Laboratory response to anthrax bioterrorism, New York City, 2001

Abstract

In October 2001, the greater New York City Metropolitan Area was the scene of a bioterrorism attack. The scale of the public response to this attack was not foreseen and threatened to overwhelm the Bioterrorism Response Laboratory's (BTRL) ability to process and test environmental samples. In a joint effort with the Centers for Disease Control and Prevention and the cooperation of the Department of Defense, a massive effort was launched to maintain and sustain the laboratory response and return test results in a timely fashion. This effort was largely successful. The development and expansion of the facility are described, as are the special needs of a BTRL. The establishment of a Laboratory Bioterrorism Command Center and protocols for sample intake, processing, reporting, security, testing, staffing, and and quality control are also described.

Figure 1

Depiction of the algorithm used to determine the priority of items received for testing at the New York City Bioterrorism Response Laboratory. One of the salient features of the surge was the broad array of items that the laboratory received for testing. Many items contained innocuous powdery substances that are now known to be unrelated to the attack, yet prudent practices required that they be ruled out. The laboratory needed to identify which items were the most urgent and place them first and used this algorithm and other triage methods to prioritize the samples. Samples with 8 out of 11 points or greater were deemed STAT for “highest priority for laboratory testing” and received preferential treatment. Most samples fell into a middle category and were processed in order based on time received.

Figure 2

Diagrammatic tracking of an environmental sample through the various units and laboratories as it was processed and tested for anthrax at the New York City Bioterrorism Response Laboratory. The first level of the diagram corresponds to the first floor or the sample intake area. Samples were moved via an elevator to the upper floors of the facility, where they were processed and tested. The final destination of all samples was the storage area. Storage was also a locked and guarded forensic evidence room, and samples released from this area after testing negative for Bacillus anthracis were released to the New York Police Department for criminal investigation, return, or disposal.

Figure 3

Depiction of the data flow at the New York City Bioterrorism Response Laboratory adopted soon after the surge of isolates after the bioterrorism attack. An access database was developed, and a number of demographic fields and test results were identified and entered. Data retrieved from the Biosafety Level 3 (BSL-3) laboratory after suspicious packages were opened had to be input into the database; the original documentation was modified if any additional information was identified. An attempt was made to monitor all transactions occurring to the sample, which began to make the system unwieldy. The database was modified numerous times and recently was entirely replaced. Most of the comments, such as “no place in database” have been corrected. PCR, polymerase chain reaction; DOD, Department of Defense; HHA, hand-held analysis; DFA, direct fluorescent-antibody assay; OEM, Office of Emergency Management.

Figure 4

Chart tracking the time needed to report the status of a sample brought in for classical Bacillus anthracis testing at the New York Bioterrorism Response Laboratory. Negative samples with no suspicious growth could be reported in 24 hours. However, any samples with growth required some degree of subplating or culturing in brain heart infusion broth (BHIB), were heat shocked, and then tested. Reporting of final results on samples could take 3–4 days. SBA, sheep blood agar; CW, cell wall; CAP, capsule; DFA, direct fluorescent-antibody assay; PCR, polymerase chain reaction; Ph, phage; +, positive.