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CDC Telebriefing Transcript
Fetal Alcohol Syndrome and A Case of Cutaneous Anthrax in a Lab Worker

April 4, 2002

CDC MODERATOR: Thank you, Lois, and thank you all for joining us as we discuss today two articles in this week's Morbidity and Mortality Weekly Report. First, we have Drs. Louise Floyd and Dr. Chasi Sadoo [?] from CDC, that will be discussing alcohol use among women of childbearing age, and then we have Drs. Nancy Rosenstein and Dr. Elena Page from CDC, that will be discussing "Suspected Cutaneous Anthrax in a Laboratory Worker, Texas, 2002."

So let's get started. Dr. Floyd has some opening remarks that she'd like to make, and then we'll open it up to Q&A for that particular article, and then we'll move on to the second article.

Dr. Floyd.

DR. FLOYD: Thank you. Prenatal alcohol use is one of the leading preventable causes of birth defects and developmental disabilities in the U.S. Children exposed to alcohol during fetal development can suffer a wide array of disorders from subtle changes in IQ to profound mental retardation. They can also suffer from growth retardation in varying degrees and be born with birth defects of major organ systems.

One of the most severe outcomes of prenatal alcohol exposure is fetal alcohol syndrome. This syndrome includes abnormalities in three domains at the same time. Disorders of the brain, growth retardation, and malformations of facial characteristics. All these disorders can be prevented with one thing--avoiding alcohol use during pregnancy.

To achieve reductions in prenatal alcohol exposure, we have to pay attention not only to women who are pregnant and currently drinking, but also to nonpregnant childbearing age women who are drinking heavily, sexually active, and not taking measures to prevent pregnancy, because some of those women will become pregnant, not know it, and continue heavy drinking during the first part of pregnancy.

Our report provides a snapshot of the drinking patterns of U.S. women 18 to 44 years of age for almost an entire decade. We looked at any reported alcohol use, which includes lower levels of drinking, but we're most concerned about frequent drinking and binge drinking, because these are the patterns most consistently related to adverse outcomes for the child.

From 1991 to 1995, there was a dramatic increase in frequent and binge drinking during pregnancy, which was about a fourfold increase. Our report today finds that since that time rates of binge drinking and frequent drinking have remained at the higher level.

When we looked at nonpregnant childbearing age women, we found that rates of any drinking, frequent drinking, and binge drinking have not substantially changed over the past nine years.

However, we did see a slight increase in 1999, in both those patterns, that's just a bit higher than previous years.

Fetal alcohol syndrome, or FAS, remains one of the most prevalent developmental disabilities affecting America's children, with reported rates ranging from .6 per thousand to three per one thousand live births.

The prevalent rates of prenatal alcohol exposure in our article today translate to more than 130,000 pregnant women every year, consuming alcohol at levels shown to increase their risk, or their child's risk of fetal alcohol syndrome or other disabilities.

While we did find that any reported alcohol use during pregnancy declined somewhat from '95 to 1999, rates of these most harmful patterns of alcohol use continue and have not declined.

CDC MODERATOR: Okay, Lois, I think we're ready for questions for Drs. Lloyd and Sadoo.

AT&T MODERATOR: Thank you. Ladies and gentlemen, if you wish to ask a question please press one on your touchtone phone. You will hear a tone indicating that you have been placed into queue, and you may remove yourself from queue at any time by pressing the pound key.

If you are using a speaker phone, please pick up your handset before pressing the number.

Our first question will come from the line of Kim Dixon with Bloomberg News. Please go ahead.

MS. DIXON: Hi; thanks. In the report, you actually just repeated it, you said health care providers should routinely screen women of childbearing age for alcohol use, even if they're not pregnant. What does that mean, "screen them for alcohol use"?

DR. FLOYD: Predominantly, what we would like is to ask about alcohol use. More than half of all childbearing age women, about 53 percent, report that they use alcohol, or that they consume alcohol. Therefore, it's not an unusual or uncommon practice. What we would like to see health care providers asking is simply questions such as on how many occasions during the week do you consume alcohol, have a drink of beer, wine, or an alcohol beverage.

