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Update on Inhalational Anthrax Investigation

February 22, 2006

OPERATOR: Please stand by for today′s conference. We′ll begin in approximately one minute.

Thanks for holding. At this time your lines have been placed on listen only until we open up for questions and answers.

I would now like to turn the conference over to Mr. Tom Skinner, spokesperson for the CDC. Please go ahead.

MR. SKINNER: Thank you, Laura.

Thank you all for joining us here today. I have with me a medical epidemiologist here at CDC by name of Dr. Lisa Rotz. That′s R-o-t-z. And she′s going to bring you up to speed on CDC′s involvement in the diagnosis of a case of inhalational anthrax, and a New York City resident who is currently hospitalized and recovering in Pennsylvania. So with that, I′ll turn this over to Dr. Rotz, who will give a brief opening statement, and then we will open it up for Q&A. Dr. Rotz.

DR. ROTZ: Thank you, Tom.

Good afternoon, everybody. As Tom indicated, my name is Lisa Rotz. I′m a medical epidemiologist here at the Centers for Disease Control.

What I′m going to talk to you about today, since New York City has provided you with quite a bit of background in regards to the case and the timelines, et cetera, I′m going to try to focus on talking to you about what CDC is currently doing to work with New York (City) Department of Health and Pennsylvania Department of Health on further investigation of this case, as well as treatment and evaluation of the patient.

CDC was first notified yesterday by the state health officials in Pennsylvania about a gentleman that was recovering in a hospital since last weekend, who had an isolate that was initially evaluated at the hospital there, and then sent to their state LRN (Laboratory Response Network) lab yesterday, and tested for potential Bacillus anthracis. They did testing yesterday at the Pennsylvania Health Department, and initial test results indicated that that isolate was Bacillus anthracis.

At that time we began working with the Pennsylvania Department of Health folks to get additional information about the patient and his condition, as well as the travel history and potential exposure history, and found out that he was also a resident of New York City, and also involved working with New York (City) Department of Health for further investigation of the case.

Last night we also arranged transportation of that isolate down here to CDC so that we could confirm their test results, as well as being initiating additional testing here at CDC as soon as possible.

As you know, we have several teams that we′ve put together to work specifically with the department of health on several different issues. One of those teams is a CDC Environmental and Epi-Investigation Team that New York City has requested to come to New York City and assist them with evaluating the storage area where the patient has hides stored and works on those hides for drum making as well as a team to help them evaluate other people that may have come into contact with those hides and may require evaluation and potentially treatment.

That team is being assembled and will be departing later today to join New York City in that environmental evaluation and further epi-investigation activities.

We also have a laboratory team here at CDC that is working with the isolate to do additional diagnostic tests on that isolate, to subtype it, as well as antibiotic susceptibility testing on the isolate.

We did confirm the results from the laboratory in Pennsylvania this morning with additional testing and are moving forward with the subsequent testing.

We have a clinical team of physicians that are working directly with the Pennsylvania State Health Department folks, as well as with the physicians treating the patient, to evaluate his condition and to provide input on treatment recommendations for his treatment, and this team also includes several physicians that were active and worked on this team evaluating patients and providing treatment recommendations during the 2001 anthrax attack.

We also have an epidemiology team here that is working in conjunction with the teams in both states to do further evaluation, trace-back of the hides and as well as potential folks that are associated with--potential folks that might have been exposed to the hides.

This team is also working with the communications here and in the states to put together information and get that information out to clinicians and public health partners, to let them know about the case, know about the investigation of the case. Currently, CDC has put together and sent out a Health Alert Network (notice) that has gone to clinicians and public health officials across the country to let them know about this case and to let them know about our investigations and our work with New York and Pennsylvania on that.

Pennsylvania and New York have also themselves put out Health Alert Network messages to their clinicians in the area as a part of their follow-up.

And with that, I′ll leave that as the summary and open it up for questions.

MR. SKINNER: Laura, we′re ready for questions, please.

OPERATOR: Thank you.

And at this time, if you would like to ask a question, please press star followed by 1 on your touchtone phone. To remove your request, you may press star 2. Once again, please press star 1 if you would like to ask a question.

And our first question comes from Larry Altman with the New York Times.

