November 1, 2001
Anthrax Update: 2nd CDC Telebriefing Transcript
This is a verbatim transcript of a teleconference from the Center for
Disease Control held on Oct. 30. It is presented without any editing to the
transcript so as to help the reader understand the context of the
Thank you. I simply just want to introduce HHS Secretary Tommy G. Thompson.
SECRETARY THOMPSON: Thank you, Bill, and good morning to all of the
reporters on the line. I'd like to say thank you for listening in and taking
this opportunity to inform you on some new events that have taken place in
the last 24 hours.
I am speaking to you this morning from the Centers for Disease Control and
Prevention here in Atlanta, Georgia. I am here as part of the ongoing
business of the operating divisions within HHS, and previously I visited and
worked out of the Centers for Medicare and Medicaid Services, the Health
Resource Services Administration, commonly referred to as HRSA, the NIH, and
the Food and Drug Administration.
I am very happy and pleased to be joined this morning by Dr. Jeff Koplan,
who is the director of CDC and is doing an outstanding job, of course,
operating that institute, and Dr. Bradley Perkins, who is one of the CDC's
leading epidemiologists and anthrax experts. Dr. Bradley Perkins was the
first, one of the first CDC people on the ground in Florida, and he headed
up that field team until it was completed.
Today, we want to provide you an update on what we know as of 12 noon
regarding the status of cases in New York City and New Jersey. Drs. Koplan
and Perkins will also talk in some detail about the assets that we have in
place in New York City and New Jersey, as well as discuss what those folks
I want to emphasize to you that, as we have since the beginning, we're
continuing to work closely with state and local officials throughout these
investigations, as well as working closely with law-enforcement officials,
especially at the federal level and more specifically the FBI.
Before we discuss what we know, I want to remind everyone that this
information we have is what we know at this time. Information is developing
that will likely alter these facts as we now know them because this is an
ongoing investigation. For this reason, we're trying to update you on a
regular basis so you will have the latest information.
As of last night, the CDC reported an additional suspected case of
inhalation anthrax in New York City. The preliminary confirmation was made
by the New York City Department of Health. We expect final tests to be
completed this afternoon. The woman works in the back room of a lower
Manhattan hospital and occasionally works in the mail room, and it's our
understanding that the mail room was changed over about a week ago when she
had spent more time there.
A new confirmed case of cutaneous anthrax has also been identified in a New
Jersey resident whose occupation is not directly linked to the mail delivery
system. The patient was discharged from the hospital yesterday. She's on
antibiotic treatment and is doing well. This situation is under active and
intense investigations by the public health and law-enforcement officials
working within the Postal Services. The investigation will examine a range
of possible links between this case and the Hamilton mail facility.
Steps that are being taken immediately include extensive interviews,
environmental sampling in the patient's home and workplace, the
environmental sampling of pathways between the Hamilton mail facility and
locations where the patient receives mail, and evaluation of other potential
sources of exposure.
A similar investigation with similar steps is also underway in the suspected
case in New York City. Additional CDC epidemiologists were dispatched to New
York last night to supplement already deployed individuals. They are on the
ground conducting the investigation. And also deployed were additional lab
assets to assist New York and New Jersey in conducting tests as part of this
Now let me turn it over to Dr. Koplan for his remarks and then Dr. Perkins.
DR. KOPLAN: As you've all been following, this is an evolving attack, and
every day there is both new information and periodically we get new cases.
As Secretary Thompson just described, these are two which require extensive
further investigation to better characterize them, and that's what we're
undertaking both in New Jersey and New York City, as he described.
SECRETARY THOMPSON: Dr. Perkins?
DR. PERKINS: I'd just like to add that the--this is an evolving
epidemiologic situation, and as we get more information about cases and the
circumstances around those cases, we will be altering strategies and public
health interventions as appropriate.
SECRETARY THOMPSON: Thank you very much, Dr. Perkins and Jeff.
