EPI UPDATE

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This is an official CDC Health Update
Distributed via the Health Alert Network
October 27, 2001, 21:30 EDT (9:30 PM EDT)

An ongoing investigation has identified a total of 5 mailroom employees with inhalational anthrax from two mailroom facilities (US Postal Service Washington DC Processing and Distribution Center at 900 Brentwood Road, NE, Washington; and Department of State Annex 32 mailroom facility) in the greater Washington DC Metropolitan area (Maryland, Virginia, and District of Columbia). Preliminary environmental sampling has also revealed contamination in mailrooms serving the Central Intelligence Agency, House of Representatives, Supreme Court, Walter Reed Army Institute of Research (WRAIR), White House, and in the Southwest Postal Station. This is in addition to previous reports of contamination in the mailroom serving the Hart Senate Building, related to a Bacillus anthracis-laden letter received by a Senator.

No cases of inhalational or cutaneous anthrax have been reported among customers who entered any US Postal facility to purchase stamps or conduct other postal business.

The CDC continues to recommend that all people who have been in the non-public, mail operations areas of the Brentwood and State Department facilities (the two facilities with inhalation anthrax cases) since October 11, 2001, receive 60-days of prophylaxis for potential exposure to anthrax. These facilities remain closed pending the results of comprehensive environmental sampling and determination of requisite remediation. In addition, the mail facilities that supply the CIA, House office buildings, Supreme Court, WRAIR, White House, and Southwest postal facilities (with confirmed environmental swabs for B anthracis) have been closed for remediation. All workers in those buildings should complete a 60-day course of prophylaxis.

Health authorities in the Metropolitan Washington area, based on the Postal Service's mailstream flow, also recommend prophylaxis for all personnel who have worked, since October 11, 2001, in the non-public, mail operations areas at any postal facility or unique private mailroom that receives incoming mail directly from the Brentwood facility. While these facilities may remain open, their employees should immediately receive 10-days of prophylaxis. Final recommendations regarding the completion of a full 60-days of prophylaxis will be forthcoming based on a careful risk assessment from environmental sampling from a portion of these facilities and from other clinical and epidemiologic data. Additionally, a set of protocols is being developed for facility managers in these and other facilities for the collection of environmental samples in their own facilities.

Results of the anti-microbial susceptibility profiles from Washington DC B. anthracis isolates, as well as prior CDC guidelines, support the use of doxycycline as the drug of choice for prophylaxis, both for newly identified individuals and for completion of the course in those previously started on ciprofloxacin.

A number of drug distribution sites have been established in the Washington DC Metropolitan area for persons in the above groups as listed below. Persons may also contact the Maryland and Virginia Health Departments for the sites of additional prophylaxis facilities. Times and places are subject to change. Those persons outside the Washington DC Metropolitan area should seek these services from their state or local health department, or private physician.

DC General Hospital, 1900 Massachusetts Avenue, SE, from 9:00 am to 10:00 pm. DC General is accessible by Metrorail (Orange and Blue Lines, Armory Stadium Station).

Federal employees -- Hubert Humphrey Building, 200 Independence Avenue, SW.

Fairfax County Government Center, 2nd floor, 12000 Government Center Pkwy, Fairfax, 9:00am to 10:00pm today.

Loudoun County Health Department, 102 Heritage Way, NE, Leesburg, 9:00am to 10:00pm today.

Prince William County Health Department, 9301 Lee Ave., Manassas, 9:00am to 10:00pm today.

For more information (in Virginia), call 703/246-3796.

Prince George's County Health Department Administration Bldg., 1701 McCormick, Largo, 10:00am to 2:00pm this weekend and noon to 7:00pm, M-F.

Suburban Maryland Processing and Distribution Center, Shady Grove Road, Gaithersburg, 10:00am to 2:00pm this weekend and noon to 7:00pm, M-F.

Federal employees -- Denis Avenue Health Center, 2000 Dennis Ave, Silver Spring, 10:00am to 2:00pm this weekend and noon to 7:00pm, M-F.

