CASE CLOSED … what really happened in the 2001 anthrax attacks?

* Minnesota investigating apparent case of inhalation anthrax … acquired from natural environment

Posted by Lew Weinstein on August 10, 2011

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anthrax spores

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AP reports (8/9/11) …

  • The Minnesota Department of Health is investigating an apparent case of someone being sickened by inhaling anthrax. Officials believe the infection was acquired from the natural environment, not from foul play.
  • The department announced Tuesday that the individual has been hospitalized in Minnesota after traveling through several western states, including North Dakota, Montana, Wyoming, and South Dakota.
  • Laboratory tests confirmed the infection was anthrax.

State Epidemiologist Ruth Lynfield says the patient was exposed to soil and animal remains, which can contain the anthrax bacteria.

  • The FBI investigated because anthrax can be used in terrorism, but found no evidence of a criminal or terrorism act.
  • Lynfield says it’s extremely rare for humans to become sickened with anthrax.

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31 Responses to “* Minnesota investigating apparent case of inhalation anthrax … acquired from natural environment”

  1. DXer said

    A case report of inhalation anthrax acquired naturally

    https://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-016-1955-0

    Z Azarkar, MZ Bidaki – BMC research notes, 2016 – bmcresnotes.biomedcentral.com
    … industry. In 2001, ten cases of deliberate infection of respiratory anthrax were
    confirmed that was due to a bioterrorist attack on the United States, in which
    individuals were targeted with packets of B. anthracis spores [8, 10]. …
    Cite Save More

    Background

    Anthrax is a zoonotic occupational disease caused by Bacillus anthracis, a rod-shaped immobile aerobic gram-positive bacteria with spore. Anthrax occurs in humans randomly and with low frequency. Most cases of anthrax are acquired through contact with infected animals or contaminated animal products. This old disease became particularly important since 2001 that the biological spores were exploited in America. …

    In 2001, ten cases of deliberate infection of respiratory anthrax were confirmed that was due to a bioterrorist attack on the United States, in which individuals were targeted with packets of B. anthracis spores [8, 10]. Whereas, only 18 cases of respiratory anthrax was reported in the US prior to that, the latest of which happened in 1976 [8, 9]. Moreover, a systematic review conducted in 2006 showed that the total number of inhalation anthrax cases reported in any languages between years 1900 and 2005 was 82 [10]. This apparently reveals the rare incident of this disease in general. Therefore, reports of anthrax is currently of particular importance in the whole world. Most cases of anthrax reported in Iran include cutaneous, gastrointestinal and meningitis types [5, 6, 7]. Based on the results of medical databases, this was the first respiratory anthrax over the last 30 years in Iran.

    ***

    We could discover no specific exposure associated with anthrax infection for this patient. However, it is proposed that the exposure occurred through contact with infected airborne dust or an unknown contaminated item. Immunodeficiency and chronic pulmonary disease can increase the susceptibility to inhalation anthrax [14]. This old patient had a long history of COPD, possibly this increased his risk.

  2. DXer said

    Source of rare Minnesota anthrax case never found
    Filed Under: ANTHRAX; BIOTERRORISM
    Robert Roos | News Editor | CIDRAP News | Jan 13, 2014

    Ingram Publishing / Thinkstock
    The man and his wife traveled through Montana, Wyoming, and the Dakotas, walking through national parks and viewing wildlife like bison.
    Medical investigators never were able to discover the source of the spores that made a Florida man severely sick with inhalational anthrax after a western vacation in August 2011, according to recent reports in Emerging Infectious Diseases (EID).

    During their trip, the couple “walked in national parks, collected loose rocks, and purchased elk antlers,” says the report by Minnesota, Florida, and federal health officials. “On July 29 they drove through herds of bison and burros, frequently stopping while animals surrounded their vehicle.”

    ***

    Auto air filters checked
    Given the circumstances, discussion eventually focused on the couple’s car, and especially its air filters. “That was the closest thing we could come to that might yield spores and sort of cover the large area they had traveled,” Griffith said.

    So investigators took 47 environmental samples from the man’s car and contents, including air filters, and 18 samples from his garage and home workshop, where he made metal and stone jewelry and knives with elk-antler handles. Among the samples were fishing flies the patient had made from elk hair a month before he got sick. But all the samples tested negative for B anthracis.