Now we will open it up for questions. Please identify yourself, if you
AT&T MODERATOR: Ladies and gentlemen, if you do have a question, please
depress 1 on your phone at this time. You may remove yourself from queue at
any time by depressing the pound key. If you are using a speaker phone,
please pick up your handset before pressing the numbers.
Our first question comes from the line of Cheryl Silver with New York Times.
MS. SILVER: Hi, Secretary Thompson and Dr. Koplan. I want to ask you, in
particular, about this case of the 61-year-old hospital worker in New York.
What can you tell us about her movements prior to getting infected? Where
was she? How much time did she spend in the mail room? Where else did she
go? And have you entertained the possibility that this anthrax did not come
from a letter, but that there was some other release of anthrax that made
this woman sick?
DR. KOPLAN: Thank you. Those are exactly the investigations that we're doing
right as we speak and that began last night with the New York City Health
Department. The issues involved in getting this information involve finding
relatives and friends who can describe some of this because she's not able
to answer all of these herself now in the hospital, speaking to coworkers,
and it's just the information you've described.
We are making no assumptions as to where this exposure occurred, and we have
to both investigate and rule out where she worked, what--where--did she have
other jobs and where else might she have been exposed, what were her
patterns of activity, both workwise, socially, recreationally and
transportationwise for the past couple of weeks and then investigate her
home environment carefully as well.
And we don't have answers on all of those yet. Those are taking place right
now. And as you've indicated, we are not making an immediate assumption that
she was either exposed at work or that it was a letter, although these are
what we've seen in recent exposures and the places that we're investigating
it. We are investigating every possible exposure that might have occurred.
MS. SILVER: And then, along those lines--about other people who may be at
risk? Are you expecting more cases like this?
DR. KOPLAN: We are certainly on alert for other cases. I think that's the
nature of this attack we've been under, is to--you know, it's imperative
that we identify new cases as possible, but when they occur, it's unclear
whether this particular instance is part of a pattern of other cases or
whether it represents something different.
SECRETARY THOMPSON: It's also important for us to find out as much of the
details as possible in order for treatment purposes, and CDC and the health
care--health care resources have been very successful in, I believe,
containing a lot of further illnesses because of the instant and the--and
the reactions done by CDC and our health workers.
CDC MODERATOR: Next question, please.
AT&T MODERATOR: Next we have
C.C. Connelly with The Washington Post.
MS. CONNELLY: Yes. Thank you. I'd like to ask Dr. Koplan and Secretary
Thompson, following on some of those themes, in the new New Jersey case, the
woman apparently with cutaneous anthrax, I think that once again goes to a
question on many people's minds, regarding is the mail safe. What have you
learned about mail that came into her office? Did it pass through the
Brentwood station? Is it your working hypothesis of cross-contamination
there? And what's happened with all the mail trucked to Ohio? Is the CDC
SECRETARY THOMPSON: You had several questions there, C.C. Let me--the mail
truck to Ohio we are not testing. That's being handled by the postal
The cutaneous case of anthrax in New Jersey that you described was--that was
announced yesterday is again under careful investigation, and all those
linkages to both the Hamilton Township facility in New Jersey and the links
to where this woman got her mail, where her--you know, the step-by-step
linkages of both her mail and where she goes and other things she's done,
she's been very informative, has very good records, and we're working with
her to try to get that exact information.
MS. CONNELLY: What have you learned so far?
SECRETARY THOMPSON: We--it's under way yesterday and today, and we don't
have anything in hand that immediately says here's the spot.
MS. CONNELLY: And, Dr. Koplan, are you still working on the--the assumption
or the hypothesis that you indicated last week, that all of these cases,
particularly of inhalation anthrax, cannot simply be off of the single
DR. KOPLAN: That's pure hypothesis. And first of all, we're talking about
New Jersey in one, New York in another case, and Washington in another. So
let's keep the locales isolated in terms of what's gone on.
