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Anthrax Update:
Telebriefing Transcript

October 30, 2001

CDC MODERATOR: Thank you. I simply just want to introduce HHS Secretary Tommy G. Thompson.

SECRETARY THOMPSON: Thank you, Bill, and good morning to all of the reporters on the line. I'd like to say thank you for listening in and taking this opportunity to inform you on some new events that have taken place in the last 24 hours.

I am speaking to you this morning from the Centers for Disease Control and Prevention here in Atlanta, Georgia. I am here as part of the ongoing business of the operating divisions within HHS, and previously I visited and worked out of the Centers for Medicare and Medicaid Services, the Health Resource Services Administration, commonly referred to as HRSA, the NIH, and the Food and Drug Administration.

I am very happy and pleased to be joined this morning by Dr. Jeff Koplan, who is the director of CDC and is doing an outstanding job, of course, operating that institute, and Dr. Bradley Perkins, who is one of the CDC's leading epidemiologists and anthrax experts. Dr. Bradley Perkins was the first, one of the first CDC people on the ground in Florida, and he headed up that field team until it was completed.

Today, we want to provide you an update on what we know as of 12 noon regarding the status of cases in New York City and New Jersey. Drs. Koplan and Perkins will also talk in some detail about the assets that we have in place in New York City and New Jersey, as well as discuss what those folks are doing.

I want to emphasize to you that, as we have since the beginning, we're continuing to work closely with state and local officials throughout these investigations, as well as working closely with law-enforcement officials, especially at the federal level and more specifically the FBI.

Before we discuss what we know, I want to remind everyone that this information we have is what we know at this time. Information is developing that will likely alter these facts as we now know them because this is an ongoing investigation. For this reason, we're trying to update you on a regular basis so you will have the latest information.

As of last night, the CDC reported an additional suspected case of inhalation anthrax in New York City. The preliminary confirmation was made by the New York City Department of Health. We expect final tests to be completed this afternoon. The woman works in the back room of a lower Manhattan hospital and occasionally works in the mail room, and it's our understanding that the mail room was changed over about a week ago when she had spent more time there.

A new confirmed case of cutaneous anthrax has also been identified in a New Jersey resident whose occupation is not directly linked to the mail delivery system. The patient was discharged from the hospital yesterday. She's on antibiotic treatment and is doing well. This situation is under active and intense investigations by the public health and law-enforcement officials working within the Postal Services. The investigation will examine a range of possible links between this case and the Hamilton mail facility.

Steps that are being taken immediately include extensive interviews, environmental sampling in the patient's home and workplace, the environmental sampling of pathways between the Hamilton mail facility and locations where the patient receives mail, and evaluation of other potential sources of exposure.

A similar investigation with similar steps is also underway in the suspected case in New York City. Additional CDC epidemiologists were dispatched to New York last night to supplement already deployed individuals. They are on the ground conducting the investigation. And also deployed were additional lab assets to assist New York and New Jersey in conducting tests as part of this investigation.

Now let me turn it over to Dr. Koplan for his remarks and then Dr. Perkins.


DR. KOPLAN: As you've all been following, this is an evolving attack, and every day there is both new information and periodically we get new cases. As Secretary Thompson just described, these are two which require extensive further investigation to better characterize them, and that's what we're undertaking both in New Jersey and New York City, as he described.


DR. PERKINS: I'd just like to add that the--this is an evolving epidemiologic situation, and as we get more information about cases and the circumstances around those cases, we will be altering strategies and public health interventions as appropriate.

SECRETARY THOMPSON: Thank you very much, Dr. Perkins and Jeff.

Now we will open it up for questions. Please identify yourself, if you would.

AT&T MODERATOR: Ladies and gentlemen, if you do have a question, please depress 1 on your phone at this time. You may remove yourself from queue at any time by depressing the pound key. If you are using a speaker phone, please pick up your handset before pressing the numbers.

Our first question comes from the line of Cheryl Silver with New York Times.

MS. SILVER: Hi, Secretary Thompson and Dr. Koplan. I want to ask you, in particular, about this case of the 61-year-old hospital worker in New York. What can you tell us about her movements prior to getting infected? Where was she? How much time did she spend in the mail room? Where else did she go? And have you entertained the possibility that this anthrax did not come from a letter, but that there was some other release of anthrax that made this woman sick?

DR. KOPLAN: Thank you. Those are exactly the investigations that we're doing right as we speak and that began last night with the New York City Health Department. The issues involved in getting this information involve finding relatives and friends who can describe some of this because she's not able to answer all of these herself now in the hospital, speaking to coworkers, and it's just the information you've described.

