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Update on Anthrax Investigations
with Drs. Bradley Perkins and Tanja Popovic

November 16, 2001

CDC MODERATOR: Yes. Thank you, everyone, for joining us today. It's Lisa Swenarski, CDC's Press Office. Today, we have Dr. Bradley Perkins, CDC anthrax expert, as well as Dr. Tanja Popovic, CDC anthrax laboratory expert, and her name is spelled T-a-n-j-a, and Popovic is P-o-p-o-v-i-c.

Dr. Perkins is going to make a few opening remarks and then we'll open it up to Q&A.

DR. PERKINS: Good afternoon. CDC continues to work with local and state public health departments on the anthrax bioterrorism attack in the four areas of investigation. Our current priorities include assuring that persons that have been recommended to complete an entire 60-day course of post-exposure prophylaxis antibiotics actually take their medicines, as prescribed, for the entire period. So we're very carefully monitoring adherence to those recommendations.

Additionally, we're actively looking for adverse events associated with this antibiotic therapy in all the areas of investigation.

Other priorities include cleanup of facilities that have been found to be environmentally contaminated with Bacillus anthracis, and I'd like to remind all of you, again, today, that although there has been a lull in the occurrence of both inhalational and cutaneous anthrax cases, that we remain highly vigilant for the occurrence of additional cases of anthrax throughout the United States and do not have a great deal of comfort, that this episode is over until the person or persons responsible for these attacks are identified and brought to justice.

Today, I have with me. Dr. Tanja Popovic, and we'd like to focus on some of her contributions in this investigation today. 

Dr. Popovic began--she's actually the main Bacillus anthracis subject matter expert for laboratory aspects of this organism. Three years ago, she began preparing to train all state public health department laboratories in methods for identification of Bacillus anthracis, using common reagents, or using standardized reagents and standardized methods for identification.

She personally was involved in training all the individuals that have reacted at state level in this investigation and we're delighted that the Laboratory Response Network for Bioterrorism has performed as well as it has during this investigation, and a large part of that credit goes to Dr. Popovic, and she's here today to discuss details.

With that, I will open it up for questions.

AT&T MODERATOR: Thank you, and once again, ladies and gentlemen, if you do have a question at this time, please press the one on your touchtone phone. You'll hear a tone indicating you've been placed in queue. You may remove yourself from queue at any time by pressing the pound key. Once again, if you have a question, please press the one.

Our first question is from the line of Miriam Felco with CNN. Please go ahead.

QUESTION: Hi. I've got two questions. One for Dr. Popovic, and then one for anyone who can answer it. Maybe [inaudible].

The question for Dr. Popovic is have you added any new tests, new methods for your investigation of the anthrax since this started? It's been what? six weeks now. Or are you still using the tried-and-true methods from before, meaning have any of these new tests that have been mentioned in the media been adopted, validated, in the past few weeks?

The other question pertains to smallpox. Can you just tell me why it's important that the U.S. maintain its smallpox stock and not destroy it as had been planned for the past few administrations.

DR. POPOVIC: As Brad has mentioned, we have been preparing for something like this for a period of time, and we have developed and validated a number of methods during those past three years, and since the very beginning of this outbreak, we have been using a number of these methods, starting with basic microbiological methods to the state-of-the-art molecular method, and they have, indeed, served us extremely well, and have been used in a real-time fashion on all of our clinical samples that we have received for the past six weeks.

At this point, we have added to our spectrum of activities several research methods that are currently being validated, here, at the CDC, but we are not, or have not yet, at this point, had an opportunity to validate some of the new methods that you are referring to, and until those validations are made, and available, we will not be able to comment on the specificity or sensitivity or the appropriateness of the use of these methods.

CDC MODERATOR: And Miriam, on your second question on smallpox, we have two anthrax experts in the room but not smallpox and so I'm going to ask you to call me later with that and I'll find someone who can answer your question. Thank you.

AT&T MODERATOR: Our next question is from Alice Park with Time magazine. Please go ahead.

QUESTION: Hello, and I'm not sure which one of you, or whether both of you will be able to answer this. It has to do with the inhalation anthrax case at the State Department and I wanted to confirm with you about the timing of when the sampling and when the testing was done.