In terms of Washington, D.C. and the letter that came to the Hart Building,
that's the only one we have in hand. Now in all of our--you know, your
guesses are as good as mine in this, but we have evidence of environmental
contamination in a number of other sites in the Washington, D.C. area. So,
yes, there is a possibility that cross-contamination could account for this,
but in an instance where we have a case of inhalation anthrax in the
Department of State facility, you could conceivably say that, well, you
know, you could come up with a construct that said that cross-contamination,
that this has happened and that has happened might have done that. But I
still feel that we have to rule out other letters, when you see that level
of contamination occurring to an individual that then leads to inhalation
So I think it pays to be vigilant and look for--for other letters still.
CDC MODERATOR: Next question, please.
AT&T MODERATOR: Next we have Paul Rieser with the Associated Press. Mr.
MR. RIESER: Yes. As a result of these cases with unknown sources, are you
planning on changing your recommendation so far as prophylactic antibiotics
for postal customers or for bulk mail handlers? You had suggested last week
that the bulk mail handlers may get special antibiotic attention, and I'm
just wondering if that recommendation is still in effect, or what is the
status of it?
DR. PERKINS: No, our recommendations--
DR. KOPLAN: This is Dr. Perkins.
DR. PERKINS: Our recommendations for chemo-prophylaxis are--are--are
currently unchanged. In incidents associated with--with the circumstances
that we have the bacterial strain and have done antibiotic susceptibility
The current inhalational or suspected inhalational case in New York City,
however, we're quite anxious to get antimicrobial susceptibility testing
done on that particular strain of bacteria to see if it matches the other
susceptibilities we've seen in other incidents. So that is a particular area
of concern. Antibiotic recommendations around that circumstance could be
modified based on that information.
MR. RIESER: And the bulk mail handlers, there was a--there was a
recommendation that was not--not all that clear last week regarding some
special attention given to a thousand or so companies that handle mail in
bulk. Is there any firm recommendation regarding those people?
DR. PERKINS: No, we're not aware of any--any recommendations that have been
made by CD in that regard.
CDC MODERATOR: Next question.
AT&T MODERATOR: Next we have David Carvilo with CBS News.
MR. CARVILO: Good morning, doctors. My question is about the vaccine
intended for high risk civilians. Could you please help clarify, is that
vaccine to be taken from stockpiles currently at Bioport, or physically in
possession in other locations of the Defense Department? And if they're from
Bioport, what testing is still required, given their difficulties with FDA?
DR. KOPLAN: The use of anthrax vaccine--this is Jeff Koplan--the use of
anthrax vaccine is under discussion both in the Department of Health and
Human Services and with the Department of Defense. They have limited amounts
of vaccine initially intended for military use, and we are discussing with
them the use of some part of their collection of vaccine.
The--the vaccine they have is--is--needs to be approved by FDA for us to
use, and we are--we are again in discussions on that, and here at CDC we are
in discussion as to who would be the target users of that vaccine, who would
be best--would it be recommended for, and that's under discussion now as
SECRETARY THOMPSON: There's been no decisions as to whether or not anybody
should be vaccinated at all for anthrax. And the second thing is is that we
have started the negotiations with the Department of Defense just in case
that CDC does make the recommendation for--for vaccinating some individuals.
And those negotiations I've started with the Department of Defense, and
they're going along very well.
And number three, Food and Drug Administration is going to be in, they've
received the application for certification to go in and inspect the
remodeling building at Bioport and take a look at their manufacturing
processes and see whether or not they're going to give the license. It
appears to me that that should be taking place some time within the next two
weeks, and if all goes well, and the remodeling is up to what it's supposed
to be, and the manufacturing process has improved, they could and should be
manufacturing new anthrax vaccine by the 22nd of the month of November.
MR. CARVILO: So this is not something about to happen imminently, Mr.
SECRETARY THOMPSON: It is not. In fact right now the negotiations are going
on with the Department of Defense at the same time negotiation is going on
with CDC, to make the final, final recommendation as to if and when and
where those vaccinations should take place.
MR. CARVILO: If I may, sir, does DOD have reservations? I mean, the
negotiations have been going on for a while.
