Adherence to Antimicrobial Inhalational Anthrax Prophylaxis among Postal Workers, Washington, D.C., 2001

In October 2001, two envelopes containing Bacillus anthracis spores were processed at the Washington, D.C., Processing and Distribution Center of the U.S. Postal Service; inhalational anthrax developed in four workers at this facility. More than 2,000 workers were advised to complete 60 days of postexposure prophylaxis to prevent inhalational anthrax. Interventions to promote adherence were carried out to support workers, and qualitative information was collected to evaluate our interventions. A quantitative survey was administered to a convenience sample of workers to assess factors influencing adherence. No anthrax infections developed in any workers involved in the interventions or interviews. Of 245 workers, 98 (40%) reported full adherence to prophylaxis, and 45 (18%) had completely discontinued it. Experiencing adverse effects to prophylaxis, anxiety, and being <45 years old were risk factors for discontinuing prophylaxis. Interventions, especially frequent visits by public health staff, proved effective in supporting adherence

Antimicrobial Postexposure Prophylaxis for Anthrax: Adverse Events and Adherence

We collected data during postexposure antimicrobial prophylaxis campaigns and from a prophylaxis program evaluation 60 days after start of antimicrobial prophylaxis involving persons from six U.S. sites where Bacillus anthracis exposures occurred. Adverse events associated with antimicrobial prophylaxis to prevent anthrax were commonly reported, but hospitalizations and serious adverse events as defined by Food and Drug Administration criteria were rare. Overall adherence during 60 days of antimicrobial prophylaxis was poor (44%), ranging from 21% of persons exposed in the Morgan postal facility in New York City to 64% of persons exposed at the Brentwood postal facility in Washington, D.C. Adherence was highest among participants in an investigational new drug protocol to receive additional antibiotics with or without anthrax vaccine—a likely surrogate for anthrax risk perception. Adherence of <60 days was not consistently associated with adverse events

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