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Telebriefing Transcript
Anthrax Research Update

December 12, 2001

CDC MODERATOR: Good afternoon. Welcome to our telebriefing. Our spokesperson today is Dr. Bradley Perkins. We do have a number of callers on the line, so as a reminder, please limit your questions to one. If you do have a follow-up question, that's fine, but know that, if necessary, we may have to stop you after two questions so that everyone gets an opportunity to participate.

Dr. Perkins.

DR. PERKINS: Good afternoon. There's been some interest in a research meeting that we held here, in Atlanta, over the last two days, and I wanted to briefly make a few statements about that.

The title of the meeting was Bacillus anthracis, bioterrorism research priorities for public health response. The objective of the meeting was to work with federal partners and other stakeholders to identify, prioritize, and coordinate near-term Bacillus anthracis bioterrorism research for public health response, and the problem this meeting was trying to address is that during this investigation, we and our partners have identified a number of areas where additional research may be useful in improving the public health response, and the disciplines and specific expertise required to approach many of these areas are varied and exist within multiple Federal Government entities, and elsewhere.

So to begin to address these questions, we convened a meeting to obtain input on critical research priorities and coordinate with federal partners in planning and conduct of applied research that needs to be initiated within the next 12 months.

So we were looking at a, you know, an applied research agenda that has a very short time frame in terms of need to be initiated. There were about 150 scientists that participated. Scientists were from multiple parts of DOD, DOE, the FDA, EPA, OSHA, NIH, the Postal Service, and some representatives from law enforcement.

We broke up into eight working groups, that parses the investigation down in useful ways. The first working group was evaluation of Bacillus anthracis containing powders or substances. The second was epidemiologic investigation. A group on environmental assessment, one on surveillance, diagnosis, treatment, post-exposure prophylaxis and remediation.

What we asked the groups to do is, in each of those eight areas, to come up with three high-priority projects, research projects that needed to be initiated in the next 12 months, and with those as introductory comments, I'll open it up for questions.

CDC MODERATOR: The first question, please.

AT&T MODERATOR: Our first question is from the line of Andrew Revkin with the New York Times. Please go ahead.

QUESTION: Thanks, again, for holding the briefing. Have you, from the medical side, in retrospect, in reexamining what you've seen so far, have you found any difference between the disease-causing ability of the anthrax that was released at American Media, and that that was released in the Hart Building and also, obviously, sent a trail of spores along through the postal facilities?

DR. PERKINS: Disease-producing ability? Can--

QUESTION: Qualitatively, are there any differences that you can see in the material in Florida, that pretty thoroughly contaminated a three-story building, and the material that was dispersed, sent to the--

DR. PERKINS: It's hard because we don't have the powder or an envelope in the context of the AMI investigation. Although there were a number of suspicious envelope stories, when we went with the FBI to try to identify a suspect envelope, we found that all the mail from the period of time of interest had been incinerated.

So it's hard to correlate, you know, powder characteristics with the disease we saw down there. I think there, you know, there was some epidemiologic evidence of different powder qualities based on the New York epidemiology versus the Washington, D.C. epidemiology, where, in New York we saw predominantly cutaneous disease, whereas in Washington, D.C. and in Florida, we saw only inhalational.

In the Hamilton, New Jersey-associated outbreak, there was a mixture of the two disease types, so--

QUESTION: Were there thoughts on the "why" there? Some people have thought that there might have been some degradation of whatever went to NBC sort of post-mailing; in other words, that it might not have been qualitatively that different when it was put in the envelope, it might have been degraded en route.

DR. PERKINS: I think that that's a reasonable hypothesis, and certainly, you know, moisture, even in the form of humidity, certainly in the form of rain or other more direct moisture, could very much change the characteristics of the powder while it was in transit. So, you know, I think that that's a reasonable hypothesis.

CDC MODERATOR: Next question?

AT&T MODERATOR: And if we do have any questions at this time, please press the 1 on your touch-tone phone. You will hear a tone indicating that you have been placed in queue, and you may remove yourself from queue at any time by depressing the pound key. And if you do have a question, please press the 1 on your touch-tone phone.

Our next question is from the line of Sanjay Bhat (ph) with the Palm Beach Post. Please go ahead.

QUESTION: Yes, thanks for holding these briefings. Dr. Perkins, do you have any more information that would support the theory that the spores in the Connecticut lady's home, if there were--if they were there, that if they arrived there through the mail, that they would have been able to re-aerosolize once they had settled on the ground? There's been a lot of press lately on this question, and is there any research that could answer that question?