SECRETARY THOMPSON: No, they have--
MR. CARVILO: Are they tending to say yes or no?
SECRETARY THOMPSON: No, the negotiations really have not been going on that
long because I'm the one that started them and they only started last
weekend. They've been going along very smoothly, at the same that CDC is
making recommendations as to whether or not any individuals should be
vaccinated, and that decision has not been made by CDC yet.
MR. CARVILO: But is DOD going along with your idea here, or is there any
SECRETARY THOMPSON: Well, I wouldn't say resistance. I would say they wanna
make sure that what we're asking for is, is a supply that they can afford to
give up and they of course are the exclusive recipient of the contract of
all the vaccine that has been manufactured which is around 5 million doses
at this point in time.
AT&T MODERATOR: Next question, please.
CDC MODERATOR: Next, we have Susan Ferraro with the New York Daily News.
MS. FERRARO: Good morning. How soon will you know about the four suspect
cases that are still being tested? There are three in New York City and one
in New Jersey. And also for people who work in offices, who might be
concerned about this, how can they go about having their mailrooms looked
DR. PERKINS: This is Brad Perkins. Regarding the suspect cases, a number of
those may become confirmed based on the availability of additional clinical
materials for testing. Some of them will not, however, be confirmed, because
we've exhausted laboratory options for further confirmatory evidence of
MS. FERRARO: What does that--I'm sorry. What does that mean?
DR. PERKINS: Well, that the case definition for, that we're working with
requires either the isolation of the bacteria, bacillus anthraces, or in the
case of confirmed disease, two laboratory, two different laboratory tests
revealing evidence of bacillus anthraces infection.
For a suspect case, we require either one laboratory test or a link to a
confirmed environmental source of contamination, whether it's in a building
or a letter.
So in cases, particularly those cases of cutaneous anthrax, where we may
have only identified relatively late in the course of disease, for example,
there may only be a tissue sample available and there's no ability to
culture the organism from that tissue sample and there may only be one
laboratory test that suggests infection.
In that situation, that individual will remain a suspect case with no option
for becoming a confirmed case.
MS. FERRARO: Okay.
DR. KOPLAN: This is standard procedure in outbreak investigations and it's
very important to have a clear definition of what a case is or it can get
very sloppy and there are lots of things that may look like what you're
dealing with. So it really is important to nail down what's a confirmed
case. Now many of these suspect cases, the reason they're suspect cases is
they may well be, and most of them probably are anthrax infections, yet the
criteria we've set up just won't get met because the person's been on
antibiotics for two weeks, or because of other reasons, where they're never
gonna get that other test that makes it a confirmed case.
MS. FERRARO: Okay, and about testing offices and mailrooms in the civilian
DR. KOPLAN: Well, many workplaces seem to have come to their own conclusions
about that. I think for--in general, I think that there is--the risk isn't
zero as the mail passes through these facilities, it's very, very small, but
we can't say it's zero because of the contamination that has occurred in
some of the facilities. Yet the risk to individual recipients, whether it's
in the workplace or at home, is extremely small.
I can tell you, you know, what we do at home is--you know, I can't base what
I do to make national recommendations, but we go get our mail and we bring
it in and we look at it. And I'll admit, I look at it with greater scrutiny
than I've ever looked at it before, and if there were something there that
was un--you know--it didn't have a return address, and it was handwritten,
and had an of these characteristics, I sure would call local law enforcement
and wash my hands fast, and get that thing covered up.
But I think we, like other citizens in the country, now receive mail with a
different level of scrutiny.
MS. FERRARO: Well, but I think with the issue--
SECRETARY THOMPSON: I would like to make two quick points about what you
said. First off, in the Nevada case, that shows how important it is to have
confirmation of a particular case, and that one was everybody was
publicizing that that was the case, when CDC had not confirmed it, and CDC,
when it went through the confirmation process, showed that it was not
anthrax and therefore it was not an anthrax potential.
