Anthrax:  Critics Attack Vaccine Treatment Plan

Opponents of a U.S. plan to offer the anthrax vaccine as a post-exposure treatment method yesterday criticized the vaccine’s safety and the lack of information as to who should be inoculated (see GSN, Dec. 19).

U.S. Representative Christopher Shays (R-Conn.), who held hearings last year on the vaccine, said it was dangerous for people “to take a vaccine that hasn’t been approved by the [U.S. Food and Drug Administration] and that was made in a plant that hasn’t been approved either.”

After the Shays hearings, the House Government Reform Committee released a report that criticized the “preposterously low adverse report rates,” issued by the Defense Department.  The Pentagon did not monitor safety adequately and had an “institutional resistance to associating health effects with the vaccine,” the report said.

U.S. Postal Service officials said that without information from the U.S. Centers for Disease Control and Prevention, they would be unable to advise postal workers on whether to take the vaccine.

“I am disappointed and frustrated,” said Azeezaly Jaffer, vice president for public affairs for the Postal Service.  “I don’t know what is best for me and my health,” Jaffer said.  “If I cannot come to a resolution on what is best for me, you can guess how frustrated my employees are” (Rosenbaum/Stolberg, New York Times, Dec. 20).

Washington Mayor Anthony Williams yesterday released a statement saying district officials were not recommending vaccinations.  “After discussing this issue at several scientific meetings, and the careful review of the scientific data, and absent a recommendation from the CDC, the District … affirms its previous public health advisory which recommends strict compliance with the 60-day course of antibiotics,” Williams said.

“As such the District Department of Health does not recommend investigational post-exposure prophylactics with anthrax vaccine at this time,” he said.

Bailus Walker, a professor of public health and policy at Howard University in Washington, said the government’s method of handling the anthrax incidents has reinforced long-held suspicions.

“There is a long-standing, deeply ingrained concern in the black community about being used as guinea pigs,” Walker said.  “As much as we try, we have not been able to remove from the minds of the black community the Tuskegee episode… We confront it almost monthly as we try to get blacks to participate in clinical trials.  This just feeds it.”

U.S. Officials’ Response

CDC Director Jeffrey Koplan yesterday described who might want to consider taking the vaccine as post-exposure treatment, according to the Washington Post.  Such people include those who were near tainted mail, those who had contact with any of the five people who died from anthrax and those who were in contaminated buildings, Koplan said.  “Those are the individuals at higher risk who may want to consider these more aggressive options,” he said (Connolly/Goldstein, Washington Post, Dec. 20).

Lt. Col. John Grabenstein, deputy director for clinical operations of the Pentagon’s Anthrax Vaccine Immunization Program, defended the safety of the vaccine.  “We have conducted 18 human safety studies—short and long term—retrospective and prospective,” Grabenstein said. “In aggregate, what they show is anthrax vaccine has a side effect profile similar as that of other vaccines.”

Severe allergic reactions are visible in 1 per 100,000 people, Grabenstein said.  Up to 16 percent of those inoculated may experience rashes, 14 to 25 percent may experience headaches, 12 to 15 percent may experience joint aches and close to a third may experience muscle aches, according to military researchers.  Those inoculated have also said they felt painful stinging and burning at the inoculation site, the Washington Post reported.

In response to claims that the vaccine has other, more serious side effects, Grabenstein said, “lots of people are confusing ‘it happened after vaccination’ with ‘it happened because of vaccination’”(Shankar Vedantam, Washington Post, Dec. 20).

BioPort Inspections Completed

Food and Drug Administration officials yesterday said they had finished inspections of laboratories at BioPort, the only U.S. manufacturer of the anthrax vaccine.  The company had successfully addressed most of the agency’s complaints, FDA officials said (see GSN, Nov. 21).  BioPort will not be fully licensed until the FDA next month completes inspections of another company contracted to decant the anthrax vaccine into vials, FDA officials said.

BioPort has been trying to obtain U.S. approval to ship the anthrax vaccine it produces, according to the Associated Press.  BioPort has produced the vaccine since 1988, but has been unable to ship since failing federal inspections in 1999 and 2000, the Associated Press reported.

The future corrections required by the FDA were minor compared to violations found in previous inspections, said BioPort President Bob Kramer (Associated Press/London Guardian, Dec. 20).  

Genetic Findings Might Not Solve Investigation

Some scientists said too little is known yet about the genetic makeup of anthrax to be able to differentiate one sample from another, the Associated Press reported yesterday. 

“It’s a race against time to get enough genetic information to make these matches precisely,” said Jill Trewhella, bioscience division leader at Los Alamos National Laboratory, which is assisting in the anthrax spores genetic fingerprinting effort (see GSN, Dec. 19).  “We want to catch the person.”