 

CDC's investigation is ongoing. Future modifications to these recommendations may occur on the basis of new epidemiologic and laboratory information.

Previous CDC recommendations for handling suspicious packages or envelopes were published as part of CDC Health Advisories on October 12 and 14, 2001.  These recommendations were part of, "Guidelines for handling anthrax and other biological agent threats."

This is an official CDC Health Advisory
Distributed via the Health Alert Network
October 24, 2001

• Do not shake or empty the contents of a suspicious package or envelope.

• Do not carry the package or envelope, show it to others, or allow others to examine it.

• Put the package or envelope on a stable surface; do not sniff, touch, taste, or look closely at it or any contents that may have spilled.

• Alert others in the area about the suspicious package or envelope. Leave the area, close any doors, and take actions to prevent others from entering the area. If possible, shut off the ventilation system.

• Wash hands with soap and water to prevent spreading potentially infectious material to face or skin. Seek additional instructions for exposed or potentially exposed persons.

• If at work, notify a supervisor, a security officer, or a law enforcement official. If at home, contact the local law enforcement agency.

• If possible, create a list of persons who were in the room or area when this suspicious letter or package was recognized and a list of persons who also may have handled this package or letter. Give the list to both the local public health authorities and law enforcement officials.

These recommendations were published on October 25, 2001, in "Update: Investigation of bioterrorism-related anthrax and interim guidelines for exposure management and antimicrobial therapy." MMWR 2001; 50: 909-919.

1. To date, 443 dead birds, 205 horses and 130 sentinel chickens from the following 55 Florida counties have been found infected with the WN virus:

• Alachua-1 mockingbird; 8 crows, 1 redwing, 1 hawk, 15 sentinel chickens, 10 horses
• Baker-2 horses, 1 crow, 1 warbler
• Bay-7 chickens, 9 blue jays, 3 crows, 4 doves, 5 unknown, 3 mockingbird, 1 finch, 1 sparrow, 1 pigeon, 3 horses
• Bradford- 1 cowbird, 5 crows, 3 blue jays, 1 thrush, 1 warbler
• Broward- 1 unknown, 1 horse
• Calhoun- 2 blue jays, 2 crow,
• Charlotte- 1 dove
• Citrus-1 blue jay, 1 sentinel chicken
• Clay- 9 horses, 1 green heron, 3 crows
• Columbia-16 crows, 1 blue jay, 6 horses
• Dade-1 blue jay, 1 crow, 1 mockingbird, 1 pigeon
• Dixie-1red-tailed hawk
• Duval– 29 sentinel chickens, 14 horses, 22 blue jays, 8 crows, 1 dove, 1 mockingbird, 2 ducks, 1 pigeon, 1 shrike, 1 cardinal, 1 savannah swallow, 7 unknowns,
• Escambia- 1 mockingbird, 2 blue jays
• Flagler-1 horse, 1 crow
• Franklin-1 crow, 2 blue jays
• Gadsden-5 horses, 10 crows, unknown, blue jay
• Gilchrist-3 crows, 1 dove, 1 horse
• Gulf- 2 crows, 2 mourning doves, 2 blue jays
• Hamilton-11 crows, 2 hawks, 1 blue jay, 1 horse
• Hernando-1feral pigeon, 1 blue jay
• Highland-1 blue jay
• Holmes- 3 crows, 1 red bird, 7 blue jays, 1 thrasher, 4 horses
• Jackson-1 horse
• Jefferson- 6 crows, 2 blue jay, 1 mockingbird, 4 unknowns, 1 sentinel chicken and 38 horses
• Lafayette-2 crows, 1 cardinal
• Lee-1 crow, 1 chicken
• Leon- 1 red shouldered hawk, 24 crows, 2 finches, 1 mockingbird, 2 cardinals, 2 sparrows, 12 unknown birds, 21 blue jays, 1 dove, 1 quail, 1 thrasher,1 conure, 1 red tailed hawk, 45 sentinel chickens, 23 horses
• Levy-1 quail, 1 blue jay, 2 doves, 2 horses
• Liberty- 3 crows, 4 blue jays
• Madison – 5 crows, 4 blue jays, 9 horses
• Marion-1 dove, 13 horses
• Martin-5 chickens
• Monroe-1 pipit
• Nassau- 7 horses, 12 crows, 2 blue jays, 1 cardinal, unknown
• Okaloosa- 2 blue jays, 2 sparrows, 1 dove, 1 unknown
• Okeechobee-1 dove
• Orange-1 pigeon
• Osceola-1 sentinel chicken
• Palm Beach- 3 sentinel chickens, 1 horse
• Pasco- 1 unknown, 1 dove, 1 sentinel chicken
• Polk- 1 grackle, 1 sentinel chicken
• Putnam- 8 sentinel chickens, mockingbird, 1 dove, 2 horse
• Santa Rosa- 1 blue jay
• Seminole-1 mourning doves, 1 dove
• St Johns- 6 horses, 7 sentinel chickens
• Sumter-1 mockingbird
• Suwannee-5 blue jays, 13 crows, 4 unknowns, 2 doves, 1 hummingbird, 1 grackle, 2 sentinel chickens, 17 horses
• Taylor – 5 crows, 4 blue jays, 1 dove 1 unknown bird, 14 horses
• Union-3 crows, 1 sparrow, 1 blue jay, 1 horse
• Wakulla-36 crows, 1 fish crow, 1 swallow, 2 tufted titmouse, 11 blue jays, 1 warbler, 1 wood pecker, 1 shrike, 4 unknown birds, 9 horses
• Walton- 1 blue jay, 1 crow, 4 chickens, 1horse
• Washington – 8 crows, 2 blue jays, 2 horses

