The CDC issued the following information regarding ongoing Anthrax investigations: Exposure to Anthrax

Persons with an exposure to, or contact with, an item or environment known or suspected to be contaminated with Bacillus anthracis — regardless of laboratory tests results (see "Anthrax Disease") — should be considered for antibiotic (prophylaxis) treatment. Exposure or contact, not lab test results, is the basis for initiating such treatment.

Anthrax Disease

For people with suspected anthrax disease, laboratory testing is essential to diagnosis.

Specimens obtained may include:

Cultures of blood and spinal fluid (best if done before antibiotic treatment has been initiated)

Cultures of tissue or fluids from affected areas of the skin

Microscopic examination of tissue with special stains to identify the anthrax bacteria.

PCR (polymerase chain reaction) test that amplifies trace amounts of anthrax DNA when the bacteria is present.

Evaluation tests conducted during an anthrax exposure investigation

If human exposure or contact is known or suspected, clinical specimens may be obtained.

Specimens obtained may include:

Nasal swabs which can occasionally document exposure, but can not rule-out exposure to anthrax. In other words, a negative nasal swab test does not mean that exposure has not occurred. Although nasal swab tests are not used to determine exposure, they can help investigators evaluate the exposure circumstances.

Antibody testing can be used to measure reactions in the blood of persons with anthrax disease and others who have received anthrax vaccine. Antibody testing also helps investigators evaluate exposure circumstances, but is not validated as a diagnostic tool for anthrax disease.

Persons with a positive antibody test for anthrax exposure, may need to take a second test. This second test is compared with their first test to measure any changes in their antibody levels. Results from the second antibody test can help investigators to interpret the significance of the initial test, and help evaluate exposure circumstances (e.g., location in a building or number of persons exposed).

Testing environments were exposure may have occurred

Powder and other specimens collected from these sources are analyzed through the Public Health Laboratory Network which includes the Laboratory Response Network (LRN). Law enforcement officials and CDC work together to investigate envelopes and packages suspected of containing anthrax or other biological agents.

Powders

Lab testing is an important component of an anthrax investigation. Specimens obtained may include:

Cultures of suspected materials.

Microscopic examination of a sample of a suspect material.

Evaluation of the microscopic characteristics of the suspect agent’s growth properties.

PCR (polymerase chain reaction) test that amplifies trace amounts of anthrax DNA when the bacteria are present.

DFA (direct fluorescent assay) to detect key bacterial characteristics.

Other specialized tests to confirm the identification of the anthrax bacteria.

Environment (where exposure may have occurred)

During the course of the public health investigation important information may be obtained from sampling the environment for the presence of the anthrax bacteria. Specimens obtained may include: samples of the air and swabbing of surfaces. These samples are processed as described for laboratory testing of suspect powders (see "Powders").

Where are specimens sent?

The specimens are sent to various laboratories. The Laboratory Response Network is a collaborative partnership and multilevel system linking state and local public health laboratories with advanced capacity laboratories—including clinical, military, veterinary, agricultural, water, and food-testing laboratories—to rapidly identify threat agents, including anthrax. Local clinical laboratory testing is confirmed at state and large metropolitan public health laboratories. The Centers for Disease Control and Prevention (CDC) conducts definitive or highly specialized testing for major threat agents.

Treatments for anthrax

The Food and Drug Administration (FDA)http://www.fda.gov has approved three antibiotics to treat anthrax:

Penicillin

Doxycycline

Ciprofloxacin

Clean-up of contaminated areas

The U.S. Environmental Protection Agency (EPA) www.epa.gov, with help from 16 federal agencies and departments, including CDC, is responsible for environmental and cleanup issues. Federal agencies, in conjunction with local and state agencies, will determine the best approach to the cleanup.

Update: On-going anthrax investigations

NEVADA

Test results sent to CDC on the initial samples from Nevada are negative. However, additional samples have been sent and will be tested.

FLORIDA

The Palm Beach County Control and Prevention have confirmed that the 73-year-old male employee of American Media Inc., hospitalized since the beginning of October, has been diagnosed as a probable case of anthrax disease. The diagnosis cannot be confirmed according to the strictest diagnostic criteria (requires isolation of the bacteria from a clinical specimen such as blood, lung samples, or spinal fluid). However, the overall picture of clinical symptoms combined with positive results on laboratory tests suggest to the Health Department, Florida Department of Health, and the Centers for Disease health officials that this individual has anthrax disease.

Also, a minuscule amount of anthrax spores has been found in a small, non-public mail processing area of the Boca Raton Main post office. There is no indication that these spores pose a health risk to workers or visitors. As an extraordinary precaution, health officials are asking employees to leave this small portion of the building. The affected area will be cleaned tonight — after the post office closes. The post office will be open again for business in the morning.

In Florida, there are 2 cases of anthrax and 1 exposure.

For more information on this investigation, contact the Palm Beach County Health Department, (561) 712–6488/6400

NEW YORK

Preliminary tests indicate cutaneous (skin) anthrax disease in an infant. The child’s mother, an ABC employee, took the child with her to the ABC building on West 66th Street in Manhattan on September 28. While it is not certain that the child came into contact with anthrax bacteria at the ABC building, it is currently the focus of the investigation. The child was started on a course of antibiotics and is doing well. The New York City Health Department is not aware of any other individuals with symptoms of cutaneous anthrax who work in, or visited, the ABC building. The infant’s doctor notified the Health Department on October 12 that the symptoms might be suggestive of a cutaneous anthrax infection. On October 13, a skin biopsy was CDC for testing and the Health Department received the results on October 15.

In New York, there are 2 cases of anthrax and 3 exposures.

For more information on this investigation, contact the New York City Health Department, (212) 295-5335 or online at:www.ci.nyc.ny.us/html/doh/home.html

WASHINGTON

CDC and health officials in the District of Columbia are conducting an public health investigation related to possible anthrax exposure on Capitol Hill. CDC has sent a team of investigators to assist with the investigation.

NATIONALLY

There are numerous reports of potential anthrax cases throughout the United States. The initial assessment of these incidents is made at the state level. CDC is providing technical assistance to the states on "How to handle anthrax and other biological agent threats." www.bt.cdc.gov/DocumentsApp/Anthrax/10122001Handle/10122001Handle.asp

For the latest update on CDC activities and on-going anthrax investigations visit www.bt.cdc.gov/ or www.cdc.gov/od/oc/media/