We are making no assumptions as to where this exposure occurred, and we have to both investigate and rule out where she worked, what--where--did she have other jobs and where else might she have been exposed, what were her patterns of activity, both workwise, socially, recreationally and transportationwise for the past couple of weeks and then investigate her home environment carefully as well.

And we don't have answers on all of those yet. Those are taking place right now. And as you've indicated, we are not making an immediate assumption that she was either exposed at work or that it was a letter, although these are what we've seen in recent exposures and the places that we're investigating it. We are investigating every possible exposure that might have occurred.

MS. SILVER: And then, along those lines--about other people who may be at risk? Are you expecting more cases like this?

DR. KOPLAN: We are certainly on alert for other cases. I think that's the nature of this attack we've been under, is to--you know, it's imperative that we identify new cases as possible, but when they occur, it's unclear whether this particular instance is part of a pattern of other cases or whether it represents something different.

SECRETARY THOMPSON: It's also important for us to find out as much of the details as possible in order for treatment purposes, and CDC and the health care--health care resources have been very successful in, I believe, containing a lot of further illnesses because of the instant and the--and the reactions done by CDC and our health workers.

CDC MODERATOR: Next question, please.

AT&T MODERATOR: Next we have

C.C. Connelly with The Washington Post.

MS. CONNELLY: Yes. Thank you. I'd like to ask Dr. Koplan and Secretary Thompson, following on some of those themes, in the new New Jersey case, the woman apparently with cutaneous anthrax, I think that once again goes to a question on many people's minds, regarding is the mail safe. What have you learned about mail that came into her office? Did it pass through the Brentwood station? Is it your working hypothesis of cross-contamination there? And what's happened with all the mail trucked to Ohio? Is the CDC testing that?

SECRETARY THOMPSON: You had several questions there, C.C. Let me--the mail truck to Ohio we are not testing. That's being handled by the postal service.

The cutaneous case of anthrax in New Jersey that you described was--that was announced yesterday is again under careful investigation, and all those linkages to both the Hamilton Township facility in New Jersey and the links to where this woman got her mail, where her--you know, the step-by-step linkages of both her mail and where she goes and other things she's done, she's been very informative, has very good records, and we're working with her to try to get that exact information.

MS. CONNELLY: What have you learned so far?

SECRETARY THOMPSON: We--it's under way yesterday and today, and we don't have anything in hand that immediately says here's the spot.

MS. CONNELLY: And, Dr. Koplan, are you still working on the--the assumption or the hypothesis that you indicated last week, that all of these cases, particularly of inhalation anthrax, cannot simply be off of the single Daschle letter?

DR. KOPLAN: That's pure hypothesis. And first of all, we're talking about New Jersey in one, New York in another case, and Washington in another. So let's keep the locales isolated in terms of what's gone on.

In terms of Washington, D.C. and the letter that came to the Hart Building, that's the only one we have in hand. Now in all of our--you know, your guesses are as good as mine in this, but we have evidence of environmental contamination in a number of other sites in the Washington, D.C. area. So, yes, there is a possibility that cross-contamination could account for this, but in an instance where we have a case of inhalation anthrax in the Department of State facility, you could conceivably say that, well, you know, you could come up with a construct that said that cross-contamination, that this has happened and that has happened might have done that. But I still feel that we have to rule out other letters, when you see that level of contamination occurring to an individual that then leads to inhalation anthrax.

So I think it pays to be vigilant and look for--for other letters still.

CDC MODERATOR: Next question, please.

AT&T MODERATOR: Next we have Paul Rieser with the Associated Press. Mr. Rieser.

MR. RIESER: Yes. As a result of these cases with unknown sources, are you planning on changing your recommendation so far as prophylactic antibiotics for postal customers or for bulk mail handlers? You had suggested last week that the bulk mail handlers may get special antibiotic attention, and I'm just wondering if that recommendation is still in effect, or what is the status of it?

DR. PERKINS: No, our recommendations--

DR. KOPLAN: This is Dr. Perkins.

DR. PERKINS: Our recommendations for chemo-prophylaxis are--are--are currently unchanged. In incidents associated with--with the circumstances that we have the bacterial strain and have done antibiotic susceptibility testing.

The current inhalational or suspected inhalational case in New York City, however, we're quite anxious to get antimicrobial susceptibility testing done on that particular strain of bacteria to see if it matches the other susceptibilities we've seen in other incidents. So that is a particular area of concern. Antibiotic recommendations around that circumstance could be modified based on that information.

