Isolated Case of Bioterrorism-Related Inhalational Anthrax, New York City, 2001

Timothy H. Holtz, Joel Ackelsberg, Jacob L. Kool, Richard Rosselli, Anthony Marfin, Thomas Matte, Sara T. Beatrice, Michael B. Heller, Dan Hewett, Linda C. Moskin, Michel L. Bunning, Marcelle Layton, New York City Anthrax Investigation Working Group

Disclosures

Emerging Infectious Diseases. 2003;9(6)

Table. Table. Summary of environmental test sampling in inhalational anthrax investigation, New York City, 2001^a
Date in 2001	Location	Items	Wet swabs	Dry swabs	Vacuum filters
10/29	Case-patient's hospital workplace: old and new mail room	Mail cubby spaces, air intake, lights, desk top, computer keyboard, and air-conditioning air-intake filters		10
	Case-patient's workplace: workroom, basement rooms, and elevator	Desk tops, floor, lighting and vents, door casings, walls, and ceilings		24
	Admitting hospital	Case-patient's clothing and personal property from admission		7
	Case-patient's workplace	Nasal swabs of hospital coworkers		28
10/30	Case-patient's apartment	Appliance tops, mail bins, table tops, post office receipts, window sills, light fixtures, trash cans, and bank cards		40
10/31	Case-patient's workplace locker and workspace	Locker contents (clothing, shoes, lab coat, personal belongings), elevator exhaust blades and cages, air-intake grills, door jambs, and computer cooling fans		52	4
11/1	Manhattan post office A	Computer fan intakes, light fixtures, teller computer monitors, air-intake grills, counter surfaces, and vacuum sample of multiple mail-sorting cubbies		12	1
	Case-patient's apartment	Mailbox, adjacent mailboxes, elevator fans, refrigerator, baseboards, personal items, clothes hampers, television screen, boxes containing recent mail, light fixtures, vacuum cleaner dust, and cooling fans		29
	Case-patient's apartment	Closet, hanging garments, bedroom clothes, and hallway bureau			8
	Personal items from case-patient's apartment	Slippers, shoes, hats, pieces of recent mail, address book, pictures, and stuffed animal		9
	Office of the Chief Medical Examiner	Autopsy room, sink, table, cutting floor, and floor		31
11/2	Bronx post office A	Multiple mail slots, sorting areas, and intake grills of ventilation systems		15	3
11/2	Manhattan post office B	Mail-sorting areas and ventilation system, fluorescent light fixtures		9
11/3	Case-patient's workplace (basement storage)	Door jams, light fixtures, conduits, air-conditioner intake filters, pipes		8
11/4	Bronx mail sorting and distribution center	Optical character readers, air intake of ventilation system, manual sorting stations, dead-letter repository, digital bar code sorters (including the machine that sorts mail to case-patient's home), overhead air filters		25
	Bronx parcel post office B	Sorting stations, registered mail cage and delivery trucks		8
	Case-patient's apartment	Powder samples		9
11/5	Bronx post office box A	Case-patient's post office box		1
	Friend's home	Dining room and bedroom surfaces		2
	Case-patient's workplace (basement storage)	Storage lockers, urinal, plumbing, switches, and bulbs		7
	Case-patient's workplace work station	Fan, light, and pipe		5
11/6	Case-patient's personal effects from apartment	Unspecified substance in case-patient's wallet		1
11/11	Subway line, #6 Lexington Ave line (including Grand Central Station) and 1 N/R station used by case-patient	Multiple dust-collecting areas along platform and multiple air-intake filters of recently installed air-conditioner system in Grand Central Station	120		19
11/11	Four subway stations not known to be used by case-patient (control stations)	Multiple dust-collecting areas along platform	76
11/30	Two businesses near to case-patient's apartment that received mail from Trenton postmarked October 9	Mail bins, scissors, letter openers, desk, phone, window, computer, air-conditioner, and copier		40
12/12	Case-patient's personal effects from apartment associated with hypothesized exposure locations or pathways	Coat, shoes, tennis shoes, slippers, hats, scarf and lab coat, hospital identification card, documents dated in mid-October including mail, money orders, bank withdrawal slips, receipts, phone, and perfume bottles			18
Total			196	372	53

