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Telebriefing Transcript
MMWR and Anthrax Update with
Drs. Koplan, Sokas and Sanderson

December 20, 2001

CDC MODERATOR: Thank you very much, everyone, for joining us today.

We have two topics and several spokespeople. We'd like to spend the first 15 minutes, at least, focused on the MMWR article released to media this morning, titled, "Evaluation of Bacillus anthracis contamination inside the Brentwood Mail Processing and Distribution Center, District of Columbia 2001."

Our spokespeople are Dr. Rosemary Sokas, S-o-k-a-s, who is the associate director for Science at CDC's National Institute for Occupational Safety and Health, as well as Dr. Wayne Sanderson, S-a-n-d-e-r-s-o-n, who is a chief industrial hygienist at NIOSH.

After that 15 minutes, we'll open it up to questions, either on the MMWR article or just general questions on the anthrax investigation and CDC's response, and we have with us CDC Director Dr. Jeffrey Koplan.

Please note that all information pertaining to the MMWR is embargoed until 4:00 p.m. today.

First, we'll start with some opening remarks from our NIOSH spokespeople.

DR. SOKAS: This is Rosemary Sokas. I just want to review, very briefly, that the article that appeared this morning was the result of more intensive sampling that was conducted in the Brentwood facility, once the inhalational cases of anthrax had been identified. There had been prior sampling, once the senator's original letter had been identified, that had been conducted by contractors, and had identified surface contamination of the building.

However, once the additional risk was appreciated, more intensive sampling was applied. This really pushed the limits of what was known about how to sample for anthrax in the environment beyond what had previously been available.

Using more intensive methods and standardizing them through this process, a protocol evolved that showed that both the surface wipe sampling and a new procedure relying on vacuum sampling were complementary to each other and able to identify additional sites of contamination.

That knowing that this was a facility in which inhalational anthrax had occurred, by looking at the intensive surface sampling patterns, several clear patterns seemed to emerge. One, that by identifying widely dispersed areas of surface sampling, and by identifying positive surface samples in locations unlikely to have come in contact with the letter, such as in an intake vent in the ceiling, or on rafters, gave a credible pattern that could be used, perhaps, in future, to identify the likelihood that aerosolization had occurred, and, finally, the new method which was using the vacuum sampling was validated as a useful additional tool in investigating these sites.

I apologize. Our industrial hygienist is en route. He has actually been trying to further resolve the precision of some of these methods and has been at Brentwood this week, and he's not in the room right now. We anticipate that he should arrive any minute.

CDC MODERATOR: Okay. We can start taking questions, then, on the MMWR article.

AT&T MODERATOR: And, once again, ladies and gentlemen, if you do have a question, please press the one at this time, and our first question is from the line of Lauren Nergard [ph] with the Associated Press. Please go ahead.

QUESTION: How much more did this intensive sampling tell you, since we did already know that Brentwood was very highly contaminated, and what does it say about cleanup of the building?

DR. SOKAS: It really doesn't help direct cleanup of the building any more than we already knew. We already knew it was terribly contaminated. What it did, I think, was help us really understand what a contaminated building looks like, to then apply it, as needed, in the future.

So that was probably the major thing it accomplished. It also, however, did demonstrate that the contamination was even more widespread than had initially been thought to be the case, and does have implications for the intensity of the cleanup effort that would be needed.

Prior to any cleanup effort, there's additional characterization sampling that's always required to make sure that you've really got a good handle on every place it could be.

AT&T MODERATOR: Our next question is from the line of Sam Java [ph] with the Palm Beach Post. Please go ahead.

QUESTION: Yeah. Did the sampling give you an idea of whether the Postal Service's plans to irradiate mail might not be adequate? Were there other areas of the facility that were contaminated, that, you know, would shed some light on other preventive techniques they could use to protect workers?

