Bacillus anthracis contamination and inhalational anthrax in a mail processing and distribution center.

AIMS: Four inhalational anthrax cases occurred in a large mail processing and distribution center in Washington, DC, after envelopes containing Bacillus anthracis spores were processed. This report describes the results of sampling for B. anthracis spores during investigations conducted in October and December 2001. METHODS AND RESULTS: Wet swabs, wet wipes, vacuum sock, and air-filter samples were collected throughout the facility to characterize the extent of building contamination. The results showed widespread contamination of B. anthracis spores, particularly associated with one delivery bar code sorter (DBCS) machine that had sorted the spore-containing envelopes and an area where the envelopes were handled by postal workers. Spore concentrations decreased as distance from the DBCS machine increased, but spores were widely dispersed into surrounding areas. CONCLUSION: The spatial distribution of culture positive samples was closely related to the work areas of the inhalational anthrax cases and supported epidemiological evidence that the workers became ill from exposure to B. anthracis spores in areas where the contaminated envelopes had travelled. SIGNIFICANCE AND IMPACT OF THE STUDY: The results of this investigation were used to guide decontamination efforts and provided baseline spore concentrations for follow-up measurements after the building had been cleaned. Implementing methods to reduce aerosolization and dispersion of dust within the facility would reduce postal workers' potential exposures to bioterrorism agents.

Health risk factors among the Amish: results of a survey.

The Amish are a unique societal subgroup deliberately setting themselves apart from the modern world through religious beliefs and practices. Few reports and no systematic studies have been conducted on Amish health behaviors. A representative sample of 400 Amish adults residing in Holmes County, Ohio, were interviewed using the Behavioral Risk Factor Survey (BRFS). For comparison, a representative sample of 773 non-Amish adults responded to the same survey through telephone interviews. Prevalence of self-reported hypertension was lower among Amish than non-Amish, obesity was greater among Amish than non-Amish women but similar among men, and stress responses were more prevalent among Amish than non-Amish. While some differences between groups could be influenced by response biases, many are supported by less systematic observations of Old Order Amish societies. Patterns of health behavior reflect characteristics of Amish culture and may be responsible for certain favorable mortality rates among the Amish population. Need for cultural sensitivity is evident in health promotion program design and implementation.

Behavioral risk factors in an Amish community.

A representative sample of 400 Amish adults residing in Holmes County, Ohio, was interviewed about certain health risk characteristics and behaviors, using the Behavioral Risk Factor Survey (BRFS). For purposes of comparison, a representative sample of 773 non-Amish adults responded to the same survey by telephone interviews. In general, the Amish report lower rates of alcohol and tobacco consumption than their non-Amish counterparts. The Amish are less likely to salt their food and are more likely to take vitamin supplements, but do not differ from non-Amish in the consumption of "health foods." Amish men and women are less likely to be trying to lose weight than their non-Amish counterparts. Further, the Amish are less likely to engage in leisure-time physical activity or in exercise associated with attempts to lose weight or deal with hypertension. Amish women are less likely to use seat belts than non-Amish women, whereas men in both groups appear rather similar. Although some differences could be influenced by response biases, many are supported by less systematic observations of Old Order Amish societies. The patterns of health behavior reflect characteristics of Amish culture and may be responsible for certain favorable mortality rates among the Amish population.