    On another investigative front, state and federal agencies in Minnesota, North Dakota, Montana, Wyoming, South Dakota, and Florida hunted retrospectively for evidence of other possible human or animal anthrax cases between Jun 1 and Aug 31, 2011, the report says. The search extended to about 450 laboratories.

    “We talked with our veterinary partners in the states and the National Park Service. Had they identified any [animal] die-offs, we would’ve sampled those areas. But there were none,” Griffith said.

    Investigators did find one bovine anthrax case in South Dakota, but the strain was unrelated to the one that infected the Florida man. The latter was most closely related to the strain involved in a cutaneous anthrax case in New Jersey in 1965. The patient in that case worked at a gelatin factory that used bone imported from India.

    ***

    Griffith said one of the features that made the Minnesota case highly unusual was that the patient and his wife had no unusual exposures. Their trip was “a very typical vacation for an older couple,” she said. “Certainly people have more significant exposures than they did and don’t get ill.”

    Third US inhalation case since 1976

    A separate EID report describes the course of the man’s illness and treatment. His illness was only the third naturally acquired case of inhalation anthrax reported in the United States since 1976 and the second since the cases caused by the anthrax mailings in 2001. In that episode, 22 people were sickened and 5 died after anthrax spores were mailed to several media offices and two US senators.

    http://www.cidrap.umn.edu/news-perspective/2014/01/source-rare-minnesota-anthrax-case-never-found

    • richard rowley said

      Did you see anything about what the guy’s occupation was? I only found something about him being a jeweler-hobbyist (hence the home workshop).
      It seems to me that if the (ready) contamination was out there, it would have also struck others. Including residents of the state (Minnesota et alia) where it happened.

    • DXer said

      Putting aside his occupation, if he was a fly fisherman making ties out of hair, that seems a good bet. One gets very close to the hair with one’s nose.

      I vaguely recall he was a landscaper in Florida but it has been a couple of years and I haven’t googled to remind myself.

      • richard rowley said

        Thanks. The reason I ask is:

        1) the incubation period is as long as 30 days.

        2) though he was in Minnesota/the Dakotas for a few weeks, that doesn’t preclude PRIOR infection.

        3) news items suggest no anthrax found in car filter or anyplace else in vehicle.

        4) wife apparently not infected.

        5) Florida, the man’s home state, has, shall we say?, a negative history of anthrax.

      • DXer said

        I’ve been watching a lot of Yellowstone videos in connection with a treasure hunt in the Rockies — and so have seen a lot of videos of buffalos approaching cars.

        I think it said he might have been bending down to pick things up in dustry environs. I would have to refer back to the arttcle linked above to be sure.

        But I believe the report said he also, among other things, did some fly tying with natural fur and that is the explanation I tend to favor.

        Last year I heard a taxidermist explain how to stuff a bird and he might have instructed on how to clean an animal carcass to avoid anthrax (in those areas of the country it is found). I can’t remember.

        But below is a video about tips on fly tying with natural fur.

        Others like Dr. Keim or Dr. Kiel could better weigh in as to why it traced to a strain in India. I have no information or background relating to the geographic distribution of strains.

        Perhaps there are maps available where that strain has been known to have been found.

        If it proved he were a landscaper (as I very vaguely recall) and I had information about the location of his clients, I would have cross-referenced it with where Adnan El-Shukrijumah, who I have ventured as the mailer of the Fall 2001 incidents, was known to visit.

        Perhaps you could research his occupation and the locality of his business and report back.

        Otherwise, we can leave that carcass where nature left it.

        To the extent I am not busy overeating, I am waiting for news on Asef Mohammad found stuck naked in a pipe at the water treatment plant in New Jersey.

  3. DXer said

    ‘Miracle man’ wins fight with anthrax
    • Article by: MAURA LERNER , Star Tribune
    • Updated: August 29, 2011 – 9:34 PM

    Florida man fell ill in Minnesota; source unknown.

    http://www.startribune.com/lifestyle/wellness/128645438.html?page=2&c=y

    • DXer said

      Flood of success, St. Petersburg Times, March 17, 2000
      http://www.sptimes.com/News/031700/Business/Flood_of_success.shtml

      Dan Anders, owner of Sweet Pump and Irrigation Co., works on a sprinkler at a St. Petersburg home … Anders and his crew performed a monthly maintenance check on this well system and yard sprinklers

      • DXer said

        Houston (cereus) case:

        The New Generation of Microbe Hunters, New York Times, August 30, 2011
        http://www.nytimes.com/2011/08/30/science/30microbe.html?_r=1&pagewanted=2

        ***

        A Real-World Test

        For Dr. Musser and his colleagues, the real-world test of what they could do came on that June evening.