DR. SOKAS: It really doesn't address that. The interpretation of the widespread nature of the contamination is really that this still seems to have come from those envelopes that passed through. As you probably know, back at that time, the way these machines were being cleaned out was with air hoses blowing the dust out of the machines. That's since been stopped, of course, and the machines themselves are being cleaned through vacuum, hepa.

So that's probably the more important piece of information, not whether irradiating the mail is the best route to go or not.

AT&T MODERATOR: And we have a question from the line of Sean Laughlin [ph] with CNN. Please go ahead.

QUESTION: Hi, Doctor. Could you just expand a little more, when you said the contamination was more widespread than initially thought. Just give me a sense of what you mean. Is it in terms of the area covered, the concentration of spores? Just if you could elaborate a little.

DR. SOKAS: It was actually both. There were locations quite distant from the known machines and from the bins that were positive, that had not initially turned up to be positive, but with the more intensive methods, did turn up to be positive. In addition--and, again, this is difficult to interpret, but the number of colonies grown from the different samples was also higher than anticipated in some of the locations.

So it basically confirmed the intensity and wide distribution of the exposures.

AT&T MODERATOR: And we have a question from the line of Greg Smith, New York Daily News. Please go ahead.

QUESTION: A two-part question. Does this same process that you applied to the Brentwood facility, is it appropriate to do the same thing up in Trenton, New Jersey? I mean, what have you done about this, or what are you going to do about it?

Also, can you describe, based on what you've found there, what you think happened when the letter actually got into the facility.

DR. SOKAS: I can make a stab at both of those. This information has been intensively shared with the Postal Service and with the public health community, and with the postal unions, and in fact the Postal Service is adapting these different procedures and has expanded its sampling methods. I believe that these methods are now being used for sure in those facilities where there have been problems.

The information that has been available on those facilities has been more complete than was initially the case, and that information is getting better as these methods come online. So that's the one question.

Yes, I believe all of these techniques are now being utilized in areas where the Postal Service has problems.

Secondly, we do believe that the likely scenario is still the one where the letters came through, where these machines basically slammed up against the letters, so it's a fair amount of energy that is transmitted to the letters as they go through the sorting and stamping and various processes. That, in addition, these are large warehouse-like facilities where there are lots of air currents.

So the thinking is that in the absence of specific efforts to limit air flow, such as plastic sheeting strips and that sort of thing, that these machines likely released puffs of spores into the environment and that the distribution through these fairly significant air currents--if you've been in one of these facilities, you will see that the machines are loud, and they bang, and they do all this stuff, but there's air coming through, and that particularly when they're shut down then for clean-out, when there was air hosing used as the clean-out, there would clearly be the opportunity to disperse it widely in the air.

AT&T MODERATOR: Our next question is from Adrian Hufstetler [ph] with the Richmond Times-Dispatch. Please go ahead.

QUESTION: My questions are for Dr. Koplan regarding the anthrax vaccine. Are you folks ready to jump to that yet, or--

CDC MODERATOR: I think we can start doing that, but, first, I'd like to invite Dr. Koplan to make some brief opening remarks, and then we'll start with your questions. Thank you.

DR. KOPLAN: Sure. Thanks. I'd like to give you an update on the logistics of providing anthrax vaccine to persons exposed to anthrax spores in these recent bioterrorist acts. Even as I'm discussing it, CDC staff are working with both the federal contractor and health officials in the affected areas--Florida, New York, New Jersey, Washington, D.C. area, and Connecticut, to put steps into place to safely and effectively administer vaccine to those exposed persons who wish to receive it.

We fully understand that it's frustrating for those who've been exposed and the people who take care of them, that the Government can't make a strong recommendation about who should receive vaccine, and the reasons for that are, as has been the case with many aspects of this bioterrorism event, that we have inadequate science upon which to base such a strong directive recommendation.

By the same token, our alternative would be to do nothing, which we don't think is in the best interests of the health of the people exposed.

