Inhalational Anthrax Outbreak among Postal Workers, Washington, D.C., 2001

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. Environmental sampling showed diffuse contamination of the facility, suggesting multiple aerosolization events. 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

The Public Health Response and Epidemiologic Investigation Related to the Opening of a Bacillus anthracis–Containing Envelope, Capitol Hill, Washington, D.C.

On October 15, 2001, a U.S. Senate staff member opened an envelope containing Bacillus anthracis spores. Chemoprophylaxis was promptly initiated and nasal swabs obtained for all persons in the immediate area. An epidemiologic investigation was conducted to define exposure areas and identify persons who should receive prolonged chemoprophylaxis, based on their exposure risk. Persons immediately exposed to B. anthracis spores were interviewed; records were reviewed to identify additional persons in this area. Persons with positive nasal swabs had repeat swabs and serial serologic evaluation to measure antibodies to B. anthracis protective antigen (anti-PA). A total of 625 persons were identified as requiring prolonged chemoprophylaxis; 28 had positive nasal swabs. Repeat nasal swabs were negative at 7 days; none had developed anti-PA antibodies by 42 days after exposure. Early nasal swab testing is a useful epidemiologic tool to assess risk of exposure to aerosolized B. anthracis. Early, wide chemoprophylaxis may have averted an outbreak of anthrax in this population

Appalachian Studies Anachronisms: A Roundtable Discussion

Since its inception in the 1970s, Appalachian Studies scholars and activists have worked to mediate, and at times rebuke, the region’s romanticized and stereotyped characterizations. And yet the very concept of a field of Appalachian studies inherently argues for an exclusivity and uniqueness that easily reinforces those romanticized notions. As this field of study enters its fifth decade, voices across this discipline are calling for recognition of Appalachia’s politically, economically and ethnically diverse histories, advocating for the field to continue to develop an interdisciplinary identity. Our question is whether “Appalachia” is a term under which these histories can truly be recognized, or whether the term itself can only inherently peripheralize and obscure these realities. To explore this question a roundtable hosted by ETSU Appalachian Studies graduate students will briefly present 8 themes or topics that have been historically characterized as unique to Appalachia. Participants will then discuss how these themes characterize the region, obscure its history, and/or can be applied to other national or global experiences. In the introduction to the collection Studying Appalachian Studies (2015), Chad Berry, Phillip Obermiller and Shaunna Scott state, “It is not useful to think of the Appalachian region as exceptional and distinctive but, rather, to scrutinize its similarity and connection to other places…charting a middle course between an overgeneralized universalism and an exclusionary individualism…is clearly no easy task.” This conversation will help explore the challenges and strengths of charting that middle course, and raise questions about the many paths the field can take at its next stage of evolution

Investigation of Bioterrorism-Related Anthrax, United States, 2001: Epidemiologic Findings

In October 2001, the first inhalational anthrax case in the United States since 1976 was identified in a media company worker in Florida. A national investigation was initiated to identify additional cases and determine possible exposures to Bacillus anthracis. Surveillance was enhanced through health-care facilities, laboratories, and other means to identify cases, which were defined as clinically compatible illness with laboratory-confirmed B. anthracis infection. From October 4 to November 20, 2001, 22 cases of anthrax (11 inhalational, 11 cutaneous) were identified; 5 of the inhalational cases were fatal. Twenty (91%) case-patients were either mail handlers or were exposed to worksites where contaminated mail was processed or received. B. anthracis isolates from four powder-containing envelopes, 17 specimens from patients, and 106 environmental samples were indistinguishable by molecular subtyping. Illness and death occurred not only at targeted worksites, but also along the path of mail and in other settings. Continued vigilance for cases is needed among health-care providers and members of the public health and law enforcement communities