Anthrax Investigation: New Jersey Department of Health Briefing
BILL HEMMER, CNN ANCHOR: We interrupt that report from CNN's Chris Burns to take you to health officials here, Ewing Township New Jersey. More information now on the testing of individuals in that area.</s>UNIDENTIFIED MALE: ... Diferdinando commissioner, New Jersey Department of Health, Dr. Eddy Bresnitz, New Jersey Department of Health, state epidemiologist, and also available, we'll have Dr. Christie Stevenson (ph), RWJ of Hamilton, their chief administrative officers, Dr. Phillip Bonaparte (ph), senior VP, medical affairs, Robert Wood, Hamilton, and Dr. Beth Vow (ph) of the CDC -- Commissioner.</s>DR. GEORGE DIFERDINANDO, N.J. DEPT. OF HEALTH: Today we're here to announce that one postal worker stationed at the route 31 mail processing center in Hamilton Township is now considered by the Centers for Disease Control and the New Jersey Department of Health and Senior Services to be a suspected case of inhalational anthrax. The patient is in stable condition, and is receiving antibiotics. Dr. Eddy Bresnitz will be discussing with you in a moment the particulars of that case. I will then come back and talk to you and talk to you about how this case changes, modifies the situation that we're in, and modifies any of our recommendations, and then we'll take some questions. Now Dr. Bresnitz will talk to you about the particulars of this case.</s>DR. EDDY BRESNITZ, N.J. DEPT. OF HEALTH: Good morning. Again, I want to emphasize this is being considered a suspected case. This is a middle aged woman, a mail handler, who worked at the Hamilton Township mail processing center, who began to feel ill sometime last week, saw her physician Friday, the 19th, and was admitted to the hospital for evaluation and treatment. Initial tests did not support the diagnosis of anthrax. Physician contacted Department of Health and Senior Services on Saturday for consultation. In conjunction with the CDC team. We sent physician out to evaluate the patient on Sunday, interviewed the patient, gathered some samples and sent them to the centers for Disease Control and Prevention for further testing. Those arrived at the Centers for Disease Control and Prevention on yesterday morning, and yesterday evening we received a word from the CDC that one of the tests indicated the person was a suspected case of anthrax, in the context of her clinical condition, where she worked, and the timeframe of when she became ill. Yesterday evening, we notified the physician of the results of those tests. The physician notified the patient and the family. They were very pleased to receive those results. Currently the patient is on a number of different antibiotics, which will address and cover her infection. She has been on those for five days now. Her condition right now is serious but stable. She is holding her own. Her temperature has improved. Although we don't have any isolation of the anthrax organism from any of the specimens, I should add that other islets that are done by the CDC suggests that what is infecting her is sensitive to the antibiotics that she is on. The family wishes to remain confidential, and the other three patients, I should add, that we previously announced, they are doing well.</s>FERDINANDO: Last Friday, the Department of Health and Senior Services recommended that all postal workers in the Hamilton township facility and in the West Trenton facility see their physicians and begin a seven-day course of antibiotics as a precaution, while the criminal and health investigation of potential exposure to disease continued. Today, I'm modifying that recommendation, consistent with the recommendation of CDC announced last night, for treatment of the Brentwood facility in D.C. to now be a 10-day treatment of preventive prescription of Ciprofloxacin. We are also expanding the number of people who might receive that to other workers from other facilities that may have come into the plant to receive materials. This is an expansion of both the length of time of prevention, so that we can be consistent with the activities that are going on in the rest of the country, as well as an expansion of those who need to receive that. The most important message I believe of this conference, is that given this suspected case of inhalational anthrax, those workers who have not seen a physician or a nurse so far, absolutely need to see a physician or a nurse to receive this preventative prescription. For those who have received this prescription and have not begun to take it, they definitely need to begin taking this medication. And for any workers who have worked at this site or who have gone into the site if they have what is either a suspect -- something consistent with cutaneous anthrax or respiratory anthrax, clearly need to see a physician, a nurse, other health care provider as soon as possible. Mainly we're focusing right now on the clinical message we're trying to get out, messages of the further environmental testing of this site, messages of environmental testing around the state, other types of environmental messages. We're not going to be focusing on those right here. We're going to give you some follow-up information on those investigations later today. Right now, that message is that suspect inhalational anthrax case, the expansion of preventative treatment to 10 days, rather than seven, and then the expansion of those who need to receive this preventative prescription to those who came in and worked at the site. We do have one other point, and I'm sorry, I forgot about this one. I think it's important to inform you in a structured way of what we call active surveillance, that is trying to find, not just asking people to come in, but the efforts that the State Department of Health and Senior Services and the CDC are doing to actively go out and find cases. And for that, I want to turn things back to Dr. Bresnit to discuss active surveillance.