The second thing. Even at HHS, we did not ask CDC or EPA to come in because
they're so busy. We went out and we hired our own laboratory to come in and
inspect the mailroom, and they came back and said "potentially positive,"
"presumptive positive," and now we're going to the next step.
A lotta companies are doing this. They're hiring laboratories to come in and
inspect their mailrooms to find out if in fact they do it, and they're
setting up procedures for handling the mail.
CDC is setting up the guidelines which should be followed, wherever
possible, and that is if you've got something that's suspect, you wash your
hands and cover it up, and then call 911.
AT&T MODERATOR: Next question.
CDC OPERATOR: The next question comes from the line of Robert Bazell with
DR. BAZELL: Hi. A question for Dr. Koplan. The 61-year-old woman in New
York. She's been reported to be on a ventilator. Two questions. One. Do you
have--are there enough other people around so that you can do a good
epidemiological investigation of her movements that you described, and the
second question is you talked about, concern about antibiotics
susceptibility in her case. Was there something in her treatment that gave
you reason to be more concerned about antibiotics susceptibility in the case
of that woman?
DR. KOPLAN: Let me--I'll take those--three different parts, Robert. One is
yes, we are, as I said, actively investigating her whereabouts. It's much
easier, obviously, to talk to the person involved, and as you said, she is
intubated and on a ventilator. So we're getting some information from fellow
workers. The New York City health department has identified one or more
relatives that can be spoken to, and then obviously neighbors and friends
have to be identified.
But as in all these investigations, the more people who are, you know, have
more details about someone's life, the better off you are in the
investigation, and this may be a slightly more difficult one to get all that
Your second question about antibiotics in this case. One striking feature
of, again, good care in this case was as soon as this woman was identified
and admitted to a hospital in New York, she was placed on the new treatment
regimen that we had in our, the Morbidity and Mortality Weekly Report, just
this last week. MMWR had a trio of antibiotics that were being used
successfully in other cities, that previously had not been the standard of
care for inhalation anthrax and from the get-go, when this woman was
admitted, she was placed on this trio of antibiotics.
Nevertheless, she is very, very ill and we hope these antibiotics,
obviously, are effective. We had no reason, immediately, to believe that
these aren't gonna be the best ones to use but with each new case in this,
one of our--you know, we do two things.
Our two primary lab responsibilities are, one, confirm it's anthrax, and
two, see what the antibiotic sensitivities are because that has the greatest
impact on the well-being of that patient. That's where we've put our energy.
DR. BAZELL: Thank you.
AT&T MODERATOR: Next question.
CDC OPERATOR: Next we have Charles Ornstein with the Los Angeles Times.
MR. ORNSTEIN: Hi there. I have a two-part question. The first deals with
whether or not you guys at the CDC are doing, you know, actual clinical
research using anthrax samples that you have there to look at issues of
cross-contamination and issues of whether or not this thing--how anthrax
spreads, if you're doing your own tests or if you're just examining cases as
they come in real time.
And then the second part deals with whether or not you've reassessed the
issue of the number of spores it takes to create inhalation anthrax,
whether, as JAMA said, it was 2,500 or as previously said, it's 8- to
10,000, if you've come to any different conclusions.
DR. KOPLAN: This is Jeff Koplan again. I'll answer the last part of your
question first. It's a very difficult thing to answer the exact number of
spores. As you're probably all aware by now, this number of spores necessary
to cause different types of disease is generated from animal studies that,
as you would well imagine, there has not been, nor is there likely to be,
the possibility of actually--nor should there be--the ability to translate
that into humans. So we extrapolate from animal studies to humans for this.
Is it possible that the number for humans is a smaller amount or a larger
amount or different? Yes, it is. Keep in mind, though, that very small
amounts, quantities of these powders contain large numbers of spores. So
those are two different things--the number of spores necessary for
infection, and that can still translate to a very small quantity of powder.
