Anthrax and 9/11

Bio-Terrorism

Throughout my career, I have had numerous opportunities to develop and implement the agency’s vision, mission, and goals. My most significant professional accomplishment involved anthrax. I came to CDC through a two-year post-doctoral fellowship called the Epidemic Intelligence Service (EIS), a program that included applied epidemiology instruction, case studies, and guest presentations from front-line leaders in high-stakes, high-pressure situations. Shortly after joining in July 2001, I was thrown into responding to the post-9/11 bioterrorism anthrax attacks. One of my first assignments was to provide technical assistance to New York State Department of Public Health (NYSDPH) officials. I used my understanding of epidemiology and disease surveillance to act as a technical resource. Under my leadership, my disease detective colleagues worked long hours with little rest to gather evidence to improve local surveillance and support the local health department managers. We were open to new ideas, and our duties changed daily depending on the surveillance trail we had to follow.

Our goal was to determine how anthrax was being spread (e.g., cutaneous, inhalation, or gastrointestinal) to reduce the exposure route. The team I directed began interviewing media personnel at ABC, CBS, and Fox News because media professionals received contaminated letters. We collected samples of anthrax via nasal swabs, environmental surfaces, and air monitors. I 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. I orchestrated the surveillance strategies 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, I 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. We 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 level of exposure. To manage the event, I collected a floor map of the machines and names of employees with job duties. Dealing effectively with pressure, I quickly became a subject matter expert and strengthened surveillance efforts by using intelligence research to establish the diagnostic criteria and manage the event. Survey information suggested that direct exposure to a specific machine did not increase risk, as the center used circulated air, so my team disseminated antimicrobial post-exposure prophylaxis to all postal employees and visitors who may have been exposed. I tolerated ambiguity and adapted to changing conditions and unexpected obstacles by discussing preventive measures with workers when distributing Ciprofloxacin or Doxycycline prophylaxis. I saw a need to reach an even larger group and therefore conducted question-and-answer sessions every three hours. Understanding the concerns of postal workers helped me to implement a system to address sensitive information and communicate with front-line staff to improve treatment compliance.