SECOND ANTHRAX CASE FOUND IN FLORIDA  



about Epidemiology & the department

Epidemiology academic information

Epidemiology faculty

Epidemilogy resources

sites of interest to Epidemiology professionals



Last Updated

22 Aug 2003

Source: Washington Post, October 9, 2001.

Second Anthrax Case Found in Fla.

Victim's Co-Worker Infected; FBI Launches Massive Probe As Va. Monitors a Third Man

By Rick Weiss, Washington Post Staff Writer

A co-worker (case 7) of a Florida man who died on Friday (case 5) from a rare form of anthrax has tested positive for infection with the anthrax bacterium, a discovery that has triggered a massive FBI investigation into how the two highly unusual events could have occurred in such close proximity.

By yesterday evening the Lantana, Fla., building where the men worked was swarming with federal investigators -- some in protective white "moon suits" -- and was surrounded by a variety of large and in some cases unmarked vehicles, including a black bus with blacked-out windows, red and blue lights and a raft of high-tech equipment on the roof.

In Virginia, officials said last night that they were monitoring a possible case of anthrax in a Northern Virginia man whose job may have brought him into contact with the company where the other two men worked.

State and local officials said the Prince William County man entered the emergency room of Prince William Hospital in Manassas yesterday complaining of flu-like symptoms. Medical personnel on the scene responded quickly by performing tests to determine whether he had anthrax, meningitis or another disease, officials said.

Officials of the Centers for Disease Control and Prevention were also on the scene and monitored the preliminary investigation. A germ culture from the man was transported last night by a State Police trooper from Prince William County to a state government laboratory in Richmond, officials said.

"The state government was notified and we are following our established procedures," said M. Boyd Marcus Jr., chief of staff for Virginia Gov. James S. Gilmore III (R). "We cannot confirm at this point whether he has developed anthrax or not."

Attorney General John D. Ashcroft said yesterday the FBI, the CDC and the Florida Health Department are vigorously investigating the Florida cases -- the first two in the United States in 25 years. The disease is not contagious, so it could not have been spread from the first man to the second.

"We take this very seriously," Ashcroft said at a midday news briefing, noting that public health officials were dispensing antibiotics to hundreds of the victims' co-workers on the off chance that some may have been exposed to the deadly bacteria. But for now, he said, "we don't have enough information to know whether this could be related to terrorism or not."

Despite that uncertainty, the investigation -- which has been underway since the first man was diagnosed last week -- took a clear turn in style and tone yesterday, looking less and less like a standard public health inquiry and more like a criminal investigation.

The building where the two Florida men worked is the headquarters for American Media Inc., which publishes several supermarket tabloids, including the Globe and the Sun. The papers are known for colorful and often provocative stories, and in recent weeks have published a number of pieces that were harshly critical of Osama bin Laden.

The building was sealed by the FBI and surrounded by police tape. Inside, agents inspected desks and CDC scientists swabbed surfaces to see how far the deadly bacteria may have spread in the building.

By mapping the locations of contamination "hot spots" in the building, investigators hope to determine how the bacterial spores entered the structure. Among the options that would be under consideration, according to experts not involved in the investigation, would be intake ducts of the building's ventilation system and the area for incoming mail. A worker whose company holds a maintenance contract for the building's ventilation system said yesterday that the structure has several air intakes and that filters in the system are not designed to keep out something as small as a bacterial spore.

Sen. Bob Graham (D-Fla.) was told by CDC Director Jeffrey P. Koplan that "human intervention" was required for the anthrax bacteria to spread to the building, a Graham spokesman said. Graham said there is no evidence that the bacteria have spread beyond the building.

Officials with the CDC and the Florida Health Department said one test had already revealed the presence of anthrax on the keyboard of the computer used by Bob Stevens, 63, the Sun photo editor who died Friday.

The business is not far from the area that once was home to several of the suspected hijackers involved in the Sept. 11 attacks on New York and Washington. Although there is no evidence that the hijackers had access to anthrax spores, they are known to have expressed interest in flying crop-duster planes.

A pharmacist in the neighborhood where the suspected hijackers had lived said yesterday that officials from the Food and Drug Administration and FBI had questioned him last week and again yesterday about a prescription for an anti-anthrax drug that he filled during the summer for a man he believes may have been one of the hijackers. But FBI officials said late yesterday they have largely discounted the pharmacist's story and do not believe that any of the hijackers received antibiotics there.

More than 400 people who had worked in or visited the tan, three-story building in recent weeks were contacted Sunday night and Monday and instructed to report to the health department in Delray Beach. Many stood in line in the rain yesterday morning, waiting to have their nostrils swabbed to test for evidence of anthrax exposure. All were given antibiotics that can prevent the disease from blossoming. Employees were also asked by FBI agents to sign consent forms allowing the agency to inspect their work stations.

More than 700 showed up and received drugs, a Palm Beach County spokeswoman said, suggesting that many nervous neighbors worked their way into the process. "A big part of this is to allay fear," she said. "If they want it, we're not going to turn people down."