Now my understanding is that the results were just released this week, but that the samples weren't done until November 6, and the gentleman was confirmed to have inhalation anthrax on the 24th. Can you explain to me why it took those two weeks to go in there and taking the sampling, when, to my understanding, the post office facilities in the meantime, several hundred of them had sampling done.

DR. PERKINS: The case of course was diagnosed promptly, and that went extremely well. The environmental samples in the location that was suspected to have been the source of exposure in that case were obtained somewhat later because the facility was closed, and therefore posed no risk to any of the persons working there. And because of concern about an unidentified letter, the priority for environmental sampling was placed on other facilities as an immediate priority, and it was until those facilities were completed that environmental sampling was then undertaken and done fully at SA-32.

AT&T MODERATOR: Thank you. Our next question is from David Caravello with CBS News. Please go ahead.

QUESTION: Good afternoon, Doctors.

I still need help on the question of transportation of select agents. I have tried to look at that law and the regulations. And on these calls it has usually been discussed in terms of laboratories, if that is not my understanding. Is it possible, if this is not your immediate area of expertise, to bring on Jonathan Richmond or someone who supervises that to tell us are we--could we, in a situation--or does a garbage company who might take away a select agent have to register with you? I just don't feel we have the answer yet.

CDC MODERATOR: David, this is Lisa Swenarski. Let me help you with that afterwards. I don't think that Dr. Perkins or Popovic can answer that, but I will give you a call right afterwards. Thank you.

AT&T MODERATOR: Our next question is from Bob Port with the New York Daily News. Please go ahead.

QUESTION: Hello, Doctors. Thank you for these briefings again.

In New York City, the Health Department has conducted some testing for anthrax in the subway system, specifically, the No. 6 line Kathy Nguyen traveled on. They tell us that they finished their testing, but they will not discuss these preliminary results.

Can you tell us what were those preliminary results? They have sent them to CDC. Have you gotten any final results, and what is going on here? Are we detecting perhaps some background-level anthrax, where a big deal shouldn't be made of it or what?

DR. PERKINS: CDC continues to work with the New York City Health Department in exploring the circumstances for the exposure of the case of inhalational anthrax that occurred there. There has been extensive environmental sampling done, and the New York City Health Department is the point of release of all results regarding that sampling.

I will, however, clarify a little bit, there is really--there is no such thing as a preliminary result. These samples, I think, should be judged at their final interpretation as either positive or negative. Particularly some of these environmental samples where there is the possibility of a large amount of other bacteria being present in the sample, it can pose a challenge to try to identify very low levels of Bacillus anthracis on those plates, and it can take some time to do that.

So there really is no preliminary results that are being released, either by CDC or the New York City Health Department. As soon as those results are final, however, I would expect the New York City Health Department to release them promptly.

AT&T MODERATOR: Thank you. Our next question is from Sarah Leek with the Wall Street Journal. Please go ahead.

QUESTION: Thank you. Just to follow up on that.

Dr. Gerberding's comment yesterday on the conference call seemed to indicate that nothing had grown yet on the plates related to the subway tests. I wondered if that is the case.

The other thing is what other environmental results are you expecting over the weekend? Are there particular locations you are waiting to hear on?

DR. PERKINS: I am not sure what comment that Dr. Gerberding made yesterday. There has been no release of any information regarding the environmental samples that were recently obtained in New York City. Those results will be released by the New York City Health Department.

We continue to work with the Post Office, the Postal system in evaluation of environmental samples in a variety of locations. And Tanja, in her laboratory, has a large number of samples that are currently being evaluated in various processes. I don't know if you want to comment, Tanja, how many specimens you have right now.

DR. POPOVIC: We basically get, on a daily basis, from 10 to 50 specimens. It really varies. As soon as we have the final result, those are forwarded back to the state departments where the specimens were collected, and as Dr. Perkins has indicated, those are the people who release that information.

So we always have a number of specimens ongoing and under the investigation. It usually takes about a day or two days if specimens are relatively simple, and sometimes a little bit longer to do the final confirmatory testing.

