Div. of Media Relations
1600 Clifton Road
Atlanta, GA 30333
Fax (404) 639-7394
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
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
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
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,
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
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
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
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
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
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
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
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
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
AT&T MODERATOR: And we have a question from Henry Neiman of Net Cog. Please
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
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 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
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
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
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
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
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.