The newest victim, identified by news sources as Ernesto Blanco, 73, a mail room worker, was hospitalized last week. Preliminary tests completed Friday had concluded that he did not have anthrax, but follow-up tests over the weekend revealed anthrax bacteria living in his nasal passages.

Doctors said yesterday it was not clear why Blanco had not developed full-blown anthrax despite the exposure. One possibility is that he was exposed to a very low dose and his immune system was beating the infection. Another possibility is that the microscopic clumps of bacterial spores that were apparently floating in the air were of a size slightly too large to be transported deep into his lungs, where the microbes typically germinate and start to cause disease.

Although Blanco was ill last week with an apparent respiratory infection, he lacked classic signs of full-blown anthrax, health officials said. Those officials would not discuss details of the man's case, but doctors said two signs that they look for to definitively diagnose anthrax are swollen lymph nodes in the chest, visible on an X-ray, and purple-staining rod-shaped bacteria in the blood (and, in late stages of the disease, in the spinal fluid).

CDC spokeswoman Barbara Reynolds said it may never be clear whether Blanco would have gone on to develop full-blown anthrax, because the antibiotics he was taking will prevent that.

It remained unclear yesterday whether all of the many other patients that CDC investigators have been screening in hospitals in the Lantana area had proven to be free of anthrax. On Friday, an official close to the investigation had said that a third person -- an employee who worked in the AMI building but not for the Sun -- was in a Miami area hospital and was being investigated as a possible anthrax case. That person was not mentioned in yesterday's briefings.

In Prince William County, Jared Florance, the county's health director, said last night that his agency was "investigating" what disease the Northern Virginia man may have contracted. The man's name was not released.

"What we're doing is dotting our i's and crossing our t's to make sure we don't miss something," Florance said. "We're doing extra tests. With everything going on, we're being extremely cautious."

Donna Ballou, a Prince William Hospital spokeswoman, said last night that the hospital had been handling no anthrax cases.

Gilmore was alerted earlier in the evening to the possible case, which state officials emphasized was still in the earliest stages of investigation.

State officials said they had received unconfirmed reports from the Prince William area that the local man had been associated with American Media Inc., either as an employee or as a contractor. Officials said they were certain that the man had not been in Florida recently.

The anthrax bacterium lives in soil and can infect cattle, goats and sheep. In the past it has caused human disease in hide handlers and wool sorters, but in those cases, it has typically caused a version that affects the skin and is relatively benign. By contrast, inhaled anthrax kills four out of five of its victims. Symptoms can strike from a few days to two months after exposure, and antibiotics are relatively useless once those flu-like symptoms arise.

One encouraging detail was confirmed by officials yesterday: The anthrax bacteria found in the two men is fully susceptible to treatment with penicillin. Some strains of the bacteria developed by the Soviet Union decades ago were selected or designed to withstand penicillin, requiring treatment with more potent drugs such as ciprofloxacin. "Wild-type" strains from soil and most of the strains developed by Iraq for biological weapons are susceptible to penicillin.

Scientists hope that with time they will be able to conduct DNA "fingerprinting" studies on the microbes and compare the fingerprints to those from other strains collected from around the world, to help trace the origins of the Florida bugs. CDC investigators did exactly that two years ago after West Nile virus arrived in North America for the first time. They were able to show that the virus almost certainly came over accidentally from Israel or a nearby Middle Eastern country in a single event -- probably inside an imported infected bird.

AMI employees and other building workers who arrived at the health department in Delray Beach to have their noses swabbed also were asked to fill out a four-page questionnaire asking them where in the building they worked, what they did and how their health has been.

Doctors warned that with flu season coming, people should try not to get overwrought about the onset of flu-like symptoms, even though those are precisely the symptoms that can indicate an anthrax infection. But that's easier said than done, some said.

"I'm a little nervous. Crazy thoughts run through your head," said Amy Silverman, who works for a photo production company on the building's second floor. "I've been feeling sick. It feels like the flu, and it probably is. But it's scary. I'm going to my doctor tomorrow."

Federal officials stressed that they had no evidence that the infections were due to a terrorist attack. But a number of outside experts said that -- given how rare inhalation anthrax is -- the only plausible explanation was a deliberate release.

Little is known about bin Laden's capacity for waging biological warfare, but that possibility has loomed increasingly large in recent years.

Some federal officials have wondered whether chemical or biological weapons might have been a subject of discussion when Mohamed Atta, one of the Sept. 11 hijackers, met last year with an Iraqi intelligence official in Prague. Iraq is known to have worked on the development of such weapons.

Ahmed Ressam, an Algerian convicted in the failed millennium bombings plot, testified that he learned how to feed poison gas through the air vents of an office building at a bin Laden training camp in Afghanistan.

Special correspondent Catharine Skipp and staff writers R.H. Melton, Sue Schmidt, John Mintz, Ceci Connolly, Dan Eggen, Lisa Rein and Peter Slevin contributed to this report.