Barbara Hatch Rosenberg, of New York State University, said they key to the case would probably involve determining a motive, rather than scientific analysis.  FBI investigators are examining political and ideological motives for the attacks, as well as possible financial gain, such as someone involved with an environmental cleanup company, a law enforcement official said (Laura Meckler, Associated Press, Dec. 19).

Anthrax spores used at the University of New Mexico are likely identical to the spores used in the attacks, a university spokesman said.  The university expects its anthrax samples to be tested soon for a genetic match with the mailed spores, said university spokesman Sam Giammo.  “We would be very surprised if it didn’t match perfectly,” Giammo said.

The university’s anthrax samples came from the U.S. Army Medical Research Institute of Infectious Disease, which also sent out samples to five other laboratories, according to the Albuquerque Journal.  The university did not use in its research the finely milled version of anthrax found in the tainted letters, Giammo said (Jackie Jadrnak, Albuquerque Journal, Dec. 19).

Russia Offers Help

Russian scientists have developed a new anthrax vaccine that they are prepared to offer to the United States, Valentin Pokrovskii, president of the Academy of Medical Sciences, said Tuesday.  The new Russian vaccine only requires two injections, as opposed to six for the U.S. version, Pokrovskii said.

Russia is also ready to send its stockpiles of anthrax vaccine and spore samples to the United States, said Health Minister Yurii Shevchenko.  “If the terrorist origin of the anthrax cases in America is proved, all of us should be ready for a mass vaccination of the population,” Shevchenko said (RFE/RL Newsline, Dec. 19).

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Threat Assessment:  New Detection Methods in Development

While terrorists have shown through the recent anthrax incidents that they are capable of launching small-scale biowarfare attacks, experts believe a determined group could carry out a much larger biological assault, according to the December issue of the Massachusetts Institute of Technology Alumni Association Technology Review.

“The level of sophistication that went into the World Trade Center attack, if applied to a chemical or biological attack, could produce an effective effort,” said Harvard University chemist George Whitesides.  “It is technically feasible.  Whether it is politically or operationally feasible, and at what scale, we don’t know.  Nonetheless, we will have to prepare for the possibility, because we need an insurance policy.”

In order to combat this threat, researchers are working on new equipment to detect biological warfare agents as well as new information-gathering methods and treatments according to the Review (see GSN, Dec. 12).

Detection Technology

The U.S. Defense Department plans to introduce a new truck- or ship-based detection system within the next few months, said Calvin Chue, a microbiologist at the Center for Civilian Biodefense Studies at Johns Hopkins University.  The system would continuously monitor the air for biological warfare agents through the use of a laser system and advanced software to screen airborned particles.  When the system detects something suspicious, a detector mixes an air sample into a solution and tests for 10 different pathogens, the Review reported.

Researchers are also developing sensors with DNA chips that could screen for a larger number of pathogens, according to the Review.  The chips carry small fragments of DNA from microbes that could be used as biological weapons.  The fragments would be able to detect if the agent is present through binding to any complementary pathogen DNA in a sample. 

DNA chips are already in use, but currently require a full laboratory of equipment, the Review reported.  “If we could shrink those down in a portable, fieldable unit, you could look at hundreds of organisms, potentially in 10 to 15 minutes,” Chue said.

Information-Gathering Methods

Researchers are looking at new means to collect information from hospitals and physicians to determine if a biological attack has been launched, according to the Review. 

The process is called biosurveillance, and was used during the inauguration of U.S. President George W. Bush, the Review reported.  The Pentagon and local and state health agencies gave patient-query sheets to hospitals, military clinics and aid-stations along the inaugural parade route and near the sites of inaugural balls.  Computers monitored incidents of complaints of several key symptoms of possible biological warfare agents for patterns that might indicate an attack.  There was brief concern when a surge of flulike symptoms was noticed at military clinics, but it turned out to be just the flu, according to the Review.

Physician and informatics researcher Kenneth Mandl, along with researchers at MIT, developed a computer system that uses emergency room intake information to monitor and track the frequency of symptoms expected during a biological weapons attack, according to the Review. 

Mandl’s system links information from many medical facilities, a task complicated by the fact that different facilities use different systems and ways to gather patient information, the Review reported.  Even so, “it’s an important public health measure to take,” Mandl said.  “Most likely the way this will eventually happen on a large scale is when it becomes a mandated reporting obligation.”

New Treatments

Whitesides and Harvard Medical School microbiologist John Collier are working on a potential anthrax treatment, according to the Review. Early studies have shown the treatment effective on rats exposed to anthrax toxin, the Review reported.

Anthrax produces both a toxin and a protein that creates a doughnut-shaped hole in the target cell to allow access for the toxin, according to the Review.  Whitesides and Collier’s new treatment works by blocking the doughnut-shaped hole from the toxin.

