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Case Reports
. 2002 Oct;8(10):1066-72.
doi: 10.3201/eid0810.020330.

Inhalational anthrax outbreak among postal workers, Washington, D.C., 2001

Affiliations
Case Reports

Inhalational anthrax outbreak among postal workers, Washington, D.C., 2001

Puneet K Dewan et al. Emerg Infect Dis. 2002 Oct.

Abstract

In October 2001, four cases of inhalational anthrax occurred in workers in a Washington, D.C., mail facility that processed envelopes containing Bacillus anthracis spores. We reviewed the envelopes' paths and obtained exposure histories and nasal swab cultures from postal workers. Environmental sampling was performed. A sample of employees was assessed for antibody concentrations to B. anthracis protective antigen. Case-patients worked on nonoverlapping shifts throughout the facility, suggesting multiple aerosolization events. Environmental sampling showed diffuse contamination of the facility. Potential workplace exposures were similar for the case-patients and the sample of workers. All nasal swab cultures and serum antibody tests were negative. Available tools could not identify subgroups of employees at higher risk for exposure or disease. Prophylaxis was necessary for all employees. To protect postal workers against bioterrorism, measures to reduce the risk of occupational exposure are necessary.

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Figures

Figure 1
Figure 1
Floor map of the Washington, D.C., Postal Processing and Distribution Center with the known locations of the two B. anthracis–contaminated envelopes (gray diamonds with letters) and work locations of case-patients (black circles with numbers) in the facility on October 12, 2001. The estimated location of case-patients during the time of processing the contaminated envelopes at point C, when the letters were processed by the high-speed sorter machine, are shown as open circles. The main processing area of the facility, containing all of the high-speed sorter machines, and the government mail section of the facility are marked.
Figure 2
Figure 2
Comparing the time period that the case-patients were at the Washington, D.C., Postal Processing and Distribution Center (solid black bars) to the time period that the two envelopes containing B. anthracis spores were processed at the facility (gray bars = known location, gray hatched bars = unknown location) on October 12, 2001. The time that the high-speed sorting machine (delivery bar-code sort number 17) was cleaned, by blowing compressed air into the machine, is denoted by the gray striped area.

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