AN EPIDEMIC OF INHALATION ANTHRAX: THE FIRST IN THE TWENTIETH CENTURY.II. EPIDEMIOLOGY1
PHILIP S. BRACHMAN,2 STANLEY A. PLOTKIN,3 FORREST H. BUMFORD 4 AND MARY M. ATCHISON5, 6
American Journal of Hygiene 72, 6-23, 1960.
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The epidemiology of inhalation anthrax has not been adequately elucidated, owing to the rarity of the disease in the last 50 years. It is well known that the disease is principally an occupational risk of workers with animal hair or its derivatives, a fact reflected by the eponyms "wool sorters' disease," "mal de trieurs de laine," "Hadernkrankheit," and "rag pickers' disease" (1-4). Although the occupational aspect of anthrax is well recognized, the factors which cause one worker to develop the disease while his co-worker remains either uninfected or inapparently infected are not understood. Moreover, occasional cases develop in individuals not known to be exposed to materials containing spores ofBacillus anthracis (5).
The occurrence of 5 cases of inhalation anthrax during a 10-week period in a goat hair processing plant in Manchester, N. H., presented an unusual opportunity to study both the epidemiology of this disease and the effectiveness of an anthrax vaccine which had been given to some of the workers several months before the epidemic (6). Clinical and pathological findings in the 5 inhalation cases as well as 4 cutaneous cases which occurred during the same period are presented elsewhere (7, 8).
1 From the New Hampshire State Department of Health and the Communicable Disease Center, Public Health Service, Atlanta, Georgia, U. S. Department of Health, Education, and Welfare. This work was supported by a contract with the U. S. Army Chemical Corps, Fort Detrick, Frederick, Aid.
2 Chief, Anthrax Investigations Unit, CDC, Wistar Institute, Philadelphia, Pa. Present address: Communicable Disease Center, Atlanta 22, Ga.
3 Epidemiologist, Anthrax Investigations Unit, CDC, Wistar Institute, Philadelphia, Pa.
4 Director, Bureau of Occupational Health, New Hampshire State Department of Health, Concord, N. H.
5 Deputy State Health Officer, New Hampshire State Department of Health, Concord, N. H.
6 We are indebted to Bertha Myhr, R.N., for her great help in making records available and in obtaining blood specimens. Dr. James Powers, Manchester City Health Officer, and Dr. L. Bennett, the mill physician, contributed vital information.
Some of the data reported in this article were graciously made available to us by the following individuals, whose contributions are mentioned in the text: Drs. W. Cherry, W. Day, S. Kalter, R. Lincoln, E. Murray, P. Norman and K. Persichetti.
Valuable advice with regard to the conduct of the investigation and the organization of this article was given to us by Drs. A. D. Langmuir, F. R. Fekety, and J. Pagano of the U. S. Public Health Service; H. Glassman of the U. S. Army Chemical Corps; and W. Albrink of Yale University. Mary Harrell assisted in the isolation of anthrax organisms in the laboratory.