        The patient was a 39-year-old man who lived about 75 miles from Houston in a relatively rural area. He had been welding at home when, suddenly, he could not catch his breath. He began coughing up blood and vomiting. He had a headache and pain in his upper abdomen and chest.

        In the emergency room, his blood pressure was dangerously low and his heart was beating fast. Doctors gave him an IV antibiotic and rushed him to Methodist Hospital in Houston. He arrived on Saturday night, June 4. Despite heroic efforts, he died two and a half days later, on Tuesday morning.

        Now it was Tuesday night. On autopsy, the cause looked for all the world like anthrax, in the same unusual form — so-called inhalation anthrax — that terrified the nation in 2001. Even before the man died, researchers had been suspicious; washings from his lungs were teeming with the rod-shaped bacteria characteristic of anthrax. Investigators grew the bacteria in the lab, noticing that the colonies looked like piles of ground glass, typical of anthrax but also other Bacillus microbes.

        “We knew we had to get this solved in a hurry,” Dr. Musser said. “We had to know precisely what we were dealing with. That’s when we put into play a plan to sequence the genome.”

        A few days later they had their answer. The bacteria were not anthrax, but were closely related. They were a different strain of Bacillus: cereus rather than anthracis.

        The bacteria had many of the same toxin genes as anthrax bacteria but had only one of the four viruses that inhabit anthrax bacteria and contribute to their toxicity. And they lacked a miniature chromosome — a plasmid — found in anthrax bacteria that also carries toxin genes.

        The conclusion was that the lethal bacteria were naturally occurring and, though closely related to anthrax, not usually as dangerous. So why did this man get so ill?

        He was a welder, Dr. Musser noted, and welders are unusually susceptible to lung infections, perhaps because their lungs are chronically irritated by fine metal particles. So his fatal illness was most likely due to a confluence of events: welding, living in a rural area where the bacteria lived in the soil and happening to breathe in this toxin-containing species of bacteria.

  4. DXer said

    Minnesota health officials update information on anthrax case

    The Minnesota Department of Health in collaboration with the Centers for Disease Control and Prevention (CDC) has been investigating a case of inhalation anthrax.

    The individual, a man in his 60s, had traveled through several states in July and early August, where anthrax is known to be in the soil and to have caused infections in animals, including North Dakota, South Dakota, Montana and Wyoming.

    He was hospitalized in early August with pneumonia, was determined to have inhalation anthrax and is now recovering. The Bacillus anthracis strain isolated from the patient was found by genetic testing to be similar to other strains isolated in North America.

    The individual had a prior chronic lung condition, which may have made him more susceptible to infection with anthrax, and had multiple exposures to soil and animal products. No other human cases of anthrax have been reported in 2011.

  5. DXer said

    When Anthrax Isn’t Anthrax
    http://www.infectioncontroltoday.com/news/2011/08/when-anthrax-isnt-anthrax.aspx

  6. DXer said

    Is there wool processing in Minnesota?

    http://www.woolenmill.com/sections/Wool_Processing.php

  7. DXer said

    A new phrase in the field is injectional anthrax. Separate from this article below, Martin Hugh-Jones on PRO-MED raised the interesting hypothesis of inhalational anthrax due to snorting heroin. I don’t believe there has ever been such a case but it would be interesting to consider whether such is possible.

    Am J Respir Crit Care Med. 2011 Aug 18. [Epub ahead of print]
    Anthrax Infection.
    Sweeney DA, Hicks CW, Cui X, Li Y, Eichacker PQ.
    Source
    Medical Intensivist Program, Washington Hospital, Fremont, California, United States.
    Abstract