Table. Table. Summary of environmental test sampling in inhalational anthrax investigation, New York City, 2001^a
Date in 2001	Location	Items	Wet swabs	Dry swabs	Vacuum filters
10/29	Case-patient's hospital workplace: old and new mail room	Mail cubby spaces, air intake, lights, desk top, computer keyboard, and air-conditioning air-intake filters		10
	Case-patient's workplace: workroom, basement rooms, and elevator	Desk tops, floor, lighting and vents, door casings, walls, and ceilings		24
	Admitting hospital	Case-patient's clothing and personal property from admission		7
	Case-patient's workplace	Nasal swabs of hospital coworkers		28
10/30	Case-patient's apartment	Appliance tops, mail bins, table tops, post office receipts, window sills, light fixtures, trash cans, and bank cards		40
10/31	Case-patient's workplace locker and workspace	Locker contents (clothing, shoes, lab coat, personal belongings), elevator exhaust blades and cages, air-intake grills, door jambs, and computer cooling fans		52	4
11/1	Manhattan post office A	Computer fan intakes, light fixtures, teller computer monitors, air-intake grills, counter surfaces, and vacuum sample of multiple mail-sorting cubbies		12	1
	Case-patient's apartment	Mailbox, adjacent mailboxes, elevator fans, refrigerator, baseboards, personal items, clothes hampers, television screen, boxes containing recent mail, light fixtures, vacuum cleaner dust, and cooling fans		29
	Case-patient's apartment	Closet, hanging garments, bedroom clothes, and hallway bureau			8
	Personal items from case-patient's apartment	Slippers, shoes, hats, pieces of recent mail, address book, pictures, and stuffed animal		9
	Office of the Chief Medical Examiner	Autopsy room, sink, table, cutting floor, and floor		31
11/2	Bronx post office A	Multiple mail slots, sorting areas, and intake grills of ventilation systems		15	3
11/2	Manhattan post office B	Mail-sorting areas and ventilation system, fluorescent light fixtures		9
11/3	Case-patient's workplace (basement storage)	Door jams, light fixtures, conduits, air-conditioner intake filters, pipes		8
11/4	Bronx mail sorting and distribution center	Optical character readers, air intake of ventilation system, manual sorting stations, dead-letter repository, digital bar code sorters (including the machine that sorts mail to case-patient's home), overhead air filters		25
	Bronx parcel post office B	Sorting stations, registered mail cage and delivery trucks		8
	Case-patient's apartment	Powder samples		9
11/5	Bronx post office box A	Case-patient's post office box		1
	Friend's home	Dining room and bedroom surfaces		2
	Case-patient's workplace (basement storage)	Storage lockers, urinal, plumbing, switches, and bulbs		7
	Case-patient's workplace work station	Fan, light, and pipe		5
11/6	Case-patient's personal effects from apartment	Unspecified substance in case-patient's wallet		1
11/11	Subway line, #6 Lexington Ave line (including Grand Central Station) and 1 N/R station used by case-patient	Multiple dust-collecting areas along platform and multiple air-intake filters of recently installed air-conditioner system in Grand Central Station	120		19
11/11	Four subway stations not known to be used by case-patient (control stations)	Multiple dust-collecting areas along platform	76
11/30	Two businesses near to case-patient's apartment that received mail from Trenton postmarked October 9	Mail bins, scissors, letter openers, desk, phone, window, computer, air-conditioner, and copier		40
12/12	Case-patient's personal effects from apartment associated with hypothesized exposure locations or pathways	Coat, shoes, tennis shoes, slippers, hats, scarf and lab coat, hospital identification card, documents dated in mid-October including mail, money orders, bank withdrawal slips, receipts, phone, and perfume bottles			18
Total			196	372	53

