Disaster and Terrorism/Brief Research Report
Medical counterbioterrorism: The response to provide anthrax prophylaxis to New York city US postal service employees*,**

https://doi.org/10.1067/mem.2003.105Get rights and content

Abstract

Study objective: We describe and analyze a recent rapid deployment of disaster medical assistance teams and other government agencies to provide medical screening and anthrax prophylaxis to New York City US Postal Service employees potentially exposed to letters contaminated with anthrax spores. Methods: A description of the response effort is presented. Data were collected on standardized forms and included the numbers of postal employees screened and offered antibiotic prophylaxis, as well as the numbers of patients seen per worker hour by various medical professionals. Results: One hundred members of 5 disaster medical assistance teams and other health professionals were deployed to New York City within 18 hours of activation. Over a 68-hour period, 7,076 patients were evaluated, representing all postal employees in the 6 major postal facilities in New York believed to be at risk for anthrax exposure. Of the total, 2,452 patients were seen during the first 24 hours, 3,875 during the second 24 hours, and the remaining 749 during the last 20 hours of operations. An average of 161 employees were screened per hour. The antibiotic most commonly dispensed was ciprofloxacin, followed by doxycycline and amoxicillin. Conclusion: The deployment of disaster medical assistance teams and other agencies to New York City to provide prophylaxis against inhalation anthrax to US Postal Service employees provides lessons for a rapid, efficient, and effective response to acts of bioterrorism. This deployment might also serve as a scaleable model for future events requiring medical prophylaxis. [Ann Emerg Med. 2003;41:441-446.]

Introduction

The mailing of anthrax spores in the fall of 2001 was the first widespread, intentional dissemination of a biologic pathogen to occur in modern US history. It was also the first known bioterrorism attempt in the United States within the past century to result in fatalities. The response of the National Disaster Medical System and other government health agencies in New York City in October 2001 to these anthrax attacks provides a unique opportunity to gauge one aspect of the nation's disaster preparedness: Implementing medical counterbioterrorism measures.

As of October 24, 2001, the US Centers for Disease Control and Prevention (CDC) had identified a total of 15 cases of anthrax in the District of Columbia, Florida, New Jersey, New York City, Maryland, Pennsylvania, and Virginia.1 The total number of anthrax cases reached 11 inhalational infections, as well as 7 confirmed and 4 suspected cutaneous infections, by December 5, 2001.2 Seven of the 15 cases were inhalational infections, and 8 were cutaneous infections. Eight cases, including 5 cases of the inhalational form, occurred in individuals who worked in postal buildings through which the contaminated letters were suspected to have passed on their way to delivery. All 5 postal workers with inhalational anthrax were employed in facilities with automated mail-sorting machines.

The possible risk to postal workers of mail contaminated with anthrax prompted the US Postmaster General, in consultation with the CDC, to recommend initiating anthrax prophylaxis at mail distribution centers from which contaminated letters were delivered in the District of Columbia, New Jersey, and New York City. This included offering antibiotic prophylaxis to more than 7,000 US Postal Service employees working in New York City postal buildings.3

This mission was coordinated by the US Health and Human Services' Office of Emergency Preparedness. The groups mobilized included 5 disaster medical assistance teams, the US Public Health Service, the Commissioned Core Readiness Force, and the CDC. We describe this effort and the problems encountered, logistic concerns, and lessons that might be applicable to a future response to bioterrorism.

Section snippets

Materials and methods

On October 24, 2001, the US Postmaster General decided to offer antibiotic prophylaxis to all postal employees at 6 New York City post offices and processing facilities. Medical professionals from the CDC, the US Public Health Service, and Office of Emergency Preparedness disaster medical assistance teams (RI-1, MA-1, MA-2, NJ-1, and NY-2) were assembled within 18 hours to carry out the mission.

The basement of the James Farley mail processing center in midtown Manhattan, an 18,000-ft2 facility,

Results

One hundred members of the 5 disaster medical assistance teams, the Commissioned Core Readiness Force, the US Public Health Service, and the CDC were deployed to New York City. Operations commenced at 11 PM on October 24, 2001. Over a 68-hour period, 7,076 patients were screened, representing all postal employees in the 6 major postal facilities in New York City believed to be at risk for anthrax exposure. Of the total, 2,452 patients were seen in the first 24 hours, 3,875 during the second 24

Discussion

The rapid dispatch of medical professionals to provide antibiotic prophylaxis to New York City postal employees potentially exposed to the anthrax bacillus was the first documented deployment of large-scale medical counterbioterrorism. The only previously known large-scale release of weaponized anthrax occurred inadvertently at a Soviet military facility outside the town of Sverdlovsk in 1979. This resulted in 79 cases of anthrax and 68 deaths, as well as thousands of additional exposures.4, 5

References (6)

  • CDC update

    Investigation of bioterrorism-related anthrax and interim guidelines for exposure management and antimicrobial therapy, October, 2001

    MMWR Morb Mortal Wkly Rep

    (2001)
  • CDC update

    Investigation of bioterrorism-related anthrax—Connecticut, 2001

    MMWR Morb Mortal Wkly Rep

    (2001)
  • Inhalational Anthrax among Postal Workers in Washington, DC, and New Jersey: Alert #5. New York, NY: New York City...
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Supported by the Rhode Island Disaster Initiative, Office of Emergency Preparedness, US Department of Health and Human Services.

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