So what we have done is taken what information we have, which is germane to this, both the information that we've gained over a day by day basis in this bioterrorism event, look back over the really scant scientific literature that offers some insight into post-exposure prophylaxis, and, on the basis of that have offered to folks who had some greater level of exposure, the opportunity to extend beyond the 60 days of antibiotics they took for preventive purposes, to taking either a longer period of antibiotics, 40 days, or a longer period of antibiotics and vaccine.

All the people who were potentially exposed, there are three groups of people within the larger group who should seriously consider this more aggressive therapy.

One, people who had significant contact with an anthrax-contaminated powder or envelope. Two, people who work in areas where someone developed inhalation anthrax, and three, people in environments confirmed to have been heavily contaminated with anthrax spores.

CDC is deploying five teams to the affected sites, to both help with logistics, to consult with the exposed persons about the risks and the benefits of the available options, and those are significant for each of these options, and it requires some detailed understanding of what we know and what we don't know about each of these approaches.

In addition, exposed persons can call CDC, for those who speak English, at 1-888-246-2675, and for those who speak Spanish, 1-888-246-2857, for referral to an appropriate site coordinator for more information.

I'm happy to answer any questions, and there's someone there with a question, I believe.

CDC MODERATOR: Right. Do you want to go ahead and ask your question now?

QUESTION: Yes. Dr. Koplan, hi. It's Adrian Hufstetler with the Richmond Times-Dispatch. I've been told that the CDC has been working on a consent form for the vaccine. Has that consent form been finished, and when will it be released?

Then my follow-up question--I have some follow-up questions, then, regarding information contained in the consent form.

DR. KOPLAN: The consent form was completed and is useable now, and is available, and I think our press office can help you get a copy of that.

QUESTION: Okay. My follow-up question, if I may, is there information in the consent form regarding the FDA's concern about BioPort's vaccine and BSE?

DR. KOPLAN: And what was the last?

QUESTION: The FDA recently updated its list of vaccines made with bovine-derived materials from countries with BSE and BioPort's anthrax vaccine remains on the list. Is there any mention of this link in the consent form?

DR. KOPLAN: The FDA did not indicate that there was any risk or concern about bovine spongiform encephalitis in our discussions around this. The consent form is pretty detailed and describes, you know, a wide range of potential risks and benefits to this, and I think a major one that's worth mentioning, is that for anthrax vaccine, most of its experience has been in a military population, so that the ages are fairly discrete, and it's mostly in men, and so in a situation where it could potentially be used for other ages, and a much greater number of women, that becomes an issue of where we have much less information about the vaccine.

CDC MODERATOR: Next question.

AT&T MODERATOR: And that's from the line of Sara Leak [ph] with Wall Street Journal. Please go ahead.

QUESTION: Thank you. It seems to me that in Washington, at least, where the Health Department is saying not--that it's not recommending the vaccine, but it's unlikely that people would ask for it, if that's the advice that they were getting. So I'm just wondering if there are people that the CDC has been able to identify, epidemiologically, by looking at where the contamination was, and that kind of thing, that might be targeted for some specific sort of individual attention about what their risks might be.

I assume that if the CDC's offering the vaccine here, that there might be some people that it would just to be at risk, and how can you kind of make sure that those people know that they're at greater risk.

DR. KOPLAN: Sure. I think those are all good points. One of the issues here is there's a variety of levels of decision making. One is, obviously, we think that this is a concern enough to make the vaccine available and suggest a couple of options that need to be considered.

There are some folks whose obvious exposure in proximity to anthrax-containing powder, and the amount of that contamination are such, that that risk is deemed great, and an example would be people who were in the suite, when the letter that was addressed to Senator Daschle was opened, might be perceived to be amongst the highest risk of anyone involved in this bioterrorism event.

As such, they made the decisions as to what they were going to do, and I don't know what all the individual decisions were, but, again, it was emphasized to them that they might be amongst the highest-risk people, and the Capitol Hill physician was, I think, enthusiastic about using both vaccine and antibiotics.

