Anthrax: Investigation Into New York Inhalation Case Continues

While New York investigators were working today to determine how the latest inhalation anthrax victim contracted the disease, new reports revealed the spread of anthrax spores beyond the East Coast.

After New York City woman Kathy Nguyen died yesterday from inhalation anthrax, investigators began examining her whereabouts for the past two weeks, the period when she was most likely exposed to the disease, according to the New York Times.  Tracing that path was harder because Nguyen was too sick to speak to investigators before she died, they said.  "What we are trying to do is backtrack in this woman's life to see who her friends were, who she associated with, who knows where she has been," municipal Police Commissioner Bernard Kerik said yesterday.

Tests at Nguyen 's apartment and the Manhattan Eye, Ear and Throat Hospital where she worked have come back negative, said Mayor Rudolph Giuliani.  Another woman who worked in a different section of the hospital, however, had a small skin lesion that may be suspicious, according to the Times.  The woman was undergoing testing to determine if she had been exposed to anthrax, officials said.  "At this point, people should not jump to conclusions about it," said Giuliani.

Nearly 30 investigators have tried to retrace Nguyen 's movements, talking to coworkers and searching her apartment to locate a possible exposure point, according to the Times.  Postal investigators were tracking the course of mail to the hospital to see if any of it passed through a Manhattan postal center where anthrax spores had previously been found.  "It's like a fugitive investigation," said FBI official Barry Mawn. "We want to know everything and anything."

One small clue was anthrax found on Nguyen’s clothing, according to health officials.  It was unlikely that the clothes were contaminated after she had gotten sick, said health officials. The anthrax may have gotten on the clothing at the time of Nguyen 's exposure.  "The reality of this is, this is a much more difficult investigation," Giuliani said.  "It does not mean it can't be done.  It just means it's going to take a while longer."

Possible New Exposures Detected

A postal employee at a mail center near Camden, New Jersey, may have contracted skin anthrax, officials said yesterday.  The victim is a 54-year-old man who works as a mail processor at the Bellmawr center, according to officials.  Final tests were pending, but the man was being treated with antibiotics for a skin lesion.  If the man tested positive for anthrax infection, it could mean that the affected area in New Jersey is larger than previously believed, according to the Times.  Past anthrax cases in New Jersey centered on a mail processing center near Trenton, New Jersey, which is north of Camden. 

The Bellmawr facility was closed yesterday.  A small amount of mail would remain inside until tests could show it was not contaminated with anthrax, officials said (Eric Lipton, New York Times, Nov. 1).

More Postal Facilities Tainted

Trace amounts of anthrax spores were found at two spots inside a postal center in Kansas City, Missouri, officials there said Wednesday.  The center had received about 7,000 pieces of mail from a Washington postal facility where anthrax spores had been found.  Tests found anthrax spores on two garbage bags near the mail from Washington.

No employees at the center showed signs of infection, but employees were to be interviewed and given antibiotics as a precaution, officials said.  They said the threat to the public was negligible.  "There is no danger to the public," said Gary Stone, manager of the postal center.  "It's important to remember that (since) Sept. 11, there have been 21 billion pieces of mail processed in this country.  And only three were contaminated" (Schultz/Hart, Kansas City Star/RealCities.com, Nov. 1).

Anthrax spores also surfaced at a private postal maintenance center in Indianapolis, Indiana, according to the Associated Press.  Trace amounts of spores were found on a printer shipped to the Indiana facility from a mail-processing center in New Jersey know to be contaminated with anthrax.  The spores were limited to the equipment and the maintenance center's workers showed no signs of infection, said Governor Frank O'Bannon on Wednesday.  "At this level of exposure, anthrax is not a threat to human health in Indiana," O'Bannon said (Associated Press/London Guardian, Nov. 1).

A mailbag from the U.S. Embassy in Lithuania tested positive for anthrax spores, officials said yesterday. Five mailbags were tested as part of a worldwide sweep of U.S. Embassies, said Lithuanian Public Health Center Microbiology Laboratory Chief Kazimiera Rutiene.  The tests involved injecting mice with a suspicious substance taken from the bag, which then died, according to Rutiene.  "This is real proof that there were traces of anthrax there," Rutiene said.