QUESTIONER: Can you explain how the patient might have gotten the spores from the animal skins? Where would the spores be on the skins from the hair, and how might he have picked them up? Anthrax is known in Africa, but can you put that scenario together a little bit better?

DR. ROTZ: It′s my understanding that spores can reside within the hairs of hides of animals, especially in areas where anthrax is endemic and endemic in the soil.

My understanding -- and I′m not a drum maker -- from what I′ve been told, is that the process of drum making with these animal hides involves soaking the hide and then stretching it and doing a lot of scraping of the hide to remove the hair, which is potentially a scenario where he could aerosolize any spores that might have been on the hides that he re-turned.

And also, again, we′re investigating with New York City Health Department, you know, what are the potential scenarios for exposure for him.

QUESTIONER: Thank you.

MR. SKINNER: Next question, please.

OPERATOR: Thank you. Our next question comes from Shahreen Abedin with CNN.

QUESTIONER: Hi. Can you tell us when was the last time naturally occurring cases of anthrax was diagnosed in the U.S., and specifically also when it was diagnosed--cases of inhalation?

DR. ROTZ: Well, the last naturally occurring case in the U.S. was actually in 2001, earlier in 2001, and it was an episodic-associated cutaneous (case) reported from Texas.

The last inhalational anthrax case occurred in the U.S. in [inaudible] associated with a person that made wool rugs as a hobby.

MODERATOR: Next question, Laura.

OPERATOR: Thank you. Our next question comes from Mike Stobbe with the Associated Press.

QUESTIONER: Thanks.

Doctor, you broke up before I asked my question. What year did you say the inhalational last case was, the wool rugs?

DR. ROTZ: The last naturally occurring inhalational case was in 1976.

QUESTIONER: 1976. Thanks. And my question: What kind of animal skins was the drum maker working with? What type of animal?

DR. ROTZ: I don′t have the specific information on that, but mammals such as cows and other animal hides can contain this in endemic areas, but I don′t know the specifics of the types of animal hides this person might have transported.

QUESTIONER: Okay. Thanks.

MODERATOR: Next question, Laura.

OPERATOR: Thank you. Our next question comes from Melanie Kron with Fox News.

QUESTIONER: Good afternoon. I wanted to ask you: If this man rode the subway while transporting the raw hides from the West Village in Manhattan to Dumbo in Brooklyn, is there any way that the inhalational anthrax could have gotten into the subway system, or, you know, had been spread that way through the air?

DR. ROTZ: We have no information that would indicate that he has done that. But again, I think, in reference to the previous question about how he might have been exposed from Mr. Altman, the most likely scenario is something that really did cause spores from the hides to aerosolize such as the, you know, the scraping that goes on with that. You know, it′s much much less likely that aerosolization would just happen by transporting the hides.

MODERATOR: Next question, please.

OPERATOR: Thank you. Our next question comes from Betsy McKay with the Wall Street Journal.

QUESTIONER: Hi. Thanks. I just wanted to clarify one thing, and then I had a question. Has it been concluded that this exposure was from animal hides, or are you investigating other possibilities still?

And then my main question was, does this patient have clinical characteristics that are different from those of patients in the bioterrorist attacks in 2001 that would tell you anything about the, you know, help you conclude anything about the source?

DR. ROTZ: Okay. To answer the first part of your question: We always go into these investigations with an open mind, but we have very good health authorities in New York and Pennsylvania that have been very, very diligent about tracking down additional information from the patient, you know, and from contacts with the patient that have, you know, had a very good chance to track down very diligent information.

And right now we′re going with the information they have that leads us to believe that the gentleman that handled these animal hides that could have been carrying spores, and that′s, you know, a leading hypothesis at that time. But, you know, again, we go into these investigations with an open mind, but, you know, we have pretty good information at this point that leads us down that road.

QUESTIONER: Okay. And the second part of the question about the clinical characteristics of the--

DR. ROTZ: The second part of the question about the clinical characteristics, you know, this gentleman presented with respiratory symptoms. I don′t have all the specifics of the clinical presentation, but he certainly did have some clinical characteristics that could be consistent with inhalational anthrax but also consistent with many other things.

It′s my understanding that he had plural effusions and some other things that were a part of his clinical presentation, but it′s certainly not inconsistent with how other people might present, but again, it could also be consistent with many other clinical diagnosis.

