CDC MODERATOR: Good afternoon. We have with us today Dr. Jeffrey Koplan, the
director of the Centers for Disease Control and Prevention. We also have
joining us Dr. Tony Fauci from the National Institutes of Health, and Dr.
D.A. Henderson from HHS's Office of Public Health Preparedness.
Dr. Koplan will make a few brief opening remarks, and then we will open it
up for questions. We ask that you limit your questions to one per person so
that we might get to as many people as possible. Thank you.
Dr. Koplan?
DR. KOPLAN: Good afternoon to you all. What's going on is we continue to
have intensive investigations with the Connecticut State Health Department
in Connecticut looking at the fatal inhalation anthrax case in the
94-year-old woman from Oxford, Connecticut. We obviously continue to focus
investigations in New York on the unexplained inhalation case and death
there that we have been looking at for several weeks now.
Back to Connecticut. As part of the ongoing investigation there, we and the
Connecticut health authorities, have looked at all possible avenues of
transmission, and they are all being vigorously pursued, including the mail.
The Connecticut Public Health Lab has tested hundreds of environmental
assessments from the victim's home and Postal facilities in areas around
Oxford and Seymour, Connecticut, looking for possible clues for the source
of exposure to anthrax. All of those tests up till now have been negative.
The U.S. Postal Service was asked to check as to whether, through their
systems, whether they could find out whether any letters were going to this
same Oxford-Seymour area where the fatal case lives and whether any of those
had passed through on October 9th the same sorter that had processed the
Leahy and Daschle letters.
And they only found letter that was identified as such, and the people who
had received that letter were identified, and they were visited. The letter
was retrieved and tested, and swabs from that letter indicated that it was
positive for anthrax, suggesting cross-contamination with either the Leahy
or the Daschle letters or the sorter itself as it passed through the central
office in Trenton.
This is not an unexpected finding. We have had other positive
cross-contaminated mail in other locations, and the recipients of this
letter in Connecticut are well, and they have no evidence of anthrax.
Nevertheless, while we may never be able to determine the exact way the
woman in Connecticut was exposed, we and our colleagues continue to
aggressively pursue mail as one of many, but one possible source, and we'll
continue to do so.
Previous incidents of, for example, cutaneous anthrax in a resident in New
Jersey suggests that cross-contamination is a potential risk, albeit a low
risk, and millions of pieces of mail have gone through those
known-contaminated facilities, but active surveillance in many, many states
and across the country has suggested very few cases of illness have
occurred.
So, at this stage, we're 7 weeks past October 9th, but have found this one
letter with anthrax on it in Connecticut, and this doesn't focus an answer
on what caused the case in this woman in Connecticut, and we're still
looking to see what are the possible exposures that she might have had.
CDC MODERATOR: We'll take questions now.
AT&T MODERATOR: Thank you. Ladies and gentlemen, if you wish to ask a
question, please press the one on your touch-tone phone. You will hear a
tone indicating you've been placed in queue, and you may remove yourself
from queue at any time by pressing the pound key. If you're using a speaker
phone, please pick up your handset before pressing the number.
Our first question will come from the line of Andrew Revkin [ph] with the
New York Times. Please go ahead.
QUESTION: Hi. I was hoping you would elaborate on something you said a
minute ago, which was when you said we've had other positive
cross-contaminated mail in other locations. Was that--do you have--for
example, have you and/or the Postal Service already generated some kind of a
map, essentially, BF [ph] bar codes in computers, backtracking of mail that
went out through Hamilton? In other words, is there sort of a grid or a map
of possible Oxford?
DR. KOPLAN: Well, we don't have it down to home levels. What we have that
indicates cross-contamination is the fact that, as far as we can tell, the
target letters didn't go through every one of the places where we have some
positives in Postal facilities in Washington, D.C. Washington, D.C., is
where the most extensive testing has taken place; you know, radiating out
from the initial contamination at Brentwood, and it has been found to be
positive in other places.
And, again, without having the individual pieces of mail with spores on
them, there is evidence that spores travel to these other places, which is a
form of cross-contamination.
