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Anthrax Update: Telebriefing transcript with Secretary Tommy G. Thompson and Dr. Jeffrey Koplan

December 3, 2001

AT&T MODERATOR: At this time your lines have been placed in a listen-only mode until the question-and-answer session of the program. I would now like to turn the call over to Mr. Bill Pierce. Thank you, sir. You may begin.

HHS MODERATOR: Good afternoon. I'd just like to briefly remind reporters when we go to question-and-answer, we'd like you to limit it to an initial question and a very brief follow-up so we can get as many questions in as possible.

With that, I'd like to turn it over to HHS Secretary Tommy G. Thompson.

SECRETARY THOMPSON: Thank you all for calling in and joining me on the call today are Jeffrey Koplan from the Centers For Disease Control and Prevention, Dr. Tony Fauci from the National Institutes of Health, and of course Dr. D.A. Henderson from the Department's Office of Public Health Preparedness.

We wanted to have this call today to give you an update on the connection and also the plausibility of the Connecticut case, and answer any questions you may have.

With the discovery of spores of anthrax at postal facilities in Connecticut, it is clear that cross contamination through the mail has occurred, number one. Number two, we have shown that cross contamination has caused inhalation anthrax before, and three, that Mrs. Lundgren did receive mail, but we do not have, at this time, any clear evidence, what led to the death of Mrs. Lundgren at this time.

It's a mystery that we had at the Department of Health and Human Services and along with the FBI, and state and local law officials, and all of us are continuing to investigate. We're taking a very serious look at cross contamination as the possible cause, as well as any other possibilities in the investigation.

We do not want, in any way, to compromise our investigation and overlook something, so we are looking at all plausibilities and all possibilities. Most importantly, as the experts say, we do not at this time have the definite scientific or medical link between cross contamination of mail and the death of Mrs. Lundgren.

The discovery of anthrax at postal facilities and on letters are significant findings, however, and hopefully vital clues that will help us solve this mystery. As we always have, we will share with you our latest findings as they become available.

With that, I'd like to turn it over to the doctors here with me, to make any opening statements that they would like.


DR. HENDERSON: Nothing further, Mr. Secretary.


DR. KOPLAN: No. Only that I think, Mr. Secretary, in your opening statement you mentioned there have been cases of cross contamination related to disease before, and I think you meant cutaneous disease caused by probable cross contamination.



DR. FAUCI: No, nothing from me. I'll just wait for the questions, Mr. Secretary.

HHS MODERATOR: With that, we'd like to take your questions.

AT&T MODERATOR: Thank you, and at this time, if you would like to ask a question please press star followed by one on your touchtone phone. You will be announced by name prior to asking your question. Once again, to ask a question, please press star one now.

Your first question comes from Laurie Garrett [ph] with Newsday.

QUESTION: Good afternoon. Secretary Thompson, I wonder if you could comment on the issue raised in two New York Times' articles in the last couple of days regarding consideration that the source of anthrax is actually inside the Federal Government and involves someone who either works at USAMRIID, or in the weapons program, or at NIH, or had access through one of those federal routes to the anthrax.

SECRETARY THOMPSON: Thank you for the question, Laurie. I think that answer has got to come from the FBI. They are doing the criminal investigation, and anything dealing with that portion of the case I believe should not be in my purview and should be discussed by the FBI.

HHS MODERATOR: Next question?

AT&T MODERATOR: Thank you. Your next question comes from Andrew Revkin [ph] of the New York Times.

QUESTION: Thanks for holding the briefing. What I'd love to know is what HHS and its various arms are doing to look down the routes of the other hundreds of letters that you have found with the help of the Postal Service, that transited the machinery in Hamilton Township within seconds of Daschle and Leahy letters. In other words, what is your concern about whether it's necessary to inform both postal officials and/or the public at the ends of those other lines that could be, I don't know, Hawaii, Idaho, wherever the other several hundred letters that passed within seconds of these same potent letters went. What are you doing along those lines?