QUESTIONER: Okay. Thank you.

DR. ROTZ: Yes.

MODERATOR: Next question, Laura.

OPERATOR: Thank you. Our next question comes from David Kestenbaum with National Public Radio.

QUESTIONER: It sounds like it took a week to figure out that this man had anthrax. Is that fast enough to satisfy you? If this had been a scattered bioterrorism attack, would it have taken a week to sort out that′s what was going on?

DR. ROTZ: Well, again, we always realize that time is of the essence when it comes to these investigations, and anthrax can be a challenge to diagnose, as I indicated, by the way, that it can present--and how it can be very much consistent with other clinical presentation.

But with that said, we are definitely reviewing the sequence of events here to see if there′s anything that we can do to speed up the process, and if it is then we′ll do that.

QUESTIONER: When you study these things, do you assume that it will take a week for someone to diagnose a single case, or do you--when you model responses, do you figure it will happen faster?

DR. ROTZ: I think it′s a matter of going back and looking at the timing and sequence of events. You know, as a patient presents, specimens are taken at the hospital and sent for diagnostic workup in the hospital.

Sometimes it takes awhile in the hospital for organisms to grow out of those clinical specimens and for that hospital to do the initial evaluation that says this could be something that could be bioterrorism, and as soon as that′s done, then they have procedures in place to contact health officials and get that specimen to a laboratory that can confirm that and can identify that organism very quickly, and that′s what′s happened in this case.

And that specimen that I thought was transported to the Pennsylvania Health Department who immediately did the testing to confirm that it was an — B.anthracis.

MODERATOR: Next question, please. Laura.

OPERATOR: Thank you. Our next question comes from Christine Gorman with Time Magazine.

QUESTIONER: Two questions: First question, is there any estimate of how many cases of inhalational anthrax there are in Africa or Cote d’Ivoire. And the second question is can you give us a sense of how the hides in this particular case will be tested?

DR. ROTZ: I don′t have an answer to the first case, because I don′t think we have good information about those types of cases in those areas. We do know that it occurs, and we do know that it′s endemic in those areas, but information about the number of cases that occur there, we don′t have, or I don′t have. We can look into that and see if there is a source for that information, but I don′t have that right now.

And secondly, your second question was in regard to--

QUESTIONER: How will the hides be tested?

DR. ROTZ: How will the hides be tested. I think that is going to be evaluated as our environmental team and laboratory team that is up there right now is able to go into the facility and look at the hides and look at the conditions of the hides, but, you know, likely they′ll be looking at doing sampling to do cultures of the hides, as well as PCR testing of the hides.

MR. SKINNER: Next question, please.

OPERATOR: Thank you. Our next question comes from Mark Santora with New York Times.

QUESTIONER: I′m just wondering if we know what port of entry the hides came through and what measures are in place to try and detect hides or other matters that might be infected with organisms like anthrax, and if we need to think more--harder about how we, you know, keep our borders protected from these things being imported?

DR. ROTZ: At this time we don′t know specifically how the hides came in to the U.S. New York City Department of Health folks are working along with (CDC’s) Division of Quarantine folks, as well as the USDA, who has responsibility for importation of hides and evaluating these sorts of things to identify where--you know, how he was able to bring the hides in, whether or not that was done through the proper channels or not, and then to address that when we have more information.

MR. SKINNER: Next question, please.

OPERATOR: Thank you. Our next question comes from Henry Goldman with Bloomberg News.

QUESTIONER: My question is along the same lines. Are there any regulations that would protect the population from bringing I hides or any other organic substance that might be infected? I mean you can′t just bring in plants. There are all kinds of restrictions on those kinds of things. How is somebody able to just bring in an untreated hide that′s infected with anthrax?

DR. ROTZ: Well, the answer is, yes, there are regulations, and those regulations, I′ll refer you to USDA for the specifics of those regulations. But I think we all know that when we pass through airports we have to go through procedures where they evaluate whether or not you′re bringing in plants or animals of things like that as a part of the process. But again, USDA is responsible for establishing the regulations for how these things are imported.

QUESTIONER: Is your answer that you′re not aware of what the regulations are to protect the population against the importation of untreated hides with anthrax?