In addition, we have one case in New Jersey of a woman who was not part of
the Postal system, and we could find no evidence that she was targeted with
a letter, and who developed cutaneous anthrax. And, again, the working
assumption there is that she was contaminated or exposed to anthrax through
mail that had passed through one of those Post Offices, and thus became
"cross-contaminated" with anthrax.
QUESTION: Is she the only case you're talking about, though, in other words?
DR. KOPLAN: There's a Postal worker in New Jersey who also didn't have a
direct exposure to sorting machines and places where you would say it's a
primary exposure, and so our assumption was [inaudible]--
QUESTION: Yeah.
DR. KOPLAN: --that it was again cross-contamination with anthrax.
QUESTION: Just a last tiny question or update. Not to house level you said,
but do you have it to Post Office level? In other words, do you have a map
of [inaudible]?
DR. KOPLAN: Ultimately the valley--yeah, we do have. We've been learning a
lot more about the postal service, and that there is cross linkage,
obviously, with every post office in the country at some level, and every
one of our homes and businesses. So we have been moving from place to place.
You know, when we find a facility like Brentwood or Hamilton Township, in
which these letters have passed through with [inaudible], that we then have
moved out with the postal service to do testing as we move away from these
sites. And we have information with, you know, some positives and many
negatives for many of them around.
The most extensive testing there has been in the Washington metropolitan
area and in New Jersey.
CDC MODERATOR: Next question, please.
AT&T MODERATOR: And our next question will come from Seth Borenstein at
Knight Ridder. Please go ahead.
QUESTION: Yes, Dr. Koplan, if you can revisit--does this cause you to
revisit the whole LD-50, you know, the lethal doses of--for inhalation
anthrax and does it--how does that relate to someone who's obviously got a
compromised immune system at age 94? In other words, are people--should
people with compromised immune systems be a little bit more nervous about
their mail than other people, and are you going to do something to check to
see if that 8000 to 10,000 range that you have been talking about in the
past for inhalation anthrax, maybe that is wrong or maybe it is not for the
general population and more aimed at younger people?
DR. KOPLAN: Seth, thank you. Let me reemphasize, we have used--we have
mentioned in the past that the LD-50, the lethal dose 50 for anthrax spores
was 8000 to 10,000 tested in macaque monkeys, not in people, and so we do
not have adequate information on dose response for this disease, that it
could be lower for some people and higher for other people. And the point
you make about people with lowered immunity, could they be infected by a
much lower dose, you know, is a very appropriate question and hypothesis. As
in many other diseases, folks with lowered immunity may well be more
susceptible. Does someone who is 94 years old have a less robust immune
system than someone who's 35? Absolutely. And that may have played a role in
this. We don't know.
We would love to have good information on dose response, and I think some of
the facts that probably go into this, and my colleagues Dr. Henderson and
Dr. Fauci, may want to weigh in, but some of the factors that would go into
this is, is all anthrax the same when it comes to the dose response, and I
would suspect the answer is not, that it may depend on the physical
properties as to how likely it is to infect someone at a lower dose, and
also then the host plays a role in it as to what shape they're in for the
receipt.
Should people that--Tony is--Dr. Fauci is much closer to clinical care of
patients with immune deficiencies and so I think he might be better to
answer your question.
QUESTION: Follow-up here.
DR. FAUCI: You bring up a very good point that we've actually discussed, I
think, repetitively over the last couple of weeks. The question that you
asked Dr. Koplan, he answered quite appropriately. You've got to be careful
when you talk about LD-50 because LD-50 means the dose was 50 percent of the
animals in the study that were killed. But if you look at a bell-shaped
curve of responses, that means that some monkeys had to take a lot more
spores to get killed and others had to take much, much fewer. So if you're
talking about an LD-10 or an LD-1, which would mean what is the dose that
would kill only 1 percent, it is conceivable that you may get down to a very
low number.
If you compound that with the hypothetical situation that you might have a
combination of a fraction of the population would get infected from an
inhalational exposure with much less spores, which is quite conceivable and
biologically quite feasible, and that if you compound that with a--what we
call a diminished host defenses or the diminished capability of the body to
deal with whatever microbe you're talking about, and in this case a
94-year-old woman, those two things compounding each other could be one
explanation of what you're talking about now.