AT&T MODERATOR: Thank you. Our next question is from Kyoshi Endo with the Nikkai Newspaper [ph]. Please go ahead.

QUESTION: Good afternoon, Doctors.

I would like to know if you are following those in the high-risk group who have been taking antibiotics. Are you checking, for example, their blood samples, and from that can you tell, in any way, roughly what percentage of them might have become ill if they have not taken antibiotics?

I also have a second question after that.

DR. PERKINS: I wish that that were the case. That would give us valuable information, but there is no way to determine which of those persons may have gotten ill if they did not take the antibiotics. We do think that the public health interventions that have been delivered by CDC, state and local public health departments, in the form of large-scale chemoprophylaxis with these antibiotics, has prevented a number of cases of inhalational anthrax, but as to the exact size of that number, it is really impossible to determine how many people have been spared this life-threatening illness.

QUESTION: And like the samples, you don't do the follow-on checks on those high-risk groups?

DR. PERKINS: Well, we do, we are doing intensive monitoring of these groups for the occurrence of illness, and they are being followed very carefully for any evidence that the antibiotics may not have prevented development of either cutaneous or inhalational anthrax.

To date, we have no evidence that anybody that has been targeted for antibiotics and is currently taking them, has developed any evidence of anthrax disease.

QUESTION: My second question was about North Carolina. There was a report from the environmental testing of a North Carolina Post Office there that you have found some spores. Do you have any information on that?

DR. PERKINS: We don't have any information to release on that environmental sampling.

AT&T MODERATOR: Thank you. Our next question is from Kim Dixon with Bloomberg News. Please go ahead.

QUESTION: Hi. Thanks. My question is about how anthrax spreads. The Health Secretary and many CDC officials have said many times that it is not contagious. But what can serve as a vector? If anthrax is found on three different stories of a building, for example, how can it get from one place to the other? Could you give me some examples of that?

DR. PERKINS: Yes. Bacillus anthracis spores can move around and behave basically like other particles of dirt in the environment, and would not be distinguishable in terms of its ability to move from one location than any other piece of dirt in a occupational, or other environmental setting.

I think it's very important to recognize that all of the cases of anthrax associated with this investigation, and all of the ones that have been reported in the United States over the last century, have been the result of principally exposures in the workplace. Persons exposed to goat hair, or wool, in the past, and laboratory workers. And then in the context of this investigation, the occupations of the persons involved have been very well-defined, suggesting that it's an occupational setting that is the key element for risk of disease.

But the spore itself has the ability to move widely in the environment, behaving basically just like a piece of dirt.

AT&T MODERATOR: Thank you. Our next question is from Charles Sievert [ph] with the Atlanta Journal. Please go ahead.

QUESTION: Dr. Perkins, I was trying just to get an update on the decontamination efforts. I understand CDC is involved in consulting with the post office and the Government folks on, oh, and Capitol Hill folks on decontaminating those buildings. Can you just tell us what about methods, any method decided on yet, other than those already been cleaned up through bleach, and so forth?

DR. PERKINS: CDC continues to work with EPA, which has the lead responsibility for cleanup efforts in areas that are environmentally contaminated with Bacillus anthracis. A variety of approaches to cleanup have been suggested. There's not much new in that regard, that I'm aware of, at the present time. The mainstay of the cleanup effort, at this point, and I think it will continue to be the use of a diluted bleach solution, and basically to wipe down contaminated surfaces, and there are good data that suggest that this is an effective way of both cleaning, mechanically cleaning of, of Bacillus anthracis spores as well as killing of those spores.

AT&T MODERATOR: Thank you. Our next question is from Karen Jacobs of Reuters. Please go ahead.

QUESTION: Hi. I was wondering, is there a suspected anthrax case in the State of Oregon, and I was hoping that you could give us an update on the number of cases of suspected anthrax, and where they are.

DR. PERKINS: My knowledge--I mean, at CDC, I'm not aware of any suspected case in Oregon. I would suggest that you contact that state health department in regard to that question, and I'm just looking through here. I do not have in front of me the information regarding the locations of the suspect cases. That's certainly available and can be provided by Lisa after this call.

AT&T MODERATOR: Thank you. Our next question is from David Brown with the Washington Post. Please go ahead.

