- The Washington Times - Friday, March 8, 2002

The rapid use of antibiotics by thousands of people cooled the hot spots in last fall's anthrax-by-mail terrorist attacks, holding down the inhaled infections and deaths, Johns Hopkins researchers say.
It could have been much worse than the 11 cases of inhaled anthrax and the five deaths, said Ron Brookmeyer, first author of a study appearing today in the journal Science.
At least 17 and as many as 50 could have become ill with the most serious form of anthrax except for the use of antibiotics by about 5,000 people potentially exposed in Florida, New Jersey and the District, said Mr. Brookmeyer, a biostatistician at the Johns Hopkins Bloomberg School of Public Health in Baltimore.
"We found that the antibiotics cut the cases by half," Mr. Brookmeyer said. "That's good news. They were able to have a rapid response with the antibiotics and limit the disease."
He said the analysis established a range of probabilities. He said it showed that the most probable number of inhalation-anthrax cases without timely antibiotics would have been 17 and that, in the worst case, the total number would have reached nearly 50.
Mr. Brookmeyer said the study focused only on the three confirmed sites that potentially exposed large numbers of people from letters laced with anthrax spores.
The locations were a media office in Florida, where two persons were infected; a postal building in New Jersey, where two were infected; and a mail-handling building in the District, where four were infected.
There were three other cases a State Department mailroom worker in Northern Virginia, a hospital employee in New York and an elderly woman in Connecticut. These cases were not considered in the statistical analysis, Mr. Brookmeyer said, because they were outside of the clustered exposures. Investigators are still uncertain how the women in New York and Connecticut were infected. The State Department employee is thought to have come in contact with mail that had been contaminated by spores from an envelope at the central mail-handling office in the District.
The study validates the quick response of public officials to the crisis and suggests that a rapid distribution of antibiotics is critical to limiting the disease, he said.
"Our study shows that when there is an exposure, you can, in fact, prevent disease provided you get in there quick enough with antibiotics," Mr. Brookmeyer said. "The shorter we can shrink that interval, the more cases we can prevent."
Antibiotics were taken by about 5,000 people associated with anthrax hot spots, about half of the 10,000 people nationwide thought to have taken the drugs because of the risk of anthrax. Most took the drugs for 60 days, the recommended regimen.
Some experts were concerned that people whose lungs still contained inhaled anthrax spores could come down with the disease after the 60-day period of antibiotics.
Mr. Brookmeyer said that, based on the anthrax disease-incubation period observed in a 1979 outbreak in Russia, this is unlikely.
"There is some reassurance in our study, because of the thousands of people who completed the 60-day regimen of antibiotics, few would be at risk of subsequent disease. Certainly, less than 1 percent," he said.

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