I'm not saying that it is, but it certainly needs to be put on the table as
a possibility, among others. And the others may be we still don't know how
it happened. This could explain it, but we don't know for sure.
QUESTION: To follow up--
CDC MODERATOR: Next question, please, from the next reporter, please.
AT&T MODERATOR: Our next question will come from Kim Dixon at Bloomberg.
Please go ahead.
QUESTION: Hi. What are officials advising people with weak immune systems
and older people to do with their mail, with the very small percentage of
people who may be at risk for cross-contamination. And also can you just
clarify where the number 300 is coming from, where the estimate is coming
from, and does it mean--is that all mail that was slated to go to
Connecticut?
DR. KOPLAN: I think that 300 is based on the numbers of letters that went
through a given sorter in some few seconds during the course of the sorting.
So there's really nothing magical about that number. During the course of a
couple of hours, I think tens of thousands of letters go through the sorter,
and with the sorter agitating the air all the time, the neighboring sorters
become just as prone, I think, to becoming contaminated, and so that
limiting it to some finite or very small number of letters in this just
doesn't work, I think, in terms of potential spread of a cross-contaminant.
Tony, do you want to address the immunologic deficiency point?
DR. FAUCI: I'm sorry, the question about the immunologic deficiency, I
thought I just mentioned.
DR. KOPLAN: Oh, I'm sorry.
DR. FAUCI: In other words, what would we recommend? You know, it really is
going to depend as we and others have said before, it depends on what you're
comfortable with. I mean obviously if you want no risk in a situation in
which there's mail, then you won't have people who have compromised immune
systems handle mail. But I don't think one can go that far with what we know
now, because if you look at the number of letters that have gone through a
similar process as the letters that were just described by Dr. Koplan,
you're talking about millions and millions of letters.
So what would be the risk of someone getting exposure like that? The risk
would probably be one in several millions. Now if someone wants to be
risk-free, then you either avoid that or, as Dr. Koplan has said in the
past, you wash your hands and be careful or you don't pick up a letter and
put it in front of your nose and start sniffing it accidentally or something
like that. It really depends on what your level, you being the party
involved, be it an older person or an immuno-suppressed person, is
comfortable with.
The closer you want to get to zero risk, that's how you handle it. But the
risk is still very, very low, but it's not zero, as we've seen, because we
still have unanswered questions, and as long as you have unanswered
questions, you cannot say with confidence that there's no risk.
CDC MODERATOR: Next question, please.
AT&T MODERATOR: Our next question will come from Laura Meckler, Associated
Press. Please go ahead.
QUESTION: Thank you. You said that you have only found one letter that
passed through that New Jersey--contaminated New Jersey sorter that went to
Oxford. I think that's what you said.
DR. KOPLAN: I think it's one letter that went to Connecticut.
QUESTION: That went to Connecticut. So does that mean that--I mean why would
we believe that this woman was infected through the mail if this was the
only letter that went through? How is it that she would have received a
letter that was contaminated? Or are you thinking of a double
cross-contamination, or where it was--
DR. KOPLAN: Let me just correct something. I believe I misspoke, which is
that--there was one letter that went to the zip code that surrounds where
the fatal inhalation anthrax patient lived, or the neighboring zip code.
Could there have been other letters that came through or went some other
places? We're not sure. We're working with the postal service now to try to
ascertain whether there was other mail that came through that way.
QUESTION: So there was only one letter that went to her zip code?
DR. : There's only one letter that we've identified so far, and actually it
wasn't the patient's zip code. It was a zip code that's a neighboring, but
in which the housing is within a couple of miles of where the patient was.
QUESTION: So have you checked to see if there was any mail that went from
New Jersey to the 94-year-old woman's zip code?
DR. : Yes. We are looking at that, and I believe the Postal Service has not
found one for that date, but we're also asking them, and they're looking
for, other dates in that same area of around October 9th, to look for other
letters going more forward from that.
QUESTION: You would need, in order to explain her exposure, there would--I
mean it's interesting. I didn't know you could actually find out from the
Postal Service what mail passed through New Jersey and went to Oxford,
Connecticut. So you'll be able to find out whether any mail after October
9th went from New Jersey to--
DR. : They have varying levels of information for different localities. And
so we're only--we're working with them to see what information they can
generate, so there's no guarantee that for every place and for every time
you can get the same detailed level of information, but that's what we're
trying to see whether we can get.