QUESTION: Hi. I have two questions. One for Lisa. Is CDC going to have a comment, later today, on the veracity of the New York Times story on page one today, that the policy on the destruction of smallpox virus has been changed by the Bush administration? That's one question. Then the second question for Dr. Perkins is the issue of whether background contamination of Bacillus anthracis spores exists is something that's come up by the public, you know, for weeks, and actually Dr. Gerberding mentioned that as one of the possible reasons for a possible--for a positive culture. 

Does the CDC have any plans of doing, you know, random tests of various environments to see if anything such as background contamination by Bacillus anthracis exists, or not?

DR. PERKINS: We know that in some areas of the United States there are background levels of Bacillus anthracis spores, and that those spores represent a risk to grazing livestock in those areas. Just within the last 18 months, CDC has worked with the State of North Dakota and the State of Texas, evaluating outbreaks of anthrax in animals.

So we know that the spores are present in those environments, yet there's no evidence of human disease as a result of that environmental contamination.

What we are interested in doing is potentially working with those state health departments, to get a better understanding of the extent of environmental contamination in those areas, potentially in occupational settings where we think that these spores may be tracked just in the normal course of events, in those areas, yet we know that they don't cause disease. We think that information may help us to extrapolate and better understand what background levels of Bacillus anthracis contamination are in the setting of no human health risk, and that could be important information for us.

CDC MODERATOR: And David, on your question on the smallpox stocks, I'm not aware of any plan to issue a statement today on that, but feel free to give me a call. Thank you.

AT&T MODERATOR: Our next question's from Pete Williams of NBC News. Please go ahead.

QUESTION: Thank you. One question about suspect cases. Do you have any suspect cases that appear, or could have been infected before any of the known letters came out, and, secondly, what has become of the plan by CDC to do simulations of how anthrax could escape from a letter? We heard about that a couple of weeks ago. I haven't heard anything since.

DR. PERKINS: Sorry. I started focusing on your second question. What was your first question again?

QUESTION: Any suspect cases that could have gotten infections before any of the known letters.

DR. PERKINS: Right. We do not have evidence of that. In fact, if you look at the epidemic curve, which is basically something we like to do as epidemiologists--it shows the occurrence of cases, over time, and you mark the point where we have known sets of letters delivered to the affected areas. There's a very nice clustering of cases around the two known mailing times. That gives us some confidence that even though we may not know all the letters that were sent, we have a fairly good epidemiologic understanding of the time that they were sent and a tight clustering of disease occurrence around those times. We don't have any particular outliers in that regard, with the exception of the last inhalational case in New York City for which we still have a very incomplete understanding of the circumstances of her exposure.

In regard to your second question, we continue to be interested in better defining the risk of anthrax around envelopes containing B. anthracis spores, and we are actively working with a number of groups that have expertise and experience in this area, and we'll be initiating a number of projects in this regard over the coming months.

CDC MODERATOR: This is Lisa Swenarski would just like to take advantage of the fact that Dr. Popovic is here and ask her if she could briefly describe what CDC has done in the last couple of months to ratchet up our capacity to meet the demands of our laboratories in anthrax testing.

DR. POPOVIC: Thank you, Lisa.

Over the past 6 weeks, we had to make some substantial changes in the way we have been dealing with the specimens that have arrived here. Starting from about 10 laboratory scientists that we had that were working full time on any issues pertaining to Bacillus anthracis, we presently have over 80 people working full time, 24 hours a day, 7 days a week.

What we did is we basically mobilized what I would call our brightest and the best, so that they will come and work with the experts that we already had before this outbreak occurred. We tried to be responsive so that we could immediately be ready to receive a very large number of specimens that were coming our way.

We have expanded activities not only here at the CDC, but we have provided laboratory support to the field sites and have sent our laboratorians, part of the CDC investigative teams, to Florida, New York, Washington, D.C., and New Jersey and have continuously provided support and consultancy to public health laboratories throughout the country and also throughout the world.

So, in addition to that, we have opened several new laboratories to expand the space and capacities so that we have laboratories that serve as triage for a large number of environmental samples that are now coming our way. So that right now we have five laboratories that, in one way or another, are dealing with various aspects of laboratory investigation that is going on right now.