    Bacillus anthracis infection is rare in developed countries. However recent outbreaks in the US and Europe and potential use of the bacteria for bioterrorism have focused interest on it. Furthermore, while anthrax was known to typically occur as one of three syndromes related to entry site of (i.e., cutaneous, gastrointestinal or inhalational), a fourth syndrome including severe soft tissue infection in injectional drug users is emerging. Although shock has been described with cutaneous anthrax, it appears much more common with gastrointestinal, inhalational (5 of 11 patients in the US outbreak of 2001) and injectional anthrax. Based in part on case series, the estimated relative mortalities of cutaneous, gastrointestinal, inhalational and injectional anthrax are: <1%, 25-60%, 46% and 33% respectively. Nonspecific early symptomatology makes initial identification of anthrax cases difficult. Clues to anthrax infection include: history of exposure to herbivore animal products; heroin use; or clustering of patients with similar respiratory symptoms concerning for a bioterrorist event. Once anthrax is suspected, the diagnosis can usually be made with gram stain and culture from blood or surgical specimens followed by confirmatory testing (e.g., PCR or immunohistochemistry). While antibiotic therapy (largely quinolone-based) is the mainstay of anthrax treatment, the use of adjunctive therapies such as anthrax toxin antagonists are a consideration.

    • DXer said

      http://www.cidrap.umn.edu/cidrap/content/bt/anthrax/biofacts/anthrax_epi.html

      An outbreak of anthrax was first observed among injection-drug users in Scotland in December 2009 (Ramsay 2010). Since then, 31 confirmed cases and 11 deaths among heroin users have been reported from three countries (Scotland, England, and Germany) (Christie 2010). The patients reported injecting, smoking, and/or snorting heroin. The symptoms at presentation varied greatly, were inconsistent, and were not typical of cutaneous, inhalational, or gastrointestinal anthrax (Booth 2010).

  8. DXer said

    http://www.livestockweekly.com/papers/97/06/05/5anthrax.html

    Post-Flooding Anthrax Risk
    Noted By N.D. Veterinarians

    FARGO, N.D. —(AP)— North Dakota veterinarians are warning ranchers to be alert for the deadly anthrax bacteria in their herds this summer.

    While no one is expecting a massive outbreak, veterinarians say history has shown the number of anthrax cases often rises following floods.

    “There’s an increase in our chances of having more cases,” acting State Veterinarian Larry Schuler said last week. “I wouldn’t say we’re at a high risk, but it’s a higher risk than we normally have.”

    Last year, the state reported just one confirmed case of anthrax in an animal found dead near Fordville in July.

    Schuler said ranchers should not be overly concerned, but need to keep a close eye on their herds and be extremely cautious about handling any dead livestock. The disease usually appears in late summer, he said.

    Anthrax is a bacterial infection that attacks the internal organs of animals. It produces a toxin that kills within a few days of being ingested. The disease can be transmitted to humans through the improper handling of infected carcasses.

    “As long as the carcass remains intact and is burned or buried properly, the spores will remain in the carcass and there’s little danger of spreading the disease,” said Ivan Berg, a veterinarian and animal disease specialist with the North Dakota State University Veterinary Diagnostic Laboratory.

    The bacterium comes from spores that often live buried in soils for years. Researchers believe floodwaters may expose the spores, which are then inadvertently eaten by livestock.

    “Once the spores are in the system, the bacteria proliferate and it’s only a matter of days until the animal is dead,” Berg said.

    While there is little ranchers can do to prevent anthrax, Berg said good herd management and communication with veterinarians will prevent its spread.

    Veterinarians can prescribe a vaccine to protect other animals in an infected herd, but that means ranchers must immediately notify their veterinarians so blood tests on the dead animals can be performed.

    Meanwhile, a continent away, an anthrax outbreak apparently claimed a third juman victim in Ukraine this week when a man died hours after being taken to the hospital with symptoms of the disease, an official said Wednesday.

    The unidentified man in the Volnovakha area in eastern Ukraine’s Donetsk region died Monday, Emergencies Ministry spokeswoman Natalia Tsushko said. Autopsy results were not yet available.

    An outbreak at a state farm in the village of Privolnoye has put 31 people in the hospital and prompted a quarantine. Two people died a week ago, and the rest remain hospitalized but out of mortal danger, Tsushko said.

    Anthrax can spread to humans through skin contact, ingestion and even inhaling the contaminated spores. It can be treated with penicillin.

  9. Anonymous said

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2870591/

    Discernment between deliberate and natural infectious disease outbreaks
    Z. F. DEMBEK,1* M. G. KORTEPETER,2 and J. A. PAVLIN3
    1Department of Medicine, U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD, USA
    2Department of Medicine, Walter Reed Army Medical Center, Washington, D.C., USA
    3Department of Emerging Infectious Diseases, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Clue no. 9 – Unusual disease manifestation. As over 95% of anthrax cases worldwide are cutaneous, even one case of inhalational anthrax should be considered an unnatural event until proven otherwise.

