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1 October 2005

Volume 41, Number 7
Clinical Infectious Diseases 2005;41:991–997
This article is in the public domain, and no copyright is claimed.
1058-4838/2005/4107-0010$15.00
DOI: 10.1086/432937
MAJOR ARTICLE

No Evidence of a Mild Form of Inhalational Bacillus anthracis Infection During a Bioterrorism‐Related Inhalational Anthrax Outbreak in Washington, D.C., in 2001

Henry C. Baggett,1,3,a

Julia C. Rhodes,2,3

Scott K. Fridkin,4

Conrad P. Quinn,4

Jeffrey C. Hageman,5

Cindy R. Friedman,6

Clare A. Dykewicz,4

Vera A. Semenova,4

Sandra Romero‐Steiner,4

Cheryl M. Elie,4 and

John A. Jernigan5

1Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska; 2National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland; and 3Epidemic Intelligence Service, Division of Applied Public Health Training, 4Division of Bacterial and Mycotic Diseases and 5Division of Healthcare Quality Promotion, National Center for Infectious Diseases, and 6National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

Background.The mail‐related dispersal of Bacillus anthracis spores in the Washington, D.C., area during October 2001 resulted in 5 confirmed cases of inhalational anthrax. We identified an additional 144 ill persons who were potentially exposed to aerosolized spores and whose symptoms were compatible with early inhalational anthrax but whose clinical course and nonserologic laboratory evaluation revealed no evidence for B. anthracis infection. We hypothesized that early antibiotic use could have decreased the sensitivity of diagnostic tests or that bioterrorism‐related inhalational anthrax may include mild disease.

Methods.Eligible patients included those with illness compatible with early inhalational anthrax who had potential exposure to B. anthracis. Patient serum samples were tested for immunoglobulin G (IgG) antibody against B. anthracis protective antigen (PA) using a sensitive enzyme‐linked immunosorbant assay (sensitivity, 97.6%).

Results.Of the 144 eligible patients, 66 (46%) had convalescent‐phase serum samples available for testing; 29 (44%) worked in an area considered to pose a high risk of exposure to B. anthracis spores. Of the 37 patients who worked in areas that did not meet the definition of high‐risk exposure, 23 (62%) worked in United States postal or other government facilities in which exposure was plausible but not documented. None of the 66 patients with convalescent‐phase serum samples showed evidence of an anti‐PA IgG serologic response to B. anthracis.

Conclusions.These data suggest that a mild form of inhalational anthrax did not occur and that surveillance for moderate or severe illness was adequate to identify all inhalational anthrax cases resulting from the Washington, D.C., bioterrorism‐related anthrax exposures.

Received 15 February 2005; accepted 24 May 2005; electronically published 29 August 2005.

Reprints or correspondence: Dr. Henry C. Baggett, CDC, Div. of Global Migration and Quarantine, MS‐E03, 1600 Clifton Rd., Atlanta, GA 30333 ().

  • Presented in part: 40th Annual Meeting of the Infectious Diseases Society of America, Chicago, Illinois, October 2002 (abstract 252).

  • Present affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.

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