SECRETARY THOMPSON: That question should be answered by Dr. Koplan from CDC.

DR. KOPLAN: Yeah. Let me discuss that with you a bit. Firstly, there is nothing magic about the next few seconds, going through the sorter line. Can I take a couple of minutes to explain a little bit what we've learned about how these major mail distribution centers work, which is that there's a sequence of steps in them, more than one of which has the opportunity to disperse spores from the letter.

The first step-- and I'm speaking like I'm an expert in the Postal Service, so bear with me, but this is what we've learned--is that the first step, for example, in the Trenton post office of record, the Hamilton Township Post Office, involves a cancellation of the letters as they come through, and in that there is a stamping of the letter, a physical ramming of the letter by the stamping device, that in itself may cause some dispersion through the envelope in some way. So that's step one.

So it's not just the sorter that is an item of interest, but also the canceler, something I believe called the AFCC, is the piece of equipment that it's called.

That comes through on one machine, but there's a row of these machines next to them, and if there's a dispersal of the spores, then it can possibly cross contaminate the other machines as it goes through.

The letters then pass on to a sorter of which there are a number of sorters, and as we've seen in the number of postal facilities in which we've looked and taken specimens, not just the sorter in which the letter goes through, but other sources get tested positive at some distance from it.

So that the idea that just in the first few seconds after a letter, that those, the letters that went through in those few seconds just from the sorter are even of particular interest isn't clear. There seems to be the potential for not just hundreds, and not just thousands, but tens of thousands, and maybe more letters to be potentially at risk for some level of cross contamination.

And because from the time one of these letters, contaminated letters passes through, to the time the facility gets closed involves periods in which air hoses were used to clean equipment, and there were other grounds for dispersal of spores throughout the facility, what we're doing now is working with the Postal Service to both determine what are those total number of letters, potentially exposed, and is there anything magic about those letters that came through in the few seconds after a letter, just in the sorter, when there is, in many ways, a blender going on in there, moving spores around the facility.

So we are working on that, trying to sort it out but the idea that there's just 300 letters, and that those are the ones of interest we don't think is probably the best route to go in this.

QUESTION: The quick follow is, though, that you still did have in that bunch, just in those letters, one and only one that went to the Bronx, and it happened to go to the neighborhood of the victim there, and one and only one that went to that part of Connecticut where Ottilie Lundgren lived.

There's maybe, I don't know if you think that there's a reason to think that proximity and time is relevant and then to search further for other factors.

DR. KOPLAN: No, I agree with you. Proximity and time is relevant, but it's proximity, and time, and what is that time, and in which pieces of equipment. Is it just the sorter or is it these other pieces as well, and then what does one learn from that? And there may be more to learn from it, but we know there's cross-contamination, and we know that some people can get sick from this cross-contamination.

So what we're trying to sort out is what further information will we gain that would help us in the investigation, and we haven't shut that off, but we're working w the Postal authorities to try to sort out what that might be.


DR. KOPLAN: Thank you.

HHS MODERATOR: Next question, please.

AT&T MODERATOR: Thank you. Your next question comes from Susan Dunser [ph] with NewsHour with Jim Lehrer.

QUESTION: Yes, good afternoon, gentlemen.

My question is how alarmed, in effect, we should be from what you just said, Dr. Koplan, which, if I understood it correctly, the possibility exists for tens of thousands of additional pieces of mail to have been contaminated, which may be coming into the hands of individuals who, for unknown reasons, may be as immune compromised, apparently, as Mrs. Lundgren was or has some additional--something going on with her, as in the case of Ms. Nguyen, that obviously made her susceptible to this.

So what you seem to be suggesting here is a scenario where, as we know in the case of the one letter, the Seymour letter, one spore was found on it. It's hard to believe that whatever piece of mail went to Mrs. Lundgren if, in fact, that's what happened, it possibly didn't have many more spores than that on it.