    It has clearly NOT been proven that this case of anthrax was naturally occurring – the authorities have no idea how this person contracted anthrax.

    • DXer said

      Thanks for the article.

      Note that we are not in a position to judge what they already know about risk factors based on his activities. Thus, they are in the best position to know whether the rule suggested by those USAMRIID authors applies.

      An Epidemic of Inhalation Anthrax: the First in the Twentieth Century. II. Epidemiology.
      PS Brachman, SA Plotkin, FH Bumford… – American Journal of …, 1960 – cabdirect.org
      … Title An Epidemic of Inhalation Anthrax : the First in the Twentieth Century. II. Epidemiology. …
      Abstract. During a 10-week period in 1957 5 cases of inhalation anthrax and 4 cases of
      cutaneous anthrax occurred in a New Hampshire goat hair processing mill. .

      Inhalation Anthrax Associated With Dried Animal Hides—Pennsylvania and New York City, 2006
      MMWR. 2006;55:280-282
      http://jama.ama-assn.org/content/295/17/1991.full

    • DXer said

      In response to the query emailed this afternoon:

      “Is there any public update that can be shared as to the 8/9 story “Health officials investigate case of inhalational anthrax from suspected natural environmental exposure,”

      the Minnesota Department of Healthpublic affairs person Doug responded:

      “Not at this time. We are continuing to investigate.”

  10. DXer said

    Arch Pathol Lab Med. 2011 Aug 9. [Epub ahead of print]
    Rapidly Progressive, Fatal, Inhalation Anthraxlike Infection in a Human: Case Report, Pathogen Genome Sequencing, Pathology, and Coordinated Response.
    Wright AM, Beres SB, Consamus EN, Long SW, Flores AR, Barrios R, Richter GS, Oh SY, Garufi G, Maier H, Drews AL, Stockbauer KE, Cernoch P, Schneewind O, Olsen RJ, Musser JM.
    Abstract

    Context.-Ten years ago a bioterrorism event involving Bacillus anthracis spores captured the nation’s interest, stimulated extensive new research on this pathogen, and heightened concern about illegitimate release of infectious agents. Sporadic reports have described rare, fulminant, and sometimes fatal cases of pneumonia in humans and nonhuman primates caused by strains of Bacillus cereus , a species closely related to Bacillus anthracis . Objectives.-To describe and investigate a case of rapidly progressive, fatal, anthrax-like pneumonia and the overwhelming infection caused by a Bacillus species of uncertain provenance in a patient residing in rural Texas. Design.-We characterized the genome of the causative strain within days of its recovery from antemortem cultures using next-generation sequencing and performed immunohistochemistry on tissues obtained at autopsy with antibodies directed against virulence proteins of B anthracis and B cereus . Results.-We discovered that the infection was caused by a previously unknown strain of B cereus that was closely related to, but genetically distinct from, B anthracis . The strain contains a plasmid similar to pXO1, a genetic element encoding anthrax toxin and other known virulence factors. Immunohistochemistry demonstrated that several homologs of B anthracis virulence proteins were made in infected tissues, likely contributing to the patient’s death. Conclusions.-Rapid genome sequence analysis permitted us to genetically define this strain, rule out the likelihood of bioterrorism, and contribute effectively to the institutional response to this event. Our experience strongly reinforced the critical value of deploying a well-integrated, anatomic, clinical, and genomic strategy to respond rapidly to a potential emerging, infectious threat to public health.

  11. DXer said

    Epidemiol Infect. 2011 Aug 11:1-8. [Epub ahead of print]
    B. anthracis in a wool-processing factory: seroprevalence and occupational risk.
    Kissling E, Wattiau P, China B, Poncin M, Fretin D, Pirenne Y, Hanquet G.
    Source

    Scientific Institute of Public Health, Brussels, Belgium.
    Abstract

    SUMMARYIn a Belgian wool-processing factory, living anthrax spores were found in raw goat hair and air dust, but confirmed anthrax cases had never been reported. Anthrax vaccines are not licensed nor recommended in Belgium. We conducted a B. anthracis seroprevalence study to investigate risk factors associated with positive serology and advise on protective measures. Overall 12·1% (8/66) employees were seropositive; 30% of persons processing raw goat hair and 20% of persons sorting raw goat hair were seropositive compared to 3% in less exposed jobs [adjusted prevalence ratio (aPR) 44·4, P=0·001; aPR 14·5, P=0·016, respectively). The number of masks used per day was protective (aPR 0·3, P=0·015). Results suggest a dose-response association for those processing raw goat hair. Host-related factors probably played a role as antibody response varied from person to person within an exposure group. Workers exposed to raw goat hair should be offered higher protection against anthrax and have access to anthrax vaccines.