This last Saturday, we had a scientific meeting that went on for half a day with folks from the D.C. Health Department, state health officers, scientists from Department of Defense and National Institutes of Health and CDC, and academia, in a discussion of this, and I think the general conclusion there was--there wasn't a vote--but the expression of all the people presenting, and discussing afterwards, that it was perfectly reasonable and worthwhile to have this vaccine available for people who might want it or feel they need it, and they being them, their doctors and other consultants, but that not everyone in the room felt that they would recommend it for the people in their area of responsibility, and, indeed, as you've indicated, some of the very competent, talented, and respected professionals in the D.C. area don't feel that this vaccine is warranted, or may be in a much more limited way than others.

Again, that is one of the problems of not having a much more clearer scientific database for the use of vaccine in this circumstance, and any kind of longer-term experience in how this might get used for a population like this.

CDC MODERATOR: Next question.

AT&T MODERATOR: And that's from Lisa Ridgewain of Reuters.

QUESTION: -- administered now and have you gotten any indication of how many people may be interested?

DR. KOPLAN: The first group that wanted to get it--it's been available to everyone at the same time, but the first group who decided that they were ready for it right now were people exposed in that Senate letter, and I think approximately somewhat under 40. 38 people was the last count I heard as of this morning, had received the vaccine. And one of the pressures there was that with Congress leaving session, staffers who were--needed to get the vaccine were going to be out of town and scattering to all parts of the country if not further, and needed to get on quicker rather than later.

In the postal workers who have exposure that merits consideration of vaccine and further antibiotics, both the unions and the Postal Service themselves have indicated that that rush to get people the next day or two is not as urgent. People will be continued on antibiotics as both the individuals involved, the unions, the Postal Service, other consultants they have, reflect on the limited data that's available, decide on what's the best way to get this information out to individuals affected so that they can actively participate in the decision as to what's going to be the best choice for them.

And to further that, we're sending teams out to every one of these sites to help in the explanation and provision of information.

CDC MODERATOR: Next question. And I'd like to point out that Dr. Rosemary Sokas is still on the line if you have questions on the MMWR article as well.

AT&T MODERATOR: And we have a question from Henry Neiman of Net Cog. Please go ahead.

QUESTION: I actually did have a question on the MMWR. A couple of the specifics on the vacuum method, which seemed to pick up quite a few more positive. One question was, how big an area is each of the samples relative to the swipes which were frequently negative? Were they all done on the 24th?

And the range was quite large. It went from 3 [inaudible] units to 9.7 million. The article indicated that by the sorting machines it got up to 2 million. Do you know where the 9.7 million sample was?

DR. SOKAS: I'm actually going to turn this over now to Dr. Wayne Sanderson, who was here, who is the investigator and author.

DR. SANDERSON: Hi. Yes, the 9.7 million sample was collected in government mail. There was a case that worked that did the kind of quality control riffling of the mail.

And, yes, there was quite a bit of difference in the number of positive vacuums versus wipes. And we think part of that reason is, is the vacuum samples covered a much broader area. It might have been 3 or 4 times the size that a wipe sample would have collected. Also we were going for locations where we were going to collect a lot of dust. That's the advantage of the vacuum sample. You could actually collect quite a bit of dirt or debris that would be in an area, whereas, with a wipe sample, you could overload a wipe sample relatively quickly if you have a very dirty area.

MS. : And one point that--and this is still an evolving method--the standard area of what was sampled was not in place at that point, so some of these reflect larger areas and some of them reflect smaller areas. That's been refined over time.

CDC MODERATOR: Next question, please.

AT&T MODERATOR: And that's from Ria Blakey with CNN. Please go ahead.

QUESTION: HI, good afternoon all. My question is for Dr. Koplan. Dr. Koplan, a number of people have already asked specifically about risk, but I wonder if you could give us a few more details in regards to what kind of risks are identified in the consent form, and I just wanted to verify your response to the number of postal workers who may be receiving the vaccine. Are you saying none at this time?

