Anthrax in Florida Probably Was Planted

But source of deadly infection still a mystery, investigators say

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By
HealthDay Reporter

TUESDAY, Oct. 9, 2001 (HealthDayNews) -- The two Florida men infected with anthrax almost certainly caught the bacteria as a result of intentional infection, experts now say. But law enforcement officials are not sure if terrorists or others are to blame.

State and federal officials today continued their hunt for the source of the highly toxic germs, which caused the death Friday of Bob Stevens, a 63-year-old photo editor at The Sun, based in Boca Raton. Stevens was diagnosed with inhaled anthrax, a particularly lethal and rare form of the disease.

Disease investigators have taken nasal swabs and blood tests, and will be working around the clock to analyze the samples, says April Crowley, a spokeswoman for the Florida Department of Health in Tallahassee. Results from the swabs are expected in a matter of days, she says, but blood tests can take "a couple of weeks" to process.

Rumors about a infectious letter as the source of the killer germ have proved to be false, Crowley says. "There's no truth to any of that."

The second victim, 73-year-old Ernesto Blanco, a mail supervisor at The Sun, is in a Florida hospital being treated. Swabs of his nasal cavity turned up spores of the bacteria, but he has not contracted the disease, officials say. A Florida health official told the Palm Beach Post that tests of the spores revealed they were identical to those found on a computer keyboard used by Stevens at the newspaper.

FBI investigators have shut down the facility, home to the American Media Inc., the parent company of The Sun, The National Enquirer and several other supermarket tabloids. Meanwhile, more than 700 people with ties to the building have undergone testing for exposure to the bacteria, and many have been given precautionary doses of the antibiotic ciprofloxacin. Another 100 people are expected to be tested.

Investigators have also been looking at the ventilation system at American Media's headquarters as a possible conduit for the microbes. However, they have yet to identify the source of the infection, which cannot be passed from person to person.

U.S. Attorney General John Ashcroft has said the inquiry could become a "clear criminal investigation" as officials piece together the trail of the infections. At the moment, however, Ashcroft told reporters, "We don't have enough information to know whether this could be related to terrorism or not."

Mohamed Atta, one of the hijackers in the Sept. 11 terrorist attacks on the World Trade Center in New York City, had lived for a time in Delray Beach, which is a short drive from the American Media offices. The building is also close to an airport in Lantana where Atta rented light planes at least three times. Investigators believe the terrorists considered trying to spread a killer organism using crop dusters.

Ashcroft said the FBI is "taking the matter very seriously…[but] on the basis of the investigation, we haven't ruled out anything at this time."

A few days ago, officials were downplaying the first anthrax case as an isolated event.

But experts say the odds of two co-workers contracting anthrax are minuscule. "It would be highly unlikely, in my opinion, that two people who work in one building would be colonized with anthrax with another exposure than human intent," says Judy English, president of the Association for Professionals in Infection Control and Epidemiology (APIC).

Testifying today before the Senate, Dr. Mohammad Akhter, executive director of the American Public Health Association, says he thinks the origins of the anthrax in Florida are "criminal."

English, who led APIC's bioterrorism task force, says the initially cautious stance of health and law enforcement officials wasn't misguided. "They were trying to not incite any undue panic in the public," she says. But after the second case, the probability of a planned outbreak had to be considered.

English, head of infection control at the Bethesda Naval Hospital in Maryland, says there's no way to know except for waiting whether there will be more anthrax cases in Florida. And if there are, only time will tell if the government is prepared to cope with a bigger outbreak, she adds.

"I don't believe we are ready to deal with a massive anthrax release, but we are a whole lot more ready this Tuesday than we were last Friday," she says.

People can be infected with anthrax three ways: through the skin (usually via cuts or other breaks), through the gastric system (usually by eating infected meat) and through the airways. All can be cured with antibiotics, but inhaled anthrax is the rarest and most serious kind, killing 90 percent of its victims. Symptoms of infection usually appear within about a week of exposure, but the organism can incubate for as long as 60 days.

Until this month, only 18 cases of inhaled anthrax -- two of which involved lab workers -- had been reported in this country in the last 100 years, including one earlier this year in Texas. The disease, which causes rapidly descending flu-like symptoms, followed by pneumonia and meningitis, can be acquired through contact with the hides, wool or other body parts of infected livestock, particularly sheep and goats.

At least 17 countries have biological weapons programs, though it's not clear how many have anthrax in their arsenals, according to an analysis of the issue two years ago done for the American Medical Association. Iraq has acknowledged turning the germ into a weapon.

Although anthrax is difficult to prepare and convert into a weapon, it's not beyond the reach of someone with sophistication in biology, experts say. In 1979, the accidental release of anthrax spores into the air at a military bio-weapons facility in the former Soviet Union led to at least 79 cases of infection and 68 deaths from the disease.

John Pape, an epidemiologist and bioterror expert at the Colorado Department of Public Health and Environment in Denver, says that although skin-borne anthrax isn't so rare in the West, a single case of inhaled infection "would send up a red flag" in any state. "Despite the reassurances [from the government], you can be sure there was a very intensive investigation" after the first patient was diagnosed in Florida, he says.

Colorado officials have been meeting regularly since last week to hash out their own response plan should an anthrax outbreak occur there, Pape says. "We've been meeting throughout the weekend to discuss options, including upping surveillance" at hospitals, coroners' labs and doctors' offices, he says.

Will Hueston, director of the Center for Animal Health and Food Safety at the University of Minnesota in St. Paul, says that even if the signs now point to human intent, "you can't jump to conclusions until you've got all the data. One thing I've learned as an epidemiologist is to never say never."

In addition to monitoring possible new cases of anthrax, public health workers in Florida must also figure out what to do about the American Media building where the bacteria was found. The germ is quite hardy, capable of surviving extremes of hot and cold, Pape says. But thorough decontamination can make the workplace safe again, he adds.

"I don't think that they're going to have to lock the building up and torch it, but it may take some time," he says.

What To Do

Florida has set up a toll-free line for residents of the state concerned about anthrax. The number, (800) 342-3557, is staffed by emergency personnel.

A vaccine against anthrax is available to soldiers, but its supply is too restricted to be useful for the public.

To read more about anthrax, check out the Centers for Disease Control and Prevention.

SOURCES: Interviews with Judy English, M.S.N., head of infection control, Bethesda Naval Hospital, and president, Association for Professionals in Infection Control and Epidemiology; April Crowley, spokeswoman, Florida Department of Health, Tallahassee, John Pape, epidemiologist, Colorado Department of Public Health and Environment, Denver, and Will Hueston, D.V.M., Ph.D., director, Center for Animal Health and Food Safety, University of Minnesota, St. Paul; May 12, 1999, Journal of the American Medical Association

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