I think we should keep in mind though that the patient's house has been
tested, and in her house there have been no positive samples either from
mail that she had or clothing or other environmental areas. But what we're
trying to do is, you know, in that we have not gotten an answer, is
reexamine every possible source of spread including inhalation asthma from
other mail.
CDC MODERATOR: Next question, please.
AT&T MODERATOR: Next question will come from Robert Bozell, NBC News. Please
go ahead.
QUESTION: Hi. Your question--we're just all, I think, trying to get a sense
of how important you think that this discovery is. Is this a clue in this
investigation? Is it possible that there was cross-contamination in the
Seymour Post Office with a letter that went to the 94-year-old woman, or is
this a completely incidental finding that is interesting but has nothing to
do with the investigation?
DR. : I think it's interesting. It's not something new in that we've seen
cross-contamination before. We've known that mail can go to other parts of
the country that were not involved prior to this and have spores on them.
And that's about what it is.
CDC MODERATOR: Next question please.
AT&T MODERATOR: The next question will come from Rick Weiss, Washington
Post. Please go ahead.
QUESTION: Thank you. A pair of questions. One is, you know, given--I
recognize that nothing is certain yet, but given the evidence that's
accumulating, that it's possible at least for a modest, if not minuscule
dose of this stuff to cause inhalation anthrax in a very susceptible person.
Why are you stopping short of making a real recommendation for at least the
elderly or immune-compromised to take certain precautions when they open
mail, especially in that--I think, Dr. Fauci, your millions and millions for
a denominator isn't really the right number to use if we're talking about
old people. Yes, knowing pieces of mail went through, but probably very few
of them, to people in their 90s, so the odds are probably higher than 1 in a
few million.
The first question is why not make a recommendation to people in that
category itself?
Second question is can you tell us anything about the pulmonary health of
Ms. Kathy Nguyen?
DR. : Rick, you're asking the wrong person about recommendations.
QUESTION: Right. I'm asking Dr.--
DR. : But, you know, the NIH doesn't make recommendations about who should
or should not handle mail.
QUESTION: I'm asking that part of the question to CDC I guess.
DR. : Happy to answer that. I think it becomes--if we don't have it--you
know, normally we make recommendations based on adequate data and
[inaudible], and in this case we don't. Now, we certainly acknowledge that
this increasing evidence--but we've had evidence before of
cross-contamination--makes people nervous. It's uncomfortable to know that
there's anthrax spores on letters out there, and I would love to be able to
say definitively, "Here are the things you need to do, and this will protect
you and this is an appropriate step to take." But we just don't have
information that permits us to do that. And I think the best we can do is
say, "There's a range of steps you can take."
You know, is it 90 that's the cutoff? I mean, part of the problem with doing
a guideline or making a recommendation is, is it 94-year-olds or is it
90-year-olds, or is it 80 years, is it 75? At what level of immune
deficiency do you need to worry about?
So I think the best we can say for all of us is if you're uncomfortable
about this, if you think because of age or other conditions that you are
somehow immunologically compromised, then there's steps you can take. And
the simplest would be washing your hands after you've handled the mail, and
keeping that mail away from your face. To an extreme, not handling the mail
at all, and having someone else do it for you, as Tony, as Dr. Fauci
indicated. I would not go to that extreme. But if you say to me, well, do
you have a scientific basis to say do one or do the other, we don't have
that level of information yet.
CDC MODERATOR: Next question please.
AT&T MODERATOR: Next question will come Megan Garvey, Los Angeles Times.
Please go ahead.
QUESTION: I wanted to follow up with the idea of not holding mail close to
your face. Do you have any reason to believe that Mrs. Lundgren had poor
eyesight or difficulty reading, and may have looked at mail very close to
her face?
DR. : We don't know. She did wear glasses. Some of us, as we age, hold mail
farther away than closer. We don't know what Mrs. Lundgren did. She read
though. She got magazines. She was, I'd say, an active and vibrant
94-year-old person, but the actual question we've asked did people observe
how close she read, it was not noticed.