Collier said he plans to conduct future tests with anthrax from military facilities.  “There is a lot of activity right now in putting together a biotech company that will work closely with government agencies to develop this rapidly,” he said (David Talbot, Massachusetts Institute of Technology Alumni Association Technology Review, December 2001).

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Anthrax:  Vaccine Will be Offered for Post-Exposure Treatment

The anthrax vaccine will be made available for people who might have been exposed to anthrax and are coming to the end of their antibiotic regimen, federal health officials said yesterday (see GSN, Dec. 18).

U.S. Health and Human Services Secretary Tommy Thompson said about 10,000 people exposed to anthrax, who are at the end of their 60-day antibiotic treatment, would be eligible for the vaccine.  Those people were also offered the options of an additional 40 days of antibiotics, or no additional treatment with a precaution to see a doctor if they become sick.

“Some of those people, especially those who may have been exposed to high levels of anthrax spores, may wish to take additional precautions,” Thompson said.

Health officials did not know how many people will choose vaccination, but D.A. Henderson, head of the U.S. Office of Public Health Preparedness, said there are only about 3,000 people who were heavily exposed to anthrax spores.

The vaccination program could begin today, with 70 staff members in Senate Majority Leader Tom Daschle’s (D-S.D.) office, the Wall Street Journal reported.  Postal Service workers who choose to be vaccinated could receive the treatment starting next week.

The vaccine is being offered as part of a federal study.  Those people who choose to participate will have to sign a consent form showing they were informed as to the risks of the vaccine, the Journal reported.  The treatment consists of three vaccine injections over the course of a month.  Side effects could include swelling and redness at the inoculation site (Sarah Lueck, Wall Street Journal, Dec. 19).

The vaccine is being offered to prevent against lingering spores germinating into full-blown anthrax.  Studies conducted in monkeys have shown that spores can linger in the lungs up to 75 days after exposure, according to the New York Times. The studies found that vaccine combined with antibiotics protected the monkeys.

Current research does not provide enough information about who should be inoculated, said Washington Health Commissioner Ivan Walks.  “The best and brightest scientists in the country have studied this, and I’ve got all those studies on my desk,” Walks said.  “If I can’t figure out whether you should take the vaccine or not, how can I expect you to figure out on your own whether to take the vaccine?” (Stolberg/Rosenbaum. New York Times, Dec. 19).

Anthrax Can Become Antibiotic-Resistant

A common strain of anthrax can become resistant to antibiotics within 21 days, a U.S. scientist said yesterday, according to Agence France-Presse. 

The anthrax strain used to create the vaccine developed resistance to eight different antibiotics—including Cipro—according to a study conducted by the U.S. Armed Force Radiobiology Research Institute in Maryland.  The study found that doxycycline, approved against anthrax by the U.S. Food and Drug Administration this year, was the most effective (see GSN, Oct. 29).

“The drugs we are using today may not be effective over time because the [anthrax] bacteria can spontaneously become resistant,” said Itzhak Brook, an Institute scientist who conducted the study. 

The study’s findings supported recommendations that doctors should prescribe two antibiotics for people who might be infected with anthrax, Brook said.  In the long term, however, it showed that mass anthrax vaccination programs might need to be considered, he said.

“You cannot count on antibiotics to do the work.  You need to immunize people to protect them from infection” since spores can lie dormant in the body for weeks, Brook said (Louise Daly, Agence France-Presse, Dec. 19).

“Amerithrax” Investigation Focused on Laboratories

The investigation into the anthrax incidents is focused on less than a dozen laboratories that have worked with the Ames strain, according to the Associated Press. 

There are between five and 12 such laboratories, a law enforcement official said.  It is taking some time to investigate each one, he said.  Investigators are interviewing employees and examining the genetic fingerprints of each laboratory’s stocks of anthrax.

To date, the anthrax at each tested laboratory was a genetic match to the spores used in the tainted letters to Daschle and Senator Patrick Leahy (D-Vt.), said another federal official.  Not every laboratory has been tested yet, he said. 

Office of Homeland Security Director Tom Ridge yesterday said that there was a possibility of a military connection, but it was not the only possibility.  “There are multiple agencies within government that have for many years, for many reasons, had access to this strain of anthrax,” Ridge said.  “[The military] connection could very well exist.  The fact is we have multiple leads.”

Barbara Hatch Rosenberg, a microbiologist at New York State University, said the FBI should investigate government contractors. “Many contractors work in government labs and would have access to material,” said Rosenberg, who recently published a paper outlining her theory as to who is responsible on the Federation of American Scientists’ Web site.

Click here to read Rosenberg’s paper.

The spores used in the tainted letters could have been processed in various ways, which would make it more difficult to determine their origin, said William Patrick, a former U.S. Army biological weapons scientist.  “You can process the stuff in so many different ways,” Patrick said.  “I don’t think that it will be the smoking gun” (Laura Meckler, Associated Press, Dec. 19).