MR. RIESER: And the bulk mail handlers, there was a--there was a recommendation that was not--not all that clear last week regarding some special attention given to a thousand or so companies that handle mail in bulk. Is there any firm recommendation regarding those people?

DR. PERKINS: No, we're not aware of any--any recommendations that have been made by CD in that regard.

CDC MODERATOR: Next question.

AT&T MODERATOR: Next we have David Carvilo with CBS News.

MR. CARVILO: Good morning, doctors. My question is about the vaccine intended for high risk civilians. Could you please help clarify, is that vaccine to be taken from stockpiles currently at Bioport, or physically in possession in other locations of the Defense Department? And if they're from Bioport, what testing is still required, given their difficulties with FDA?

DR. KOPLAN: The use of anthrax vaccine--this is Jeff Koplan--the use of anthrax vaccine is under discussion both in the Department of Health and Human Services and with the Department of Defense. They have limited amounts of vaccine initially intended for military use, and we are discussing with them the use of some part of their collection of vaccine.

The--the vaccine they have is--is--needs to be approved by FDA for us to use, and we are--we are again in discussions on that, and here at CDC we are in discussion as to who would be the target users of that vaccine, who would be best--would it be recommended for, and that's under discussion now as well.

SECRETARY THOMPSON: There's been no decisions as to whether or not anybody should be vaccinated at all for anthrax. And the second thing is is that we have started the negotiations with the Department of Defense just in case that CDC does make the recommendation for--for vaccinating some individuals. And those negotiations I've started with the Department of Defense, and they're going along very well.

And number three, Food and Drug Administration is going to be in, they've received the application for certification to go in and inspect the remodeling building at Bioport and take a look at their manufacturing processes and see whether or not they're going to give the license. It appears to me that that should be taking place some time within the next two weeks, and if all goes well, and the remodeling is up to what it's supposed to be, and the manufacturing process has improved, they could and should be manufacturing new anthrax vaccine by the 22nd of the month of November.

MR. CARVILO: So this is not something about to happen imminently, Mr. Secretary?

SECRETARY THOMPSON: It is not. In fact right now the negotiations are going on with the Department of Defense at the same time negotiation is going on with CDC, to make the final, final recommendation as to if and when and where those vaccinations should take place.

MR. CARVILO: If I may, sir, does DOD have reservations? I mean, the negotiations have been going on for a while.


MR. CARVILO: Are they tending to say yes or no?

SECRETARY THOMPSON: No, the negotiations really have not been going on that long because I'm the one that started them and they only started last weekend. They've been going along very smoothly, at the same that CDC is making recommendations as to whether or not any individuals should be vaccinated, and that decision has not been made by CDC yet.

MR. CARVILO: But is DOD going along with your idea here, or is there any resistance, sir?

SECRETARY THOMPSON: Well, I wouldn't say resistance. I would say they wanna make sure that what we're asking for is, is a supply that they can afford to give up and they of course are the exclusive recipient of the contract of all the vaccine that has been manufactured which is around 5 million doses at this point in time.

AT&T MODERATOR: Next question, please.

CDC MODERATOR: Next, we have Susan Ferraro with the New York Daily News.

MS. FERRARO: Good morning. How soon will you know about the four suspect cases that are still being tested? There are three in New York City and one in New Jersey. And also for people who work in offices, who might be concerned about this, how can they go about having their mailrooms looked at?

DR. PERKINS: This is Brad Perkins. Regarding the suspect cases, a number of those may become confirmed based on the availability of additional clinical materials for testing. Some of them will not, however, be confirmed, because we've exhausted laboratory options for further confirmatory evidence of infection.

MS. FERRARO: What does that--I'm sorry. What does that mean?

DR. PERKINS: Well, that the case definition for, that we're working with requires either the isolation of the bacteria, bacillus anthraces, or in the case of confirmed disease, two laboratory, two different laboratory tests revealing evidence of bacillus anthraces infection.

For a suspect case, we require either one laboratory test or a link to a confirmed environmental source of contamination, whether it's in a building or a letter.

So in cases, particularly those cases of cutaneous anthrax, where we may have only identified relatively late in the course of disease, for example, there may only be a tissue sample available and there's no ability to culture the organism from that tissue sample and there may only be one laboratory test that suggests infection.

In that situation, that individual will remain a suspect case with no option for becoming a confirmed case.