So we now have a possibility of a very limited number of spores being very widely disbursed over lots and lots of mail, potentially even now being received by individuals. Is that, in effect, the upper bound of what could be happening here? And if so, what do you advise the message to be that we transmit to the public about the degree to which we should be worried now about cross-contamination of mail?

DR. KOPLAN: What you describe is an uncomfortable situation, and we do have probably cross-contamination of mail, but we have had for several weeks, with probably low levels of spores on letters in a relatively wide distribution. Nevertheless, the important thing is in the observation of the family that received this letter with a spore and one colony on it were not sick and had no symptoms and have not gotten sick.

We are now probably 8 weeks out from when these letters first passed through, and with each passing day the lack of further cases occurring is grounds to diminish the risk from any one of these letters. But what you say is true in the fact that there are cross-contaminated letters. That mail has been distributed. I think the risk to any one individual is very low, but there may be, in the case of individuals whose immunity is compromised, that it may pose a greater risk to them.

However, we've had very intensive case surveillance going on throughout the country and have not turned up more cases. May we find more? Yes, we might. Could we have missed some? Yes, we might have. But, nevertheless, we're getting lots of reports of cases that don't turn out to be anthrax. I think people are very sensitive to this and are looking.

What would I say to people in terms of getting mail that might be possibly contaminated, it would be that if you personally know that you're immunocompromised in some way, you might be more comfortable having someone deal with your mail or you might be comfortable dealing with it, but washing your hands after you deal with it, probably not bringing the mail close to your face is wise if there's that concern. That's basically where we are at the moment.

DR. HENDERSON: This is D.A. Henderson speaking.

I think you're jumping to the conclusion here that this is the way that both of these people or at least one of them may have been infected, and I think we have difficulty in accepting that as fact, at this point, and the reason is that there's been a great of experimental work done in endeavoring to infect monkeys at various times in the past by various quantities of spores.

There's been a lot of study done in goat hair processing mills, where there was a lot of spores in the air. There's been quite an extensive study on this. And it certainly, from all that we have seen, everything indicates that it is just not that easy to infect someone with spores of anthrax and cause inhalation anthrax, and the fact we've had just 20 cases in the whole of the 20th century certainly bears that out, when there's certainly been a lot of people exposed in a lot of different circumstances.

So it's for this reason that we're reluctant to go ahead and say now we've got the answer and that one needs to be worried about every piece of mail that's even contaminated because all of the evidence we've had before indicates that this is not that sort of a risk.

And so we've got pieces of information which really don't add up, and this is the reason that Jeff has indicated that there's a lot of work going on yet, and that the answer is, by no means, definitive, and there's no reason, at this point, to rest on our oars because we've got a lot of questions yet to answer about these cases.

QUESTION: Okay, just one quick follow-up. The Secretary, though, was quoted, and perhaps in an erroneous press report today as saying that there is now the feeling, at least on his part, that there's enough evidence to label the death of Mrs. Lundgren a case of cross-contamination. So I would be grateful if you would clear that up if, in fact, that's not what is now believed, first of all.

And, secondly, on the matter of the other lines of investigation that are being pursued, if you could mention what some of the other explanations are that are now being actively pursued. If there are any that seem anywhere near as credible as the cross-contamination scenario, I'd love to hear about that as well.

SECRETARY THOMPSON: Basically, on the cross-contamination, the question was asked, and I responded that this certainly solves part of the mystery, and it does solve part of the mystery that there has been cross-contamination, and cross-contamination has caused cutaneous anthrax poisonings to date.

In regards to the other things that are being looked at is the itinerary of the two individuals to find out where they went and what kind of people they met to see if there was any encounter in which there might be a more plausible explanation or more evidence to find any kind of anthrax exposure whatsoever. We haven't found that. As of right now, the only thing that we have found is the cross contamination, and so that's high on our list but it's not the only thing that we're looking at.