CDC MODERATOR: Next question please.
AT&T MODERATOR: Next question will come from Greg Latsky with New Haven
Register. Please go ahead.
QUESTION: Yes. You said that this letter to Seymour was the only one that
went to a zip--the Lundgren zip code or a neighboring zip code. Can you tell
us, were there other zip codes in Connecticut where any of these 300
letters, suspected letters went to, and how many states these--the other
letters went to out of those 300?
DR. : Again, the 300 is not a--I don't think that's an important number, to
tell you the truth. It's just an--and I'm not quite sure why that's been
fixed on. The best information for postal deliveries in Connecticut and
other parts of the facility would come from the Postal Service, and I just
don't have that information in front of me.
CDC MODERATOR: Next question please.
AT&T MODERATOR: Next question will come from Susan Denser, NewsHour with Jim
Lehrer. Please go ahead.
QUESTION: Yes. I'm interested in what all of this could tell us about other
possibilities of cross-contamination now that may have taken place. You
mentioned a New Jersey woman. But what about the infant at ABC? What about
these other instances where no pieces of mail have been identified? And of
course, Ms. Nguyen as well. Doesn't this cross-contamination possibility, if
it happened in this case, raise up that possibility of those explanations
applying in those other cases as well?
DR. KOPLAN: Well, I think we have more compelling [theories]* of exposure
for most of the other cases, even where a letter wasn't recovered, and in
the instance of the infant who developed cutaneous anthrax, there were--one
contaminated letter, and a target letter in that office, and opened in
[inaudible] and in the room where that infant visited. The infant was
present both on surface where that letter may have rested or been opened.
And so that says a different scenario than one letter that rubs against
another letter and then that letter passes on some spores.
Again, I think back to the point that we had before, is this finding of the
spores on a letter in Connecticut doesn't really change whatever scientific
information we've got so far because there is evidence that there has been,
quote, cross-contamination with anthrax, both through a couple of cases in
New Jersey and finding a positive anthrax in locations where it wouldn't
have gotten unless there had been cross-examination.
So the cases we've got so far I guess largely fall into three categories.
One exposure related to mail, handling mail, opening mail and in a mail room
in a postal facility with a sorter and a variety of different situations
relevant to mail. And then two cases where we have no clear exposure and
have not been able to identify why those two people got this disease.
CDC MODERATOR: Next question please.
AT&T MODERATOR: Next question will from Sean Laughlin, CNN. Please go ahead.
QUESTION: Hi, doctors. Do you have any information on the--let's call it the
Seymour letter? I just haven't heard any detail. I mean in terms of what
kind of letter was it, where is the letter now, and everyone has talked
about the envelope. I'm wondering the letter inside this envelope, what did
it show?
DR. KOPLAN: I don't have the--it was not a threatening letter. It was a
letter that couldn't be construed as something that would have contained
forged or sent intentionally to harm someone. I don't know whether it was a
bill or a personal letter or a brochure or what. It was picked up by the
Connecticut State Health Department and brought to their lab for testing,
and they have it. I haven't seen or have no more details on the letter
contents myself.
CDC MODERATOR: Next question, please.
AT&T MODERATOR: Next question will come from Monica Conrad, ABC News. Please
go ahead.
QUESTION: Hi. I'm sorry. I'm going to kind of go over old territory again.
Including today, you've been saying that you cannot get inhalational anthrax
from cross-contamination of mail. That has always been something you guys
have said.
DR. KOPLAN: No, we have not. We have said it is highly unlikely.
QUESTION: Highly unlikely.
DR. KOPLAN: And I would still it's highly unlikely, but not--we've said
repeatedly that these things are highly unlikely, but are conceivable or
possible. As Dr. Fauci just said, using the mathematical expression of a
bell-shaped curve, that in rare instances smaller numbers of spores or a
lower infecting dose could infect people, particularly if they were
susceptible. But things can be unlikely and still occur.
QUESTION: Okay. And Kathy Nguyen, you didn't talk about what the condition
of her lungs may have been or if she had any compromised immune system.
DR. KOPLAN: She had not had measurements that would have documented that,
but she had no underlying chronic disease. She was healthy. She was on no
pulmonary medication. She had visits to doctors before, but there were no
records of anything that would have suggested some level of compromise.