Preliminary tests of the mailbags showed two out of the five to possibly contain anthrax spores, U.S. State Department spokesman Richard Boucher said Wednesday.  The embassy mailroom was sealed and antibiotics were to be provided to any employee who requested them, Boucher said (Liudas Dapkus, Associated Press/Washington Post, Nov. 1).  

Is Washington in the Clear?

The U.S. Centers for Disease Control and Prevention yesterday proposed relaxing guidelines on which postal and private mailroom workers in Washington should take antibiotics as a precaution against anthrax.  No new anthrax cases were reported in Washington in the last week and three patients infected with inhalation anthrax were believed to be improving, according to the Washington Post.  “We're hoping and praying that we won't see any new cases in the next few days,” said CDC Emergency and Environmental Health Services Director Patrick Meehan. 

The CDC proposed that postal workers at three reopened facilities stop taking antibiotics.  Mailroom workers at close to 4,000 private firms that receive large volumes of mail could also stop taking antibiotics, according to the CDC. Mailroom workers at Washington media companies, other organizations that could be possible terrorist targets and companies with mechanized mail sorting equipment located in ZIP codes starting with 200, however, should continue taking antibiotics and those companies should conduct environmental testing at their buildings, the CDC said.

Mayor Anthony Williams said city officials would announce today whether or not they would accept the new CDC guidelines (Cohn/Goldstein, Washington Post, Nov.1).

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BWC: U.S. Blocks U.N. Proposal to Condemn Anthrax Incidents

The United States yesterday blocked a French proposal for the U.N. Security Council to condemn the recent U.S. anthrax incidents, said senior U.S. and European officials.   The proposed resolution would have stated that the use of biological weapons was prohibited under the Biological Weapons Convention.  It also would have said that, under the U.N. charter, the United States had a right of military to militarily to defend itself unilaterally against biological warfare.

A U.N. condemnation would only be appropriate if there was clear proof that the anthrax came from a foreign source, said a senior official in U.S. President George W. Bush’s administration.  "Let's assume this was the work of a bunch of right-wing nuts or a Unabomber kind of thing," the official said.  "That would make it a domestic criminal matter.  The Security Council just has no legitimate role in this." 

The decision to reject the proposal came after debate within the U.S. State Department over whether or not the anthrax incidents violate the Convention, administration officials said.  "The French told us this was a clear violation of the convention, but I don't know how it would be if it's a domestic nut case," said another administration official. 

European officials said the U.S. rejection of the proposal was shortsighted and a missed opportunity.  "This was the first time that a biological agent was used against a civilian population and we felt that it was important at the very least that the international community say something about it," said a senior European official.  "The goal was to reaffirm the value of the convention and assure solidarity.  But the answer clearly was 'No'" (Elaine Sciolino, New York Times, Nov.1).

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Anthrax:  U.S. Investigation Continues

Some officials expressed frustration yesterday over the lack of information and patterns in the investigation into the recent anthrax incidents, while the fourth victim of inhalation anthrax died in New York City (see GSN, Oct. 31).

The recent anthrax incidents are something totally new for scientists and investigators, Surgeon General David Satcher said yesterday.  “We’re used to dealing with infectious diseases, but we don’t have a lot of experience dealing with terrorists, Satcher said.  “We don’t know what the attacker is doing or what the attacker is going to do next in terms of strategy” (CNN.com, Nov. 1).

What’s needed are “scientifically trained people who are able to … come up with new hypotheses” to explain why certain people contract anthrax and others do not, said former U.S. Centers for Disease Control and Prevention Director Bill Roper, highlighting the need for more epidemiologists.  The recent New York City case, examined by epidemiologists, could provide clues into the recent anthrax incidents, according to the Philadelphia Inquirer. “The hospital worker who died doesn’t fit [known patterns] and may well be an opening wedge” for a better understanding of the problem, Roper said.