  12. DXer said

    http://www.mitchellrepublic.com/event/article/id/55771/group/homepage/

    Published August 12, 2011, 05:54 AM
    Anthrax confirmed in SD for 1st time this year

    Anthrax has been confirmed in South Dakota for the first time this year. The South Dakota Animal Industry Board has confirmed that one adult cow was lost in a herd of 175 unvaccinated animals in Aurora County.

    ***

    Significant climate change, such as drought, floods and winds, can expose anthrax spores to grazing livestock. Alkaline soils, high humidity and high temperature present conditions for anthrax spores to vegetate and become infectious to grazing livestock.

  13. DXer said

    1. The have anthrax just about every summer in the Dakotas.

    2. Flooding along the Missouri River, for example, prompted a call for cattle and other livestock producers to watch for signs of anthrax once floodwaters recede. It is now 20 days after this report.

    http://www.infozine.com/news/stories/op/storiesView/sid/48280/

    Livestock Producers Should Watch for Signs of Anthrax After Flooding
    Monday, July 18, 2011 :: Staff infoZine

    Flooding along the Missouri and other rivers through the central United States is prompting a call for cattle and other livestock producers to watch for signs of the deadly anthrax bacteria once floodwaters recede.

    Manhattan, KS – infoZine – “Cattle producers in areas along the Missouri River should watch for unexplained cattle deaths which might occur as a result of anthrax spores washing down and being consumed by cattle after the floodwaters recede,” said K-State Research and Extension veterinarian Larry Hollis. Veterinarians and animal health officials in North Dakota, Minnesota and Canada have issued similar warnings.

    “Because the Missouri River is carrying water from the Dakotas where they historically have anthrax just about every summer, anthrax spores may be carried down and end up on flooded Kansas backwater pastures,” Hollis said. “Any unexplained cattle deaths should be reported immediately to a veterinarian. The veterinarian may choose to necropsy the carcass to make sure that anthrax is not the cause. Spores of other spore-forming organisms, such as the Clostridial specie that causes blackleg, also can be carried to new areas by floodwaters.”

  14. anonymous said

    I think they haven’t got a clue – they just “know” it was naturally occurring.

    http://www.cidrap.umn.edu/cidrap/content/bt/anthrax/news/aug1011anthrax.html

    Anthrax investigators hope to learn where exposure occurred

    Robert Roos News Editor
    Aug 10, 2011 (CIDRAP News) – An investigation into the origins of Minnesota’s first human anthrax case in many years is focusing on where the patient might have been exposed to the deadly pathogen, Minnesota State Epidemiologist Dr. Ruth Lynfield said today.

    The Minnesota Department of Health (MDH) announced yesterday that a person who had recently traveled through North Dakota, South Dakota, Montana, and Wyoming was being treated for inhalational anthrax in a Minnesota hospital. Officials said the case was apparently caused by naturally occurring anthrax in the environment.

    The MDH has not revealed the patient’s condition or listed any identifying details such as name, gender, home state, or hospital.

    Lynfield said today that the patient had been on a “multi-week trip” and was sick on arrival in Minnesota after traveling through the four western states. “Anthrax is in the environment in the soil in all these places, so it’s hard to know for sure” where the exposure might have occurred, she said.

    “We’re trying to go through the [travel] itinerary. We’ll be learning more, but at this point what we know is that the person was in a place where anthrax does cause disease in animals,” she said. She noted that the disease strikes cattle and wildlife such as bison and deer.

    She also said officials are looking into whether the patient has any risk factors that could have made him or her more susceptible to inhalational anthrax.

    Lynfield noted that floods can move anthrax spores in the soil, leading to animal outbreaks. “One thing we’re doing now is checking in with various wildlife groups and veterinarians to try to determine if there’s anything going on this summer,” she said.

    She said Minnesota has not had a confirmed human anthrax case in “decades,” and neighboring states have not had any recent cases, either.