Then, on typical days, when you're drinking, how many drinks do you usually have. And then you really want to move toward the target, asking how many times a week do you consume five or more alcohol drinks in one occasion.

Those simple questions can provide the information needed to identify an individual who is drinking above--or if it's not a--this is someone who is a nonpregnant woman--that allows you to identify women who are drinking above the guidelines of the federal advisory, and therefore would put them beyond the moderation point and would also address issues that we're concerned about in regards to prevention of alcohol-related, or prenatal alcohol exposures.

MS. DIXON: Thanks.

CDC MODERATOR: Next question, please.

AT&T MODERATOR: Our next question will come from Erin McClain [ph] with Associated Press. Please go ahead.

MR. McCLAIN: Hi, Dr. Floyd. I wanted to ask you about the finding in your report that women who are 30, or older, are less likely to cut back on alcohol, after they learn that they're pregnant.

Do we have any idea why that might be? Can you speculate on that.

DR. FLOYD: This is a fairly consistent finding and what we think it most likely reflects is a longer drinking history and the development of tolerance, which makes it much more difficult to stop drinking, because the individual has begun to consume larger and larger amounts, and the dependency can be much more difficult to overcome.

A longer drinking period, a longer drinking history goes along with higher age groups, so it probably is more related to that aspect. On the other hand, we found that among the nonpregnant women of childbearing age, those drinking patterns of binge drinking and frequent drinking were more common in younger women. That makes sense, too, because we are also seeing in the younger age group increased rates, young adults, of binge drinking, and many of these young women may not be planning to get pregnant, and really have not given a lot of thought to the possible impact of that on pregnancy.

CDC MODERATOR: Next question, please.

AT&T MODERATOR: And we have no further questions. Thank you.

CDC MODERATOR: Okay. Thank you, Drs. Floyd and Sadoo.

Let's move on to the next portion of our briefing to discuss the article, "Suspected Cutaneous Anthrax in a Laboratory Worker, Texas, 2000."

Many of you probably reported on this about a month ago when it occurred and let me just, before we turn it over to Drs. Rosenstein and Page, bring to your attention a few of the highlights that are in this article.

The results of the evaluation that CDC completed indicate that the most likely source of exposure was the surface of vials that contained B. anthracis isolates that the worker placed in a freezer on March 1st, and I think that this article highlights the need for, you know, laboratory workers handling B. anthracis specimens to follow recommended procedures to minimize their risk, and that would include using solutions that contain 10 percent bleach on laboratory surfaces and vials to remove these viable B. anthracis spores.

This laboratorian was not vaccinated against B. anthracis and this suspected case certainly highlights the need for anthrax vaccination for laboratorians who routinely work with B. anthracis specimens, and CDC's working with state and local health departments to identify and vaccinate these very laboratory workers.

So with that said, let's turn it over, Lois, to Q&As for Drs. Rosenstein and Page, please.

AT&T MODERATOR: Thank you. Again, ladies and gentlemen, if you do have a question please press one at this time. And we have a follow-up question from Erin McClain with Associated Press. Please go ahead.

MR. McCLAIN: Yes; hi. We know that this lab worker handled these vials of anthrax spores and we also know that there's a swab taken from the sore on the jaw, that tested positive for anthrax.

Is it safe to say, then, that this guy just handled these vials and maybe scratched the sore? I mean, are there different ways that he might have contracted it that way?


DR. PAGE: Yes. The most likely thing would be that the spores were on his hand and when he touched the open wound, it transferred them.

CDC MODERATOR: Next question?

AT&T MODERATOR: The next question comes from the line of Kim Dixon with Bloomberg News. Please go ahead.

MS. DIXON: Hi; thanks. Is this the first lab worker, the first case of a lab worker getting skin anthrax, and does the vaccine actually prevent skin anthrax?

CDC MODERATOR: Dr. Rosenstein will comment.