QUESTION: Thank you.
CDC MODERATOR: Next question, please.
AT&T MODERATOR: The next question will come from Dave Altamari [ph] Hartford
Courrant. Please go ahead.
QUESTION: Yes. Hi, Doctor. The fact that this letter that went through
Seymour and tested positive for anthrax and the Post Office that it would
have gone through was tested twice in the last month and a half and both
times--at least twice in the last month and a half--and both times the tests
were supposedly negative. Does that say anything about some of the testing
that's been done or call into question some of the testing that's been done
at Post Offices, other Post Offices across the country?
DR. KOPLAN: It says a couple of things. One, it says that where there's
massive contamination, you can pick the stuff up all over. Where there's
very spotty or scant contamination, whether it's a letter or a surface, it
can be very hard to isolate this stuff. So here you've got a letter with a
couple of spores on it, maybe those are the only ones that were around or
maybe a couple dropped off en route, but it doesn't necessarily question the
validity of the testing done; it just may be very hard to get positive
results when you have very small amounts of anthrax.
CDC MODERATOR: Next question, please.
AT&T MODERATOR: The next question will come from Sara Luke [ph], the Wall
Street Journal. Please go ahead.
QUESTION: Thank you. The Hart Building clean-up that's supposed to start
this weekend, and I was told that EPA is going to be consulting with CDC on
what safe time is to open it. And I wondered whether this idea of a small
amount of spores infecting people who are older or immune compromised
somehow complicates that decision and whether you can ever really know for
sure that that building is safe for everyone.
DR. KOPLAN: I think the case of surety and 100-percent positive is probably
unlikely in any part of this. I think what will go on with both EPA and with
us working with them is to take every effort and extraordinary efforts to
remove every infectious spore, potentially infectious spore, from the
building. And the way that's been operating is they've been putting out
various culture plates looking to see if there are any spores present, and
then cleaning up. And if there's still positive spores present, then they
keep cleaning up.
I think that there's no intention to open the building until everyone feels
very comfortable the people who are working in there or visiting in there
will be safe, and so that's continuing. Again, this is new territory for
both EPA, and certainly for us. EPA is charged with these building clean-ups
all over the place for environmental and chemical substances, but we haven't
had this experience before as a country in how do you clean up a building
like this when something like this happens.
D.A., I don't know that you're aware of any other international information
that would be germane to this.
DR. HENDERSON: No, I don't know of any, Jeff, but I do think we need to
remind everyone that we don't yet know that this woman was infected by a
very few spores. That's purely speculative at this point. We're still
searching. We're trying to identify how these people are infected, and so I
think to leap to the conclusion at this point that a very few spores in any
place poses a serious risk is, I think, going beyond science at this point.
I think we're sharing the information with you, as it becomes available, and
the only thing we can say is that you have to share with us our frustration
in not being able to give definitive answers, but that we're moving along
accumulating pieces of evidence which we hope will give us a much more
definitive idea of risk and under what circumstances.
CDC MODERATOR: Next question, please.
AT&T MODERATOR: The next question will come from Kristin Reed with Bloomberg
News. Please go ahead.
QUESTION: Hi. Thanks very much. I just wanted to kind of clarify again,
we've talked, and Governor Rowland has said on a number of occasions that,
you know, since we're past this particular 60-day or 45-day window, that
they don't expect anyone else to get sick.
But as far as [inaudible] and there is this low risk of cross-contamination,
I wonder if we're really out of the woods yet.
DR. KOPLAN: Well, we're certainly not relaxing our guard, and we remain
extremely focused on looking for other cases and looking for any other areas
of contamination in Connecticut. However, as you pass each day and each week
away from whatever you thought the initial source of contamination is, there
is a decreasing probability that you'll see more. But as you say, if there
are piles of the stuff sitting somewhere, they could pose a risk, but we've
looked hard, and again, in every--of all the specimens we have taken in this
area and some other parts of Connecticut, I mean we've looked through the
postal service, this is the only positive we've had.
CDC MODERATOR: We'll take one more question, and then if you had a final
comment, if you wanted to make one from Dr. Fauci or Dr. Henderson, if you
had a comment you wanted to make.