Scientists’ Mistreatment May Have Caused Bitterness

Several former scientists at the U.S. Army Medical Research Institute of Infectious Disease (USAMRIID) at Fort Detrick, Md., complained about a workplace atmosphere that could have created the angered scientist some experts believe is responsible, the Chicago Tribune reported. 

Ayaad Assaad, a research former USAMRIID scientist, complained that discrimination was practiced and tolerated by the facility’s commander.  Other employees mocked Assad’s language skills, wrote a crude poem making fun of him and other Arab-Americans and passed around an obscene camel, Assad said. He later lost his position at USAMRIID after a round of layoffs, according to the Tribune. 

Assad said he went to USAMRIID’s commander at the time, Col. David Franz, with his complaints, but Franz “kicked me out of his office and slammed the door in my face, because he didn’t want to talk about it.  I just wanted it to stop.”

Franz said Monday the layoffs at USAMRIID in the late 1990s “were the toughest part of my job.  I lost nearly 30 percent of my people during the Clinton [administration] downsizing,” Franz said.  “If I lost my job, I might be pretty upset, too” (Tuohy/Dolan, Chicago Tribune, Dec. 19).

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U.S. Response:  Los Alamos Delays New Biological Facility

The U.S. Energy Department’s Los Alamos National Laboratory has delayed plans to build a new biological weapons research facility in order to hear more public comment, Los Alamos officials said yesterday.

Los Alamos officials said they would extend the comment period until Jan. 15, because of concerns and criticisms that arose during a public meeting last month.

Los Alamos needs a new Biosafety Level 3 laboratory in order to handle live versions of biological warfare agents, such as anthrax, and to research effective defenses, officials said (see GSN, Dec. 18).  “We’re just upgrading our facility and going to the next level,” said Energy Department spokeswoman Tracy Loughead.  “It’s an extension of the research Los Alamos has already been doing.”

If approved, the new laboratory would be the first Biosafety Level 3 facility housed at a nuclear weapons research laboratory, according to Reuters.  The current Los Alamos facility is a Level 2, which can work with noninfectious strands of DNA, but not live biological warfare agents themselves.

Critics said completion of the new laboratory Los Alamos would place neighbors in danger and may violate the Biological Weapons Convention.  Placing a biological research facility at Los Alamos is likely to lead to work on developing biological weapons, they said.

“There are also safety considerations because this lab does not operate itself safely and has endemic management programs,” said Greg Mello, executive director of the Los Alamos Study Group, a citizen watchdog group. 

Los Alamos officials denied that their research would violate the treaty.  “We do not make biological weapons,” Loughead said (Zelie Pollon, Reuters/Environmental News Network, Dec. 19).

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BWC:  Russia Criticizes U.S. Opposition to BWC Protocol

The Russian Foreign Ministry criticized the United States for opposing a previously negotiated enforcement protocol to the Biological Weapons Convention, ITAR-Tass reported Monday (see GSN, Dec. 10).

“At the time of an intense fight against terrorism, including biological terrorism, it proved impossible to implement a most important international mechanism for coordinating the actions aimed at strengthening the enforcement of the ban on biological weapons and of their nonproliferation,” the ministry said in a press release.  “Even though one of the effects of this mechanism would have been to close off channels through which these weapons fall into the hands of terrorists.”

Participants at the review conference were unable to reach agreement on the protocol, mostly due to U.S. opposition, the release said, according to ITAR-Tass (Dmitriy Panovkin, ITAR-Tass, Dec. 17 in FBIS-SOV, Dec. 18).

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Anthrax:  Spores Came From Domestic Source, White House Says

The anthrax spores sent in several tainted letters probably came from a U.S. source, the Bush administration said yesterday, but a U.S. Army spokesman said the powder certainly did not come from Ft. Detrick in Maryland (see GSN, Dec. 17).  Meanwhile, federal health officials said yesterday that workers at high risk to anthrax exposure, such as those at the U.S. Capitol, should be inoculated with the anthrax vaccine.

White House spokesman Ari Fleischer said the administration’s belief that the spores came from a domestic source is based on “scientific means.”  The U.S. Army said earlier this week that the Ames strain spores used in the letters exactly matched those the Army produced in small amounts for testing purposes.

U.S. and British investigators have questioned researchers at laboratories where the Ames strain is stored, according to the Los Angeles Times.  Subpoenas also have been issued for records of employees and visitors to the facilities in recent years. 

Some scientists, however, wonder if the investigators’ list of facilities is extensive enough, the Times reported.  Previously, anthrax strains and other microbes could be sent from laboratory to laboratory with few records kept.  “You’d get to know someone doing research and say, ‘Can I have selection of what you’ve got?’ and it turned up in the mail,” one anthrax researcher said (Megan Garvey, Los Angeles Times, Dec. 18).