DR. ROSENSTEIN: This is the first laboratory worker in this, associated with this outbreak, who has gotten cutaneous anthrax from handling of these specimens. The efficacy of the vaccine in cutaneous anthrax is actually not well-known. Most of the studies that have been done have documented good efficacy of the vaccine, but in those settings, most of the people who got anthrax had inhalational anthrax.

We expect that the efficacy against cutaneous anthrax would be high, and that is why we're recommending that laboratory workers who handle B. anthracis routinely be vaccinated.

MS. DIXON: And just one follow-up. Do you know why these lab workers weren't vaccinated?

CDC MODERATOR: Kim, at the time that this was--you know, during the height of the crisis in the fall, you know, vaccine was not readily available. So over the, you know, the last few months more vaccine has been made available and CDC is, you know, working on a plan with state and local health departments to identify which workers should be vaccinated, and still, there's a limited supply of vaccine, so, you know, we're being very careful in formulating these plans.

MS. DIXON: Okay; thanks.

AT&T MODERATOR: And our next question will come from the line of Martin [inaudible] with Science magazine. Please go ahead.

MR. : Hi. Yeah, I would like to know, is the lab actually at fault for not having the right procedures in place to prevent this patient's infection? And, secondly, does CDC plan to have more oversight on the labs, in the laboratory response network, other than seeing that people are vaccinated?

CDC MODERATOR: Martin, this is Tom and I'll ask Dr. Page to elaborate a little bit, but I'm not sure I understand what you mean by "fault." I think what was identified--and Dr. Page can elaborate more on this--what was identified is that this particular, these particular laboratory workers were using a solution comprised of basically, you know, rubbing alcohol to decontaminate the tops of these files when they should have been using a 10 percent solution containing, you know, bleach.

So the reason we're, one of the reasons we're putting this article out is to remind, you know, laboratorians working with these agents that they really do need to use the 10 percent bleach solution when they decontaminate the vials.

I don't know what you mean by--

MR. : Well, basically, I mean this was a mistake, correct, that they didn't use the right solution?

CDC MODERATOR: Well, I don't know for sure if they knew that they should have been using the 10 percent bleach, so in that context, if they didn't know, maybe, you know, to their understanding it wasn't a mistake. But that's the reason why we're putting this article out, is to remind people of the need to, you know, use the 10 percent bleach on lab surfaces and vials.

Dr. Page, I don't know if you want to elaborate any more, but--

DR. PAGE: I think you stated it very clearly.

CDC MODERATOR: Next question?

AT&T MODERATOR: Our next question will come from Erin McClain, Associated Press. Please go ahead.

MR. McCLAIN: Yeah; thanks. The article says that this lab worker was hospitalized for a time, I guess for four or five days, and then was released. Do we have any later information on his condition? Is he still taking antibiotics? Also I would like to know whether the lab, was it shut down for a time, and, if so, is it back in operation now?


DR. PAGE: He is doing--the patient is doing very well. He is still on oral antibiotics and the lab was not shut down. It's still operating.

MR. McCLAIN: Thank you.

CDC MODERATOR: Next question?

AT&T MODERATOR: And we have no further questions. Thank you.

CDC MODERATOR: Maybe we'll wait just a few more seconds, then.

AT&T MODERATOR: We do have a question from Rio Concepcion [?] with NHK. Please go ahead.


MS. : Hi; yes. I'd like to see if you can please discuss any, you know, further, the overall anthrax investigation?

CDC MODERATOR: I don't--I mean, that's a pretty open-ended question. Do you have a specific question?

MS. : Currently, are there any updates you can provide us with, with the current-- anthrax investigation in the fall. I mean, what can you tell us about that?

CDC MODERATOR: There's nothing really new. I mean, we, you know, the FBI is continuing to lead the criminal aspect of this investigation, and, you know, we, here, at CDC are developing quite an extensive, you know, research agenda as a result of this, you know, this incident. But, you know, those programs are ongoing.

Are there any more questions, Lois?

AT&T MODERATOR: We have none in queue. Please continue.

CDC MODERATOR: Okay. If there are no further questions, once again, thank you for participating. If you have any follow-up questions, feel free to call our main press office at [404] 639-3286. Thank you for participating.

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

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