DR. KOPLAN: This is standard procedure in outbreak investigations and it's very important to have a clear definition of what a case is or it can get very sloppy and there are lots of things that may look like what you're dealing with. So it really is important to nail down what's a confirmed case. Now many of these suspect cases, the reason they're suspect cases is they may well be, and most of them probably are anthrax infections, yet the criteria we've set up just won't get met because the person's been on antibiotics for two weeks, or because of other reasons, where they're never gonna get that other test that makes it a confirmed case.

MS. FERRARO: Okay, and about testing offices and mailrooms in the civilian world?

DR. KOPLAN: Well, many workplaces seem to have come to their own conclusions about that. I think for--in general, I think that there is--the risk isn't zero as the mail passes through these facilities, it's very, very small, but we can't say it's zero because of the contamination that has occurred in some of the facilities. Yet the risk to individual recipients, whether it's in the workplace or at home, is extremely small.

I can tell you, you know, what we do at home is--you know, I can't base what I do to make national recommendations, but we go get our mail and we bring it in and we look at it. And I'll admit, I look at it with greater scrutiny than I've ever looked at it before, and if there were something there that was un--you know--it didn't have a return address, and it was handwritten, and had an of these characteristics, I sure would call local law enforcement and wash my hands fast, and get that thing covered up.

But I think we, like other citizens in the country, now receive mail with a different level of scrutiny.

MS. FERRARO: Well, but I think with the issue--

SECRETARY THOMPSON: I would like to make two quick points about what you said. First off, in the Nevada case, that shows how important it is to have confirmation of a particular case, and that one was everybody was publicizing that that was the case, when CDC had not confirmed it, and CDC, when it went through the confirmation process, showed that it was not anthrax and therefore it was not an anthrax potential.

The second thing. Even at HHS, we did not ask CDC or EPA to come in because they're so busy. We went out and we hired our own laboratory to come in and inspect the mailroom, and they came back and said "potentially positive," "presumptive positive," and now we're going to the next step.

A lotta companies are doing this. They're hiring laboratories to come in and inspect their mailrooms to find out if in fact they do it, and they're setting up procedures for handling the mail.

CDC is setting up the guidelines which should be followed, wherever possible, and that is if you've got something that's suspect, you wash your hands and cover it up, and then call 911.

AT&T MODERATOR: Next question.

CDC OPERATOR: The next question comes from the line of Robert Bazell with NBC News.

DR. BAZELL: Hi. A question for Dr. Koplan. The 61-year-old woman in New York. She's been reported to be on a ventilator. Two questions. One. Do you have--are there enough other people around so that you can do a good epidemiological investigation of her movements that you described, and the second question is you talked about, concern about antibiotics susceptibility in her case. Was there something in her treatment that gave you reason to be more concerned about antibiotics susceptibility in the case of that woman?

DR. KOPLAN: Let me--I'll take those--three different parts, Robert. One is yes, we are, as I said, actively investigating her whereabouts. It's much easier, obviously, to talk to the person involved, and as you said, she is intubated and on a ventilator. So we're getting some information from fellow workers. The New York City health department has identified one or more relatives that can be spoken to, and then obviously neighbors and friends have to be identified.

But as in all these investigations, the more people who are, you know, have more details about someone's life, the better off you are in the investigation, and this may be a slightly more difficult one to get all that information from.

Your second question about antibiotics in this case. One striking feature of, again, good care in this case was as soon as this woman was identified and admitted to a hospital in New York, she was placed on the new treatment regimen that we had in our, the Morbidity and Mortality Weekly Report, just this last week. MMWR had a trio of antibiotics that were being used successfully in other cities, that previously had not been the standard of care for inhalation anthrax and from the get-go, when this woman was admitted, she was placed on this trio of antibiotics.

Nevertheless, she is very, very ill and we hope these antibiotics, obviously, are effective. We had no reason, immediately, to believe that these aren't gonna be the best ones to use but with each new case in this, one of our--you know, we do two things.

Our two primary lab responsibilities are, one, confirm it's anthrax, and two, see what the antibiotic sensitivities are because that has the greatest impact on the well-being of that patient. That's where we've put our energy.

DR. BAZELL: Thank you.

AT&T MODERATOR: Next question.

CDC OPERATOR: Next we have Charles Ornstein with the Los Angeles Times.

MR. ORNSTEIN: Hi there. I have a two-part question. The first deals with whether or not you guys at the CDC are doing, you know, actual clinical research using anthrax samples that you have there to look at issues of cross-contamination and issues of whether or not this thing--how anthrax spreads, if you're doing your own tests or if you're just examining cases as they come in real time.