2. Eastern Equine Encephalomyelitis virus cases, confirmed per Florida DOH case definition, have been reported from the following counties:

• Alachua: 1 sparrow,

• Bay: finch(es), 1 blue jay, 3 horses

• Calhoun: emu(s), 1 horse

• Clay: 1 horse

• Desoto: 1 horse

• Duval: 1 blue jay, 1 bird,

• Escambia: 1 horse

• Franklin: 1 pigeon, 1 mockingbird

• Jackson: 2 horses

• Jefferson: 1 horse

• Holmes: 7 horses

• Leon: 1 dove, 1 "blue bird", 1 horse

• Madison: 1 horse

• Nassau: quail, 1 horse

• Okeechobee: 1 horse

• Orange: 1 horse, 1 bird

• Osceola: 1 deer

• Santa Rosa, 4 horses, 1 dove

• Seminole: 1 horse

• Suwannee: 1 horse

• Walton: 2 horses

• Washington: 2 horses

Three confirmed EEE human cases have been reported. A 9-year-old Okaloosa resident, a 39-year-0ld Levy County resident and an 8-mo-old Leon County resident.

To date, 1098 mosquito pools containing more than 20,500 mosquitoes of 35 species, have been processed for WN virus testing. Nineteen WN virus isolates (Culex salinarius (3), Cx quinquefasciatus (6) and Cx nigripalpus (2), Cx. sp. (1), Culiseta melanura (3)) from Jefferson county, Cx nigripalpus (1) Washington county, Ochlerotatus atlanticus/ tormentor (1) from Madison county, Oc. taeniorhynchus(1) from Bay County and Oc. taeniorhynchus (1) from Monroe County. One EEE virus isolate (from Ochlerotatus atlanticus/ tormentor) have been recovered, from collections in Holmes County.

Medical Alert

After horses in Broward and Palm Beach counties were confirmed with WN virus infections this week Broward and Palm Beach counties were added to the list of 51 Florida counties currently on Medical Alert.

CDC Information Number

CDC has temporarily dedicated the phone number: (404)-639-2468 as a direct line for state and local health departments with bioterrorism-related issues and questions.

The department has developed a packet of clinical information and management guidelines for anthrax. It has been posted to the department’s website and will be mailed to all physicians in the state in about 10 days.

* The column of data representing the "3-year average to week ##" is the average of years 1998, 1999 and 2000 cases to the current listed week (##).