Table. Table. Summary of environmental test sampling in inhalational anthrax investigation, New York City, 2001^a
Date in 2001	Location	Items	Wet swabs	Dry swabs	Vacuum filters
10/29	Case-patient's hospital workplace: old and new mail room	Mail cubby spaces, air intake, lights, desk top, computer keyboard, and air-conditioning air-intake filters		10
	Case-patient's workplace: workroom, basement rooms, and elevator	Desk tops, floor, lighting and vents, door casings, walls, and ceilings		24
	Admitting hospital	Case-patient's clothing and personal property from admission		7
	Case-patient's workplace	Nasal swabs of hospital coworkers		28
10/30	Case-patient's apartment	Appliance tops, mail bins, table tops, post office receipts, window sills, light fixtures, trash cans, and bank cards		40
10/31	Case-patient's workplace locker and workspace	Locker contents (clothing, shoes, lab coat, personal belongings), elevator exhaust blades and cages, air-intake grills, door jambs, and computer cooling fans		52	4
11/1	Manhattan post office A	Computer fan intakes, light fixtures, teller computer monitors, air-intake grills, counter surfaces, and vacuum sample of multiple mail-sorting cubbies		12	1
	Case-patient's apartment	Mailbox, adjacent mailboxes, elevator fans, refrigerator, baseboards, personal items, clothes hampers, television screen, boxes containing recent mail, light fixtures, vacuum cleaner dust, and cooling fans		29
	Case-patient's apartment	Closet, hanging garments, bedroom clothes, and hallway bureau			8
	Personal items from case-patient's apartment	Slippers, shoes, hats, pieces of recent mail, address book, pictures, and stuffed animal		9
	Office of the Chief Medical Examiner	Autopsy room, sink, table, cutting floor, and floor		31
11/2	Bronx post office A	Multiple mail slots, sorting areas, and intake grills of ventilation systems		15	3
11/2	Manhattan post office B	Mail-sorting areas and ventilation system, fluorescent light fixtures		9
11/3	Case-patient's workplace (basement storage)	Door jams, light fixtures, conduits, air-conditioner intake filters, pipes		8
11/4	Bronx mail sorting and distribution center	Optical character readers, air intake of ventilation system, manual sorting stations, dead-letter repository, digital bar code sorters (including the machine that sorts mail to case-patient's home), overhead air filters		25
	Bronx parcel post office B	Sorting stations, registered mail cage and delivery trucks		8
	Case-patient's apartment	Powder samples		9
11/5	Bronx post office box A	Case-patient's post office box		1
	Friend's home	Dining room and bedroom surfaces		2
	Case-patient's workplace (basement storage)	Storage lockers, urinal, plumbing, switches, and bulbs		7
	Case-patient's workplace work station	Fan, light, and pipe		5
11/6	Case-patient's personal effects from apartment	Unspecified substance in case-patient's wallet		1
11/11	Subway line, #6 Lexington Ave line (including Grand Central Station) and 1 N/R station used by case-patient	Multiple dust-collecting areas along platform and multiple air-intake filters of recently installed air-conditioner system in Grand Central Station	120		19
11/11	Four subway stations not known to be used by case-patient (control stations)	Multiple dust-collecting areas along platform	76
11/30	Two businesses near to case-patient's apartment that received mail from Trenton postmarked October 9	Mail bins, scissors, letter openers, desk, phone, window, computer, air-conditioner, and copier		40
12/12	Case-patient's personal effects from apartment associated with hypothesized exposure locations or pathways	Coat, shoes, tennis shoes, slippers, hats, scarf and lab coat, hospital identification card, documents dated in mid-October including mail, money orders, bank withdrawal slips, receipts, phone, and perfume bottles			18
Total			196	372	53

Authors and Disclosures

Timothy H. Holtz,*^¶ Joel Ackelsberg,^¶ Jacob L. Kool,^¥ Richard Rosselli,^¶ Anthony Marfin,^¥ Thomas Matte,*^§ Sara T. Beatrice,^¶ Michael B. Heller,^¶ Dan Hewett,* Linda C. Moskin,^¶ Michel L. Bunning,^¥± Marcelle Layton,^¶ and the New York City Anthrax Investigation Working Group ¹