</s>BRESNITZ: I should emphasize that even just after the World Trade Center disaster, the Department of Health and Senior Services sent out messages around the state through our Health Alert Network, which is our e-mail system linking us with health care providers and public health officials around the state, to be on the alert for potential bioterrorism events, including anthrax. And we continue to send those messages out throughout that time period. As the situation developed with the anthrax outbreak, we reemphasized our message as well. So this is really a continuation of our public health alert to our health deliverers and our public health officials throughout the state. This morning, in conjunction with the Centers for Disease Control Prevention. We sent out a public health alert to chief executives officer and infection control practitioners throughout the state, basically with the objectives of enhancing our surveillance efforts to date. What we are trying to do is identify any previous cases of human anthrax that occurred after September 11th that may not have come to our attention, and also to alert them we want to emphasize a surveillance to detect any future potential cases, both cutaneous as well as inhalational. And there are certain methodologies that we're using, basically certain criteria that we are going to be asking them to look for in their hospitals, both retrospectively and prospectively, that might tune them in to the fact that they have a case. In addition, we are going to reach out to our medical examiner to look back over the last six weeks to see whether there are any suspected cases. Obviously, medical examiners are always interested in unusual deaths, but in this case, we are going to again reach out to him and say, please look around and see if there is anything reported that might in any way, shape or form be relative to anthrax. And there are other efforts as well. We are actively reviewing the work records of the postal employees. That was done some what unofficially initially, because the records, many of them were in the plant. We were able to obtain more detailed records from the Postal Service, and we're combing through those to see if there were other workers that may have been absent that we are unaware of. One more thing. I just wanted to formally acknowledge the excellent work of Robert Johnson Hamilton. They have seen the vast majority of those who have come forward for preventative prescriptions. And I'll turn it over to you now.</s>UNIDENTIFIED MALE: OK, we're going to take a few questions related to this topic. Just a reminder, the criminal investigation by the state police, FBI and postal authorities remains ongoing, and there will no further comment regarding that aspect -- Brian.</s>QUESTION: I'm not sure if Dr. Bresnitz, Commissioner Bucant (ph) or is it Dr. Bell from the CDC can address this or perhaps all of you can, but considering the fact now that we have potentially four people in this facility, and the way this microbe is spreading itself, what assurance can you give us, or can you give us an assurance that this material did not pass from these hotspots within the processing plant on to normal, everyday letters and get out to the general public, whether it be in New Jersey or wherever those letters might have crossed the nation?</s>DIFERDINANDO: This is a question that's under active consideration by -- at the federal level. Clearly, it's a question of great interest to all of us, but in terms of being able to document type of what you call cross contamination, we can't document cross contamination at this point. And it is of some intelligence in this situation that up until now, all of the suspect or confirmed cases have been people who have been workers. These have been occupational injuries so far.</s>QUESTION: If I may follow up on that, this alert notification system doctors, are you asking doctors in general to watch out for cases of the general public with symptoms that might be consistent?</s>DIFERDINANDO: Absolutely. The idea is for all physicians and advanced nurse practitioners and physician's assistant to consider cutaneous or inhalation anthrax. Sometimes the history is not taken of a worksite exposure. Sometimes it doesn't come up in the rush of the emergency room visit. So you can't always define those interactions between clinicians and patients quite so exactly. We don't know the answer to that question.</s>QUESTION: You said you were going to have a number of different workers taking antibiotics. How many?</s>DIFERDINANDO: We don't know. The Postal Service will be working on that. The message of this conference is for those who came in and worked there, you know, one option would have been to create a list of all of the workers that came in. Rather than sending the message out through the media, at this point, we are sending this message out prior to creating the list of all those who might have worked in there. So I do not have an answer for you either within New Jersey or within Washington of how much this broadens the number of people we're recommending.</s>HEMMER: All right, the news out of New Jersey today, one case of suspected inhalation anthrax, a woman, apparently though the good news here, she is responding to treatment at this time. All postal workers in the Trenton, New Jersey area will be treated with Cipro as a precautionary measure in the event that others are infected as well. Let's get to Michael Okwu, also in New Jersey, with more information on this -- Michael.