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In October 2001, four cases of inhalational anthrax occurred in workers in a Washington, D.C., mail facility that processed envelopes containing Bacillus anthracis spores. We reviewed the envelopes' paths and obtained exposure histories and nasal swab cultures from postal workers. Environmental sampling was performed. A sample of employees was assessed for antibody concentrations to B. anthracis protective antigen. Case-patients worked on nonoverlapping shifts throughout the facility, suggesting multiple aerosolization events. Environmental sampling showed diffuse contamination of the facility. Potential workplace exposures were similar for the case-patients and the sample of workers. All nasal swab cultures and serum antibody tests were negative. Available tools could not identify subgroups of employees at higher risk for exposure or disease. Prophylaxis was necessary for all employees. To protect postal workers against bioterrorism, measures to reduce the risk of occupational exposure are necessary.

Presents a report that updates previous findings on cases of bioterrorism-related anthrax. Information on case investigations in Florida, New York, New Jersey and Washington, D.C.; Susceptibility patterns of Bacillus anthracis isolates; Recommendations for managing potential threats and exposures, and for treating anthrax.

Reports on the investigation of bioterrorism-related anthrax and the provision of antimicrobial prophylaxis to exposed persons and the assistance given by the U.S. Center for Disease Control and Prevention to other countries investigating similar cases. Specific recommendations for the use of antimicrobial prophylaxis; Increase in the number of countries requesting for assistance.

Presents a report to update the investigation of bioterrorism-related anthrax and the provision of antimicrobial prophylaxis to exposed persons, and highlights the assistance of the United States Centers for Disease Control and Prevention (CDC) to other countries investigating causes of bioterrorism-related anthrax. How a 60-day course of antibiotics has been recommended to persons who may be potentially exposed; How the CDC has assisted other countries; Editorial note from the CDC.