Inhalation Anthrax Case Investigation, Pennsylvania, New York City – Update, 2/24/2006

Laboratory testing from the patient’s storage/work facility, his van and his residence have identified Bacillus anthracis.  These findings are consistent with the hypothesis that the patient’s exposure occurred while working on contaminated hides while making traditional drums. 

The patient remains hospitalized in Pennsylvania. 

Investigation of other potentially exposed persons continues; seven persons are currently on post-exposure prophylaxis for inhalation anthrax.  None of these individuals have symptoms of anthrax.  In addition, surveillance has not identified any other illness consistent with anthrax disease in NY and PA. 

Animal hides pose a low risk of cutaneous anthrax, and an extremely low risk of inhalation anthrax. Exotic animal hides may pose a higher risk for exposure than domestic (U.S.-origin) hides. The risk of contracting Bacillus anthracis from handling individual hides is believed to be very low. The industrial handling of large numbers of hides, or hair from multiple animals, has historically been associated with increased risk of anthrax. Among the 236 cases of anthrax reported to CDC from 1955 to 1999, 153 (65%) were associated with industrial handling of animal hide or hair. Only 9 of the 153 cases (6%) associated with industrial handling of hair or hide were inhalation anthrax.

The risk of acquiring anthrax from an animal hide drum is very low.  Of 236 cases of anthrax reported to CDC from 1955 through 1999, only one case of cutaneous anthrax was associated with a goat hide bongo drum purchased in Haiti.  No cases of inhalation anthrax in the US have ever been associated with animal hide drums.  The New York patient’s exposure occurred when he was making and finishing drums made from untanned animal hides, and was not associated with playing finished drums. His exposure was similar to that experienced during industrial handling of hides, which has been previously associated with an increased risk of anthrax.  CDC does not currently recommend prophylaxis for persons who have had contact with animal hide drums. However, drum owners or players should report any unexplained febrile illness or unusual skin lesions to their healthcare provider, and describe their recent contact with animal hide drums. 

For case definitions, treatment guidelines, laboratory testing procedures, etc, see Anthrax Information for Health Care Providers.

http://www.bt.cdc.gov/agent/anthrax/anthrax-hcp-factsheet.asp

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