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Gary J. Kerkvliet, MD, Associate Program Director

To the Editor:

The US Centers for Disease Control and Prevention (CDC) counts as victims 22 people who were involved in the postal anthrax attack of 2001. We disagree. As scientists it is difficult to accept that fewer than 68 people were harmed in this event. There is no debate that at least 5 people died from inhalational anthrax, 11 people had cutaneous anthrax develop, and 6 people had diagnosed inhalational anthrax and survived. The debate concerns those individuals at the periphery: 38 people at the Hart Senate Office Building, Washington, DC, and 5 people at the America Media Inc building, Boca Raton, Florida, in whom anthrax was detected by nasal swab. These people were treated with antibiotics for 60 days and offered the anthrax vaccine, which many agreed to receive. Although they were treated like victims, because they did not have symptoms of anthrax, they were never counted as victims of that attack.¹

The state of Delaware postal worker who tested positive for anthrax antibodies, but had a rash that appeared different than would be expected from anthrax, therefore was not counted as a victim because the rash was atypical.² The CDC laboratory technician who had an abrasion while working with anthrax samples from the attack and, subsequently, had cutaneous anthrax develop was not counted as a victim.³ Finally, the US postal inspector in whom "aborted anthrax syndrome" developed after being exposed to large amounts of anthrax and becoming seriously ill⁴ was yet another victim not counted in this category.

That totals 68 people.

Bioterrorism affects more people than those who express the worst or classic case of an ensuing illness. Weaponized anthrax is a new illness that is still not understood. If we are to learn from this attack we need to start with an open mind.

Family Medicine Sinai Hospital of Baltimore
Internal Medicine Johns Hopkins School of Medicine Baltimore, Maryland

Sinai Program in General Internal Medicine Johns Hopkins School of Medicine

References
1. Daschle T. Like No Other Time: The Two Years That Changed America. New York, NY: Three Rivers Press of Crown Publishing Group;2004 .

2. Hinant L. Another regional NJ post office is closed after employee develops possible skin anthrax. Newsday. October 31,2001 .

3. Centers for Disease Control and Prevention. Cutaneous anthrax in a laboratory worker—Texas, 2002. MMWR Morb Mortal Wkly Rep. 51:279 -281.

4. Cymet TC, Kerkvliet GJ, Tan JH. Gradon JD. Symptoms associated with anthrax exposure: Suspected "aborted" anthrax. J Am Osteopath Assoc. 2002;102:41 -43.[Abstract]

This article has been cited by other articles:

				B. Schmitt, D. Dobrez, J. P. Parada, D. N. Kyriacou, R. M. Golub, R. Sharma, and C. Bennett Responding to a Small-scale Bioterrorist Anthrax Attack: Cost-effectiveness Analysis Comparing Preattack Vaccination With Postattack Antibiotic Treatment and Vaccination Arch Intern Med, April 9, 2007; 167(7): 655 - 662. [Abstract] [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cymet, T. C. Articles by Kerkvliet, G. J. Search for Related Content PubMed PubMed Citation Articles by Cymet, T. C. Articles by Kerkvliet, G. J.