Researchers examine deaths of two postal workers

November 12, 2001

The Center for Civilian Biodefense Studies at the Johns Hopkins Bloomberg School of Public Health and the National Institutes of Health (NIH) have published a case study examining the deaths of two Washington, D.C. postal workers who died from inhalational anthrax as the result of the bioterrorism attack. Both postal employees worked at the Brentwood facility, which processed an anthrax-laden letter mailed to Senator Tom Daschle on October 9, 2001. The report, which appears in the November 12, 2001 online edition of the Journal of the American Medical Association (JAMA), illustrates the difficulty doctors and clinicians face in distinguishing the symptoms of anthrax from a number of other common illnesses. The report also emphasizes the need for better communication of epidemiological information to front-line medical providers and the need for rapid diagnostic tests for anthrax and other dangerous pathogens that could be used as biological weapons.

"The symptoms of anthrax look like many other common diseases. None of the doctors who treated these patients suspected anthrax until they heard reports of other sick postal workers from the news media," says the study's lead author, Luciana Borio, MD, a fellow at the Johns Hopkins Center for Civilian Biodefense Studies and the Critical Care Medicine Department, Clinical Center, at NIH. "These cases emphasize the importance of developing more rapid lines of communications between medicine and public health. Clinicians need information to make a proper diagnosis and provide timely treatment for their patients," adds Dr. Borio.

According to the report, a 47 year-old male postal worker developed "flu-like" symptoms on October 16, which he attributed to food poisoning. A few days later, he sought medical attention in an emergency room, where he received intravenous fluids and anti-nausea medications. He was sent home after his symptoms improved.

On October 22, the man eventually collapsed at home and was taken to the hospital. Doctors then suspected the man had inhalational anthrax after learning from media reports of two other postal workers hospitalized with the disease. The patient was treated with multiple antibiotics, but died five hours later.

The second postal worker began feeling ill on October 17. The 55 year-old male visited a primary care doctor complaining of weakness, muscle aches, and fever. The man was diagnosed with a viral infection, but the symptoms persisted. By October 21, the postal worker was admitted to the hospital. Once again, doctors suspected inhalational anthrax after hearing media reports of similar cases. Doctors treated the man with antibiotics, but he died after 13 hours. The next day, his blood culture came back positive Bacillus anthracis.

"These cases also demonstrate the urgent need for better disease detection capacities in the public health and clinical communities. This should be a priority in our strategy to improve response to biological attacks and other outbreaks," explains Dr. Borio.

It is important to note that the nasal swab of the first postal worker to die from inhalational anthrax was negative, underscoring that the nasal swab cannot be used as a clinical diagnostic test.

"Our report demonstrates the need for rapid diagnostic tests to distinguish an early anthrax infection from other diseases with similar symptoms. More research is needed in this area and should be a high priority on a national research agenda to respond to threats of bioterrorism," says co-author Thomas Inglesby, M.D., deputy director of Center for Civilian Biodefense Studies and assistant professor of infectious diseases at the Johns Hopkins School of Medicine.

Dr. Borio says that the rapid release of this information to the medical community was only possible because of the collaboration of several groups, such as the doctors and nurses from Greater Southeast Community Hospital, Southern Maryland Hospital Center, the medical examiners for the State of Maryland and the District of Columbia, the expedient review of JAMA, and the patient's families, who gave her permission to publish the manuscript in JAMA.

"Hopefully, this case report will help other front line health care providers who may be dealing with anthrax patients in the future," adds Dr. Borio.
-end-
Research for the article was conducted by Luciana Borio, MD, Dennis Frank, MD, Venkat Mani, MD, Carlos Chiriboga, MD, Michael Pollanen, MD, PhD, Mary Ripple, MD, Syed Ali, MD, Constance DiAngelo, MD, MS, Jacqueline Lee, MD, Jonathan Arden, MD, Jack Titus, MD, David Fowler, MD, Tara O'Toole, MD, MPH, Henry Masur, MD, John Bartlett, MD, and Thomas Inglesby, MD.

For more information, visit the Johns Hopkins Bloomberg School of Public Health on the internet at www.jhsph.edu. The case study may be viewed by visiting www.jama.ama-assn.org.

Johns Hopkins University Bloomberg School of Public Health

Related Public Health Articles from Brightsurf:

COVID-19 and the decolonization of Indigenous public health
Indigenous self-determination, leadership and knowledge have helped protect Indigenous communities in Canada during the coronavirus disease 2019 (COVID-19) pandemic, and these principles should be incorporated into public health in future, argue the authors of a commentary in CMAJ (Canadian Medical Association Journal) http://www.cmaj.ca/lookup/doi/10.1503/cmaj.200852.

Public health consequences of policing homelessness
In a new study examining homelessness, researchers find that policy such a lifestyle has massive public health implications, making sleeping on the street even MORE unhealthy.

Electronic health information exchange improves public health disease reporting
Disease tracking is an important area of focus for health departments in the midst of the COVID-19 pandemic.

Pandemic likely to cause long-term health problems, Yale School of Public Health finds
The coronavirus pandemic's life-altering effects are likely to result in lasting physical and mental health consequences for many people--particularly those from vulnerable populations--a new study led by the Yale School of Public Health finds.

The Lancet Public Health: US modelling study estimates impact of school closures for COVID-19 on US health-care workforce and associated mortality
US policymakers considering physical distancing measures to slow the spread of COVID-19 face a difficult trade-off between closing schools to reduce transmission and new cases, and potential health-care worker absenteeism due to additional childcare needs that could ultimately increase mortality from COVID-19, according to new modelling research published in The Lancet Public Health journal.

The Lancet Public Health: Access to identification documents reflecting gender identity may improve trans mental health
Results from a survey of over 20,000 American trans adults suggest that having access to identification documents which reflect their identified gender helps to improve their mental health and may reduce suicidal thoughts, according to a study published in The Lancet Public Health journal.

The Lancet Public Health: Study estimates mental health impact of welfare reform, Universal Credit, in Great Britain
The 2013 Universal Credit welfare reform appears to have led to an increase in the prevalence of psychological distress among unemployed recipients, according to a nationally representative study following more than 52,000 working-age individuals from England, Wales, and Scotland over nine years between 2009-2018, published as part of an issue of The Lancet Public Health journal on income and health.

BU researchers: Pornography is not a 'public health crisis'
Researchers from the Boston University School of Public Health (BUSPH) have written an editorial in the American Journal of Public Health special February issue arguing against the claim that pornography is a public health crisis, and explaining why such a claim actually endangers the health of the public.

The Lancet Public Health: Ageism linked to poorer health in older people in England
Ageism may be linked with poorer health in older people in England, according to an observational study of over 7,500 people aged over 50 published in The Lancet Public Health journal.

Study: Public transportation use linked to better public health
Promoting robust public transportation systems may come with a bonus for public health -- lower obesity rates.

Read More: Public Health News and Public Health Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.