DOE Laboratory Illegally Obtains Anthrax Samples

An Energy Department laboratory illegally received live anthrax samples from a U.S. university in late October, Representative Edward Markey (D-Mass.) said yesterday.

The Los Alamos National Laboratory (LANL) “requested, received, and used virulent anthrax it was not authorized to possess,” Markey said.

LANL received the anthrax from Northern Arizona University on Oct. 26, but did not report the shipment for more than a month, Markey said.  He added that the laboratory was not authorized to work with virulent anthrax.  The Energy Department had no comment (Gwen Robinson, Financial Times, Dec. 18).

Army Has Its Doubts

The scientists at the U.S. Army Medical Research Institute of Infectious Diseases did not have the equipment or ability to make the kind of anthrax found in the tainted letters, Maj. Gen. John Parker, head of the facility, said yesterday.

Parker made the statement in response to charges that the spores used in the letters were a genetic match with those used at USAMRIID and five other labs that received their samples from the facility, according to the Associated Press. 

Scientists at the Army facility grew the Ames strain for experiments that used a liquid form of the bacteria, and they never made the dry powder form, Parker said.

“We don’t have that capability here nor do we have the scientists who know how to do that,” he said.  “I can’t give credibility to others who say they would have had to have been in our program.”

Parker said he doubted that a trained scientist would be responsible for the mailed anthrax.  “This person is a criminal,” Parker said.  “They have to be of the ilk of a terrorist.  I don’t think they can be logical thinkers” (David Dishneau, Associated Press, Dec. 18).

New Tests May Help Determine Source

While previous testing showed that the anthrax sent in the letters was of the Ames strain, new, more refined testing methods may be able to more accurately determine where the anthrax originated, the Wall Street Journal reported today.

Scientists are conducting the new tests at the Institute for Genomic Research in Rockville, Md., a not-for-profit laboratory founded by human genome decoder Craig Venter.  At the institute, investigators are attempting to find and catalog thousands of tiny genetic mutations, called single nucleotide polymorphisms, within the anthrax genome. 

These small changes occur as the cells of anthrax bacteria mutate, the Journal reported.  Finding and identifying these differences could help investigators determine which of the existing anthrax stockpiles most closely resemble the mailed spores, according to the Journal.

“The sophisticated tests aren’t done yet,” said an FBI agent.  “There haven’t been any conclusions.”

It is unknown whether investigators have taken anthrax samples from facilities known to have a supply, the Journal reported.  A collection of samples would be needed in order to find a precise match.

Institute scientists plan to find the polymorphisms by comparing two complete versions of the anthrax genome already mapped out.  “It’s a pretty new field,” said David Alland, a researcher at the institute.  “But we think these changes in the DNA provide a good way to identify a strain and even to understand its genealogy” (Regaldo/Fields, Wall Street Journal, Dec. 18).

Vaccine Urged as Post-Exposure Treatment

Federal health officials yesterday advised workers at the U.S. Capitol to get inoculated with the unlicensed anthrax vaccine to prevent against developing anthrax symptoms after their courses of antibiotics end.

An inoculation plan could involve up to 3,000 Senate and U.S. Postal Service workers in Washington, New York and New Jersey, according to the Washington Post.  Officials want to begin as soon as possible because many of the 10,000 Capitol staff members and postal workers placed on 60-day antibiotic treatments are starting to finish the regimens, the Post reported.  They could still be at risk if anthrax spores are lingering in the body and their immune systems are not prepared.

Capitol workers will be the first to be inoculated because Capitol officials requested they be so, health officials said.  That plan, however, has generated controversy among Washington municipal health officials, according to the Post. 

“There are only 10,000 doses of the latest batch of vaccine—and that is the lot that the Capitol Hill physician has requested,” said Washington Deputy Health Director Larry Siegel.  “We have made it very clear that if it is released, we want access to the same lot.” 

Siegel said he disagreed that only 3,000 workers were at high enough risk for the vaccine.  “There’s no science yet that will allow anybody to make a determination that any of the 3,500 people in Brentwood [postal facility] are at any lower risk than the people in [Senate Majority Leader Tom Daschle’s (D-S.D.) offices],” Siegel said.  “If anybody is going to be offered vaccine, everybody should.” 

The Postal Service and the postal unions have made no decision on the vaccination plan, said Postal Service spokeswoman Kristin Krathwohl.  “It’s an area that few of us know anything about,” said Barry Burns, a chief shop steward at the Brentwood facility.  “The only thing we can do is put our trust in [the U.S. Centers for Disease Control and Prevention].”

“We have very little trust of postal management and what the post office was telling us,” Burns said.  “As of yet, we have no reason to distrust the CDC” (Vedantam/Connolly, Washington Post, Dec. 18). 

