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11/29/2001

New Jersey Hospital Runs Anthrax Screening Operation for CDC

Donna Young

On October 31, the New Jersey Department of Health announced a suspected case of cutaneous anthrax in a Delaware resident who works as a postal worker at the South Jersey Processing and Distribution Facility in Bellmawr.

A Federal Bureau of Investigation (FBI) sample taken that day at the postal facility later tested positive for anthrax.

That evening, hospital pharmacist Jackie Sutton found herself at the center of a public health operation where she dispensed anti-infectives to hundreds of postal workers and counseled them about the possible adverse effects of doxycycline, ciprofloxacin, and amoxicillin.

Sutton, pharmacy director for Cooper Health System in Camden, New Jersey, said she and members of her staff spent nearly three days at the Bellmawr facility dispensing a 10-day supply of anti-infectives to about 900 of the facility’s 1300 postal workers.

"We mostly dispensed doxycycline," she said.

Before postal workers could receive their 10-day supply, they first had to complete an information form about where they worked in the postal facility and provide medical information, Sutton said.

Cooper’s physicians spent time with each postal worker to discuss medical history, she said. Hospital nurses assessed the vital signs of any postal worker who had an illness or medical condition.

"The pharmacists did the final review of the patients to make sure the appropriate medication was chosen by the physician," Sutton said. "There were a few [instances] where we suggested changes."

The postal service contracted with a local private physicians group, Riverfront Medical Facility, to be onhand during the screening operation to perform nasal swab tests if any postal worker requested to be tested, said Mike Brose, district manager and lead executive for the postal facility.

The medical group also provided flu shots during the three-day operation for any postal worker who requested vaccination, Brose said.

Sutton said the Centers for Disease Control and Prevention (CDC) provided the supply of anti-infectives that were dispensed—some were already packaged for patients in white plastic bottles.

But, she said, Cooper’s pharmacists and other staff members had to package most of the anti-infectives in the hospital’s amber prescription bottles. The hospital also used its own supply of child-resistant lids and labels.

Sutton said pharmacists dispensed a CDC-provided drug information sheet to each postal worker who received a supply of anti-infectives.

The information sheet cautioned about possible allergies, drug interactions, and adverse effects, such as tendonitis, she said.

Ralph L. Dean, Cooper’s chief operating officer, said CDC, New Jersey’s health department, and the U.S. Postal Service turned to the hospital for help because Cooper is a level-1 trauma center.

"We are the leader in the area when it comes to trauma or disasters," he said. "They knew they were dealing with the type of institution that is accustomed to mobilizing in a certain way. And we have been proactive in developing and working on bioterrorism issues. We made it part of our disaster team training when the National Republican Convention was held in [nearby] Philadelphia last year."

Dean added that New Jersey Senators Jon S. Corzine (D) and Robert G. Torricelli (D) asked Cooper to "take the lead" in the patient-screening operation.

Dean said 130 members of Cooper’s staff, including pharmacists, physicians, nurses, and mental health counselors, ran the operation.

Compensation to the hospital for supplies and personnel has not yet been discussed with any federal or state agency, Dean said.

"Our senators know who we are, and they know the services we provided," he said. "We are confident that compensation will be provided. We don’t know what the vehicle will be. But we are confident."

Sutton said CDC helped the hospital "set things up" on the first night of the operation. But, she said, "we pretty much ran things for the next few days following CDC’s guidelines."

Dean said the hospital’s head of infectious diseases kept in communication with CDC officials throughout the operation.

"The CDC monitored us in an advisory capacity," he said.

Sutton said her staff of 20 pharmacists took turns working at the Bellmawr facility for a few hours at a time during the operation.

"We had about five or six there at a time," she said.

Sutton said pharmacy students from the University of the Sciences Philadelphia School of Pharmacy who were completing experiential rotations at Cooper also participated in the screening operation.

Sutton and her team wrapped up their operation on Monday, November 5—or so they thought.

By the end of the week, they found themselves back at the Bellmawr facility dispensing more drugs.

The postal facility’s Brose said the FBI had given incorrect information to CDC, and the wrong area of the postal facility had been decontaminated.

Brose said postal workers had returned to work and were working in the area that was originally identified by CDC as contaminated with anthrax spores.

He said the postal facility was then closed again for cleaning by a company contracted by the postal service.

After the facility reopened, a federal judge ordered the facility closed once again when the American Postal Workers Union sued the post office.

Within 24 hours, Brose said, postal management and the union agreed on terms to monitor the post office for anthrax, and the judge lifted the restraining order and reopened the post office.

Sutton and her team went into action once again and prepared several 10-day supplies of anti-infectives.

But Sutton said there was a "low turnout" during the second screening operation on Friday, November 9.

"We only got about 25 [people]," she said. "Only a few asked for a second 10-day supply. Some of them didn’t because there had been some gastrointestinal side effects. And some of them that showed up were people that didn’t get an opportunity the first time to come. But we had prepackaged and prepared in advance so we would be ready because we had more than 1000 show up the first time. And then we didn’t use it."

But, she added, "for all we know, we could be back there again."