about Epidemiology & the department

Epidemiology academic information

Epidemiology faculty

Epidemilogy resources

sites of interest to Epidemiology professionals

Last Updated

13 Jul 2003

Source: Washington Post, May 22, 2002.

IMF-World Bank Anthrax Response Causes Furor

Lack of Notification Angers D.C. Health Officials; U.S. to Issue Protocol for Positive Field Tests

A furor triggered yesterday in the District, because of the reaction of two global financial institutions to anthrax field test results, will lead to a federal medical protocol to prevent unnecessary prescription of antibiotics and needless alarms, officials said.

That decision by officials at the U.S. Department of Health and Human Services was made after D.C. health officials complained bitterly that the World Bank and the International Monetary Fund failed to notify them before taking actions that, they said, caused unnecessary alarm and could pose a health risk to their employees.

Jerry Hauer, director of HHS's office of public health preparedness, said his staff would develop national guidelines because, he said, field tests such as those used by the World Bank and the IMF were unreliable. Of field tests, he said, "By and large, what they've done is create a lot of unnecessary anxiety."

The World Bank sent workers home Monday afternoon, encouraged them to stay home yesterday and started four employees on antibiotics after a field test showed possible contamination. A second test turned up negative results, and further tests are underway.

The IMF closed its mailroom and prescribed antibiotics yesterday to 100 employees after a positive field test result.

Those actions and the failure to notify city health officials angered Larry Siegel, the senior physician at the D.C. Health Department.

"I'm outraged that we were not notified that these agencies had an event they were concerned about relative to anthrax," Siegel said. "The District requires that any evidence of an infectious reportable disease be reported to the Health Department. They did not do that with an incident they thought was potentially dangerous to the public health." He said he discussed his concerns with Hauer yesterday.

It is unlikely that the preliminary findings would be confirmed by laboratory cultures, city and postal officials said, because U.S. mail delivered to the institutions is irradiated before delivery. Mail to all federal government offices in the area also is irradiated, but some agencies, such as the Federal Reserve, have hired contractors to perform routine anthrax screening as a backup. So far, no confirmed anthrax contamination has been picked up by that screening this year -- only false positives, Siegel said.

On May 9, the Federal Reserve reported a similar result in its mailroom, and a spokesman yesterday said subsequent tests had not turned up positive. He said that further testing was being conducted but that operations had returned to normal.

Siegel, who helped manage the city's response to last year's anthrax outbreaks, said the medical director for the World Bank and IMF acted without considering the impact on the region -- and the reactions of people in other institutions.

"When they do things like this, it has public health implications that go far beyond their little isolated island of concern," he said.

World Bank and IMF spokesmen defended their decisions as being based on the advice of their health services department, a jointly funded medical unit that serves workers at both organizations.

World Bank spokeswoman Caroline Anstey initially said the 1,200 employees of the J Building, at Pennsylvania Avenue and 18th Street NW, were advised not to go to the office yesterday because it was too hot. The cooling system was shut down to keep spores from being recirculated in the building, she said.

But later she said that there was no concern about contamination and that closure was a suggestion, not an order.

"People were advised to work at home, but the building hasn't been closed, and some people have gone in and out," Anstey said. "They were told there was a health warning and that they may want to stay away. We envisage turning the air conditioning on Thursday morning, hopefully, after receiving results of the tests."

She said Siegel's criticisms were misplaced.

"It's only four people," she said. "We can be attacked for doing too little or attacked for doing too much. I think it's better to be attacked for doing too much. It would be irresponsible simply to do nothing."

Across the street at the IMF, spokesman Tom Dawson said Monday's delivery of irradiated mail tested negative. But after reports of the World Bank field test, IMF contractors tested again and got a positive reading. No employees were sent home, and only the loading dock and the mailroom were sealed off, said Francisco Baker, another spokesman.

Siegel said 100 IMF workers were taking doxycycline to head off any infection that could be caused by exposure to any anthrax bacterium. But he said such actions could prompt a private employer to conduct its own tests, in which a false positive could sow fear and trigger demands for antibiotics.

Medical experts warn against unnecessary use of antibiotics because they can cause uncomfortable side effects and because widespread indiscriminate use can allow pathogens to mutate into strains that resist the drugs.

Two weeks ago, the Federal Reserve did not contact the Health Department before announcing its field test result, and a city advisory issued the next day said that caused "a great deal of public consternation" in the region. No anthrax was ever confirmed. In the advisory, the Health Department urged institutions to make no public announcements on the basis of positive field tests.

Four letters containing anthrax spores killed five people in New York, Florida, Connecticut and the District in the fall. Contaminated letters sent to the Senate last year resulted in one office building being shut for months during a painstaking cleanup. The District's central mail processing facility, Brentwood, which was contaminated, is to be disinfected with chlorine dioxide gas soon, postal officials said.

Staff writers Manny Fernandez and Spencer S. Hsu contributed to this report.