October 12: First Letter Tested Positive
Before B. anthracis was identified in letter C from media outlet 1, two other letters (A and B) were received and tested by BTRL. Letter A came from media outlet 1, and letter B came from media outlet 2. Letters A and B were tested for the four priority bioterrorism agents and were negative. At the time, the negative result for letter A was somewhat surprising because the patient diagnosed with cutaneous anthrax was employed by media outlet 1. When letter C later arrived at BTRL, it was tested and found to contain a powdery substance that was positively identified as spores of B. anthracis. The discrepancy involving the positive results of letters A and C was soon resolved when it was determined that letter C was actually received before letter A at media outlet 1 but was inadvertently placed in a corporate "hate-mail" file and was thus recovered after letter A.
A number of important events took place almost simultaneously after letter C tested positive for B. anthracis: 1) the BTRL was contaminated with B. anthracis spores during the sampling process and three BTRL laboratory employees were exposed; 2) the news media and the U.S. Attorney General broadcast a message to Americans asking them to report all suspicious mail to their local law enforcement authorities; and 3) as a result of this increased attention, the sample volume surged and did not abate for another 6 weeks.
These events worked synergistically to complicate NYC DOH's ability to contend with bioterrorism testing on the scale needed during this crisis. At this time, CDC contacted NYC DOH to offer support and aid. On learning of the situation developing in NYC and the events surrounding the contamination of BTRL, including exposure of employees, the PHL, in conjunction with CDC, instituted several important policies: 1) A Bioterrorism Response Laboratory Command Center was established at PHL to direct and coordinate all bioterrorism laboratory activities and communications; 2) A secure and separate entryway was set up so bioterrorism specimens could enter the PHL building without jeopardizing the safety of PHL building personnel; 3) A separate specimen-receiving area containing a decontamination site was established, and all specimens were double bagged and externally decontaminated (sprayed with a bleach solution) before being brought to the testing laboratory for analysis; 4) All environmental bioterrorism specimens were tested by using strict and secure BSL-3 containment and BSL-3 protocols; 5) BTRL personnel exposed in the contaminated laboratory were treated with ciprofloxacin HCl; 6) Extensive infection control and environmental monitoring procedures were set up throughout the PHL building to monitor for B. anthracis spores; 7) Security was extensively increased throughout the building's interior and exterior; 8) During the transition to the new BSL-3 testing facility, samples received for bioterrorism testing were shipped to offsite level C laboratories for analysis; 9) A dedicated database was developed for accepting and tracking bioterrorism specimens and testing results; and 10) CDC and NYC DOH requested a Department of Defense (DOD) Microbiology Response Team to assist with rapid testing of bioterrorism specimens.
After the initial evaluation, the NYC PHL facility was configured to operate 24 hours a day, accepting, processing, and testing samples. Additional laboratory space was identified, consisting of three separate areas for handling and testing bioterrorism samples (two polymerase chain reaction [PCR] units and an enzyme immunoassay [EIA] rapid screening unit). The BTRL coordinator was also appointed to work in conjunction with CDC and DOD teams. Staffs from other units were also redeployed to further assist in the bioterrorism response effort.
Emerging Infectious Diseases. 2002;8(10) © 2002 Centers for Disease Control and Prevention (CDC)
Cite this: Laboratory Response to Anthrax Bioterrorism, New York City 2001 - Medscape - Oct 01, 2002.