And then the second part deals with whether or not you've reassessed the issue of the number of spores it takes to create inhalation anthrax, whether, as JAMA said, it was 2,500 or as previously said, it's 8- to 10,000, if you've come to any different conclusions.

DR. KOPLAN: This is Jeff Koplan again. I'll answer the last part of your question first. It's a very difficult thing to answer the exact number of spores. As you're probably all aware by now, this number of spores necessary to cause different types of disease is generated from animal studies that, as you would well imagine, there has not been, nor is there likely to be, the possibility of actually--nor should there be--the ability to translate that into humans. So we extrapolate from animal studies to humans for this.

Is it possible that the number for humans is a smaller amount or a larger amount or different? Yes, it is. Keep in mind, though, that very small amounts, quantities of these powders contain large numbers of spores. So those are two different things--the number of spores necessary for infection, and that can still translate to a very small quantity of powder.

On the question of what type of research are we doing now, we are largely doing outbreak investigation right now, which is that our laboratories are hard at work on identifying isolates, characterizing the virus, identifying the antibiotic sensitivities to this virus, identifying where there are positive exposures in the environment, et cetera, and so we are not much in the research mode at the moment.

And in terms of the kind of investigative research you described, which involved physical characteristics of letters and size of particles and all of that, that is not something that we do here.

MR. ORNSTEIN: Let me just add a follow-up then. You know, based on the fact that you're doing the--looking at it, in terms of the outbreak investigation, you had given us suggestions in terms of looking for suspicious packages. You, yourself, said that you're looking more carefully. But if there's a possibility that the cross-contam--if there is cross-contamination, somebody couldn't necessarily see that on their Chase Manhattan bill. What are you advising people to do about regular mail if there's no suspicious characteristics?

DR. KOPLAN: Well, again, I think that the risk is very small, but not zero. And what I would recommend people do is hand wash, if they're concerned about that, wash their hands after they handle the mail, open it, discard it, and do what they're going to do. I think the risk is so very, very small and the risk, where there is one, is for cutaneous anthrax, rather than inhalation.

So, again, what we recommend, and what I'd recommend to myself, family and friends is the same thing, which is look with scrutiny, wash your hands after you've handled the mail, and be--we're all cognizant now of skin lesions. If you find yourself developing a skin lesion that has the characteristics of a brown recluse spider bite; i.e., a nodule with an ulcerated center, and it forms a scar, that's an immediate sign to seek your physician, and get proper treatment, and get that reported to your local and state health department.

Now that is going to be a very rare occurrence, given the billions or hundreds of pieces of mail going through, but, unfortunately, it's now something we've got to think about in life at this stage in late October.

CDC MODERATOR: Next question, please.

AT&T MODERATOR: We have Monica Conrad with ABC News.

MS. CONRAD: Hi. Thank you. Two things.

First of all, I think it was Secretary Thompson who said that this woman from the New York City hospital, that she had spent more time in the mail room this week, and she occasionally works in the mail room; is that true?

SECRETARY THOMPSON: No, Monica. What I said is I understand that the mail room was modified.

MS. CONRAD: The mail room was modified this week.

SECRETARY THOMPSON: Well, a week ago, wasn't it, Brad?

DR. PERKINS: Uh-huh.

MS. CONRAD: So the mail room was modified in the past week, but she does occasionally work in the mail room.

DR. PERKINS: Our understanding--and, again, this is Brad Perkins--based on very preliminary reports from the investigators in the field, that prior to one or two weeks ago, that the stockroom and the mail room were the same space and that within the last couple of weeks, they were subdivided into two separate spaces.

MS. CONRAD: And the second question is, we're finding all of these trace amounts or amounts of anthrax throughout Washington, D.C. Do we know how much is dangerous levels of anthrax? We hear one spore in one building, a couple spores in another. At what point does it start to affect the health of the individuals who work there?

DR. PERKINS: I think that's an excellent question, and I'd love to be able to give you a clear and concrete answer on that.

We know at the two extremes. We know that if you have a large number of these spores, whether it's 5,000 or 10,000 or 50,000, that they clearly pose significant human danger. And I think we can be pretty assured that if you have one or two or five or ten spores, that they pose very little danger. It's what's in between, and we don't--we don't have either research experience or even clinical experience or epidemiologic experience to be able to give a definitive answer on that.

