Anthrax and 9/11

Bio-Terrorism

Throughout her career, she has had numerous opportunities to develop and implement the agency’s vision, mission, and goals. Her most significant professional accomplishment involved anthrax. She came to CDC through a two-year postdoctoral fellowship in the Epidemic Intelligence Service (EIS), a program that included applied epidemiology instruction, case studies, and guest presentations from frontline leaders in high-stakes, high-pressure situations. Shortly after joining CDC in July 2001, she was thrown into responding to the post-9/11 bioterrorism anthrax attacks. One of her first assignments was to provide technical assistance to officials at the New York State Department of Public Health (NYSDPH). She used my understanding of epidemiology and disease surveillance to act as a technical resource. Under her leadership, she worked with disease detectives to gather evidence to improve local surveillance and support local health department managers. As a collective, they applied a variety of strategies in the coming weeks.

Our goal was to determine how anthrax was transmitted (e.g., cutaneous, inhalational, or gastrointestinal) to reduce exposure routes. She began interviewing media personnel at ABC, CBS, and Fox News because media professionals received contaminated letters. She collected anthrax samples via nasal swabs, environmental surfaces, and air monitors. She developed a survey to identify key symptoms, victim job tasks, and locations to determine how the disease was being spread. The survey helped verify that the source of anthrax was cutaneous and contracted by victims who opened the letters. She orchestrated surveillance strategies in collaboration with the NYSDPH, HHS, the Federal Bureau of Investigation, and the New York City Police Department.

Shortly after sharing the environmental evidence and behavioral survey data with identified partners, she learned that a high proportion of postal service employees were experiencing flu-like symptoms. Inspection of the J.A. Farley U.S. Postal Service determined that the postal machines that processed the contaminated letters had infected postal workers with inhalational anthrax. The team relocated operations to the processing and distribution center and conducted interviews with postal workers to establish diagnostic criteria and assess whether the machine they operated affected their exposure levels. To manage the event, she collected a floor map of the machines and the names and job duties of the employees. By effectively managing pressure, she quickly became a subject-matter expert and strengthened surveillance efforts by leveraging intelligence research to establish diagnostic criteria and manage the event. Survey data indicated that direct exposure to a specific machine did not increase risk because the center used circulated air. She and her team distributed antimicrobial post-exposure prophylaxis to all postal employees and visitors who may have been exposed. She tolerated ambiguity and adapted to changing conditions and unexpected obstacles by discussing preventive measures with workers during the distribution of Ciprofloxacin or Doxycycline prophylaxis. She recognized the need to reach a larger audience and therefore conducted question-and-answer sessions every three hours. Understanding postal workers’ concerns helped her implement a system to manage sensitive information and communicate with front-line staff to improve treatment compliance.