    Because of the potential for bioterrorist use of anthrax, the Federal Bureau of Investigation (FBI) initially collaborated with the MDH to investigate the case, the MDH said yesterday. The FBI ended its involvement after concluding there was no evidence of terrorist or criminal activity, officials said.

    Lynfield declined to describe the patient’s condition today. “There was a rumor that the patient had died—that’s just a rumor,” she said. She noted that the patient’s family has had bad experiences with the news media in the past and has asked the MDH to protect its privacy.

    Inhalational anthrax is the most deadly form of the disease, which is caused by Bacillus anthracis. Anthrax spores that were sent by mail to several media offices and two US senators’ offices in 2001 sickened 22 people, killing five of them.

  15. DXer said

    Epidemiologic response to anthrax outbreaks: field investigations, 1950-2001. (Anthrax Perspectives).

    Publication: Emerging Infectious Diseases
    Publication Date: 01-OCT-02 Format: Online

    We used unpublished reports, published manuscripts, and communication with investigators to identify and summarize 49 anthrax-related epidemiologic field investigations conducted by the Centers for Disease Control and Prevention from 1950 to August 2001. Of 41 investigations in which Bacillus anthracis caused human or animal disease, 24 were in agricultural settings, 11 in textile mills, and 6 in other settings. Among the other investigations, two focused on building decontamination, one was a response to bioterrorism threats, and five involved other causes. Knowledge gained in these investigations helped guide the public health response to the October 2001 intentional release of B. anthracis, especially by addressing the management of anthrax threats, prevention of occupational anthrax, use of antibiotic prophylaxis in exposed persons, use of vaccination, spread of B. anthracis spores in aerosols, clinical diagnostic and laboratory confirmation methods, techniques for environmental sampling of exposed surfaces, and methods for decontaminating buildings.

    CDC anthrax-related field investigations from 1950 to 2001 were identified from several sources. First, the new database of historical Epi-Aid documents (1950-1999) was searched to retrieve all documents in which “anthrax” or “anthracis” appeared either as an assigned keyword or as a text string in a full-text search. Epi-Aid documents related to anthrax investigations in 2000 and 2001 were identified manually in an EIS administrative database. These searches identified a variety of types of documents, including initial requests for epidemiologic assistance, interim progress reports, final reports, and memoranda.

    Routes of infection were largely a function of setting. Of the 27 cases in textile mills, 21 (78%) were cutaneous, and 6 (22%) were inhalational. Contaminated goat hair or wool was the primary vehicle of infection. Persons working with raw, unprocessed materials were at greatest risk for infection (4). Of the six inhalational cases in textile mills, five were fatal. Three cases of fatal inhalational anthrax were also reported in non-textile mill workers (12,31) (Epi-Aid 1967-43).

    Of the 24 investigations in agricultural settings, 9 (38%) included at least one human case. All human cases were acquired cutaneously while a person was handling, performing necropsy on, or disposing of dead animals. The most extensive cross-infection between animals and humans occurred in the 1998 outbreak in Kazakhstan, in which at least 53 human cases occurred; most were cutaneous cases acquired from slaughtering animals (Epi-Aid 1998-83).

    Although four investigation reports included concern over possible waterborne transmission ([15] and Epi-Aids 1966-12, 1975-6, 1979-95), this route was not identified in any of the repons of human cases, and water contamination was not regarded as a source of infection. However, disease incidence in animals usually coincided with extremes of wet and dry weather conditions.

  16. DXer said

    After hearing the report of Dr. Stevens illness in the news, Dr. Ivins wrote an email dated October 4, 2001 suggesting explanation of inhalational anthrax as due to “tromping around some dusty field area.”

    Rather than deduce based on this evidence that Dr. Ivins was surfing the internet for news — and obtaining that evidence from the hard drive and history of his computer — the government relied on this email as evidence of consciousness of guilt because the explanation (coming from an expert) was so unrealistic. (It was deemed implausible even though drinking from a stream was being urged by the Health Secretary as the explanation). At the same time, the government relied upon Dr. Ivins’ presence in the lab as evidence of his drying anthrax.

    Moreover, the DOJ intentionally withheld the lab notes showing the reason for him being in the lab.

    GAO should address in its report the withholding of the lab notes and direct that DOJ release them as part of its production under FOIA. There are extensive lab notes from the August – October 2001 that the DOJ is still withholding (in addition to those released by the USAMRIID on May 11, 2011).