State Department Startled by Possible Anthrax Hoax

A possible anthrax hoax shut down the office of Deputy Secretary of State Richard Armitage yesterday after a staff member opened an envelope containing white powder, according to the Washington Post.

The hazardous materials specialists who responded to the incident said they believed the letter was a hoax because of the irregular-sized granules in the powder, a State Department official said. Powder samples were taken to the FBI for further testing and results should be available this week, the Post reported.

State Department spokeswoman Eliza Koch said she believed the letter posed little risk because it had been irradiated at an Ohio facility.  The bulk of the mail sent to the State Department has been sent through the Ohio facility after anthrax spores were found in a State mailroom two months ago.

“Because it came through the postal service we assume it was irradiated and therefore poses no immediate health threat,” Koch said (Steven Mufson, Washington Post, Dec. 18).

Hart Office Cleanup Delayed…Again

The cleanup of the Hart Senate Office Building was delayed again yesterday after mechanical problems stopped the fumigation of the building’s ventilation system, according to Reuters.

The fumigation of the ventilation system in the southeast quadrant of the Hart building was scheduled for Friday.  Problems, however, delayed the process until late Sunday, according to Reuters.  After seven hours, mechanical glitches stopped workers from reaching the needed saturation level in the building, which led them to cease operations, authorities said.

Federal officials said they would attempt the plan again, but did not say when (Reuters/Boston Globe, Dec. 18).

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Smallpox:  CDC Trains Health Officials for Smallpox Outbreak

The U.S. Centers for Disease Control and Prevention yesterday began a three-day training course for 200 public health workers on how to diagnose and contain smallpox.  The course includes information on how to detect smallpox and differentiate the disease from more common infections, such as chicken pox and syphilis (Erin McClam, Associated Press/Chicago Tribune, Dec. 18).

Course instructors are also teaching medical personnel how to quarantine confirmed smallpox cases and to vaccinate people who have had contact with the victim, according to the CDC emergency smallpox plan (see GSN, Nov. 27). Click here to read the plan.

Experts at the seminar discussed the best methods for quarantine.  Peter Havens of the Medical College of Wisconsin said hospitals could treat some smallpox cases but the disease was certain to spread in hospitals.  Mike Lane, former director of the CDC’s smallpox eradication program in the 1970s, said he preferred proposals to quarantine smallpox patients and people who had contact with them in a suburban motel or remote government building to prevent further spread of the disease.

“You can bring care to the patient if you elect to use the Motel 6 on the edge of town” rather than put smallpox victims in a hospital where the disease could spread to patients with weakened immune systems, Lane said (see GSN, Nov. 21).

Some health officials said they advocated ordering suspect cases to isolate themselves at home during the disease’s incubation period of seven to 17 days.  Others said mandatory quarantine was necessary for people who had contact with a smallpox patient.

The CDC provided instruction at the seminar for establishing “smallpox strike teams” to search for potential cases and people who had contact with them.  The teams would then isolate patients and their contacts and vaccinate them.  Discovering smallpox cases and potential cases early is essential because a smallpox vaccine can fight the disease if administered within four days of infection, said Walter Orenstein, director of the CDC’s National Immunization Program.

Health officials also debated vaccinating first responders, such as hospital workers and firefighters, before any smallpox case appears (see GSN, Nov. 6).  Some said the vaccine’s potential negative side effects and the high turnover of health workers countered the benefits of vaccinating first responders before a smallpox case was discovered (Chad Terhune, Wall Street Journal, Dec. 18).

CDC Deputy Director David Fleming told state and local health officials to coordinate plans with law enforcement officials, who could be responsible for enforcing quarantines and protecting smallpox vaccine stockpiles if an epidemic occurs.

Health authorities declared smallpox eradicated in 1980, but the Sept. 11 attacks and anthrax mailings have heightened concern that terrorists could release smallpox on a vulnerable population (see related GSN story, today).  “It’s a sad day that we feel this meeting is necessary … I hope and pray that this is a big waste of time,” said Orenstein.

“We have a large, susceptible civilian population,” Orenstein said.  “The threat of smallpox is probably not zero, although it is close to zero, and given its severity we need to be better prepared” (McClam, Associated Press/Chicago Tribune).

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Anthrax:  Senate Spores Match Those From U.S. Army

As the “Amerithrax” investigation continued, officials and experts debated whether the spores sent to members of the U.S. Senate came from a U.S. program (see GSN, Dec. 14), according to reports yesterday.