DR. KOPLAN: At this moment I don't think any have opted to receive it. We'll have vaccine and antibiotics and staff at all the sites, but I'm not--I can't tell you today whether at any individual site some workers have requested it or not. But in our daily discussions with the folks in the Postal Service, they've indicated they do want to have some more time for an educational program so that people can make the best decisions for them.

In your earlier question about risks and benefits, I think, you know, in general, there's--one option is for people who have taken 60 days of antibiotics, to stop taking antibiotics and not get vaccine. And then it's important that those individuals carefully observe any new symptoms they develop of any kind, and have ready access to medical personnel who they share with--or who know about their previous exposure and use of antibiotics, are able to say, "I've developed a high fever and a bad cough, or I'm just not feeling well. I don't know what's wrong." But whatever it is, that they have someone to turn to to explore whether they might have developed a late case of anthrax.

The pros and cons for the option two, which is antibiotics alone, are similar to the ones we've described before for antibiotics, which are, they have a certain incidence of side reactions to them ranging from gastrointestinal upset to the potential for allergic reactions, et cetera. And then that certainly just the difficult of taking an antibiotic for another 40 days is appreciated by all of us.

And then the third option of the vaccine and the antibiotic, the antibiotics, again, the problems are potential adverse effects of those are described, and the vaccine, its most common side effect has been--again, in its previous experience and use--is that one, obviously, there's a burning in the arm right after, stinging, burning in the arm right after the shot, usually goes away shortly, but then in some vaccinees it can cause some soreness, redness, itching, swelling in the arm that can last up to a week, and in some of these instance a lump, an actual palpable lump at the site is common. It goes away within a few weeks without treatment, but that is an uncomfortable and disconcerting side effect, and it seems to be more common in women.

In different studies it's ranged, but from 5 percent to about a third of the people who get the vaccine may have muscle aches, joint aches, headaches, malaise, rashes, chills, low grade fever, nausea, symptoms that usually go away within a week. These are--these are the risks which have to be balanced again against what's really an unknown benefit.

It's a theoretical benefit, and that theoretical benefit is that in people who had an excessive exposure to a lot of spores--and again we can't point out--and we'd love to have a list and say, "You've got that exposure and you don't." The best we can do is describe these circumstances where people may have been exposed to a larger number of spores, but for those people who did get an excess number of spores, the way the antibiotics work over 60 days is as those spores germinate--change from a inactive spore into an active bacteria, the antibiotics are there to destroy that active bacteria.

The value of the continued antibiotics and/or the vaccine is, should there be a few more spores or some number still being harbored in that individual, as those come out at this stage, they would be taken care of by first the antibiotic, and then over a longer term, by the vaccine. But this is an unknown entity. We don't have evidence one way or the other.

CDC MODERATOR: Next question please.

AT&T MODERATOR: And that's from David Kassenbaum with National Public Radio. Please go ahead.

QUESTION: Hi. Dr. Koplan, the CDC's been criticized is editorials saying it's irresponsible to say "Here's the vaccine, take it if you want," instead of recommending who should take it. "The New York Times" called it a medical cop-out. I know it's been tough for you. I mean, I wonder how these make you feel.

DR. KOPLAN: I feel great about being in public health. I think it's a very important field and it's filled with difficult decision making, and I'm perfectly willing to be saddled with that, if you like. We've got the opportunity to do a lot of good, and here's an instance where we've got a couple options.

We could say, well, we know about this vaccine and we know about the antibiotics, and we know that people--as we look over what went on in the course of this bioterrorist event, may be at more risk than the previous studies that were done that suggested 60 days was about [inaudible].