We're learning as each day goes by something about this, but unfortunately we just don't have, neither we nor others around the world, have had an experience that can offer a clear-cut line that says, with X number of spores you're okay, and over that you're not. We just don't have it.

MS. CONRAD: So what do you--so then you obviously err on the side of caution, as far as all of these people who work in these buildings.

DR. PERKINS: Well, you err on the side of caution, but caution goes in two directions, and therein lies a conundrum in this, which is, on the one hand, we don't want anyone to get anthrax where we can prevent it; on the other hand, we don't want anyone to get a severe reverse reaction to a potentially toxic medication that's got to be taken for 60 days if you decide to do that, and we've seen adverse reactions to some of the medications, and we've seen cases of both cutaneous and inhalation anthrax.

So you end up having to balance those risks out and make the best judgment, based on laboratory and epidemiologic information as it comes in. And with each day or if in a couple of days we get some new piece of information, you will see some changes in these recommendations. And people will say, well, that's different than it was yesterday. Yes, it is, and it will be. It will be different next week probably because we get new information coming in.

And if you want a clinical analogy to this, if you're in a hospital for 30 days with an illness and new data is being developed and new exams done and your condition changes over that time, you sure don't want the doctor making the same decision on Day 30 that they would have made on Day 1, and that's what's going on here.

MS. CONRAD: But is that, clearly, is that CDC's role then to investigate where that threshold of danger comes in? Is that something you at CDC--

DR. PERKINS: I think we're very interested in that and concerned about it. But, again, the investigation is difficult because in these exposures we weren't there to know whether it was 50 spores or 500. We can only draw conclusions about it based on was there a letter, what were the characteristics of that letter? Was there no letter? Is there dust present around, and do we do environmental sampling that gives some indication? How much growth do we get on the plate?

So much of the information we get, we use all that we get, but we, you know, much like in any investigation, we take all of the information we can find and then try to process in a way to come to a conclusion that's then usable for the public good.

CDC MODERATOR: This will be the last question.

AT&T MODERATOR: We have Rhonda Rollin with CNN.

MS. ROLLIN: Hello. I'd just like to ask a question about antibiotic resistance. I know that's something that you're trying to avoid in the situation. So when individuals come in to get their antibiotics, how is it presented to them? Are they given a choice so that they can make the decision, or does whoever is seeing that individual suggest, you know, why don't we go with Doxy unless you have a problem with it? And then who's making that decision? Are these recommendations by the CDC or are the physicians on the ground seeing making those decisions?

DR. PERKINS: This is Brad Perkins. It's a--it's a combination of--of individuals that are making those decisions. State and local health authorities are there on the scene when these antibiotics are distributed. They're working with--with CDC recommendations in broad stroke regarding the antibiotic susceptibilities around these specific circumstances, and then they're tailoring those recommendations to specific individuals that they're seeing there in the antibiotic distribution sites, so that the best possible decisions are made at the individual level.

MS. ROLLIN: So it's kind of between the physician seeing the individual, then they get together, or is it kind of placed on their shoulders like, all right, if you take this one, you could have these side effects, or you have to take this antibiotic with milk or without, you know? So who is actually making the final call on what antibiotic you walk out the door with?

DR. PERKINS: Well, the health professional on the scene has a set of recommendations that--that have been endorsed by CDC, and those recommendations are tailored to specific circumstances.

For example, we have preferred antibiotics in these circumstances for someone who is pregnant or believes that they might be pregnant, and that decision is made right there at the interface between the health professional and the individual that's being treated.

MS. ROLLIN: Now I understand that more than 10,000 individuals in the Washington area alone are on antibiotics. Do we know an exact number total now who have been on the antibiotics, and do we have a breakdown like, you know, 8000 on Cipro? You know, do we have an idea of how it's played out?

DR. PERKINS: Yeah, it's--this is Brad Perkins again. Certainly it's in the tens of thousands of persons, and we are--we're following those individuals or trying to follow those individuals very carefully at all the sites that are--that are doing antimicrobial chemo-prophylaxis for the occurrence of adverse events. So the situation has been quite dynamic in terms of numbers of total individuals, but we are committed to try to develop strategies to follow those individuals to--for surveillance of adverse events and for adherence to recommended durations of therapy.

CDC MODERATOR: I want to thank everybody for this afternoon's telephone call. Appreciate it. Bye-bye.

AT&T MODERATOR: Ladies and gentlemen, that does conclude your conference for today. Thank you for your participation and for using AT&T. You may now disconnect.

[End of conference.]

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