On the question of what type of research are we doing now, we are largely
doing outbreak investigation right now, which is that our laboratories are
hard at work on identifying isolates, characterizing the virus, identifying
the antibiotic sensitivities to this virus, identifying where there are
positive exposures in the environment, et cetera, and so we are not much in
the research mode at the moment.
And in terms of the kind of investigative research you described, which
involved physical characteristics of letters and size of particles and all
of that, that is not something that we do here.
MR. ORNSTEIN: Let me just add a follow-up then. You know, based on the fact
that you're doing the--looking at it, in terms of the outbreak
investigation, you had given us suggestions in terms of looking for
suspicious packages. You, yourself, said that you're looking more carefully.
But if there's a possibility that the cross-contam--if there is
cross-contamination, somebody couldn't necessarily see that on their Chase
Manhattan bill. What are you advising people to do about regular mail if
there's no suspicious characteristics?
DR. KOPLAN: Well, again, I think that the risk is very small, but not zero.
And what I would recommend people do is hand wash, if they're concerned
about that, wash their hands after they handle the mail, open it, discard
it, and do what they're going to do. I think the risk is so very, very small
and the risk, where there is one, is for cutaneous anthrax, rather than
So, again, what we recommend, and what I'd recommend to myself, family and
friends is the same thing, which is look with scrutiny, wash your hands
after you've handled the mail, and be--we're all cognizant now of skin
lesions. If you find yourself developing a skin lesion that has the
characteristics of a brown recluse spider bite; i.e., a nodule with an
ulcerated center, and it forms a scar, that's an immediate sign to seek your
physician, and get proper treatment, and get that reported to your local and
state health department.
Now that is going to be a very rare occurrence, given the billions or
hundreds of pieces of mail going through, but, unfortunately, it's now
something we've got to think about in life at this stage in late October.
CDC MODERATOR: Next question, please.
AT&T MODERATOR: We have Monica Conrad with ABC News.
MS. CONRAD: Hi. Thank you. Two things.
First of all, I think it was Secretary Thompson who said that this woman
from the New York City hospital, that she had spent more time in the mail
room this week, and she occasionally works in the mail room; is that true?
SECRETARY THOMPSON: No, Monica. What I said is I understand that the mail
room was modified.
MS. CONRAD: The mail room was modified this week.
SECRETARY THOMPSON: Well, a week ago, wasn't it, Brad?
DR. PERKINS: Uh-huh.
MS. CONRAD: So the mail room was modified in the past week, but she does
occasionally work in the mail room.
DR. PERKINS: Our understanding--and, again, this is Brad Perkins--based on
very preliminary reports from the investigators in the field, that prior to
one or two weeks ago, that the stockroom and the mail room were the same
space and that within the last couple of weeks, they were subdivided into
two separate spaces.
MS. CONRAD: And the second question is, we're finding all of these trace
amounts or amounts of anthrax throughout Washington, D.C. Do we know how
much is dangerous levels of anthrax? We hear one spore in one building, a
couple spores in another. At what point does it start to affect the health
of the individuals who work there?
DR. PERKINS: I think that's an excellent question, and I'd love to be able
to give you a clear and concrete answer on that.
We know at the two extremes. We know that if you have a large number of
these spores, whether it's 5,000 or 10,000 or 50,000, that they clearly pose
significant human danger. And I think we can be pretty assured that if you
have one or two or five or ten spores, that they pose very little danger.
It's what's in between, and we don't--we don't have either research
experience or even clinical experience or epidemiologic experience to be
able to give a definitive answer on that.
We're learning as each day goes by something about this, but unfortunately
we just don't have, neither we nor others around the world, have had an
experience that can offer a clear-cut line that says, with X number of
spores you're okay, and over that you're not. We just don't have it.
MS. CONRAD: So what do you--so then you obviously err on the side of
caution, as far as all of these people who work in these buildings.