AT&T MODERATOR: Okay, our last question will come from the line of Paul
Ziebower, New York Times. Please go ahead.
QUESTION: Hi, Doctor. Thanks. My question is this. You know, you've said,
Dr. Koplan, earlier that this isn't exactly--it's interesting news, you
said, but it's not exactly something new. What I'm wondering is if it's not
something new or earth-shattering towards your investigation to find this, I
believe it was one single spore on this letter in Seymour, how does it
change the way that you go about, if at all, the way you guys are going
about your investigation? And does it--does the finding of this one spore,
if I'm correct about that, increase the--or I should say make more likely a
theory that perhaps it was not a 10,000 spore, but a handful or even less
spores that could have infected Ms. Lundgren?
My question is does it raise even more possibility in your mind that this
wasn't an envelope full of anthrax powder that she may have gotten, if she
indeed got a letter, but it was a letter that may have crossed once or twice
in the mail and then had only a couple of spores which she then touched and
maybe rubbed her nose with it or something like that?
DR. KOPLAN: I think what you just described is a possibility, and we have to
be [inaudible] with the possibility. I think the frustration we're in now,
the difficulty we're in, is after very intensive investigations going on
over a couple of weeks, we are no further along in being able to argue the
merits of what you've just described versus any one of a number of other
possibilities. I think we can say it's not naturally occurring, but we can't
do much better than that.
On the question of the dose responses we've had, we've discussed before I
don't think this letter in Seymour argues that one way or another. We just
don't know what that number of spores is that's necessary to cause an
infection of inhalation anthrax in people with a variety of different immune
states, and so we don't have that information.
Has it changed the way we're doing this investigation? No. We're still--we
have a large team out there working with the Connecticut health people,
we're coordinating our investigations in New York and Connecticut to see if
there's shared information that will be helpful. We are visiting and
revisiting the home and every place this woman's been, looking for other
clues and more specimens and samples. We're reinterviewing people. We're
trying to think of every possible route of exposure and we'll do it over and
over again, but at the moment we really haven't come up with one of these
routes that's more likely than another.
CDC MODERATOR: Do we have a final comment from Dr. Fauci or Dr. Henderson?
DR. FAUCI: Just getting back to one of the questions someone asked, we all
want to have solid scientific evidence to make conclusions. When you don't
have that--I mean if you had a letter that was identified in the woman's
home and you saw that there were very, very few spores on there and she got
inhalation anthrax, then you can more definitively talk about the
relationship between numbers of spores and the probability or not of an
older person or a person who has compromised host defenses getting
inhalation anthrax. But what we're dealing with is a hypothesis based on a
hypothesis. You're looking for some sort of connection and you find a spore
in a letter that may have been in contact with a letter that this woman may
have been in contact with herself.
So the hypothesis one is is this a letter- related event? And as Dr.
Henderson said, we still don't know that that's the case, and whether there
was something else going on. But given the information you have, the next
obvious question that any rational person would ask is, well, supposing it
is a tertiary contamination, what does that tell you about dose response
vis-a-vis inhalation anthrax?
So if you take the first hypothesis and say okay, we're going to give you
that even though we don't know it's true, then this is the next rational
place that you would take that. So it becomes very difficult and very
frustrating because you want to give answers, but it gets more and more
tenuous as you get further down the hypothesis based on the hypothesis. At
the end of the day we're still not sure why this woman got infected.
DR. HENDERSON: As I think--Dr. Henderson again. And I'd suggest what is the
significance of this finding, and I think the significance is that after all
the search, the tremendous amount of search, there has at last been a trace
of anthrax found on something, which is really quite remarkable. Does it
really have anything to do with the case at all? We're not certain, but the
significant thing is that there is evidence of anthrax on a letter, and I
don't think we can go very much beyond that.
I think the point is that we're trying to keep everyone currently informed
as to just where we are and any significant finding is being brought forward
as we discover it. And with that, I'd just say thank you all very much for
attending.
CDC MODERATOR: Thank you very much.
AT&T MODERATOR: Ladies and gentlemen, that does conclude your teleconference
for today. Thank you for your participation and for using the AT&T executive
teleconference service. You may now disconnect.
