In New York City, a 61-year-old female hospital worker had contracted inhalation anthrax, the most deadly form of the infection that has already claimed three lives. The woman, identified as Kathy Nguyen, died early Wednesday morning at Lenox Hill Hospital in Manhattan, according to a hospital spokeswoman.
Nguyen worked in the stock room at Manhattan's Eye, Ear and Throat Hospital. Her hospital was shut down Tuesday, and at least two dozen of her co-workers are taking protective antibiotics.
And in New Jersey, officials confirmed the diagnosis of skin anthrax for a 51-year-old woman who worked in an accounting firm not far from the Hamilton Township postal facility that processed anthrax-tainted letters.
In New York City's first case of inhaled anthrax, Nguyen's duties included occasionally handling mail, officials say. But although the hospital's stock room and mail room were recently combined, the source of her infection remains a mystery.
"We are making no assumptions as to where this exposure occurred," says Dr. Jeffrey Koplan, director of the Centers for Disease Control and Prevention. Koplan says investigators are trying to track the woman's recent movements by interviewing relatives, friends and co-workers to see where she might have come into contact with anthrax. "We are not making an immediate assumption that she was exposed at work or that it was a letter."
Yet for now, officials seem to be at the mercy of unfolding events. "This is an evolving attack," Koplan says. "Every day there is new information, and periodically we get new cases."
New York City Mayor Rudolph Giuliani said on the radio Tuesday that the Bronx woman developed chills and muscle aches Oct. 25, but reported for work that day and the next. "By Sunday, the symptoms had gotten very serious," the mayor added. She was admitted that day to Lenox Hill Hospital.
Marilyn Riley, a spokeswoman for the New Jersey Department of Health and Senior Services in Trenton, says that the newest incident there brings the number of confirmed or suspected anthrax cases in the Garden State to six. The other five are postal workers.
The unidentified accounting firm employee first noticed a lesion on her forehead two weeks ago, and was treated with the antibiotic Cipro. An initial test proved negative for anthrax, but a subsequent biopsy of the sore came back positive last week, Riley says.
In the meantime, the woman was put on intravenous Cipro, has been released from the hospital and is "doing well," Riley adds.
Acting Gov. Donald DiFrancesco says officials are looking into a possible connection between the woman and the mail-processing facility in Hamilton Township.
Meanwhile, Dr. Bradley Perkins, chief of the CDC's meningitis and special pathogens branch, says "tens of thousands" of Americans believed at risk of exposure to anthrax are now taking antibiotics as insurance against developing the infection.
In addition to Cipro, doxycycline and penicillin G procaine are also approved to treat or prevent inhalation, gastric and skin, or cutaneous, anthrax. The Food and Drug Administration issued a notice today encouraging drug makers to rewrite labels for doxycycline and penicillin G procaine to reflect the utility of these medications against the illness.
Health officials are also in talks with the military and the sole U.S. anthrax vaccine maker, BioPort Corp., about releasing part of the Army's stock of the vaccine for civilians at high risk of infection. "There has been no decision made as to whether anybody should be vaccinated for anthrax," says Health and Human Services Secretary Tommy Thompson.
If officials do decide to proceed with mass inoculations, and provided BioPort passes an upcoming FDA inspection, shots could be available by Nov. 22, Thompson says. The military currently has about 5 million doses on hand, Thompson adds.
Last week, CDC director Koplan called the anthrax investigation "as major as anything we've done" in the agency's history.
The CDC now has more than 500 staffers working on the anthrax investigation, including laboratory technicians, epidemiologists and other specialists, says Curtis Allen, an agency spokesman. Of those, approximately 200 are working in the field and the rest are stationed at the CDC's Atlanta headquarters, which has a 24-hour command center to monitor the inquiry.
Allen says the shuffling of personnel to meet the anthrax threat has led to temporary staffing shortfalls in other areas of the CDC's operations. "But that doesn't mean that the work [of the agency] is ceasing or abating. We may be doing it with a few less people, but it's not like we've totally decimated their staffs."
What To Do
Koplan says the risk of catching anthrax by handling your personal mail is "very, very small, but we can't say it's zero." To be safe, people may want to wash their hands thoroughly after taking in, reading and discarding their letters, he says.
To read more about the anthrax attack, click on the Centers for Disease Control and Prevention.
For more on defending against bioterrorism, visit the Center for Civilian Biodefense Studies or the Association for Professionals in Infection Control and Epidemiology.
For more on the various bioterrorism weapons, try the American Medical Association.
For more on anthrax and the mail, go to the U.S. Postal Service.