A suspicious second case of skin anthrax at the same hospital where yesterday’s victim had worked could also provide clues.  “These two particular cases don’t meet an exposure scenario consistent with what we’ve seen before, so we’ve got to be more open-minded,” said CDC Director Jeffrey Koplan.  The new and seemingly different cases would “throw you off,” said Greg Evans, director of the Center of the Study of Bioterrorism and Emerging Infections at the St. Louis University School of Public Health.  “You always have to ask, ‘Is this the beginning of another pattern, or was this an isolated case?’”

Not only will investigators and epidemiologists try to learn more about the New York victim’s movements before she became ill, but will also look into ‘host-risk factors,” such as smoking or a weakened immune system, according to the Inquirer.  All of those who died from inhalation anthrax were over 47, and being older means a person has a diminished immune system, Koplan said.  Smoking weakens the lungs and allows infections, such as anthrax, to occur, said epidemiologist Howard Frumkin.  “If the anthrax spores glob onto the smoke, then the smoke can basically act as a carrier, and brings other materials into the lungs and deposits them deep down,” Frumkin said (Seth Borenstein, Philadelphia Inquirer, Nov. 1).      

Research Labs Subpoenaed

Federal officials have issued 60 subpoenas for records from research facilities that work with anthrax to determine whether the spores used in the recent incidents were taken from a lab, according to sources.  There is no evidence thefts have occurred, said sources, but the subpoenas were issued as a precaution.  “We were fishing,” said a law enforcement official.  “But we need to understand who could have access to the bacteria.  We wanted to know everyone who had entered a lab, been interested in anthrax research, and background them.”

The subpoenas were to obtain laboratory visitors logs and shipping documents from universities, research institutes and CDC-licensed companies.  “It was a friendly subpoena,” said Richard Hidalgo, assistant to the dean of the School of Veterinary Medicine at Louisiana State University.  “I think they are just looking for any missing shipments, trying to cover all the bases.”

“We’re chasing ghosts,” a source said.  “Issuing those subpoenas was a smart thing to do to try to get a handle on where the anthrax is and who has access to it.  So far, we have nothing to go on” (Kidwell/Garcia, Miami Herald, Nov. 1).

A decades-old sample of anthrax at Iowa State University’s College of Veterinary Medicine was destroyed two weeks ago with a state trooper standing guard, according to the Associated Press.  The process, which took about two weeks, used steam pressure to destroy the bacteria (Associated Press, Nov. 1).

Witches, bin Laden, or Angry White Males?

Media organizations received threatening letters before the Sept. 11 terrorist attacks that were similar to recent anthrax-tainted letters sent to targets, such as NBC News, according to the New York Post.  The prior letters were mailed from Indianapolis, Indiana, according to the Post. They were addressed in block writing similar to that on anthrax-tainted letters mailed to NBC News, the New York Post and Senate Majority Leader Tom Daschle (D-S.D.), the Post reported.  Each line clearly sloped downward to the right and the handwriting resembled that on the tainted letters.

The similarities between the pre-Sept. 11 letters and the recent tainted letters could mean the anthrax incidents were the result of a domestic source rather than a foreign terrorist such as Osama bin Laden.  A number of groups were being investigated, according to the Post, including members of a pagan cult (Murray Weiss, New York Post, Nov. 1).

There are still no clear leads as to who is responsible, law enforcement officials said.  Possibilities range from bin Laden to domestic terror groups to even a lone individual.  “Everything is still on the table,” said a senior law enforcement official.  “We need a break, we need to get lucky.”

Signs point to either bin Laden’s al-Qaeda organization, domestic sympathizers, or to an angry white male with a microbiology degree and engineering skills, an official said (ABC News.com/Yahoo.com, Oct. 31).

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Anthrax: Vaccine is on the Way

BioPort Corp., the sole U.S. maker of anthrax vaccine, could resume production as early as Nov. 22, U.S. Health and Human Services Secretary Tommy Thompson said this week. By then, the company should have completed a renovation and expansion project.