    • DXer said

      As a further example, we saw the United States Attorney rely on the lyophilizer as the means Dr. Ivins dried the anthrax even though now everyone agrees that explanation was not plausible. We are well past the point where mere assertions on such an issue should be made without disclosure of the relevant information. Here, a patient’s privacy interest would not prevent disclosure of specifics of a general nature explaining the contact with dead animals.

      • Anonymous said

        This Minnesota case seems rather bizarre. What did this woman actually do to be in “exposed to soil” – walk across the ground? What about “exposed to animal remains” – buy some ground beef at the grocery store?

        Any case of inhalational anthrax will trigger a major security alert – this one seems to being downplayed – much like Bob Stevens “the avid outdoorsman who drank from a stream”.

        • Anonymous said

          MDH: Woman hospitalized in rare anthrax case
          The following is a press release from the Minnesota Department of Health:
          What is really neeed are the exact details of what “had exposure to soil and animal remains” means. Anybody who steps outdoors is exposed to soil. Anybody who visits the butchers department is exposed to animal remains.
          Now, if this person was collecting soil samples in remote areas that hadn’t seen rain in months where animal carcasses were lying around – that would be one thing. Leaving out these details reminds us all of the Tommy Thompson “he drank from a stream” – and is entirely unhelpful.

          MDH: Woman hospitalized in rare anthrax case

          The Minnesota Department of Health is working with the Centers for Disease Control and Prevention to investigate an apparent case of inhalational anthrax in an individual who officials believe acquired the infection from the natural environment. The individual was hospitalized in Minnesota after traveling through western states, including North Dakota, Montana, Wyoming, and South Dakota. Laboratory analysis in Minnesota confirmed the diagnosis of anthrax.

          “All evidence points to this case of anthrax being caused by exposure to naturally occurring anthrax in the environment,” said Minnesota State Epidemiologist Ruth Lynfield. The individual had exposure to soil and animal remains. Cases of anthrax in hooved animals occur yearly in parts of the country including the Midwest and West as far south as Texas, and up to the Canadian border.

          Because anthrax can be used as a bioterrorism agent, the Federal Bureau of Investigation investigated this matter jointly with MDH, but no evidence suggesting it was a criminal or terrorist act was obtained. As such, the FBI is no longer actively investigating the incident.

          Health officials stressed that the case does not represent an increased risk of anthrax to the public. “Anthrax is not spread from person to person, and it is extremely rare for humans to become sickened with anthrax, especially through inhalation,” Lynfield said. In rare cases, individuals can become sickened by anthrax if they handle infected animal carcasses or ingest contaminated soil or meat from infected animals. People can also become infected by handling contaminated wool or hides or other products from infected animals. In years past, anthrax was known as “woolsorter’s disease”.

          Because these cases are so rare, health officials are not discouraging people from traveling to areas where anthrax can be found naturally in the environment.

          The individual is being treated at a Minnesota hospital.

      • DXer said

        The press release does not indicate that it was a woman. (You don’t cite a link but I believe you are just quoting a headline from a blog that likely is mistaken). Someone at CIDRAP confirmed it was a male.

        BTW, Michael Osterholm from Minnesota addressed these issues in a 2000 book co-authored with a NYT correspondent. It was on Ayman Zawahiri’s reading list and discussed microencapsulation.

        As indicated in the links I’ve provided, rain reportedly actually exacerbates the frequency of anthrax in the natural environment — though someone like Martin Hugh-Jones is the expert who could confirm and/or explain this. See CDC epidemiological study I posted that I think is from 2002.

        My nephew once lived under Mount Kilimanjaro and was pictured holding up the leg of a zebra that had just recently been killed by a lion or tiger (I forget which). I said “Anthrax isn’t just a band.” ; ) Besides, upon hearing the big cat was in the compound he might have kept my niece inside. :0)

        People should be wary of handling dead animals, although in the CDC epidemiological study I linked all the cases from handling dead animals (38% of the cases included humans) were cutaneous. Cows typically get inhalational anthrax because their nose is right next to the ground.

        It’s wool sorters who historically in the United States contracted inhalational.

        And more recently, we’ve seen drum players infected from the spores wafting off the dried animal skins being used.

        • DXer said

          Picture a man on the road who purchases an animal hide and snuggles up with it at night, having the fur right under his nose.

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