follow-up increased from 37% (105/286) to 41% (47/116). Clinical follow-up was conducted on 214 of 464 possible inhalational anthrax patients and 98 possible cutaneous anthrax patients; 49 had additional laboratory testing. No additional cases were identified. To verify the limited scope of the outbreak, surveillance was essential, though labor-intensive. The flexibility of the system allowed interim evaluation, thus improving surveillance efficiency.
ISSN:1080-6040
1080-6059
DOI:10.3201/eid0810.020322