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CDC Lists Six Anthrax Sites

Spending time in these areas means two months on anti-anthrax drugs, officials say

THURSDAY, Nov. 15, 2001 (HealthDayNews) -- The Centers for Disease Control and Prevention today released a list of six locations where anthrax was discovered and where people who spent time might have been vulnerable to infection.

Health officials say anyone who was potentially exposed to anthrax spores at the six sites -- in New York, New Jersey, the District of Columbia, Virginia and Florida -- within a two-month window should be taking 60-day courses of antibiotics, chiefly Cipro, doxycycline or penicillin, which have been approved to treat the disease. The CDC recently reported that 32,000 Americans had at least briefly begun preventive doses of the anti-anthrax medications, although only about 5,000 are believed to still be taking the long-term regimen.

"The circle of people who need to be treated has narrowed substantially, but now the emphasis is really honing in on those people who were exposed, because they are still at ongoing risk for developing anthrax if they do not complete their antibiotic therapy," says Dr. Julie Gerberding, acting deputy director of the CDC's National Center for Infectious Diseases.

The two-month exposure window is based on a pair of observations, Gerberding says. The first comes from a 1979 outbreak of anthrax in Siberia, in which some patients fell ill more than 40 days after they presumably last came into contact with the germs. In addition, she says, lab studies show that some animals develop the disease if treatment lasts only 30 days after exposure to anthrax spores.

"So it's important, in our mind, to kind of put these two pieces of data together and make sure that we've covered people for the period of time where we're giving the maximum benefit," she says.

In a report released today, the agency says anyone who spent an hour or more at the Boca Raton, Fla., offices of American Media Inc. -- where the anthrax outbreak first surfaced -- between Aug. 1 and Oct. 6 should be taking antibiotics as a precaution.

In New York, health officials say anthrax antibiotics should be taken by any mail workers stationed on the second and third floors of the Morgan Central Postal Facility in Manhattan, where equipment has tested positive for the bacteria between Oct. 9 and Oct. 26. However, the CDC is not recommending mass antibiotics for employees of NBC and other media outlets in New York City that received the spiked envelopes.

In Hamilton Township, N.J., anthrax drugs are recommended for all employees and visitors who were in restricted areas of the Route 130 Processing and Distribution Center between Sept. 18 and Oct. 18. Tainted letters passed through this postal building.

The CDC recommendations cover two locations in Washington, D.C: The Senate's Hart office building, where Majority Leader Tom Daschle, who received an anthrax-laced letter, works. Anyone who was on the fifth and sixth floors of the southeast wing of the building between 9 a.m. and 7 p.m. on Oct. 15 was potentially exposed to anthrax. Also, the Brentwood Road postal facility, where one worker died from inhalation anthrax. All employees and business visitors who were on this site between Oct. 12 and Oct. 21 were at risk of exposure.

The CDC says all mail room workers and business visitors to the State Department's Annex 32 mail facility, in Sterling, Va., between Oct. 12 and Oct. 22, should also take preventive antibiotics.

As of today, the CDC had identified 17 confirmed and five suspected cases of anthrax, including four deaths. Ten of the cases involve the inhaled form of the infection, the most serious variety and the one blamed for all the fatalities. The remaining cases are confirmed -- or apparent -- skin anthrax.

Three of the four deaths have been linked directly to toxic mail. However, the fourth case, a 61-year-old New York hospital worker who died Oct. 31, has bedeviled investigators, who have thus far been unable to find the source of the germs that killed her.

Health officials have tested several subway stations in New York City, on the chance that the woman, Kathy Nguyen, picked up anthrax during her travels around the area. The results of those tests are expected to be released tomorrow.

In a separate report today, the CDC says infants and children potentially exposed to anthrax may be given a 60-day course of amoxicillin in lieu of Cipro and doxycycline, which might cause bad reactions in young people. Children with the confirmed disease should also take amoxicillin after doctors bring the infection under control with other, more potent antibiotics.

All three drugs may be taken by breastfeeding women, officials say. Yet no one knows exactly what the effects are on infant health of long-term use of Cipro, doxycycline and related medications.

Although pregnant women with lung anthrax should be treated the same as other adults, at least initially, what to do for pregnant women exposed to the bacteria is less clear. Doxycycline and other tetracycline drugs are known to harm developing fetuses, Gerberding says, while those risks for Cipro and its siblings aren't known. "Finding safer alternatives is a priority," she says.

What To Do

For more on the drugs available to treat and prevent anthrax, check out the U.S. Food and Drug Administration.

And for more on anthrax, try the Centers for Disease Control and Prevention, which also has the latest information on the bioterror investigation.

SOURCES: Interviews with Julie Gerberding, M.D., acting deputy director, National Center for Infectious Diseases, Centers for Disease Control and Prevention, teleconference, Nov. 15, 2001; Nov. 16, 2001, CDC Morbidity and Mortality Weekly Report
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