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

Tan CG, Sandhu HS, Crawford DC, Redd SC, Beach MJ, Buehler JW, Bresnitz EA, Pinner RW, Bell BP, Regional Anthrax Surveillance Team, Centers for Disease Control and Prevention New Jersey Anthrax Surveillance Team
Emerg Infect Dis. 2002 8 (10): 1073-7

PMID: 12396918 · PMCID: PMC2730289 · 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.

MeSH Terms (18)

Adult Anthrax Bacillus anthracis Bioterrorism Coroners and Medical Examiners Delaware Equipment Contamination Female Hospitals Humans Inhalation Exposure New Jersey Pennsylvania Population Surveillance Postal Service Respiratory Tract Infections Skin Diseases, Bacterial Time Factors

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