Next question.

AT&T MODERATOR: That is from Jill Carroll of the Wall Street Journal. Please go ahead.

QUESTION: Hi. Thank you for holding these press conferences.

I'm calling about smart tickets, and I wanted to know if all of the HAZMAT teams out there that you are talking with are still using smart tickets and are those part of the problem with the labs being overwhelmed?

DR. POPOVIC: As you may have heard before, we are not, at this present, using or recommending the use of these rapid or hand-held devices that we have heard about. The main reason is that what is missing is a comparison with any new test that is out there being used in the field is necessary so that it can be compared head-to-head with the current gold standards, and those are the tests that we have validated and used over the past several years, and especially in the past 6 weeks.

So CDC has been asked to participate in validation of these essays, and those activities were underway and had to be delayed somewhat during the past 6 weeks, but as soon as those comparison results are available, they will be shared with the public.

AT&T MODERATOR: Thank you. Our next question is from Bridget Harrison with the New York Post. Please go ahead.

QUESTION: Just returning briefly to--I have two questions. First, returning briefly to the investigation of the subway line, No. 6 subway. Am I right in thinking the CDC has now finished its investigation and given its results to the New York Health Department and now you're waiting for them to make an announcement? If that is the case, when do you anticipate that might be? Why would there be sort of a time lag between you giving them the results and an announcement?

The second question is regarding the labs and all of the specimens you are dealing with. I don't know where there's too many to give a quote on, but how many specimens now are you dealing with from all over the country and how many of those have come from locations in New York?

DR. PERKINS: I'll do the first one and Tanja can take the second one.

CDC has not completed their investigation and neither has the New York City Health Department or the FBI of the circumstances of exposure of the last inhalational case in New York City. We have people there. Actually, there will be some additional people joining the team over the weekend, and we remain committed to doing everything that we possibly can do to try to find out how this lady was exposed to Bacillus anthracis.

DR. POPOVIC: We have looked at over 2,500 specimens in the past several weeks, and they were indeed coming to us from the major four states, but also from other parts of the country. I cannot tell you exactly how many of those are coming from New York, but a number of specimens are coming still from New York and Washington, D.C., and they are being currently investigated and tested.

AT&T MODERATOR: Thank you. Our next question is from David Rube with the National Journal Group. Please go ahead.

QUESTION: Hi. This is for Dr. Perkins.

I was wondering if I could get your view on whether antibiotics, other than Cipro or penicillin, would do the job just as well as Cipro, and if that is the case, why is Cipro--should Cipro remain the drug of choice for treatment?

DR. PERKINS: I think it is important to clarify in what context you are asking the question. Ciprofloxacin remains the drug of choice for post-exposure prophylaxis in settings where antimicrobial susceptibilities of the organism are not known. There are a variety of reasons for that. In the current setting, where the antimicrobial susceptibilities have been well defined by Dr. Popovic and other colleagues here at CDC, we may make different decisions.

And the switchover to preferring Doxycycline in the context of this investigation occurred when we got up to tens of thousands of people using Ciprofloxacin, which creates concern, on our part about the development of resistance, not by Bacillus anthracis, but by development resistance among other bacteria.

Ciprofloxacin is one of a class of drugs called fluoroquinolones that are used for empiric treatment of other serious infectious diseases in the United States. By using that drug in tens of thousands of people, when there's another alternative, we can get into an unneeded cycle of development of resistance that will shorten the life, shorten the utility of Ciprofloxacin for other infections.

In new, unrelated incidents Ciprofloxacin will continue to be the drug of choice. In this current incident, where the antimicrobial susceptibilities are well defined, and we are treating large numbers of people, Doxycycline became the preferred drug.

AT&T MODERATOR: Thank you. Our next question is from Anita Manning with USA Today. Please go ahead.

QUESTION: Hi. Thanks very much for taking the call.

I have a little cluster of questions. You mentioned expanded lab activities at CDC in support to field sites and sending laboratorians out and so on. I am wondering if you have any idea how much that has cost. You mentioned that you now have five labs dealing with aspects of lab investigations. What was it before?