We're looking at the possibility, was that somehow, somebody was able to give her some anthrax. Did she run into some anthrax? We haven't found any evidence of that whatsoever.

The only evidence we've found so far is the cross contamination, and that leads us to certainly look at that very seriously.

QUESTION: Okay; thank you.

HHS MODERATOR: Next question.

AT&T MODERATOR: Thank you. Your next question comes from Sean Laughlin [ph] with CNN. Sean Laughlin, your line is now open.

HHS MODERATOR: Next question, if he's not there.

AT&T MODERATOR: Thank you. Your next question comes from Rick Weiss with Washington Post.

QUESTION: Hi; thank you. I'm wondering, you said you're still trying to decide whether, or to what extent it's going to be worthwhile to do a full-blown survey, checking out into the outer reaches of these various pathways where cross contamination may have spread to by now, and I take it that could include not only looking at letters that have been delivered but also mail carrier bags, and so on, to get this information.

It seems to me--tell me if I'm wrong--that even if there is not a lot to be gained, immediately, in the way of finding forensic information that would help you find the perpetrator, or protecting people, or making policy because the spores are just too rare, it's still a golden opportunity to get some epidemiological work done, so that next time someone puts anthrax in the mail you will actually have some data as to how far these things spread and how long they hang on.

Why isn't--I mean, that seems to me what CDC is in business to do most of the time.

Why isn't that epidemiological study going on?

DR. KOPLAN: We've got a fair number of epidemiologic studies going on and when we do epidemiologic studies, normally you try and answer a specific question, and have the study designed to give you that answer, and not leave you a little unclear at the end.

Tracing letters is fine if you know both the route of the letter and what happened to that letter in the course of its progress, so that it's not--you know, this idea that there's some finite number of letters at one particular spot in the post office, that are special, may or may not be true, and as I tried to indicate before, there's enough other activity that goes on in that processing, that focusing on a given set of letters at the moment, that we can see, isn't the--won't give us the answers we need.

One of the things--we have evidence, ample evidence, epidemiologically now, that there is cross contamination. There is evidence that that cross contamination can cause cutaneous anthrax, and what we're trying to do now, epidemiologically, is, as you say, work with the postal system.

Our major epidemiologic thrust now is working with the information that the postal system has, and, indeed, we have one of our senior epidemiologists that has moved from the Connecticut team to postal system headquarters in Washington, working with their staff, doing, looking at this letter passage and routes that they went, and what we're trying to sort out is what would be the best studies to undertake now to answer some of these questions.

QUESTION: Thank you.

HHS MODERATOR: Next question?

AT&T MODERATOR: Thank you. Your next question comes from Susan Lilly [ph] with CNN.

QUESTION: Good afternoon, gentlemen. This question is for Mr. Secretary Thompson. With this new announcement, right now, that you can see from Tom Ridge, about an unspecified threat, I'm wondering if you can share some of the briefings you must have had with regard to your territory.

Is there any indication that we're looking at something biochem? If I could follow with what kind of measures do you go through, now that this is the third such alert we've received?

What changes in your territory with this kind of alert?

SECRETARY THOMPSON: Well, we are very much on alert over here. As you know, I have put Dr. D.A. Henderson in charge of overall preparedness, and today we're having an ongoing meeting with Phil Russell who's the retired major general from USAMRIID who is a consultant to us. Jerry Howard is in from New York, who is a consultant on biochem as well as bioterrorism, and he's the one that put together the City of New York's plan for bioterrorism.

We also have Mike Asher [?] who is very much involved with laboratory protections and laboratory development.

Dr. Henderson has been putting together an ongoing plan and we've just increased our vigilance once again, even though it was very high, even before the further announcement from Governor Ridge.