*Centers for Disease Control and Prevention, Atlanta, Georgia, USA; ^¶New York City Department of Health, New York, New York, USA; ^¥Centers for Disease Control and Prevention, Fort Collins, Colorado, USA; ^§New York Academy of Medicine, New York, New York, USA; and ^±Office of the Surgeon General, Bolling Air Force Base, Washington, D.C., USA

Dr. Holtz is a medical epidemiologist in the Division of Tuberculosis Elimination at the Centers for Disease Control and Prevention (CDC). From 1999 to 2001, he served as an Epidemic Intelligence Service officer for the Malaria Epidemiology Branch, CDC, after which he completed a preventive medicine residency through the CDC at the NYC Department of Health. He was an active participant in the public health response to the World Trade Center disaster and served as one of many epidemiologists investigating the anthrax outbreak in New York City in 2001.

¹New York City Anthrax Investigation Working Group: New York City Department of Health: Sharon Balter, Katie Bornschlegel, Darcy Carr, Neal Cohen, Debjani Das, Annie Fine, Jane Greenko, Laura Mascuch, Benjamin Mojica, Farzad Mostashari, Denis Nash, Beth Nivin, Sheila Palevsky, Sarah Perl, Michael Phillips, Jeanine Prud'homme, Barbara N. Samuels, Karen Schlanger, Polly Thomas, Isaac Weisfuse, Don Weiss; New York City Public Health Laboratory: Alice Agasan, Joselito Amurao, Josephine Atamian, Debra Cook, Erica DeBernardo, Philomena Fleckenstein, Anne Marie Incalicchio, Ed Lee, William Oleszko, Lynn Paynter, Chiminyan Sathyakumar, George Williams, Marie T. Wong, Ben Yang Zhao; Lenox Hill Hospital: Dilcia Ortega, Sarah Petrello, Michael Tapper; Centers for Disease Control and Prevention/Division of Vector-Borne Diseases: May Chu, David Dennis, Kathleen Julian, Lyle R. Petersen; National Institute of Safety and Health: Josh Harney, Robert McCleery, Ken Martinez; Centers for Disease Control and Prevention: McKenzie Andre, Mick Ballesteros, Mary Brandt, Shadi Chamany, Daniel Feikin, Collette Fitzgerald, Jessica Gardom, Alex Hoffmaster, Kristy Kubota, Richard Leman, Naile Malakmadze, Els Mathieu, Leonard Mayer, Shawn McMahon, Juliette Morgan, Tim Naimi, Steve Ostroff, John Painter, Harald Pietz, Tanya Popovic, Joe Posid, Efrain Ribot, Dejana Selenic, Tanya Sharpe, Montserrat Soriano-Gabarro, Allison Stock, Phil Talboy, Sara Whitehead, William Wong, Weigong Zhou; University of North Carolina Medical School: Manoj Menon; U.S. Department of Defense: Francis S. Baluyot, Marcelo V. Bayquen, Monicka J. Boyd, Lisa A. De Los Santos, Martin E. France, Lora L. Galloway, Theron J. Hudson, Angel Lorenzo, Ludwig Mantay, Patrick H. Murray, Debra M. Niemeyer, Len Peruski, Christopher M. Sekula; New York City Police Department: Michael T. Corr, Kevin G. Frazer, John Galasso, Evelyn M. Harris, Joseph M. Herbert, Kevin J. Kehoe, Patrick E. Pogan, Phil T. Pulaski, Joseph J. Reznick; Port Authority of New York and New Jersey Police Department: Michael J. Podolak; Federal Bureau of Investigation: William P. Hyland, Gregory Jones, Howard Leadbetter II, Anthony Willett, and William A. Zinnikas.

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Isolated Case of Bioterrorism-Related Inhalational Anthrax, New York City, 2001

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