Pharmacist-Turned-Disease Detective Helps Trace Path of Anthrax in Nation's Capitol

Terrorism has touched CDC disease detective Jim Hayslett more than once. In 1995, he worked and trained at the University of Oklahoma Health Sciences Center, just 10 blocks from Oklahoma City's Alfred P. Murrah Federal Building that was bombed on April 19 of that year.

After September 11, 2001, he was one of many disease detectives from CDC's Epidemic Intelligence Service (EIS) deployed to five sites experiencing anthrax attacks. In the EIS' 51-year history, Hayslett is the third ever CDC disease detective with a pharmacy background. Hayslett's training made him an obvious choice to assist local health officials when Senator Daschle's office received an anthrax-tainted letter, requiring that thousands of Capitol and U.S. Postal Service employees receive chemoprophylaxis. He arrived in Washington, D.C. on Oct. 18 and remained for 16 weeks.

Hayslett and others on the Epidemiology and Intervention Team had the tough task of entering anthrax-contaminated buildings to determine the exposure route and learning quickly about the mechanization in postal facilities and building air-handling systems. The goal: to minimize further risk. The team also served with other fellow Public Health Service officers to make sure that those people who were exposed, received appropriate treatment. They implemented a system to address side effects to ensure postal workers could finish their supply of antibiotics.

Hayslett followed the epidemiologic trail in the 500,000 square-foot U.S. Postal Service Brentwood Processing and Distribution Center in Washington, D.C. where he was part of the team that went through the facility prior to its closure – a task that later required him to take 60 days of antibiotics to prevent anthrax infection. He and other investigators looked at where there was co-mingling of air facilities, interviewed workers on what routinely happened in their work space, and studied how the mail-processing procedure could affect letters transiting the facility.

"We asked the things that people don't routinely think about, such as, 'Does someone run a fan at their desk?' That changes the air flow pattern we think about. This work required us to deal directly with the folks who have been affected. We don't want to be too many layers above that," he said.

On working with the local health department, Hayslett noted, "People here appreciate what we do and vice versa. This issue would have overwhelmed any health department in this country. Our goal was to work within the existing infrastructure, and to build relationships and strengthen the bridges between their infrastructure and the rest of the healthcare community."

Hayslett divided his day between investigative work and visits with mail handlers around the metro D.C. area. He spoke with more than 5,000 postal workers in 20 days. Besides advising workers on the importance of taking antibiotics for the full 60 days, Hayslett also answered their questions in an effort to provide them a level of comfort in an uncertain situation.

"It's very helpful to have someone come out and talk to the workers. It's also helpful to be honest and tell them if we don't have an answer," said Hayslett. "We hoped to increase our public health presence in the community and to make these workers our public health partners."

"These types of interactions are pivotal for the public health process. Besides being researchers, we're conduits within the public health infrastructure. We distill complicated public health messages for dissemination in the community and listen to concerns and feedback."

CDC has helped the nation's healthcare system use surveillance mechanisms. Emergency rooms and other healthcare facilities keep track of people coming in with flu-like symptoms and, if their chest x-rays are suspicious, they are evaluated for anthrax. Hundreds of cases need to be evaluated and ruled out in order to find the very few who do have anthrax and to get them immediate treatment.

Prior to the anthrax investigation, Hayslett was busy working on a major botulism outbreak in the Dallas area involving 14 cases. The United States averages between 20 and 25 cases total of the food-borne disease each year. "We thought this was big-time epidemiology, but it has been dwarfed by recent events," he said.

Hayslett credits earlier career experiences for helping him prepare for the challenges of anthrax. He was in Albuquerque, New Mexico, on September 11 participating in U.S. Agency for International Development (USAID) Disaster Assistance Response Training, which trains public health assessment teams to respond to disasters in foreign countries. He also worked six years in the Indian Health Service on the Navajo Indian Reservation, where he and other staff handled an estimated 600,000 outpatient visits yearly.

Hayslett, who looks forward to remaining with CDC as an epidemiologist, thinks the role of EIS is important because of the expertise that can be brought to bear quickly. "Knowing that some of the best minds in the world are dedicated to these challenging public health problems makes a big difference," he said. "Recent events have shown that public health professionals at the local, state and federal levels will do whatever it takes to keep our communities safe."