Of course Scott Lillibridge is also up here, full time, from Atlanta, for the duration. All of these individuals are meeting daily with me and we're meeting with Homeland Security, interaction with them on a daily basis. In fact I just left the White House on a different subject, but both Governor Ridge and the President and other individuals were there, and I did have a chance to talk to Governor Ridge.

We're just looking at all possibilities and preparing plans to follow through, if something does come.

QUESTION: And if I could follow up. Have there been any lessons learned form the previous two announcements like this, that intelligence has indicated that yes, in fact you were dealing with a biochem threat that was either not carried through or that was prevented?

SECRETARY THOMPSON: I get daily briefings, top security, that we discuss all of the things that are put together on the threat matrix, and sometimes there are threats about biochem, radiological, and nuclear, as well as bioterrorism dealing with biological agents.

We monitor each and every one. Those individual rumors or tips are given to Dr. D.A. Henderson for his evaluation and we discuss them.

But right now we are looking at all possibilities and developing plans to respond to any one of these concerns.

DR. HENDERSON [?]: I think I could add that one of the frustrations, sometimes, in prevention, that if you're successful, an event doesn't happen, then you don't know it would have happened if you hadn't been alert. So it's a little bit difficult to evaluate these.

HHS MODERATOR: This will be our last question.

AT&T MODERATOR: Thank you. Your last question comes from Lauren Nergard [ph] with the Associated Press.

QUESTION: Thank you. I'm just struggling a little bit with what seems to be conflicting messages that you're giving. On the one hand you're saying it's really, really likely that it was cross contamination in Connecticut. On the other hand, you're saying but we don't have proof of that.

So if you're saying that yes, there's ample evidence that cross contamination occurred, but all you've found in Connecticut is a trace amount, then what physical steps are you taking to try and prove what minimum level, what trace amount could actually have sickened Mrs. Lundgren?

Are you doing any sort of a recreation study, I mean, or is it just going to be pure chance as to whether you stumble across any anthrax contamination, any mail that she ultimately did receive?


DR. KOPLAN: Yeah. I would characterize our environmental sampling as not stumbling but kind of a purposeful directed search for environmental samples, and as we've been doing throughout the investigation, and in Connecticut, there's been a mixture of epidemiologic investigation and environmental testing.

Can one do an experiment that determines what the minimal dose is that will cause disease? None that we've been able to think of.

In this instance, as with many naturally-occurring epidemics, but this is a bioterrorism event, obviously, you can end up with epidemiologic indicators as to what the cause is but not with the definitive scientific proof that we all might like, and that's where we might end up here.

I think what we're saying, repeatedly, is not that this is clearly or even most likely to be cross contamination. We think that the likelihood of that has certainly increased as we have no evidence for other things, and as there is further evidence that the mail is cross contaminated in many sites, and may be the case here.

But we're continuing to look and would like to have more evidence that this is the case.

As Dr. Henderson indicated earlier, for such a low level of exposure to cause inhalation anthrax, would be extraordinary, given past scientific information, but throughout the course of this investigation we've learned new things on a regular basis.

So where we are is we're still in the middle of an investigation. We've learned some new pieces of information, regularly, in this. They've guided us and continue to guide us in different ways, but they don't give us a clear answer.

QUESTION: But you are suggesting that people who know that they're immune-compromised might want to take even more steps than the wash your hands after you handle the mail advice that has already been out there.

DR. KOPLAN: I think, you know, people have a right to be uncomfortable about this. We don't have all the answers, and people would like to have some reassurance that we know exactly what's going on, and we don't.

Given that level of discomfort, if folks will feel better in terms of dealing with the mail, to take some extra steps, we can't say that they're based on guidelines or any scientific evidence we've got, but they certainly would not be harmful and would be prudent for their piece of mind. That's the stage we're in at this point.

QUESTION: Okay; thank you.

HHS MODERATOR: I want to thank everybody for this afternoon's call. Bye-bye.

AT&T MODERATOR: This concludes today's conference call. We appreciate your participation.

[End of conference.]

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