The spores in the tainted letter mailed to Senate Majority Leader Tom Daschle (D-S.D.) and Senator Patrick Leahy (D-Vt.) are identical to those kept by the U.S. Army, scientists familiar with the genetic testing said.  Only five laboratories have stocks of anthrax spores with genetic matches to those in the tainted Senate letters, the scientists said.  Those spores are kept at the U.S. Army Medical Research Institute of Infectious Disease (USAMRIID) at Fort Detrick, Md., the Dugway Proving Ground in Utah, the Porton Down military laboratory in the United Kingdom and microbial depositories at Louisiana State University and Northern Arizona University.

All of the other four laboratories can trace their stockpiles of anthrax spores back to USAMRIID, according to the Washington Post.  “That means the original source [of the spores used in the letters] had to have been USAMRIID,” a scientist said.

It is still unknown which, if any, of the laboratories might have lost control of some of its anthrax stock, according to the Post.  Investigators know little about the security at the Porton Down facility, but have no reason to suspect it is inadequate, one of the two scientists familiar with the genetic testing said.  Among the U.S. facilities, the FBI has focused on Dugway, the scientist said.  Dugway is the only facility known to have produced the weaponized form of anthrax in recent years.

Experts said it is possible, however, that the exact subtype of the Ames strain might have originated somewhere else, such as a dead animal or soil.  “It’s an important finding, but it’s not one of those things that says ‘Aha!’” said Richard Spertzel, former director of the U.N. biological weapons inspection teams in Iraq.

Researchers are still planning to conduct tests on anthrax samples from the Canadian Defense Research Establishment Suffield, the University of New Mexico in Albuquerque and the Battelle Memorial Institute in Columbus, Ohio,  according the Post.  Those three facilities are the only other ones to have received samples of the Ames strain from USAMRIID, the Post reported.

Scientists also plan to examine other characteristics of the anthrax samples, such as proteins and carbohydrates, the Post reported.  “If there’s also a telltale piece or trace of nutrients or chemicals that show the process, that’s even better,” said University of Maryland Biotechnology Institute President Jennie Hunter-Cevera.  “You start adding the pieces and go from tentative to confirmative” (Weiss/Schmidt, Washington Post, Dec. 16).

U.S. Army Response

The findings of the genetic tests on the spores sent to Daschle and Leahy will not necessarily indicate who was responsible, a U.S. Army spokesman said. 

The USAMRIID received its samples of the Ames strain from the U.S. Agriculture Department and then shared it with five other laboratories, USAMRIID spokesman Chuck Dasey said.

“I’m not sure it tells us anything about who the perpetrator is,” Dasey said.  “You can’t say it all came from USAMRIID,” he said.  “We got it from another lab in the first place and so presumably USAMRIID is not the only lab that got it from the Department of Agriculture” (John Heilprin, Associated Press/Salon.com, Dec. 16).

The genetic test findings could mean a domestic source, rather than a foreign one, is responsible for the anthrax attacks, according to the Wall Street Journal.  FBI agents are heavily investigating military personnel, civilians, and academics that had access to the Army programs.  FBI officials said agents have investigated scientists at Dugway, USAMRIID and Louisiana State University since late October. 

Federal officials said, however, the genetic tests remain incomplete.  “These are important leads,” said Michael Osterholm, an epidemiologist at the University of Minnesota.  “But if, in fact, the organization that originally developed the anthrax strain sent it to others, or if it could have been stolen, there are still a wide array of possibilities out there.”

CIA Connection

Investigators have also looked at a CIA program that maintained small supplies of the Ames strain for use in comparisons with other samples, the Journal reported. A CIA spokesman said he did not know the source of the program’s Ames samples. “We are quite confident that whatever the source, it did not come from our supply,” he said (Wall Street Journal, Dec. 17). 

Army’s Admission Angers Some

The Army’s earlier admission that it produced small amounts of weaponized anthrax at the Dugway Proving Ground angered some experts, who said the admission could hurt the credibility of the anthrax investigation, according to the Financial Times.  The Army’s previous silence, even as it conducted chemical analyses on the tainted letters for the FBI, could be a potential conflict of interest, critics said (Gwen Robinson, Financial Times, Dec.14).  

Vaccine Could be Available for Civilians

The United States is debating whether or not to make the anthrax vaccine available to civilians at high risk, such as postal workers (see GSN, Dec. 13), federal health officials said Saturday.

Health and Human Services Secretary Tommy Thompson could make a decision on the matter next week, officials said after a U.S. Centers for Disease Control and Prevention forum. 

The first candidates for the anthrax vaccine would be those with possible exposure to heavy amounts of anthrax spores, said D.A. Henderson, director of the HHS Office of Public Health Preparedness.  “We are concerned with people who may have had a very heavy dose,” Henderson said, and added that this group may number close to 3,000 people (Warren Leary, New York Times, Dec. 16).

Also at the CDC forum, state and local health department officials said that the U.S. public health system was unprepared for a larger outbreak. 