Now, do we want to stick firmly to what we had said before and not reevaluate data as it comes along? Do we not want to make other options available to people, but arbitrarily say, nope, we're not going to do anything else, and then not have to answer all these questions, or do we say, you know, we don't know everything. We've learned new things as this has gone along. We think that an alternative to doing nothing is to make something that might be really valuable to people available to them, and try to work with them and health authorities to come up with the best conclusions for individuals in this case.

Is it satisfying to us? No. Do we know we get criticized for not being definitive and clear and issuing hard guidelines? Sure, we did, and I'm sure we'll be criticized regularly for other things, but we've got to try to do the best public health that we're capable of doing.

CDC MODERATOR: Next question.

AT&T MODERATOR: And that's from C.C. Connelly with the Washington Post. Please go ahead.

QUESTION: Thank you all. Dr. Koplan, I was wondering if you could shed a little more light on the approval process for this IND, specifically if you could tell us when your IRB first met? I'm assuming that was sometimes in October. What sort of concerns they've raised with you and how the IND has changed over the last 8 weeks?

DR. KOPLAN: C.C., I don't have a timetable in front of me. Well, I don't want to misspeak. The last IRB meeting I'm familiar with took place right after this Saturday meeting that we had, and there was an IRB meeting on Sunday, because I had to ask that it be called on an urgent basis to meet and begin to discuss and get familiar with the conclusions and where things were going based on that meeting. And then our IRB met last night because of--sorry I'll back up.

And then in the aftermath of Secretary Thompson's decision to go ahead and make this vaccine available, then we worked hard to put together consent forms and a protocol for the vaccine that would meet FDA needs, and we had input from the National Institutes of Health and a variety of other players that involved regular revisions of the document, getting the language straight and trying to best convey risks and benefits to the people getting the vaccine. Then that had to be submitted again to the IRB, which isn't behoven to anyone in this event. Their view is what is best and fairest to the potential recipient of something under an IRB. They met last night for two or three hours until fairly late in the evening, and then approved the revised version of the consent form and the protocol, which is what's in use today.

And I guess our press office can give you the earlier dates of IRB meetings.

CDC MODERATOR: Next question, please.

AT&T MODERATOR: And that's from Guy Taylor, Washington Times. Please go ahead.

QUESTION: Thank you for holding the conference, sir. I just wanted to ask about these teams of CDC officials that are going to be sent out to set up the vaccination or educate people. Where are they going to be sent and what are they going to be doing specifically?

DR. KOPLAN: The teams are composed largely of folks who are conversant with explaining medications and explaining the benefits and risks of various procedures, and health educators who can make those explanations ones that people can understand and help them make decisions on.

They'll probably involve anywhere from 4 to 8 people each, maybe a couple more, depending on the size of the group they're likely to find in a site. They're being sent to the affected areas where there were anthrax cases, New Jersey, District of Columbia, Florida, New York City and Connecticut. They will be there working with the local health authorities with whom we've worked all along, and so that would mean the D.C. Health Department and the Palm Beach County Health Department, State of Florida, et cetera, et cetera. And of course with the appropriate employers or unions at the affected sites. So where that involves postal workers, it will be both with unions and with the Postal Service. And where it's in a private setting in Florida--well, Florida involves both potentially postal workers' unions and the private facility that was initially involved.

CDC MODERATOR: Next question, please.

AT&T MODERATOR: And that's from Ellen Bunk, United Press International. Please go ahead.

QUESTION: Yes, thank you very much.

Dr. Koplan, could you clarify for me exactly what delivery of vaccine this is coming from? Is this from the 10,000 from Bioport [ph] that came after the renovations that we discussed on Saturday?

DR. KOPLAN: Yes, it is. I'm afraid more detailed information as to the characteristics would be best from FDA. But it is from the newer lot from Bioport, done after renovations. And I believe--and again, you'll require confirmation on this--but I believe it's lot numbered 063.

CDC MODERATOR: Next question.

AT&T MODERATOR: Susan Livial from the Star Ledger. Please go ahead.

