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Special Health Care Team Screens Postal Workers for Anthrax

Donna Young

When medical authorities confirmed October 21 that a Washington, D.C., postal worker had inhalational anthrax, about 50 health care and support workers, including 20 pharmacists, of the U.S. Public Health Service (PHS) Commissioned Corps Readiness Force (CCRF) reported that day for duty to the district’s downtown government offices.

Their tasks: interview thousands of postal workers and others who may have been exposed to Bacillus anthracis, the bacterium that causes anthrax; obtain nasal-swab samples for medical testing; provide patient education and drug information; and dispense anti-infectives.

CCRF consists of PHS officers who are specially trained to respond to public health emergencies and disasters. Members hold regular jobs in various government agencies but are called to serve during times of crisis.

The Office of the Surgeon General created CCRF in 1994 to assist federal, state, and municipal governments when necessary.

Pharmacist Mark Gonitzke, a commissioned officer with PHS’s Office of Emergency Preparedness (OEP), said a small team of CCRF pharmacists, nurses, and support personnel were deployed on October 17 to help deal with an anthrax attack at the U.S. Capitol.

A staff assistant in the office of Senate Majority Leader Thomas A. Daschle (D-S.D.) had opened a letter that later was confirmed to contain anthrax spores. Hundreds of Capitol Hill employees and officials were tested for exposure to anthrax and provided with anti-infectives by CCRF members and local public health workers.

Gonitzke said the medications that he and other pharmacists dispensed that week on Capitol Hill came from OEP and the Capitol physician’s office.

D.C. postal employees and anyone who had visited the district’s main mail processing center since October 11—the day the facility processed the anthrax-tainted letter addressed to Daschle—were given a 10-day supply of ciprofloxacin, doxycycline, or amoxicillin, Gonitzke said.

The pharmacists asked each person about medical conditions, allergies, and other relevant information before selecting which anti-infective to dispense, he said. Amoxicillin was given mostly to women who are pregnant or lactating, or to people who could not tolerate the other two anti-infectives.

"We are depending on what [the postal employees] tell us about their medical history," he said.

The tablets and capsules were dispensed to the postal workers in self-sealing plastic bags that CCRF, the Centers for Disease Control and Prevention (CDC), and local public health workers labeled with the drug name and dosage, Gonitzke said. And, he added, postal employees also received drug information sheets.

Gonitzke said some of the postal workers were given plastic bags containing two blister packs of 10 doses each, while other employees were given plastic bags with 20 loose tablets or capsules.

CCRF pharmacists counseled all postal employees about possible adverse effects and allergic reactions, Gonitzke said.

Two postal workers from the district’s main mail facility died of what was confirmed later as inhalational anthrax, and two postal employees from that center were hospitalized with the infection.

On October 22, city public health officials, in conjunction with CDC, moved the operation from the district’s government offices to D.C. General Hospital, Gonitzke said. The following day, postal employees from all 36 post offices in the district were called in to receive a 10-day supply of anti-infectives, he said.

On October 24, the Washington Post reported that public health officials had advised more than 120 D.C.-area employers that their mail handlers should also report to D.C. General Hospital to receive a supply of medication.

Gonitzke said CDC would advise those individuals who received the 10-day supply of medication when or if they needed to continue treatment.

Michael Robbins, an emergency pharmacist with the CDC’s National Pharmaceutical Stockpile (NPS) program, said the anti-infectives distributed to the postal workers and local residents came from NPS’s supply.

Robbins said he was deployed from his office in Atlanta, CDC’s headquarters, to provide backup support and "assist if they needed more pills."

"Our job primarily is to provide guidance and to assist the state and local municipalities," he said.

Gonitzke said other CCRF members were deployed to the New York and New Jersey areas to screen postal workers following three confirmed cases of anthrax—two cutaneous and one inhalational—in New Jersey postal workers.

The letter sent to Daschle, in addition to two anthrax-tainted letters received at the New York offices of NBC and the New York Post, had been postmarked in New Jersey.

According to the CCRF Web page, 16 pharmacists, 35 nurses, and 4 physicians were deployed to screen postal workers in the New York area.

This second CCRF team was sent to handle an operation similar to the one in Washington.

CDC and the postal service intended to make anti-infectives available to 7000 Manhattan postal workers, the New York Times reported on October 25.

"We’re just standing by until they let us know where else we need to be," Gonitzke said.