DR. PERKINS: I think there is research that can answer that question, and that was one of the outcomes from the meeting we've held over the last couple of days, and that is to reopen some of these issues of re-aerosolization.

In regard to the investigation in Connecticut, I mean, speculating that cross-contamination of the mail would occur and then that cross-contamination would be associated with re-aerosolization and causing inhalational disease is contrary to most of the dogma available from research studies done since the 1950s. So whether there was an alignment of, you know, multiple rare events, where there was cross-contamination and then some other--some other event that, you know, strongly energized particles to result in re-aerosolization is one of the things being explored. And, you know, things like cross-contamination and then somehow getting into a vacuum cleaner system, those kinds of, you know, alignment of multiple rare occurrences, setting up to cause re-aerosolization, are things that are being explored.

CDC MODERATOR: Next question, please.

AT&T MODERATOR: Our next question comes from the line of Michael Ocuin (ph) with CNN. Please go ahead.

QUESTION: Hi, yes, it's Michael Ocuin again. I thank you for having this.

My question goes to the--goes back to the thousands or tens of thousands of letters that were processed at or around the same time as the Daschle and Leahy letters. Those letters presumably went out around the country, if not just along the East Coast somewhere. And we know that postal inspectors are able to determine what processing centers, what additional processing centers that they go to before reaching their ultimate destination, to their ultimate addresses.

Have you at the CDC determined those particular processing centers? And are tests being conducted or plan to be conducted at those places? And sort of a follow-up question to that is: We also know that the CDC and postal officials know about the ultimate addresses of some of those letters, and we've been told for the past week or two that there is no plan at this point, at least publicly, to find those people or to conduct tests or do anything of that nature. And the reason I ask this is that there are plenty of people who sometimes hold on to their mail, sort of stack them up in a corner, and I'm just wondering whether the CDC is looking into that and has considered that possibility.

I know it's a long question and there are two, and I appreciate your indulging me.

DR. PERKINS: There are actually millions of pieces of mail that went through the implicated sorting machines prior to those facilities being closed. And one of the number--one of the estimates was included in a recent MMWR, but it's literally millions of pieces of mail.

Most of them went to metropolitan areas around the implicated postal handling facilities, but literally they went to, you know, all over the country.

We think based on available data, you know, clearly that there was some level of cross-contamination, that that level of cross-contamination represents an extremely small health risk. And that's demonstrated by the lack of cases associated with cross-contamination, particularly in the Washington, D.C., area where we've had very aggressive surveillance for cutaneous disease and inhalational disease in a population that received cross-contaminated mail, and we did not find--we have not found any evidence for either cutaneous or inhalational disease in that area as a result of that phenomenon. And with every passing day, obviously, the likelihood of identifying additional cases resulting from cross-contamination of these isolated events becomes less and less.

CDC MODERATOR: Next question, please.

AT&T MODERATOR: The next question is from the line of Henry Neiman with Net Talk. Please go ahead.

QUESTION: Hi, thank you. Thanks for having these conferences again.

I had a question. I had noticed that one of the questions that came up from the scientists that you had interest from was the--whether one spore--or how low the number was as far as being able to cause inhalational disease. And there seemed to be this correlation that you alluded to with the batch, that the material that went to New York seemed to just cause cutaneous, and at least at Brentwood and Florida it was just inhalational.

So as far as designing some of these experiments, will any of the material that was actually mailed be available for studies, such as from the Leahy letter to see if there's something within the preparation that makes it more lethal, or display these unusual characteristics, where one batch will cause inhalational, exclusively, and the other seems to be just cutaneous?

DR. PERKINS: That's a topic that's been, you know, very thoroughly addressed by many of the scientists involved, and we have considered trying to do a variety of research activities, using the actual powder in any of the implicated letters.

There's a number of concerns however, about doing that. First, from the law enforcement perspective, there's concerns about the integrity of evidence, and then from the laboratory or scientific side, there's concerns about the safety of doing such experiments, and, to date, we have not really tried to do any reaerosolization, or primary aerosolization studies using the actual powder, and I think the approach that is most likely to be taken is rather than using this actual material, is to understand, you know, the characteristics of this material and use a nonpathogenic simulant, such as Bacillus gorbegii [?], which is one that's been traditionally used and has the same kind of a spore that's indistinguishable, and, you know, prepare it as closely as possible to how this material was prepared, and to use that to do some of these experiments to better characterize the risk around envelope opening, and envelopes in transit through the mail system.

CDC MODERATOR: Next question, please.

