Beginning October 8, hospitals were notified through infection-control professionals and public health alerts. On October 3 through the employer, on October 8 through press releases and media briefings, and on October 8–10,13, 17, and 19 through information bulletins, we asked workplace-exposed persons and medical personnel caring for them to report influenzalike illness or skin lesions to the FDOH. Workplace-exposed persons were defined as those who, within 60 days of onset of illness in the index patient, spent >1 h in the building where he worked. Surveillance in Potentially Exposed Groups All case-finding surveillance was retrospective to September 11, 2001, and prospective beginning October 5. A statewide veterinary alert was issued for cases of anthrax in animals. We initiated enhanced surveillance locally through alerts to medical examiners and statewide through requests to laboratory directors to forward to the FDOH laboratories any cultures suspicious for Bacillus species isolated from sterile sites. Nearby counties implemented similar case-finding efforts in ICUs and emergency departments. anthracis and other potentially causative pathogens was offered if indicated. If anthrax was not ruled out, further interviews were done with patients, family members, and medical providers. ICU patients who had blood or cerebrospinal fluid cultures performed within 24 hours of hospital admission had more detailed chart reviews and interviews. We implemented case-finding through daily chart review in Palm Beach County intensive-care units (ICUs) and regionally in ICUs in North Carolina, where the index patient had traveled during the potential exposure period. Supportive laboratory tests included polymerase chain reaction (PCR) ( 4) of DNA from patient fluid from a normally sterile site, immunohistochemical staining of patient tissue samples, and enzyme-linked immunosorbent assay serologic tests to detect immunoglobulin G (IgG) response to B. anthracis infection based on at least two supportive laboratory tests ( 3). anthracis from an affected tissue or site or 2) other laboratory evidence of B. This report summarizes the findings of our epidemiologic investigation.Ī confirmed case of anthrax was defined as a clinically compatible cutaneous, inhalational, or gastrointestinal illness confirmed as anthrax by laboratory tests, including 1) isolation of B. The patient’s condition deteriorated, and he died 3 days after admission ( 2).Īfter anthrax was confirmed and in consideration of possible bioterrorism, we initiated an investigation to determine the extent and source of the event, develop control strategies, and protect potentially exposed persons. anthracis from a culture of cerebrospinal fluid. On October 4, the Florida Department of Health (FDOH) Bureau of Laboratories confirmed B. No history of cough, dyspnea, abdominal pain, diarrhea, or skin lesions was reported. On October 2, 2001, a 63-year-old Florida man was hospitalized for a nonlocalizing severe illness that began 2 days earlier, characterized by fever, chills, sweats, fatigue, and malaise, which progressed to vomiting, confusion, and incoherent speech. These new cases revealed the possible source of the exposure: almost all of those infected in New York had come into direct contact with letters containing a mysterious powder.In Florida, human anthrax has been rare among eight human cases reported in Florida in the 20th century, the most recent was a cutaneous case in 1974 ( 1). Other cases began to appear at media outlets in New York City. However, after two of the victim’s co-workers fell ill and anthrax spores were discovered throughout the building in which they worked, these initial assessments soon gave way to apprehension. Initially, the patient’s condition was attributed to a natural source. (AMI), had been diagnosed with pulmonary anthrax – the first such case in the United States in almost twenty-five years. Further attacks were anticipated, although there was a great deal of uncertainty as to when those attacks might occur and what form they might take.Īgainst this backdrop, on 4 October 2001, health officials in Florida announced that Robert Stevens, a tabloid photo editor at American Media, Inc. The attacks and their dramatic demonstration of American vulnerability created an atmosphere of apprehension and uncertainty. A fourth plane crashed in rural Pennsylvania en route to its suspected target, the U.S. Two of the planes crashed into the World Trade Center towers in New York City, and a third into the Pentagon in Washington, DC. On September 11, 2001, terrorists linked to Osama bin Laden’s al-Qaeda terror network hijacked four airliners.
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