DR. PERKINS: Well, you err on the side of caution, but caution goes in two
directions, and therein lies a conundrum in this, which is, on the one hand,
we don't want anyone to get anthrax where we can prevent it; on the other
hand, we don't want anyone to get a severe reverse reaction to a potentially
toxic medication that's got to be taken for 60 days if you decide to do
that, and we've seen adverse reactions to some of the medications, and we've
seen cases of both cutaneous and inhalation anthrax.
So you end up having to balance those risks out and make the best judgment,
based on laboratory and epidemiologic information as it comes in. And with
each day or if in a couple of days we get some new piece of information, you
will see some changes in these recommendations. And people will say, well,
that's different than it was yesterday. Yes, it is, and it will be. It will
be different next week probably because we get new information coming in.
And if you want a clinical analogy to this, if you're in a hospital for 30
days with an illness and new data is being developed and new exams done and
your condition changes over that time, you sure don't want the doctor making
the same decision on Day 30 that they would have made on Day 1, and that's
what's going on here.
MS. CONRAD: But is that, clearly, is that CDC's role then to investigate
where that threshold of danger comes in? Is that something you at CDC--
DR. PERKINS: I think we're very interested in that and concerned about it.
But, again, the investigation is difficult because in these exposures we
weren't there to know whether it was 50 spores or 500. We can only draw
conclusions about it based on was there a letter, what were the
characteristics of that letter? Was there no letter? Is there dust present
around, and do we do environmental sampling that gives some indication? How
much growth do we get on the plate?
So much of the information we get, we use all that we get, but we, you know,
much like in any investigation, we take all of the information we can find
and then try to process in a way to come to a conclusion that's then usable
for the public good.
CDC MODERATOR: This will be the last question.
AT&T MODERATOR: We have Rhonda Rollin with CNN.
MS. ROLLIN: Hello. I'd just like to ask a question about antibiotic
resistance. I know that's something that you're trying to avoid in the
situation. So when individuals come in to get their antibiotics, how is it
presented to them? Are they given a choice so that they can make the
decision, or does whoever is seeing that individual suggest, you know, why
don't we go with Doxy unless you have a problem with it? And then who's
making that decision? Are these recommendations by the CDC or are the
physicians on the ground seeing making those decisions?
DR. PERKINS: This is Brad Perkins. It's a--it's a combination of--of
individuals that are making those decisions. State and local health
authorities are there on the scene when these antibiotics are distributed.
They're working with--with CDC recommendations in broad stroke regarding the
antibiotic susceptibilities around these specific circumstances, and then
they're tailoring those recommendations to specific individuals that they're
seeing there in the antibiotic distribution sites, so that the best possible
decisions are made at the individual level.
MS. ROLLIN: So it's kind of between the physician seeing the individual,
then they get together, or is it kind of placed on their shoulders like, all
right, if you take this one, you could have these side effects, or you have
to take this antibiotic with milk or without, you know? So who is actually
making the final call on what antibiotic you walk out the door with?
DR. PERKINS: Well, the health professional on the scene has a set of
recommendations that--that have been endorsed by CDC, and those
recommendations are tailored to specific circumstances.
For example, we have preferred antibiotics in these circumstances for
someone who is pregnant or believes that they might be pregnant, and that
decision is made right there at the interface between the health
professional and the individual that's being treated.
MS. ROLLIN: Now I understand that more than 10,000 individuals in the
Washington area alone are on antibiotics. Do we know an exact number total
now who have been on the antibiotics, and do we have a breakdown like, you
know, 8000 on Cipro? You know, do we have an idea of how it's played out?
DR. PERKINS: Yeah, it's--this is Brad Perkins again. Certainly it's in the
tens of thousands of persons, and we are--we're following those individuals
or trying to follow those individuals very carefully at all the sites that
are--that are doing antimicrobial chemo-prophylaxis for the occurrence of
adverse events. So the situation has been quite dynamic in terms of numbers
of total individuals, but we are committed to try to develop strategies to
follow those individuals to--for surveillance of adverse events and for
adherence to recommended durations of therapy.
CDC MODERATOR: I want to thank everybody for this afternoon's telephone
call. Appreciate it. Bye-bye.