</s>MICHAEL OKWU, CNN CORRESPONDENT: Bill, hello to you. Again, that was the officials from the CDC and from the New Jersey Health Department. And again, just to reiterate, one case of suspected inhalation anthrax, a woman at this facility, which is a major sorting and distribution center in the Trenton area, specifically Hamilton Township. She has been put on 10 days of treatment. They are encouraging other workers in the area to come in and get tested, and also to be put -- and treatment at this point we know that some 5,000 workers from this facility and abutting areas have been tested. Many of them are on Cipro. Again, they say that she is in serious, but stable condition. In their words, holding her own. Also the medical practitioners here, the health officials mentioned the fact they are going to be engaging in what they call -- quote -- "active surveillance," essentially trying to put all public health officials and other health officials on notice to try to look out for these signs, to be looking for symptoms related to cutaneous anthrax and to inhalation anthrax. You may recall, Bill, that in other cases, specifically those cases having to do with the woman at CBS News, and the woman who contracted cutaneous anthrax at "The New York Post," that those two women went in to see their private physicians, were put on antibiotics, without those physicians knowing of course, that it could have been anthrax, and it was only after the situations got worse, and they sought help from other health officials that they were prescribed Cipro. They are also trying to identify other cases that might be, of course, related in any way it anthrax. They are looking, they mentioned, to some of the workers who have worked in this site, as well as sites across New Jersey, trying to find out what their work records were, find out, of course, whether they might have come into contact with any anthrax spores. Back to You,</s>HEMMER: And, Michael, I don't know the answer here, so give it to me, if you can. The mail that went to New York City, when we're talking about ABC News, CBS, "Washington Post," would it have gone through the facility we are talking about today?</s>OKWU: We know at this point that three such letters were postmarked at this facility in Trenton -- the letter that went to Senator Tom Daschle, the letter that went to Tom Brokaw, Mr. Brokaw at NBC News, as well as a letter that was addressed to "The New York Post." So we know those letters were passed through here, and were postmarked here, and that's why, obviously, this center is getting a lot of attention these days.</s>HEMMER: Thanks for the clarification, Michael Okwu, there on the ground in New jersey. Let's bring in Dr. Sanjay Gupta now. Doctor, good morning to you.</s>SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Nice to see you.</s>HEMMER: The good news in New Jersey, suspected at this point, and is responding to treatment. The interesting thing that came out that almost kind of a search and find mission right now, doctors go out and try determine who might be infected, kind of a reverse method here at this point.</s>GUPTA: It really is really interesting. We are seeing certainly individuals, but we're talking about trying to treat communities of people as a whole as well. Doctors actually going out and finding the patients here, sometimes the patients not knowing that they are patients, until they are deemed to be exposed and subsequently treated with Ciprofloxacin, a really sort of interesting cross section between medicine and epidemiology, Bill.</s>HEMMER: I made the comment earlier that whoever did this must have been real pro, because they had to take the anthrax -- and many people don't know how it could be infecting postal workers. But simply, based on one theory, you could take the anthrax down to a size so small that it could leak out of the letters as they were processed, correct?</s>GUPTA: Yes, you know, just for a sake of reference here, we are talking anthrax spores one to five microns. A strand of hair is about a hundred microns. That will gives you a little frame of reference. And most paper, the pores in the paper will allow the anthrax to get through, Bill, but you're point is well taken because we are talking about the right size spore here. If it is in fact too small, you might actually breathe it in and breathe it right back out. If it's too big, it may in fact never make it down into your lungs. We're talking about the right size spore here, one to five microns, and you're right, it very well may have been a pro.</s>HEMMER: Some people wondering yesterday with the two deaths that we saw as a result of inhalation anthrax that was not seen in time. These people have passed away since then. Some are wondering why the doctors did not see it ahead of time. I think it should be fair enough to point out that 99.9 percent of doctors in this country have never seen a case of anthrax in their medical careers.</s>GUPTA: That's right, we are seeing a lot of confusion, not only from doctors, but the public health officials, certainly potential patients, the two deaths in D.C.. Not yet confirmed to be anthrax, but everyone says most likely to be anthrax. I never saw a case of anthrax in medical school. We glossed over it in our studies, you know, just something that people are quickly preparing themselves for. But, Bill, you're absolutely right, I think we are not there yet.</s>HEMMER: A curious thing there happened in Atlanta, Conyers, Georgia last night, just east of downtown. They held a seminar for doctors to come out, nurses to come out and ask questions, whatever they want know about anthrax. The education is one that is ongoing.</s>GUPTA: Right, and the CDC did something similar last week. They had a sort of satellite course. They don't call it a specific tutorial, but sort of a primer on anthrax, and what to look for, how to diagnose it, and certainly when to treat it, when that's appropriate, and certainly something of a lot of doctors are sort of freshening up on once again.</s>HEMMER: Quickly, when we talk about being treated by Cipro antibiotics, can everyone take this, or is it like penicillin when some people are allergic to it.</s>GUPTA: There are allergies to Cipro. They are not quite as common as penicillin, and someone who has a penicillin allergy doesn't necessarily -- isn't necessarily going to have a Cipro allergy. But it is a very powerful antibiotic. It is a broad spectrum, meaning it treats all sorts of different bacteria, and it is not something to be taken lightly. Even with all that's been going on, I know a lot of people are on it now, but as a doctor, and I think I speak for a lot of different doctors, it is still something that should be thought about carefully before taking.</s>HEMMER: Doctor, thank you. Dr. Sanjay Gupta, thank you, much appreciated. TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com