DR. ROTZ: My answer is that USDA has the responsibility for that, and they would have the specifics of the regulations of that for you.

MR. SKINNER: Next question, please.

OPERATOR: Thank you. Our next question comes from Jonathan Boer with the Baltimore Sun.

QUESTIONER: Yes. I′m sorry, I missed the first part of this press conference. But am I correct in believing there has been no testing done yet on these hides, and that the scenario that′s been drawn between the contracting of the disease and the potential source being the hides is really just putting together a sequence of events?

DR. ROTZ: Right. The hypothesis is based on the interviews of the patient and the patient′s wife, and the work already done by New York City Health Department folks and Pennsylvania Health Department personnel. They have identified the area where the person stores the hides and they′re currently evaluating and going into that area to sample that area, but as of now, I don′t know whether or not they have gone into that storage facility yet or not.

QUESTIONER: Okay. And when do you expect to have results of testing done to determine once and for all whether the anthrax indeed came from those hides?

DR. ROTZ: Well, certainly, as soon as we work with them to get in there and do the hide sampling. The testing of those samples that are obtained will be expedited, and we hope to get those as soon as possible. Again, this all depends on the timing for when they are able to go in and get the samples first to test.

QUESTIONER: But then does it take a certain number of days for the testing to produce results one way or the other?

DR. ROTZ: The culture may take longer, but again, there are two types of tests that we would probably do in regards to the polymerase chain or PCR amplification testing that we could do, which we might be able to have some results in hours, but it could be hours to days depending upon the condition of the hides and the types of samples that we are going to have to deal with.

QUESTIONER: Okay. Thank you.

MR. SKINNER: Next question, please.

OPERATOR: Thank you. Our next question comes from Sewell Chan with the New York Times.

QUESTIONER: Hello. I just wanted to confirm one thing about the timing and the isolate that was transported to the Pennsylvania Department of Health, Dr. Rotz. Was that isolate transported yesterday, and again, could you just go through a little bit as to when the hospital first determined that these organisms growing out of the clinical specimens might in fact be anthrax bacilli?

DR. ROTZ: I would refer you back to the briefing by the New York (City) Department of Health that had the specifics on the timing of that.

We were notified yesterday afternoon from Pennsylvania Department of Health that they had received this specimen in the morning, and they had set it up for the testing. And as soon as they had initial testing results, they called us as soon as they had that yesterday afternoon.

QUESTIONER: And did they follow certain epidemiological protocols? Are you fully satisfied with the State agency′s performance?

DR. ROTZ: Yes.

MR. SKINNER: Next question, please.

OPERATOR: Thank you. Our next question comes from Delthia Ricks with News Day.

QUESTIONER: Hello there. Can you explain to me how the patient wound up in the hospital in Pennsylvania, and was he hospitalized in New York?

DR. ROTZ: This is a resident of New York that was visiting Pennsylvania on a business trip and became ill there, and then was admitted to the hospital in Pennsylvania

QUESTIONER: Thank you.

MR. SKINNER: Next question, please.

OPERATOR: Thank you. Our next question comes from Mike Stobbe with the Associated Press.

QUESTIONER: Doctor, just to clarify, what′s the prognosis of the patient, and what condition is he listed in right now?

DR. ROTZ: Apparently right now I believe he′s been listed in fair condition. I am told from our discussions with Pennsylvania Health Department folks and the clinician treating the patient, that they are very optimistic and happy with the way he′s progressing in his recovery.

QUESTIONER: And he′s 44, is that right?

DR. ROTZ: That′s correct.

QUESTIONER: Okay, thank you.

MR. SKINNER: All right. Laura, we′ll take on last question, please.

OPERATOR: Thank you. Our final question comes from Jill Gardener with the New York Sun.

QUESTIONER: Yeah, hi. I′m just wondering if you′re interested or if you′re already looking into whether these hides were sold or the drums were sold, and if you′re trying to follow that trail of where they ended up, and concerned about whether, you know, people who bought them might have also been exposed?

DR. ROTZ: We′re definitely investigating that possibility with New York (City) Health Department State officials in the lead on that.

MR. SKINNER: Thank you, Laura.

Thank you all. And as this investigation evolves, and as we become aware of new or more information, we′ll make sure to pass that along to you. Thank you very much.

END

####

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