Epidemiologic Response to Anthrax Outbreaks: Field Investigations, 1950-2001

Michael E. Bales, Andrew L. Dannenberg, Philip S. Brachman, Arnold F. Kaufmann,Peter C. Klatsky, David A. Ashford


Emerging Infectious Diseases. 2002;8(10) 

In This Article


CDC anthrax-related field investigations from 1950 to 2001 were identified from several sources. First, the new database of historical Epi-Aid documents (1950-1999) was searched to retrieve all documents in which "anthrax" or "anthracis" appeared either as an assigned keyword or as a text string in a full-text search. Epi-Aid documents related to anthrax investigations in 2000 and 2001 were identified manually in an EIS administrative database. These searches identified a variety of types of documents, including initial requests for epidemiologic assistance, interim progress reports, final reports, and memoranda.

To identify published reports on these Epi-Aid investigations, we searched indexes to the Morbidity and Mortality Weekly Report (MMWR) for anthrax-related reports for the years 1961-2001. The individual issues of MMWR and its predecessor (Weekly Morbidity Report) were searched manually for the years (1950-1960) for which no index exists. To identify published reports on anthrax-related Epi-Aid investigations, we searched Medline for the years 1966-2001 and Index Medicus for 1950-1965. The names of the lead investigators from the Epi-Aids were used as keywords.

Additional CDC anthrax-related field investigations were identified by two coauthors (PB and AK) who were personally involved in most anthrax investigations conducted by the agency since the 1950s. References describing these additional investigations were located in the MMWR and in published medical articles. To limit this report to a description of CDC's institutional experience, rather than a broader review of publications on anthrax investigations, we excluded (a) anthrax case reports published in the MMWR but unrelated to a CDC field investigation and (b) published reports on anthrax by investigators not affiliated with CDC.

From the unpublished Epi-Aid documents and published reports for each investigation, we abstracted the following information: year, location, number of human and animal cases, clinical form of the disease, occupational or other exposures for human patients, environmental sampling methods and data, and study recommendations.


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