QUESTION: Hi. I know you can't be really specific about which workers ought to be concerned, but particularly at the Hamilton--October 9th. And we're wondering if like for those people, or the 1,500 postal workers who worked at Hamilton all together, is there a hierarchy that you're establishing or that these teams of people will describe about, you know, depending on where you worked or, you know, you should receive the vaccine versus more antibiotics?

DR. KOPLAN: That would make life a lot easier for all of us. The problem is, and here it relates to what Dr. Sokas was describing earlier in Brentwood, which is some of the initial concepts of if you worked in this given area or you worked in this limited time or this letter was next to that letter, that the risk is higher, we don't have grounds really to document that or to say that that's true.

And even the theoretical aspects of it have begun to dissolve when one sees the degree of contamination that can occur in one of these big open spaces. The fact that you can find contamination in distant corners at one of these very large rooms or on other pieces of equipment makes it really hard to say, well, you 120 people that worked on this machine are at greater risk than the 50 that worked over in that corner, and because a couple of the cases that we've seen in different facilities were not necessarily at that one seemingly higher risk location, that undermines the ability to say it's just one site or one time frame.

The other aspect--and you mentioned time or on a given shift. The spores are--during that period of time were around, so it's not--yes, the mailmen have come through at that point, but the spores remained in that room, and through the process of cleaning and the movement of equipment and air currents, were being moved--potentially re-aerosolized, redisseminated, longer than just that night shift. So that's where it becomes a case of the difficult of easily stratifying risk by location or time frame.

Our folks in the field will be working more closely with the individuals to maybe get a better handle on what you just said, which is try to document where they were, where they worked, what time was their period of exposure at which site, and thus try to help them towards a higher level of risk or a lower level of risk, almost has to be done by the individual, once you get beyond the fact that there are certain circumstance where people were clearly of higher risk.

CDC MODERATOR: Next question.

AT&T MODERATOR: Thank you. That's from Dave Altameri with the Hartford Courant. Please go ahead.

QUESTION: Hello, doctor. One of the things--just talking about, people who potentially could get the vaccine, are people who have had significant contact with someone who had inhalation anthrax. I was thinking specifically of the case of Mrs. Lundgren. Who would you think--since you don't exactly know yet how she got it, what is your plan for up here in Connecticut as far as who you might offer that vaccine too.

DR. KOPLAN: Let me just clarify one of your introductory comment, which is people who worked in areas where someone developed inhalation anthrax. It's not contact with someone who had it, because the disease can't be transmitted from person to person.

But if I worked in a mail room right next to someone who developed inhalation anthrax, then the suggestion would be that I had a similar level of exposure but didn't get anthrax at the time.

In terms of the situation in Connecticut, again, we don't have a letter in hand, an anthrax-containing envelope or powder in hand. The inhalation anthrax case was not in a work place, and the level of contamination in the postal facilities there is relatively low compared to other places that we've looked. So on the set of criteria which I'm just using as a general guideline, of when--we have to again look individual by individual, but most of those--or any of those criteria don't seem to be readily met for most of the folks who might consider this in Connecticut. But again, we're going to leave that to local postal authorities, the physicians involved, and our team on site.

But that's the way I would kind of use these broad criteria to come up with either advice or a way of looking at exposure.

CDC MODERATOR: We have time for one more question.

AT&T MODERATOR: That's from the line of David Poulson with Booth Newspaper. Please go ahead.

QUESTION: Sorry I joined late, and I'm sorry if this question's been asked. But I was wondering have you reviewed the most recent 7 observations made by FDA of the vaccine production process? They just released them yesterday. And do you agree with the manufacturer that they have no impact on safety and effectiveness of the vaccine?

DR. KOPLAN: FDA has played a intimate role in the use of this vaccine, in the selection of the lot to be used, and the conclusions about its safety and efficacy, and they have indicated their satisfaction with its safety and efficacy or we would not be using it.

CDC MODERATOR: Okay. Thank you everyone for joining us today, and that concludes our session.

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