And then I have another question about Ciprofloxacin or actually it's about IV antibiotics. The MMWRs say that you are recommending that people start patients on IV and then switch to oral antibiotics at some point, and I am wondering at what point that might be. What would signal the switchover?

Thank you.

DR. POPOVIC: I will start with the first question.

Working on this investigation has been the highest priority at the CDC for the past month and a half. I cannot give you the numerical values, but those have not been an issue for us at this time.

What we had before October 4th was basically two laboratories that were dealing primarily with triage and rapid detection of genetic material in clinical and environmental samples, and then we had a laboratory that was the one where we did the basic development and standardization of methods. We did the research, and we did the training of all of the laboratorians, as Dr. Perkins has mentioned. Those two laboratories, between them, had about 10 to 12 people.

In addition, there are other activities at CDC that cover a wide range of activities that sometimes have to deal with detection of Bacillus anthracis by various methods, and those have been substantially expanded. One of those is an activity where we are looking for the antibodies, which is the laboratory that has not been as active in getting that many samples as we are getting now.

The next one was detection of Bacillus anthracis by immunohistochemistry methods, which was also expanded substantially.

The last one, as I mentioned, was creation of a new laboratory, so-called surge capacity laboratory, for triaging of a large number of samples in terms of ruling in or ruling out Bacillus anthracis and then those materials will be sent to either one of the other laboratories for final identification confirmation or molecular characterization and antimicrobial susceptibility.

AT&T MODERATOR: Thank you. We have a follow-up from Miriam Falco with CNN. Please go ahead.

CDC MODERATOR: I'm sorry. There was a third question from Anita on Ciprofloxacin that we haven't answered yet.

AT&T MODERATOR: My apologies. Ms. Manning, please go ahead.

QUESTION: The question was about intravenous use of Ciprofloxacin or Doxycycline, along with some other antibiotic, and then switching over to oral. I am wondering what would signal the time, you know, at what point do you know that you don't need IV any more, and you can go to oral?

DR. PERKINS: That is a good question. As we've seen in our treatment guidelines, we are recommending the use of multiple antibiotics, including Ciprofloxacin or at least one fluoroquinolones, which is the class of drugs that it comes from, as well as other antibiotics in hospitalized persons.

The decision about when to switch over to oral therapy is really a clinical decision and is driven by the patient's ability to tolerate taking oral medications and is actually expedited in this situation because when a patient is able to take oral Ciprofloxacin, the levels that are reached in the bloodstream with that particular drug are quite high when taken orally.

That is not the case with all of the antibiotics that may be useful for treatment of anthrax. And so while you might be able to switch over on Ciprofloxacin fairly early, some of the other drugs may be a little more difficult to do that, and so at least most severe infectious diseases like this, we would suggest that people need at least 14 days of intravenous therapy, because that's the most definitive way to know that people got the antibiotics that doctors intend for them to get, and then after that, it becomes a clinical judgment issue as to when they can be switched over to oral therapy.

CDC MODERATOR: Next question.

AT&T MODERATOR: And we'll go to Miriam Felco. Please go ahead.

QUESTION: Hi. I've got two quick questions. Just where exactly are those five labs located. Are they all in Atlanta? And then you were talking about how you're quite confident, from all the information you've gathered from these events, that the folks who--the place where you are gonna get anthrax is occupationally-related. 

One of the deaths, in Kathy Nguyen's case, it's--you don't know where she got it from, and given the small number of deaths in these incidents, that seems like a pretty big question mark. So could you comment on that.

DR. POPOVIC: These four laboratories are at various locations and they are very well linked in terms of communication and sharing of specimens, and that's all that I would be able to say at this time.

DR. PERKINS: In regard to the last case of inhalational disease in New York City, we're quite concerned about the issue that you bring up. She does deviate from our other experience, having people in very tightly defined occupational groups, and that's why we have spent such an extraordinary amount of time, energy, and effort, in trying to define the exposure of her--I mean, the circumstances of her exposure.

She does have a vague link to a mailroom sort of environment, but clearly, the hospital that she was employed by does not fit the pattern of other targets of this terrorist, and there's no evidence of environmental contamination in that mailroom, and so your concern is appropriate, and is shared by public health authorities, and that's why we continue to work, urgently, on defining her circumstances of exposure.