The Food and Drug Administration effectively shut the plant down in 1998, citing concerns about the quality and sterility of the vaccine (see GSN, Oct. 26). Once BioPort resumes production, FDA officials can reinspect the plant and test samples of a stockpile of 5 million doses of quarantined vaccine.

The U.S. military, which has immunized some of its personnel with stocks of previously manufactured vaccine, hopes to vaccinate 2.4 million personnel, the Washington Post reported. The U.S. Centers for Disease Control and Prevention could immediately receive vaccine for 800 to 1000 epidemiological investigators and researchers. Additionally, health officials are considering vaccinating a substantial number of people in high-risk occupations, such as postal workers, law enforcement officers, and firefighters (David Brown, Washington Post, Nov. 1).

Make Government Bigger

The U.S. federal government should oversee and finance the research and production of vaccines against germs that could be used as bioweapons, said a panel of congressional advisors.

“We’ve suggested that the private sector can no longer respond to the requirements of producing vaccines for diseases that may only emerge if they are intentionally perpetrated,” said Michael Wermuth of Rand. “The private sector can’t see any profit motive in doing this over the long term” (Scott Lindlaw, Associated Press/Real Cities, Nov. 1).

Cipro Gets Around

The governments of France and the United Kingdom signed agreements this week with German drug maker Bayer to buy the anthrax antibiotic Cipro, a company spokesman said today. The spokesman declined to provide details of the agreement (Agence France Presse, Nov. 1).

In the United States, government health officials are treating tens of thousands of people with Cipro. Additionally, in the third week of October private pharmacists sold nearly 63,000 more prescriptions for Cipro than in the same week last year, according to a pharmaceutical tracking company (Jeff Donn, Associated Press/ Real Cities, Nov. 1).

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BWC: Europeans Say They Will Work Together with U.S.

Two veteran European diplomats confirmed today that their governments were ready to work with the approach to enforcing the Biological Weapons Convention proposed by the United States, the New York Times reported (see GSN, Oct. 29). Both representatives, however, added that they still hoped the United States would eventually endorse some of the more sweeping measures that it rejected earlier this year.

“We are ready and willing to work with the Americans to bridge the gaps,” one of the diplomats said. “But we hope this is only a first step and that it opens the door to more sweeping multilateral measures.”

In July, the Bush administration blocked a protocol that would have allowed international inspectors to tour potential bioweapons manufacturing sites. Bush administration officials proposed new measures to European officials last week (see GSN, Oct. 23) and to Canadians this week (see GSN, Oct. 29).

Provisions that the United States is proposing reportedly include requiring signatories to “accept international expert inspectors” on the order of the U.N. secretary general, and creating procedures for “international investigations of suspicious disease outbreaks” or alleged treaty violations. The provisions, however, fall short of mandatory inspections of dual-use facilities. Administration officials were expected to formally announce the new plan soon.

“We strongly believe in the importance of the Biological Weapons Convention and the need to strengthen it,” a senior administration official said. “But the anthrax attacks against Americans show that a treaty is not the be-all and end-all to stopping the spread of biological weapons or preventing and dealing with germ attacks” (Judith Miller, New York Times, Nov. 1).

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Anthrax:  More Public Health Funding Needed, Says Surgeon General

The United States needs to spend billions to upgrade its public health system to better combat bioterrorism, Surgeon General David Satcher said Monday. 

The U.S. Centers for Disease Control should increase its annual budget by ‘a few billion” dollars, said Satcher, to hire trained epidemiologists and advisors nationwide.  State and local public health systems also need better communication networks and improved laboratory facilities to test suspected bioterrorism agents, said Satcher. 

“If there’s anything these bioterrorism attacks have taught us, it’s that the best defense is a strong public health infrastructure,” Satcher said.  “The CDC has funded some good initiatives, but we need more than we have.”  

Federal officials have had a difficult time finding and treating people exposed to anthrax, Satcher said.  “The attacks have been different than we anticipated,” he said.  “We hope we’re more ready now than we were.  But until an attack comes, we can’t be fully ready.  We’re all learning together” (Gavin McCormick, Associated Press, Oct. 30).

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