AT&T MODERATOR: Our next question's from the line of David Kassenbaum with National Public Radio. Please go ahead.

QUESTION: Hi. Some of the preliminary studies in Daschle's office suggested that just by moving around it was pretty easy to get the spores back into the air again. On the other hand, there are those early military studies that suggest that once a spore landed somewhere, it really stuck. How do you reconcile these two bits of research?

Is it possible this is a different material than the military was using?

DR. PERKINS: That's possible. I think one of the things that was discussed during the meeting over the last couple of days is the potential for material, you know, small particle-size material to remain suspended, or very lightly dispersed on environmental surfaces, if the air-handling system is turned off, as it was in the Hart Building.

So there was fairly vigorous discussion during the meeting about whether, you know, having the air system turned off was the explanation for this, and the difference that was seen with the military studies.

QUESTION: How would that work?

DR. PERKINS: Basically, if there's any kind of ventilation or flow of air, the small particle-size preparations behave as a gas and disperse, you know, and very rapidly become diluted into the, you know, the larger environment. If the air is turned off, while you may limit a spread in the immediate area, this gas may basically stay stagnant, and settle out very slowly, over time, so that you set up a situation where relatively small particles become very lightly settled on environmental surfaces, and can be easily reaerosolized with minor disturbance in the room. So that was the explanation offered during the meeting over the last couple of days.

CDC MODERATOR: Next question, please.

AT&T MODERATOR: The next question's from the line of Ellen Beck with United Press International. Please go ahead.

QUESTION: Thank you, Dr. Perkins. Can you just give me, you know, not going through 24 projects here, but what are the top three research projects and how soon can you get them going?

DR. PERKINS: I'd say probably three of the top projects that were identified was we think we need to move aggressively to make available anti-toxin therapy as an adjunct to antibiotics for future cases of disease, and that's in progress, actually, at the present time, and getting that reagent available to treat additional cases was a clear, high priority

The other--one of the other areas was better characterization of aerosol risk around envelope--contaminated envelopes in transit, and that includes, you know, evaluating aerosols produced from the entry of envelopes into the mail system through all aspects of processing, and then relooking at the dispersion characteristics associated with opening of envelopes.

I think a third one, a third area of clear interest is additional animal studies to better understand the best post-exposure prophylaxis regimen, for example, the duration of antibiotic therapy and how dose might affect needed duration of therapy. The central role of vaccines as an adjunct to antibiotics for post-exposure prophylaxis clearly needs to be better understood for us to make good public health decisions.

CDC MODERATOR: Next question, please.

AT&T MODERATOR: Our next question is from the line of Lynn Adrini with ABC News. Please go ahead.

QUESTION: Again, thank you very much for holding these calls. Just one question about whether or not there have been any other cases anyplace else in the past 20 days.

DR. PERKINS: The last case that we're aware of is the case that occurred in Connecticut. We've had no additional reports of cutaneous or inhalational anthrax since that time.

CDC MODERATOR: Next question, please.

AT&T MODERATOR: The next question is from the line of Kristen Reeve of Bloomberg News. Please go ahead.

QUESTION: Hi. I just wanted to clarify again--I'm sorry to keep going back over what I think some of the questions have touched on, but it seems like--you know, it would be very reassuring to believe, I think, in a way, that the Connecticut case and perhaps the New York case stems from some sort of cross-contamination or tertiary cross-contamination, because that would suggest that the only threats that are out there are ones we already know about.

But what I'm hearing you and some other people saying is that the possibility of that happening is actually--you know, it seems like a long shot in terms of the number of things that would have to occur for that to happen. And I guess I just wondered if there were other theories that were as plausible or if there were other things that we should be looking at in terms of how that happened.

DR. PERKINS: That's an excellent question, and, you know, one of the reasons we continue to entertain and look very closely at cross-contamination is it still remains--it still remains the leading hypothesis in terms of supporting evidence. You know, however unlikely it may be, we do not have another good hypothesis that's supported by any evidence that we've identified so far. But the pieces don't fit, and when the pieces don't fit, you know, we feel quite compelled to continue to look for other explanations.

QUESTION: Okay. Thanks.

CDC MODERATOR: Next question, please.

AT&T MODERATOR: The next question is from the line of Tina Heston with the St. Louis Post. Please go ahead.

QUESTION: Hi. This question is along those same lines. Are there any plans to conduct research studies to figure out if older people or those with compromised immune systems might have different thresholds for infection than 18-year-old battle-ready soldiers?