Officials said they were concerned over the idea that a more massive bioterrorism attack may happen than the 18 cases of anthrax seen since early October.  “This was not the big one,” said Lou Turner, director of the North Carolina Laboratory of Public Health.  “The big one is still out there,” Turner said.

It was difficult to come up with a definition of a large outbreak, said Ross Brechner, of the Maryland State Health Department.  A 100 cases might be large, “but 1,000 would be a monster,” Brechner said.

Laboratories were unprepared to handle the mass amounts of anthrax tests needed soon after the incidents began, forum participants said.  Public health workers also had difficulties in collecting specimens, maintaining a proper chain of command and in communications, they added. 

Health officials said the anthrax attacks were a test that the U.S. public health system had passed in some ways, and failed in others.  “What we did right, and did a lot of, was learn an incredible amount” during the progression of an outbreak of a disease few U.S. doctors had seen before, Brechner said (Lawrence Altman, New York Times, Dec. 15). 

Anthrax Still in Hart Building

Trace amounts of anthrax are still present in the Hart Senate Office Building, despite fumigation with chlorine dioxide gas (see GSN, Dec. 12), officials said Friday.

Out of 380 samples taken from Daschle’s office, nine came back positive, according to the Los Angeles Times.  The result was “encouraging,” said U.S. Environmental Protection Agency officials. 

“That means there is still some live anthrax there,” EPA spokeswoman Bonnie Piper said Friday.  “We still have a ways to go to clean the building, but the use of the gas was so effective we are actually tonight going to fumigate a small portion of the ventilation system to see how well [the gas] performs there,” Piper said.  The goal of the Hart building cleanup, she said, is “zero contamination” (Megan Garvey, Los Angeles Times, Dec. 15).

Supreme Court Recovering from Scare

The anthrax scare that closed the Supreme Court briefly in mid-October (see GSN, Oct. 29) placed a strain on proceedings through mail delivery delays and the taxing of the Court’s traditional paper-based methods due to new security measures, according to lawyers familiar with the situation.

The court may have difficulty finding enough cases to fill its oral argument calendar for the current term, which began Oct. 1, the lawyers said.  No permanent damage is apparent, according to the Washington Post.  Court rules allowed automatic extensions of filing deadlines during the weeklong shutdown. 

The Supreme Court took the nearly unprecedented step of allowing e-mailed or faxed backup copies of filings, the Post reported.  The move prompted discussions on whether the court should make it a permanent practice.  “Even before Sept. 11, there were very compelling reasons for any court, including the Supreme Court, to move that way,” said Representative David Vitter (R-La.).  “After Sept. 11, with the anthrax scare and stoppage of the mail, it doubles the reasons to move aggressively,” Vitter said (Charles Lane, Washington Post, Dec. 16). 

Anthrax in Austria

The U.S. Embassy in Vienna mailed back to the United States 10 mailbags that were tainted with anthrax for further tests, U.S. State Department spokesman Richard Boucher said.  The amount of anthrax spores on the mailbag was so small, it required several tests to detect them, Boucher said (U.S. State Department release, Dec. 14).

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Smallpox I:  Biologist Urges U.S. to Allow Vaccination

Americans should be able to choose to receive a smallpox vaccination, said Paul Ewald in a column in the New York Times today (see GSN, Dec. 6).  Ewald, a biology professor at Amherst College and author of Evolution of Infectious Disease and Plague Time, said voluntary vaccination might prevent a smallpox attack, because if part of the population was immune to smallpox, “the bang for the terrorist’s buck could be drastically curtailed.”

Offering the option of vaccination could also help prevent difficult decisions that would occur if terrorists released smallpox on a vulnerable population, Ewald said.  For example, a woman who intended to become pregnant could choose to receive a smallpox vaccine before pregnancy rather than being forced to choose between the risks to the fetus of a smallpox vaccine and acquiring smallpox itself if an epidemic occurred. 

A partly vaccinated population would also reduce the stress on medical resources if an outbreak occurred, Ewald said (Paul Ewald, New York Times, Dec. 17).

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Smallpox II:  Greece Orders Vaccine

Greece has ordered 150,000 doses of smallpox vaccine, the Financial Times reported Saturday.  The vaccine is to be part of a strategic reserve against a biological weapons attack, Greek officials said, but they did not say who would be inoculated.

“We are not sure as to what extent Muslim elements in the Balkans could be used by extremists,” said the Greek Embassy in London.  “Like any other government in the coalition, we must be thinking of taking precautions.”

Greece’s announcement followed a meeting of European health ministers on ways to better coordinate bioterrorism responses.  European Commission officials said they were aware that some countries had begun to build vaccine stockpiles, especially of anthrax and smallpox vaccines.

“We are getting together all the information we can get on what kind of vaccines people have in stock and asking ourselves whether there is need for strategies for pooling our resources,” said a Commission official (Financial Times, Dec. 15).

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