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

• 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
• ISSN: 1080-6040; 1080-6059
• DOI: 10.3201/eid0810.020322

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.