DR. PERKINS: Yeah, there is extensive discussion of that over the last couple of days because, as has been recognized, there's some--there are some limited data suggesting that perhaps older individuals and persons with certain kinds of underlying diseases, perhaps those that affect macrophages that are responsible for handling these spores may be more predisposed to illness.

A couple of approaches were discussed. I mean, first, we're going to try to look very carefully at the groups of people where disease occurred and compare characteristics of those that acquire disease with characteristics of other people that were exposed but didn't get disease.

The problem with that is that the number of cases in terms of statistical power is relatively small, and there's a relatively small spread of age groups, you know, those constituting, you know, working Americans for the most part. So that's--we're going to try that, but that may not resolve the issue completely.

There is discussion about, you know, the animal studies that had been done, and those studies all being done among adult--you know, basically the military equivalent, you know, in sort of young healthy adults, but in animals. And, you know, there is the potential of doing studies in younger animals or older animals, and that was discussed as a possibility, but it wasn't anything that people identified as a high priority.

I think what's going to happen is, you know, we're going to try to look at the data we have from this investigation and see if anything emerges from that and decide where to go from there.

CDC MODERATOR: Next question, please.

AT&T MODERATOR: The next question is from the line of David Caravello with CBS News. Please go ahead.

QUESTION: Hi, Doctor. About a month ago, there was a fairly deliberate assertion that we were about to start vaccinations of lab workers as well as first responders. Is there anything definitive on whether the IND has been completed, whether the Defense Department has agreed to provide any vaccine, and has anyone been vaccinated, or how far away is this issue? And do we know if Dr. Koplan is going to take a facility of a postal center, as the post office had indicated a week ago was going to offer them that opportunity?

DR. PERKINS: Say that last part of your question again. I missed that. I'm sorry.

QUESTION: About a week ago--this was not on camera--at a briefing of reporters, the post office indicated it wanted to take Dr. Koplan on a tour of a postal facility, I thought in the near future, just for mutual understanding of how that system works. And I wondered if that--is anything (?) or if it's scheduled, about to be scheduled, or if it's just (?) .

MS. HAWKINS: David, this is Katie Hawkins. I'm not sure if that invitation--or, you know, an invitation like that has been extended, but I'll check on that for you and get back to you.

QUESTION: Thank you.

DR. PERKINS: Regarding the vaccine, CDC does have an IND protocol on file with the FDA--that's an investigational new drug application--that would allow us to use vaccine, you know, for pre-exposure and post-exposure situations in the context of this outbreak. And as recently as last week, the final arrangements were made for vaccine that had previously been owned by DOD to be--to be now owned by the Department of Health and Human Services, and that's about 220,000 doses of anthrax vaccine for use in public health response.

The ACIP is advising the director of CDC about the use of a vaccine, and we have had active discussions about use in laboratory workers and other populations. Dr. Koplan is continuing to work with the department in making final decisions, but all of the pieces are in place to move when those decisions are made.

CDC MODERATOR: Thank you. Next question?

AT&T MODERATOR: The next question is from the line of Lee Bowman with Scripps Howard. Please go ahead.

QUESTION: Hi. Getting back to the threshold question, Doctor, there was some discussion a couple weeks ago about going back to some of the areas where anthrax was endemic and trying to get some background readings on levels that seem to be acceptable in terms of not producing disease. Was that discussed at this time, or is that already underway in some fashion?

DR. PERKINS: That was discussed and considered an important activity to begin, and we're interacting with several states that have endemic animal disease and trying to find the best situation to do those studies. I do think they will be done over the next couple of months.

CDC MODERATOR: Thank you. We have time for one more question.

AT&T MODERATOR: The last question is from the line of Bob Roos, news editor of University of Minnesota Infectious Disease Webcast. Please go ahead.

QUESTION: Yes, thank you. I think my question was just asked, but I wondered if the research on background, on natural background levels of anthrax, if there were any results from that yet.

DR. PERKINS: You know, we want to do those studies, but we've really focused on the places that are contaminated as a result of this incident and trying to make sure that we've learned everything we can from these--from these situations before they're--they're remediated, you know, by EPA and other folks. And so we've deferred somewhat those other studies because we don't want to miss opportunities to learn things in the current situation.

CDC MODERATOR: Thank you, ladies and gentlemen, for joining us for this telebriefing. The transcript will be posted later this afternoon.

AT&T MODERATOR: Ladies and gentlemen, that does conclude our conference for today. We thank you for your participation and for using AT&T Executive Teleconference Service, and you may now disconnect.

[Whereupon, the telebriefing was concluded.]

Listen to the telebriefing

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