AT&T MODERATOR: Thank you. Our next question is a follow-up from Kim Dickinson of Bloomberg News. Please go ahead.

QUESTION: Hi. I just wanted to follow up on, I think earlier in the week, the CDC said that they finally agreed to test that New Jersey cardiologist who had self-diagnosed himself, and who might have had anthrax. Do you have the results of those tests?

DR. PERKINS: Those results will be released by the New Jersey State Health Department as soon as they're available.

AT&T MODERATOR: And our next question's a follow-up from Jill Carroll of Wall Street Journal. Please go ahead.

QUESTION: Hi. I just wanted to ask why is it that all the hazmat teams are using smart tickets, in the first place, since they've turned out to be such, kind of a waste of time? I mean, I know they're meant for battlefield, but why did everyone decide to jump to those?

DR. PERKINS: I'm sorry, I don't quite understand the question. Why are they using them?

QUESTION: Yeah. Why did they decide--like who decided to tell them, when you have anthrax cases, go out there and use smart tickets? Where did that--how did they know to do that?

DR. PERKINS: Those decisions are certainly decentralized decisions that are made at local and municipal levels, and, you know, those tests are available on the commercial market. And I don't mean to disparage, you know, completely, the potential utility of these tests. Our position is that CDC has not validated these tests, and we know that the sensitivity is relatively low based on other people's work, so that you have to have a very large number of spores in order to have a positive test.

But in certain situations, those performance characteristics may be useful, and in settings where a pattern is identified that has a very high concentration of B. anthracis spores, based on our understanding, these tests may be useful in those settings. So we look forward to validating tests, this test, and tests like it, and making some recommendations. But the actual decisions are decentralized decisions made at local and municipal level.

AT&T MODERATOR: And we have a follow-up question from David Brown of the Washington Post. Please go ahead.

QUESTION: Yeah. Dr. Perkins, this is just getting back to the environmental testing. I should have mentioned that I was interested, you know, I was asking about indoor, not outdoor environmental testing. Can you tell me a little bit more about the plans that you mentioned, that state health departments are going to be looking for how much anthrax bacteria gets tracked around into indoor environments, and how that's going to be investigated, and perhaps when?

DR. PERKINS: Yeah. You know, we don't, just to clarify on indoor environments on the East Coast, we don't believe that there is any normal background level of Bacillus anthracis contamination prior to this event in most occupational settings, you know, currently existing on the East Coast. So that's one issue.

We think that there may be occupational setting contamination, unrelated to this bioterrorism attack, in places that have disease in animals, and the places that CDC has been involved with most recently is in North Dakota. There's actually a publication on that investigation in the MMWR, and, more recently, in Texas. We think that there may be contamination with spores in these environments that represent a more normal background level setting, and that defining that level of background contamination could be helpful in the context of better guiding the cleanup effort associated with this investigation.

The timing of those studies is gonna be eminent. You know, within the next several weeks those studies will be undertaken and completed.

CDC MODERATOR: We have time for one more question.

AT&T MODERATOR: And that'll be from Bob Port of the New York Daily News. Please go ahead.

QUESTION: Hello. Forgive me, but I just feel the need to follow up on the questions about the testing of the subway system in New York.

I really haven't heard a direct answer, why can CDC not release what it knows of these results? Why do we have to wait for the New York City Health Department to tell us? They have been unresponsive on this question.

It seems almost as though you might have some positive results but no one wants to publicly explain them. Is that the case, or not the case?

DR. PERKINS: There are no results from those specimens at this point. They're in Dr. Popovic's laboratory and as soon as the results are final, they will be released by the New York City Health Department.

We've been operating in this manner with the state and city health departments taking the lead in releasing clinical or environmental results, you know, germane to their local jurisdictions. This is the way we do business. This is the way we've always done business and this is the way we're gonna continue to do business.

CDC MODERATOR: Thank you very much. That's the conclusion of our telebriefing for today.

AT&T MODERATOR: And, ladies and gentlemen, that does conclude your conference for today. We thank you for your participation and you may now disconnect.

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